- FOLATE aka FOLIC ACID (most important)
- +/- Iron (this can also be supplemented separately as needed, such as for anemia)
- Folate reduces risk of neural tube defects (birth defects), such as spina bifida
- Iodine optimizes thyroid health and fetal brain development
- Optimal to start about 3 months prior to conception
- Take 1 serving (number varies by vitamin) daily
- At least 400 mcg folate per day, but individual needs may be higher
- 150 mcg per day of iodine
- Any pharmacy or grocery store, or available online
- Limited evidence for other ingredients, but they are usually not harmful.
- It is important to avoid excessive quantities, such as for Vitamin A or B vitamins.
Which are legitimate products?
- Prenatal vitamins can be given as a prescription from your doctor
- Prescription brands are FDA-regulated
- Direct-to-consumer (aka over-the-counter, or OTC) brands are not as strictly regulated
- If you buy it OTC, check for the following certification standards:
- Look for NSF (National Sanitation Foundation) certified
- Or look for USP (United States Pharmacopeia) verified
I am incredibly proud to work at a REI clinic that has the highest live birth rate in the country. A recent study, however, suggests that IVF may not be enough. Lifestyle and the environment can impact your IVF success rates, even at a top notch REI clinic.
In this study, levels of pesticides and common pollutants were measured in the fluid that was obtained from the ovary during an egg retrieval. They found that higher levels of Pretilachlor, β-cyfluthrin, PCB 28 and 180 was associated with fewer eggs at retrieval, lower fertilization rates, and impaired embryo development. They also found that high PCB and pesticide concentrations negatively affected embryological outcomes. This study provides evidence that these harmful chemicals are found in the fluid surrounding individual eggs and are associated with decreased success with IVF. This suggests that if you want the very best chances of success with IVF, you should consider optimizing your lifestyle to minimize exposure to these harmful chemicals.
What you can do:
- Learn how to minimize your exposure to PCBs and pesticides
- Make a plan to optimize your health before you invest in an IVF cycle
- Talk to your doctor about a timeline for implementing these changes
I spend a considerable amount of time working with my patients to prepare them for a healthy pregnancy. Lifestyle modifications like small changes to your diet and environment can absolutely optimize your chances of conceiving, regardless of what kind of treatment you are undergoing. This blog is dedicated to exploring the research behind our recommendations to couples.
I want to share an additional helpful resource to those of you who are trying to initiate these lifestyle changes. This group helps you tackle lifestyle changes, one room at a time in a user friendly and interactive manner. Check them out!
Common air pollutants include ozone and fine particles. Exposure to air pollution may increase the risk of problems with fertility and pregnancy complications like pregnancy loss.
A recent study conducted in Michigan and Texas found that ozone, commonly found in urban smog, was associated with early pregnancy loss. These researchers found that couples that had higher exposures to ozone were more likely to experience and early pregnancy loss than couples who had lower levels of exposure to air pollution. We do not know why exposure to air pollutants might cause pregnancy loss, but it could be related to inflammation and oxidative stress.
This is not the first time we have seen that air pollution can negatively impact fertility. Researchers in Salt Lake City found that sperm parameters like sperm motility were decreased for two to three months after exposure to higher air pollution. In a study done in Korea, researchers found that exposure to air pollution resulted in pregnancies rates through IVF.
These findings suggest that women who are trying to conceive and pregnant women may want to consider avoiding outdoor activity during air quality alerts, but more research is needed to confirm this association.
What you can do:
- Click here to learn more about air pollution and how you can reduce your exposure
My goal as a REI is to help provide patients with the information they need to not only boost their natural fertility, but also to help them have a healthy pregnancy and to, ultimately, bring home a happy healthy kiddo. Those of you who know a family affected by autism, know how terrifying the condition can be. Autism is a neurodevelopmental disorder characterized by impaired social interaction, impaired verbal and non-verbal communication, and restricted and repetitive behavior.
Autism is thought to develop during pregnancy. Many neurodevelopmental disorders, like problems with the baby’s spinal cord, are known to be impacted by maternal nutrition during pregnancy. New research suggests that what mom eats during her pregnancy may alter the risk of her child developing autism.
In this large study of over 270,000 mother-child pairs, women were screened for vitamin use and their children were followed to see if they developed autism throughout childhood. Maternal multivitamin use with or without additional iron or folic acid, or both was associated with lower odds of having an autistic child with intellectual disability in the child compared with mothers who did not use multivitamins, iron, and folic acid (odds ratio 0.69). This study suggests that maternal multivitamin supplementation during pregnancy may be something women can do to decrease their risk of having a child with autism.
What you can do:
- Take a prenatal vitamin when you are trying to conceive and throughout your pregnancy
We have previously reviewed the negative impact that chemicals in plastics may be having on our health and fertility. One of the best ways that we can reduce this exposure is in our kitchen. When food is stored or heated up in plastic, the dangerous chemicals can leach into the food that we ingest. These chemicals can then interact with our endocrine system and cause disease.
When I first started considering my exposure to plastics, it felt like an impossible uphill battle. By starting in my kitchen, the task of reducing plastic exposure felt more manageable. I started by removing all plastic storage containers and making sure that we do not heat up food in plastic.
Here is a quick article that I thought I would share to help reduce your plastic exposures at home in the kitchen. I hope this helps you find reasonable solutions for limiting your plastic exposure in your home.
At a recent trip to Target, I realized just how many things are labeled as “antibacterial.” But what is antibacterial, anyways? And why do we need it?
“Somehow, through marketing or misinformation, we’ve been led to believe that if we get rid of bacteria, we’ll improve our lives and our health. In fact, the opposite is probably true” –Dr. Martin Blaser In fact, to date, there is no evidence that washing your body and home with antibacterial products does any good compared to old fashioned soap, water, and scrubbing!
Triclosan is an anti-bacterial compound added to personal care products like soaps but it is also added to plastics found in toys and medical devices. Triclosan is so common that the majority of people in the US population are exposed to this chemical; triclosan exposure is real and widespread.
Breaking news this week reveals that triclosan may target the ovary and make it harder for a woman to conceive. This group investigated whether ovarian reserve, a marker of how many eggs a woman has and how she might respond to fertility treatment, was different in women with high levels of exposure compared to those with lower levels of exposure. They found that antral follicle count, a marker of ovarian reserve, decreased as the triclosan levels increased. Perhaps even more concerning was that this relationship became even stronger in lean and young women, suggesting that this may contribute to reduced natural fertility and could lead to a need for fertility treatment at a younger age.
Other studies have found similar concerning results: women with higher levels of triclosan exposure take longer to conceive when compared to women with lower levels of this chemical. Triclosan is also associated with lower oocyte yield in couples undergoing IVF. Similarly, triclosan has been found to disrupt implantation of a pregnancy and alter placental function, leading to pregnancy complications in animal models.
The good news is that the FDA is banning the use of triclosan in antibacterial soaps, effective next month (September 2017). Way to go FDA! Thank you! Unfortunately, manufacturers can still add this chemical to dish soaps and toothpaste.
What you can do:
- Reduce your exposure. Avoid purchasing anything labeled “antibacterial”.
- Use bar soap and water, instead of hand-sanitizers.
- Avoid toothpastes that include triclosan, such as Colgate Toothpaste
- Read here if you want to learn more about triclosan and how to reduce your exposure
One of the best parts of my job, is getting to know individuals and hearing their “story.” I love learning about occupations, interests, and their goals for a family. I spend a lot of time listening to my patients so that I can fully grasp all that my patients have been through leading up to their visit with me.
I have to be honest: I’m saddened by how hard my patients are on themselves. There is so much unnecessary blame and justifying in fertility. For example, a common thing I hear can be something like the following: “I love coffee, but after trying to conceive for so long I gave it up. I miss it but I’m willing to give up anything in order to prove that I’m ready for a family.” Does this sound familiar to you? First off, you can drink coffee. Secondly, please try to be kind to yourself.
Research suggests that kindness and mindfulness will not only help you cope with fertility struggles, but may even improve your outcomes. Unfortunately, this important step is often overlooked in many fertility clinics. I try to address the potential benefits these practices may have with my patients.
As a self-diagnosed perfectionist, I will be the first to admit that I have very high expectations that I set for myself. When I fail to meet a certain goal that I’ve set for myself as a physician or a mom, I beat myself up about it. My advice to you: try kindness instead. Pretend a friend told you the exact same story. How would you react to your friends’ tribulations?
Life is stressful and that won’t change, even once you get pregnant. We can’t control the stressors in our life but we CAN control how we react to them. So please, consider being kind to yourselves and help me support you through this fertility journey.
My neighborhood pools opened this week for summer and my family couldn’t be more excited. Unfortunately, mosquitos are popping up again and reminding me of the importance of discussing insect repellants with my friends, families, and patients.
Many women who never wear insect repellants have recently become interested in these products because of the news coverage of the Zika virus. The Zika virus was introduced to the world during the most recent Olympic games in Brazil. Mosquito bites were linked to severe birth defects and the Zika virus was identified.
The number of pregnant women with laboratory evidence of possible recent Zika virus infection and the number of fetuses/infants with Zika virus–associated birth defects continues to increase in the United States. About 1000 pregnant women in the US were diagnosed with Zika virus infection last year. Of these pregnancies, birth defects were reported in 15%. Congenital microcephaly, or severely small head in the affected child, has been a hallmark of intrauterine infection with Zika virus. However, the full clinical spectrum and severity of Zika remains unknown. Others have recently reported much lower rates of confirmed Zika virus in other parts of the US and no confirmed fetal or neonatal infections, which puts some doubt on the true prevalence of this widely publicized virus. The field of perinatal Zika virus infection is evolving and we continue to learn more about the virus as well as the risk of disease.
Insect repellants can be a good option for reducing your exposure to mosquitos and tics. The EWG has published excellent resources for consumers to learn about what is in their bug repellent.
My family uses DEET. It protects you against tics and mosquitos. DEET is the only insect repellant that has been tested on pregnancy women. The children of mothers who used DEET in their second and third trimesters showed no birth defects, changes in body size or developmental problems. No studies have examined the children of women who applied DEET during their first trimester. However, at toxic doses, DEET has been associated with seizures and neurological damage. Although this risk is scary, The EPA reports that this risk is very low- 1 per every 100 million persons. As with medications, I tend to recommend limiting the use of multiple products in order to limit exposure to multiple chemicals. Choose one insect repellant and stick with it.
A more natural alternative is also available as oil of lemon eucalyptus. The tree extract is refined to intensify the concentration of the naturally occurring substance para-menthane-3,8-diol (PMD) from 1 to 65 percent. The resulting oil is very different from unprocessed tree oil. Some testing shows that concentrations of 20 to 26 percent PMD may perform as well as 15 to 20 percent DEET against both mosquitoes and ticks (Barnard 2004, Consumer Reports 2010). I think it is important for us to recognize the limited safety data available on essential oils in pregnancy and in children. Refined oil of lemon is classified as a possible biochemical pesticide. Oil of lemon eucalyptus and essential oils have disadvantages but is a good choice for people who want a botanically based bug repellant. EWG recommends that consumers who are in high-risk areas for bug-borne disease or need long-lasting, effective bug protection avoid botanically-based bug repellents, aside from Oil of Lemon Eucalyptus. In other cases, you may find it worth your while to try botanical repellents to identify one that works well for you.
What you can do:
- Avoid exposure to mosquitos: use insect repellants with <50% DEET when trying to conceive and during pregnancy. More is not better. My family uses 30%.
- Wash your hands well after applying insect repellant. Wash repellant-coated skin at the end of each day.
- You and your partner should avoid travel to areas with Zika virus when trying to conceive and during pregnancy. Discuss your travel plans with a physician if there is any question about the safety of travel. Talk to your physician if you or your partner are concerned that you have been exposed to the Zika virus.
For more information:
The terrifying association between consumer products and health problems is described in this recent article found in Time Magazine. Wow. What a headline. This article was written as a result of a large lawsuit for baby powder being associated with ovarian cancer. Yep, you read that right.
I’ll leave the rest of the reading up to you if you are interested but just had to share one more quote from the article:
“But it’s actually not surprising. The fact is, many personal care products on store shelves—products we lather in our hair, rub on our skin, and put in our babies’ bathtubs—contain chemicals with known links to health problems, with no warnings at all to consumers.
Many of us assume the companies are using the latest science as a guide to choose the safest ingredients, especially for products used on babies.
We should be able to expect that.
Unfortunately, nobody is watching the store. Companies in the U.S. are allowed to put ingredients into personal care products with no required safety testing, and without disclosing all the ingredients.”
What you can do:
- Keep reading our blog to stay current .
- Be an informed consumer
- Check out the Environmental Working Group to check the safety of the products you already use.
- I use this website every time I need to buy a new product so that eventually I will only have the safest products in my house and in my life. For example, I needed to re-stock on hand soap this week and used the EWG app to ensure I purchased the best rated kind.