- 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
Bisphenol A (BPA) is commonly found in plastics and the majority of us are exposed to this hormone disruptor multiple times daily. We previously introduced BPA and the negative health impacts here. We know that BPA exposure when trying to conceive can negatively impact multiple aspects of your health, including your fertility and the likelihood of your children having health problems.
New basic science research is adding to our previous concerns about this endocrine disrupting chemical:
- BPA negatively impacts how an egg matures and egg quality by increasing DNA damage and oxidative stress. This study also shows the potential for the damage that BPA causes for mom to impact her future children.
- BPA can decrease sperm count in males and lead to neurodevelopment problems in their children. This study also was associated with increased obesity in female offspring.
What you can do:
- Switch to BPA free drinking bottles like those with a #5 stamped on them or use either glass or metal instead;
- Purchase soups and foods packaged in cardboard cartons or glass instead of the plastic lined cans;
- Hand wash plastic dishware with mild soap in warm water instead of using dishwashers for these products;
- Don’t place plastic ware in microwave ovens to warm;
- Express your support to companies that are voluntarily phasing out the use of BPA in their products.
It is estimated that up to 54% of couples with infertility experience a high level of stress, anxiety, and depression before and/or during fertility treatment. It is incredibly common to need additional help when going through fertility treatment, which is why I encourage the use of complementary stress reduction techniques with my patients. But sometimes yoga, acupuncture, and mediation isn’t enough and more help is needed. The most commonly prescribed antidepressant is a group of medications called selective serotonin reuptake inhibitors (SSRIs).
A recent study compared women on SSRIs going through IVF to women who were not on antidepressants. They found that the embryo health and IVF outcomes did not differ between the groups. This suggests that, from a fertility standpoint, there is no reason to avoid using an antidepressant if you need it.
Fertility treatment is hard enough. There is no reason to suffer through poorly controlled anxiety and/or depression while going through fertility treatment. If you need additional help, please reach out. The best way to have a happy healthy family is to start with a healthy mom before conception. You are not alone.
Take home points:
- The diagnosis and treatment of infertility is stressful
- It’s common to struggle with stress, anxiety, and depression at any phase of treatment
- Antidepressant use does not impact IVF success rate.
- Do not hesitate to get additional help if needed
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
Changing your habits is HARD– it’s hard to change what you eat, to make time for regular exercise, and to prioritize your well-being. But it’s absolutely worth it!
So many patients with infertility tell me they feel powerless and hopeless. I want to empower you to believe that there are some things that you can do to boost your fertility. And it starts with taking care of yourself.
Your weight is very important for your health and your fertility. So important that we have discussed it here, here, here, and even here. It’s a recurring topic on the blog because it’s important and it is, unlikely your age, something that you can change.
A study was recently published that the hard work that is needed to lose weight is worth it. Women who consumed fewer calories and started exercising were much more likely to lose weight, ovulate on their own, and get pregnant compared to people who didn’t make these changes. A combination of fewer calories by reducing fat and refined carbohydrate intake, and increased aerobic exercise is the cornerstone of healthy weight loss.
What you can do
- Do something, ANYTHING for exercise 30 minutes, 5 days a week.
- Consider using a fitness tracker or pedometer like FitBit
- Schedule your workouts when nothing will interrupt your session. Make your fitness a priority.
- Take a closer look at your diet and what you can cut out easily. Consider an app like MyFitnessPal.
- Start by eliminating refined carbohydrates found in juices, sodas, and sweets
- Don’t get discouraged. Any step is a step in the right direction.
- Talk to your doctor for more information about local support groups and fitness programs in your area.
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.
“If the benefits of better diet came in a pill, it would be hailed as a medical miracle.”
I spend a portion of each new patient visit evaluating diet and lifestyle. Since I started asking, I’ve been surprised by how many patients have confided in me that they are willing to try something new and want to change. I believe that as your doctor, I have the responsibility to share with you the evidence that diet and lifestyle absolutely can work for or against you in terms of fertility. I also believe that one of the most important parts of my job is helping families become the healthiest they can be BEFORE conceiving.
I want to be honest. I’m not perfect and I would never pretend to be. My family members love meat- including (gasp!) hot dogs! Being vegetarian is challenging, especially when kids and working parents are involved. I get it. My goal is to make my family as plant -based as is reasonable. I hope that it will work, but I also recognize that the benefits of a plant-based diet are not “all or nothing.” Any change is a step in the right direction. And I absolutely will not shame or judge you if this doesn’t work for your family. With that, I encourage you to consider learning more about plant-based diets and whether it might be something you would be willing to try. It can’t hurt, but it may help enhance your fertility naturally and reduce your risk of a number of medical problems.
If you are interested in learning more, here are a few links to evidence-based resources that sold me on plant-based.
I would love to hear from you. What is the biggest challenge in your family that prevents you from going plant-based? Have you tried being vegetarian? What worked? What didn’t? What are your favorite plant-based meals to help convince my family?
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: