Ep.2 The Fertility Series: How to support fertility before conception

 

00:00 - Introduction

00:37 - Blood sugar balance

01:04 - Protein-rich meals

02:12 - Getting enough sleep? 

02:43 - The impact of stress

03:24 - Caffeine + alcohol 

04:58 - Nutrients to optimise conception

07:53 - GLP-1s and fertility

10:54 - What testing should I consider?

12:56 - Emotional realities of TTC

14:46 - Free nutritional therapy advice

 

Transcript:

Thalia: Stress. I think that's underestimated, particularly if we are perpetually and chronically stressed. That's affecting their fertility journey as well.

Gail: We know from scientific data that alcohol has very negative impacts on our egg quality.

Thalia: What I often hear is I don't eat breakfast, but if she's skipping breakfast, her blood sugar is probably dropping, which means she might be more inclined to have more sugar. She might be more inclined to have more caffeine to support her energy, which is probably a bit low.

Gail: The foundations for fertility start long before you actually try to conceive. My name is Gail Madalena. I'm a registered nutritional therapist with over eight years specialist experience in fertility and preconception health.

Thalia: Most people focus on ovulation, but your fertility journey starts long before that and your basic health is far more important. I'm Thalia Pellegrini. I'm a registered nutritional therapist specialising in women's hormonal health. I've been qualified for more than 15 years.

Let's talk about the core lifestyle and dietary measures that we can take to improve our fertility. Gail, the first one, the biggest one in blood sugar balance.

Gail: Yes, this is a big one. You know, lots of people don't even realise that their blood sugar is a bit dysregulated. And this is fundamental to overall fertility. Poor blood sugar control can lead to fluctuations in weight, energy dips and crashes, poor nutrient intake, also inflammation which are negative to egg health and hormones in general.

Thalia: So when I'm talking to a woman who's asking me about how to optimise herfertility, I'm going to ask her what she's eating. What did you have for breakfast? And what I often hear is I don't eat breakfast. And there'll be many reasons for that. She's too busy. She's watching her weight, whatever it is. But of course, that means one less meal a day she's getting nutrients in. And the key one for me is protein. So to optimise egg quality, we need to make sure there's plenty of protein going into the diet. And that just puts more pressure on those other two meals of the day. But if she's skipping breakfast, her blood sugar is probably dropping, which means she might be more inclined to have more sugar. She might be more inclined to have more caffeine to support her energy, which is probably a bit low.

Gail: It's all those quick fixes, when you're running on empty and get to 11 o'clock and you need that caffeine hit. You mentioned protein, it is fundamental. Protein and healthy fats: they really blunt that blood sugar response. And they can keep your energy more stable which is key. That's what we want. So really looking at three balanced meals with enough of those core macros.

Thalia: We'll talk later about nutrient intake specifically. But there are other factors that women may not associate with their fertility journey. For me, a big one is sleep. How are you sleeping? What is the quality of your sleep? What's your bedtime routine? These are all the questions we're going to ask in the consultation. Why does it matter?

Gail: It's where the body does its housework. And that's essential for carrying out waste products from the day and preparing ourselves for the day ahead. Having a lack of sleep and not going into those deep sleep cycles can have drastic impacts on hormone health, your energy energy and what you're eating the next day. So your choices have a bit of a snowball effect.

Thalia: Likewise stress. I think that's underestimated. And the impact of stress, particularly if we are perpetually and chronically stressed - not just feeling a bit stressed at odd times in the day - where we're seeing women who I would say have probably elevated cortisol. Particularly they're waking up in the morning feeling exhausted. All of these indicate to us that they're stressed and that's affecting their fertility journey as well.

Gail: Stress in general is quite inflammatory. You've touched on cortisol, which is our stress hormone, that will directly impact progesterone. Progesterone is that key hormone we really need to get pregnant and sustain a pregnancy. And so we want to be reducing and managing stress as best as possible.

Thalia: I think one of the questions I'm asked most is can I drink caffeine? Do I need to give up my coffee if I'm trying to conceive. It's a really tricky one, actually. What's your take on caffeine?

Gail: So I think coffee is not the enemy. I do always say try to act as if you're already pregnant. So, thinking about caffeine consumption, we don't want to overdo it. And also I think it depends on how you individually respond to caffeine. If it makes you jittery or nervous, if you're having coffee as a replacement for meals, that's when it can have negative impacts on your fertility. Generally speaking, though, if you've got a well-balanced dietand your stress levels are under control, one cup of coffee a day is not going to be detrimental to fertility.

Thalia: But when we say one cup of coffee, it's around 200mg. 200mg is more like a cup of tea or an instant coffee. 

Gail: Not a double shot espresso.

Thalia: It's not a double shot or espresso, so that has to be considered. And of course we're also asked about alcohol.

Gail: That's a really big one. I think it's really important across both parties. Women and men. We know from scientific data that alcohol has very negative impacts on our egg quality. It also can lead to dehydration and less nutrient absorption in the gut. I think it's the repercussions of alcohol. I think in moderation, potentially OK, but if you're regularly drinking throughout the week, that is less than ideal. And I'd always say on a fertility journey it's best to abstain from drinking if possible.

Thalia: Yep, I agree. So as nutritional therapists, we're asked all the time about the best diet to optimise conception. So let's focus on the key nutrients. Where would you start?

Gail: Really, really important are Folate and Choline. These are needed for early foetal development and to prevent neural tube defects so it's fundamental that we build up these nutrients prior to conception.

Thalia: So Folate: dark green leafy vegetables primarily. Choline: the best food source is eggs. If you don't eat eggs, that might be one to consider supplementing separately.

Gail: Definitely.

Thalia: For me, it's Omega 3. It's thinking about cell membranes and egg quality. I'm thinking how much oily fish are you eating a week, if you eat fish? If you eat oily fish aim for 2 or 3 portions a week. I always think putting in an Omega 3 supplement is a good investment, because it's really going to support that eqq quality.

Gail: Absolutely. And you know, Omega 3 is hugely anti-inflammatory. And inflammation we know is detrimental to fertility outcomes. And a lot of people are not getting sufficient levels of oily fish in their diet.

Thalia: And if you are vegan, you can opt for an algae based Omega 3. Nuts and seeds in the diet obviously are a good, valuable source. And Vitamin D, all of these nutrients are really important. So we know that Vitamin D is important for fertility. We know that it lowers the risk of miscarriage in the first trimester. In the UK we're not getting enough Vitamin D through the whole year. So for me that's a key one because we can't really get it from food alone. That's a key one to supplement. Oily fish is a good source of Vitamin D, but if there's not many foods that give it to us. So particularly in autumn/winter, if you're trying to conceive.

Gail: It's a fundamental nutrient for hormone production. And regular cycles.

Thalia: And B vitamins. Energy, methylation, hormone metabolism. We need our B vitamins. And we're getting those from our protein foods, if you eat meat, fish and chicken but also from our whole grains. So if we have a good balanced, healthy diet, we should be getting sufficient B vitamins. But that's why they feature so much in our our pre-conception care. Antioxidants for egg and sperm quality of course.

Gail: Yep. And I think particularly in the day to day lives that we live, oxidative stress creates damage in the body. That's where antioxidant support is really crucial and you can get it from eating lots of colourful fruits and vegetables. But it's always a good idea to have that additional support via a supplement.

Thalia: So our options at Wild are Fertility Support for Women and for Men. Or you have the Daily Essentials for Men and Women. And that's a lovely daily combination in a sachet of the Multi and Omega 3. So you've got the options of how to take them. But actually just getting that great multi vitamin and then Omega 3 and a Vitamin D is going to give you everything you need.

Gail: So one of the fastest growing questions we get is how do GLP-1 medications like Mounjaro affect fertility?

Thalia: I think for us the key questions are how helpful it can be for certain gynaecological conditions. So PCOS, endometriosis, fibroids. So tell us a bit about how useful or otherwise Mounjaro or similar GLP-1s can be.

Gail: Well we know that having a high BMI can negatively impact egg quality. And you're at a slightly higher risk bracket for miscarriage. And if you've got metabolic issues like poor blood sugar control, that is typically very prevalent in PCOS. Mounjaro can also be really helpful for that in lowering it.

Conditions that are very inflammatory. So thinking about things like endometriosis and adenomyosis, which have an immune component to it and inflammation is very high. Again the GLP-1 medications can really dilute that. So you can see how that can be really beneficial in getting on top of the condition.

Thalia: And in terms of blood sugar as well, how does that play if you're taking GLP one and you're thinking about trying to get pregnant? 

Gail: I think the main consideration is looking at the dose and the foods that you're eating. My main concern is are we getting enough nutrients across the day?Are you getting enough protein to support muscle mass? Are you skipping meals?Because we know it's the one life stage where nutrients are so specific, that if we're not getting them through our diet, then that can actually have negative impacts on fertility.

Thalia: We're definitely hearing that in consultations. Women will say, well, I'm working to around 1000-1200 calories a day. I'm on a GLP one, and for us, that's alarm bells. It's like, are you getting enough protein? Where's the healthy fat coming from? Are you getting your B vitamins?

Gail: Absolutely.

Thalia:: So when we think about weight changes as a result of taking a GLP-1, we've talked about blood sugar shifts and the impact that's going to have on your hormones. So there is a little bit of a knock on effect as well.

Gail: I think the key thing with the GLP-1 medications is it's new. We don't have long term data or information. And also to flag that it's contraindicated in pregnancy. So really we want to use it as a tool months before we're thinking about conception. Ideally you want to be stopping it at that three month window so that you've got time to really optimise egg health. The medication does have quite a long half life, so it takes a bit of time for the body to clear it. So you want to be off the medication by the time you're actively trying.

Thalia: So when someone is planning to come off a GLP-1 in order to conceive, that's when we want to get involved. We want to help to optimise nutrition, ensure there's been no nutrient depletion and really support that egg quality and general hormone balance.

Gail: Yep and that's where our free 15 minute consultations are so valuable. And people can get that to support them coming off this and with the rest of their journey.

Thalia: So Gail, there are some test we recommend you do before you start a conception journey and some you don't need to rush into. What would you say they are?

Gail: So I think it's always really important for a female to test her thyroid function. That can be a really big indicator of fertility health and actually being able to go on and carry a pregnancy successfully. Also, it can be beneficial to look at your Vitamin D, your B12 and Iron levels, particularly if you're a vegan or vegetarian. And with regards to testing, that maybe comes a bit later. I'd say if you're under the age of 30, really, you can try for a year. It can take a bit of time. If you're over 35, after six months of trying, I'd be looking at a full hormone profile. So that's your oestrogen, testosterone, LH, FSH. Also AMH, which is a marker of your ovarian reserve. So that gives you an indication of how many eggs you've actually got left. It doesn't tell you about the quality of the eggs, though, which is important. And also, if you have long-standing diet issues, a stool test might be beneficial, but not always needed. Or a vaginal microbiome test can be beneficial if you have symptoms. A sexual health screen is pretty fundamental for both the female and male partner.

Thalia: There are so many emotional realities of trying to conceive, aren't there? Let's chat about them a little bit.

Gail: Absolutely. And I think having gone through my own fertility journey, it really can take over your life. It can become such a pillar of your relationship and it can cause disruption. Everything becomes about trying for a baby. It can disrupt friendship groups if everyone around you suddenly announcing baby news. It can overtake your work. You know you're distracted - every month hoping for that positive pregnancy test. And then your period arrives and it can be really devastating.

Thalia: I think what we do in our society very well is focus on the women. And of course, we don't focus on the man. And this is two parties. And it's so important that that discussion as a couple is about what you can both do to support your fertility so the pressure isn't all on the woman.

Gail: A lot of women, let's be honest, we mostly speak to women. We do have an incredible amount of pressure, and we're the ones that do the research and look into it, and it becomes all-consuming. And you're absolutely right. It takes two people to make a baby. And there's a lot that both parties can do. And also it's really important to have open conversations with your partner because it can become a big elephant in the room and it can really disrupt your relationship.

Thalia: We hear from so many people who want a TTC supplement that is clean, dependable and convenient. And that's what we've done with two offerings. We've got our Daily Essentials for Fertility, one for Men and one for Women. And that's a sachet that contains our Omega 3 and our Fertility Support. Really convenient. And we've also got our daily Support Duos, one for men and one for women too.

Gail: We speak to over 1200 women a month, and we're here for you too. You can book a free consultation via our website at wildnutrition.com.

Thalia: In our next episode, we're going to be focusing on male fertility, which is the often essential but missing part of the conversation.