I'm officially at the age and stage of life where pretty much every single female friend/family member of mine is pregnant, trying to conceive, or just had a baby.
Children are an amazing blessing, and for many women, a significant part of the life they envision for themselves. So when pregnancy doesn't happen right away, it can be devastating. For many, the drive to "fix" their fertility issues can become all-consuming.
I understand. I know what it's like to have a really irregular and sometimes absent period and at the same time a big desire to have children. I also know how good it feels to get a normal period back after years of feeling like there was just something wrong with me. It may surprise you, but for a lot of women, healing your hormonal imbalance and being able to ovulate doesn't have to include crazy rigid plans and protocols.
Just like I want everyone to be free from obsession with food and exercise, I also want women to be free from all-consuming worry and helplessness over their fertility. Part of that freedom comes from stepping back and knowing that it's okay not to be perfect and that we cannot ( and should not attempt to) control everything, including the food we eat. In fact, when we let go of some of that control we usually find ourselves in a much healthier state -- but more on that later.
Of course, always consult your health care practitioner first to rule out underlying conditions. There are many root causes of infertility to consider and by no means is it always related to the female partner. However, the purpose of this post is to discuss general lifestyle behaviors that may promote fertility in females, and are beneficial for most women.
But First We Need a Normal Period.
So here we go, let's start from the beginning. In order to become pregnant, you need to be ovulating. Ovulation usually occurs in the middle of a woman's cycle. During this time she releases an egg from her ovaries into the fallopian tubes. Once there, if the egg becomes fertilized by a male sperm, it begins to divide and multiply as it makes its way to the uterus. When it reaches the uterus, the fertilized egg implants in the thick lining of the uterine wall and begins the long process of growing and maturing until birth. Of course, if the egg is not fertilized, the body signals to shed the uterine lining and start anew. This is the woman's monthly period. Typically if a woman is ovulating monthly, she will also have a regular period.
This process, which is necessary for reproduction, is quite impressive and reliant upon a cascade of hormonal signals. Conditions for this process need to be ideal. Skipping your period or experiencing completely absent menstruation is a sign that something is off kilter. If too much stress induced by lifestyle factors or illness interferes with this cascade, reproduction is likely to be put on halt. The body is quite smart, it knows that times of stress are not ideal for pregnancy.
So what lifestyle factors interfere with and influence this delicate hormonal balance? Well, when I'm working with women with absent periods or hormonal imbalances we look at four areas: nutrition, exercise, sleep and psychological stress. Many times modifications in one or more of these four areas result in restored menstrual function. And if the goal is fertility, regular menstruation is key.
Much of the research on fertility supports the same lifestyle interventions that we use to restore a normal period. While nutrition research is often hard to quantify and specific nutrient interventions yield conflicting results based on the population, there are some well-supported recommendations that we will explore.
Energy Balance & adequate nutrition
One of the biggest ways to ensure a normal period and encourage fertility is to meet the body's basic energy needs. Even small unintentional energy deficits may elicit enough physiological stress to stop a woman's menstrual cycle, especially if she has physiological stress coming from one of the other four lifestyle contributors (i.e. intense exercise, poor sleep, or psychological stress). In athletes and active individuals especially, under-fueling is closely tied to amenhorrea (absence of the female period) and/or annovulation (absence of ovulation).
One way to ensure energy balance is to stop restricting food based on calorie amount, or food group. Learning the principles of intuitive eating and practicing honoring your hunger and fullness without judgement are a great place to start.
Beyond that, we need to make sure we are not restricting any macronutrient or food group, especially fat or carbohydrate intake. Both of these macronutrients are closely tied to hormonal production and health. Not eating enough fat or carbohydrates can throw your hormones off.
It's also important to note that many women ovulate at a preferred body fat percentage. This percentage varies from woman to woman, but in the research the lower end required for reproductive maintenance is about 22% body fat. So while a woman may have a "normal" BMI and weight, if her body fat percentage is too low, she might not ovulate. Again, this value and the body weight range at which a woman ovulates is very individual. Intuitive eating can be used to help you find your body's preferred healthy weight and body fat range.
Regulating blood sugar
Some conditions which contribute to infertility like PCOS may be tied to insulin resistance and blood sugar irregularities. The best way to regulate blood sugar with diet while still meeting energy and macronutrient needs is to practice eating in balance every 3-4 hours throughout the day. This is our bodies' preferred rhythm for eating. And research shows that when we eat at the first signs of hunger and do not skip meals we have better blood sugar regulation. Often times, if we are skipping meals or going long periods without eating, it's because we are either ignoring or numb to our hunger cues. Chronic dieting inhibits our ability to recognize hunger signals, which is why it's sometimes necessary to follow a flexible eating schedule until we're better able to recognize hunger signs.
Besides fueling regularly at the first signs of hunger, we can help regulate blood sugar with balanced meals and snacks. A balanced meal contains carbohydrates, fat, protein and fiber. While snacks should contain at least two macronutrients (carbs, fat, & protein) to help stabilize blood sugar.
Foods To Include
Like I mentioned above, nutrition research can be hard to quantify and fertility is no exception. While no study is perfect, probably the best one that we have on nutrition and fertility is the Nurses Health Study II. This is a prospective cohort study of 17, 844 women ages 24- 42. Results detail commonalities in the diets of women who had the lowest rates of infertility. Other studies have looked specifically at ovulatory disorders of infertility, which account for at least 1/4 of cases of infertility and do not include structural causes of infertility. Obviously there is no PERFECT fertility diet, but the foods below have been associated with lower rates of infertility and merit inclusion in a balanced diet.
Swap out trans fats found in processed foods and shortening for monounsaturated fats which are associated with better rates of fertility. Foods high in monounsaturated fats include:
- Olive oil
- Nuts & Seeds (esp. macadamia nuts)
- Nut butters
- Sesame, Sunflower, & peanut oil
- Beef Marrow (which can be found in beef bone broth)
Try making your own salad dressings with olive oil or cooking with it on medium heat. Use sesame oil and peanut oil in stirfrys. Add nut butters or avocado to toast or make a snack mix with nuts and fruit. Purchase or make your own beef bone broth and use it in soups and stews. These are just a few ideas to increase your monounsaturated fat intake. If these are foods you don't consume regularly pick one or two tips and incorporate them.
A commonality among women with lower rates of infertility is that they consume higher amounts of vegetable protein. Notice, I did not say that they ate only vegetable protein, that they were vegetarian or vegan---simply that incorporating plant based protein sources has been shown to be beneficial. Try including some of the following foods in soups, stews, stir-frys, casseroles, atop oatmeal, or in smoothies. You may find that you aren't hungry for as much animal protein, which can be nice on your budget (especially when you have a hubby who eats meat like it's going out of style).
- Beans (black, chickpea, white, red, navy, you name it)
- Green Peas (or pea protein powder)
- Pumpkin seeds
- Nutritional Yeast
Full Fat Dairy
This one might be my favorite, because I'm a firm supporter of whole milk (mainly because it tastes so good, but also because it's been wrongly accused of causing health problems for too long). Studies show that women who consume 5-6 servings of full-fat dairy per week had the lowest risk of infertility compared to those who consumed only 2-4 servings of full fat dairy. Beyond that, the more servings of low-fat dairy a woman consumed the greater the risk of infertility.
Moral of the story, choose whole milk and full fat yogurt and cheese over skim and 1%. Go ahead and enjoy the delicious satisfying flavor of full fat dairy and don't look back.
Obviously if you're allergic to dairy, you should not consume it. If you're lactose intolerant, you may try full fat yogurt and cheese as these are often tolerated with lactose intolerance.
Non-heme iron is the iron found mainly in plant foods. Increase your intake of this nutrient by including some of the following foods:
- Beans & Legumes
- Nuts & Seeds
- Eggs (NEED THE YOLK)
- Dried fruit
- Whole grains
- Dark Leafy Greens
You can also find non-heme iron in supplement form. Most prenatal vitamins you take should include this type of iron. If you do take an iron supplement as a part of a prenatal vitamin make sure to take it with food to prevent stomach upset. You can also increase the absorption of this iron by consuming it with vitamin c rich foods like oranges, lemons, & strawberries.
High Fiber Carbohydrates
Studies show that women who include fiber rich carbohydrates in the form of whole grains, beans, nuts, fruits and vegetables have decreased rates of infertility. Remember that eating enough carbohydrates in general is important for blood sugar regulation and hormonal health. Meet your carbohydrate needs and get the reap the benefit of high fiber carbs by filling 1/4 to half your plate with whole grains, beans or starchy vegetables at meal time.
Vitamins & mineral supplementation
I prefer to meet nutrient needs with food, but when used correctly vitamin and mineral supplementation may be helpful. Specifically, folate from supplementation and Vitamin D for those with low levels may be considered. Typically, I recommend finding a good prenatal vitamin and taking it before pregnancy. Ideally it would contain 800 mcg of folate, at least 18mg of iron and no more than 100% or the DRI for other vitamins and minerals. Vitamin D can be taken separately or consumed in Vitamin D rich foods such as milk, fatty fish and eggs. I can give more specific recommendations for individual clients, but am always cautious to do this over the blog.
Research seems to suggest that decreased alcohol intake is related to increased rates of fertility, while intake of 6-10 drinks per week is associated with higher rates of infertility. My recommendation for women who are trying to get pregnant is to bring their alcohol intake down as much as they can. Obviously a glass of wine or two on the weekends is not going to derail your pregnancy efforts, however once you do become pregnant it'll be important to stop drinking alcohol anyways. It can't hurt to start now.
When it comes to caffeine and coffee, moderate amounts, 1 to 3 8 oz. cups of joe a day, do not appear to affect fertility. Caffeine intake above 500 mg/day (~ 5 cups of coffee), however may increase the amount of time it takes to get pregnant. Moderation is key!
Exercise is a stressor. While some stress followed by rest, recovery and adaptation is a good thing-- chronic stress from exercise without adequate recovery does more harm than good. The level of exercise that seems to correlate best with fertility is 16-60 minutes a day of moderate exercise. Exercising every single day and exercising to exhaustion are associated with higher rates of infertility. Moral of the story, if your goal is to get your period back and/or to get pregnant, ask yourself whether the amount and intensity of exercise you're doing supports that goal.
Sleep is an important component of regulating cortisol levels. Too little sleep increases cortisol and excess cortisol interferes with the reproductive hormonal cycle. If you regularly get less than 6 hours of sleep a night, ask yourself how you can shift your priorities, change your routine or improve your sleep environment to get your 7-8 hours of shut-eye a night.
Some great first steps are:
- Going to sleep and waking up at the same time each day.
- Shutting down electronics an hour before bed.
- Incorporating a nighttime routine, like, bath, book, bed, etc.
- Dimming the lights in your house in the evenings and blacking out windows that let in light from the street.
These are just a few suggestions, pick what works for you!
Last but not least, reducing psychological stress may help decrease the overall physical stress load on your body, which could help encourage normal hormonal cycles. Exercises like deep breathing, journaling, walking and yoga may help decrease stress. Every person is unique and what relaxes me may make you annoyed, what is it that makes you relax? Make it a priority to do that thing regularly.
If concerns over food, exercise and your body are constantly stressing you out, seek help from a counselor and/or a non-diet RD. Nourishing and caring for your body was not meant to cause you distress or inhibit you from living the life you're meant to live. Don't underestimate the power of your mindset to influence your behaviors and your physical health!
I hope this post has been helpful for you. Please remember that what I've written is not intended to diagnose, treat or replace advice from your doctor. If you need more specific recommendations please see your health care practitioner. If you want to work one on one to make targeted modifications unique to your needs and lifestyle, I'd love to work with you! Contact me and we can set up a free discovery call to see if we'd be a good fit.