Pre-Pregnancy & Fertility
Just over a third of couples will conceive in the first month of trying, while for others it can be a much longer road, with factors such as age, general health and reproductive health affecting how long it takes.
Around 1 in 6 couples in Ireland may experience issues with fertility. The growing demands of a modern lifestyle are having a significant impact on our nutritional health. Stress, anxiety, lack of sleep, dieting and poor nutrition all impact the body’s ability to absorb the nutrition needed to optimise reproductive health.
Improving nutrition and lifestyle for as little as three months before trying to conceive can make a noticeable difference to both genders as both the male and female reproductive systems need adequate nutritional support to contribute to sperm and egg quality.
Factors Affecting Fertility
Age: For women, the most fertile period is in their mid-twenties and fertility starts to decrease after the age of 35. For men, sperm is strongest in their mid-twenties and starts to decrease after the age of 40.
Smoking: Smoking can affect fertility in both men and women, it can affect the chances of conceiving for women and sperm quality in men.
Weight: A body mass index (BMI) of 30 or over is known to reduce fertility in men and women. While, for women, being underweight (BMI less than 18) can also affect ovulation.
Alcohol: For women planning to get pregnant, the HSE recommend the safest approach is not to drink alcohol at all. For men drinking too much alcohol can affect the quality of sperm.
Stress: Stress can affect your relationship and cause a loss of sex drive. In severe cases, stress may also affect ovulation and sperm production.
Diet & Lifestyle: The HSE recommends all women begin taking folic acid for at least 3 months before conception. There are number of other vitamins, minerals and amino acids that are known to be beneficial to the reproductive system, however it can be difficult to get all of these nutrients in the diet in today’s busy world. This is where supplements can help, by providing extra support needed to support good pre-conception health.
How Do Fertility Supplements Work?
Supplements can help to correct nutritional deficiencies associated with the reproductive cycle by supplying the raw materials needed to support the reproductive system so it can function optimally.
For Women: Supplements can support the nutritional needs of the female reproductive system. Getting the environment right and developing good quality egg cells are key factors when trying for a baby.
Nutrients play an important role in the development of the egg, womb and hormonal system. Each month, the reproductive and hormonal cycle develop an egg cell, prepares the womb and a myriad of other processes have to be performed to create the right fertile balance.
Egg quality can be enhanced if it is released into a healthy nutritious environment. Fostering a good diet and ensuring that you are taking the essential nutrients can positively affect the health of your eggs and subsequently the developing foetus.
For Men: Men have to produce between 40 and 300 million sperm cells to be fertile. This is an intensive process and the energy involved in creating these cells is significant. Getting the environment right and developing good quality sperm cells are key factors when trying for a baby. A deficiency in any nutrient may have an impact on male fertility. Improvements to both sperm quality and quantity can be made in as little as 3 months.
Key Nutrients for Conception:
Look for a combination of Folic Acid, Vitamins, Minerals, Amino Acids, CO-Q10 & Omega 3 DHA.
Folic acid contributes to normal maternal tissue growth during pregnancy. The HSE recommends all women begin taking 400ug folic acid at least 3 months before conception.
Minerals including Calcium, Magnesium, Iron, Zinc, Copper (gluconate), Manganese, Selenium, Chromium, Molybdenum, Iodine and Boron, are essential for both male and female reproductive health. Minerals work together creating a synergy. Multiple mineral deficiencies are common amongst many women particularly those who have been using hormonal contraception.
Vitamins are vital for the production of energy in the body. Sufficient energy production is required for reproductive health. Key reproductive vitamins are: Beta Carotene, Vitamin B1 (Thiamin), Vitamin B2 (Riboflavin), Vitamin B3 (Niacin), Vitamin B5 (pantothenic acid), Vitamin B6 (Pyridoxine), Folic acid, Inositol, Biotin, Vitamin C, Vitamin D, Vitamin E, Vitamin K1.
Amino acids are the building blocks of proteins necessary for growth and repair in the body. Look for: L’Arginine, L’Carnitine, L’Citruline, L’Glutamine, N-AcetylL-cysteine, Glycine, Taurine.
Antioxidants such as Co-Q10 are important for reproduction. CoQ10 is a powerful antioxidant and energy powerhouse. It is present in the membrane of almost every cell in the body.
Omega 3 DHA contributes to the maintenance of normal brain function and vision. During pregnancy, essential fatty acids are important to the baby’s brain and eye development.
Pharmacy teams have the unique role as accessible healthcare providers to optimise preconception health, such as in screening tobacco and alcohol use, in offering advice on preconception risk factors and current medication use.
Heartburn and Indigestion
Many women suffer from both heartburn (acid reflux) and indigestion during pregnancy and it tends to become more common as the pregnancy progresses. In fact, by the third trimester nearly three quarters of pregnant women can suffer from heartburn.
There are two main reasons why heartburn and, to a lesser extent, indigestion are common at this time:
1. The surge in the hormone progesterone causes muscles to relax. This includes the sphincter (ring of muscle) at the entrance to the stomach. When this relaxes, stomach acids are able to travel back up into the oesophagus (food pipe) causing heartburn.
2. During the latter stages of pregnancy symptoms can also be caused by the baby physically putting pressure on the woman’s digestive tract.
Although harmless to the baby, heartburn and indigestion can be painful and uncomfortable for expectant mothers and pharmacists can advise patients that eating a healthy diet and sitting and/or sleeping in a more upright position can help ease heartburn and indigestion.
Fatigue
Fatigue is an early sign of pregnancy which nearly all women experience in the first trimester and can begin weeks after conception and implantation. It typically gets better around the start of the second trimester and returns in the third trimester, though it varies from pregnancy to pregnancy.
A number of tips to give expectant mums include:
1. Get enough rest. Advising a patient to start by going to bed earlier, and take naps during the day when they can. Even a 15-minute catnap can make a difference.
2. Stay hydrated. Cutting back on caffeine, and making sure plenty of water is consumed. If frequent urination is keeping a patient up at night, suggest drinking less water a few hours before bedtime and making up for it during the day.
3. Exercising regularly. Getting at least 20-30 minutes of moderate activity, such as walking can also help a patient feel less fatigued and that they have more energy.
Morning Sickness
Despite its name, can happen any time of day or night. It’s also extremely common affecting over 80% of mums-to-be.
Although it’s not known exactly what causes expectant mums to feel nauseous, it’s most likely that the feelings of nausea are all down to hormones, particularly Beta hCG, although it is thought that it can be due to a lack of vitamin B6, too.
There are several techniques that although have not been scientifically proven to work, have been frequently noted as helping subside the nausea symptoms for pregnant women.
1. Eating little and often, 6 meals a day.
2. Avoiding food with lots of sugar or saturated fats – such as sweets, chocolate and red meat.
3. Avoiding “trigger” foods or smells that make a patient feel sick.
4. Try food or drinks that contain ginger.
5. Wearing acupressure bands throughout the day.
Sciatica and Muscular Back Pain
As many as 98% of women will suffer from muscular back pain at some stage during their pregnancy. The pain is caused by the additional weight and changes in the body during pregnancy; hormonal changes can cause ligaments which support the spine to become loose, which puts more pressure on the lower back.
There are a number of suggestions pharmacists can make to alleviate symptoms:
1. Use a warm compress on the area where pain is being experienced.
2. Placing a pillow between the legs to better align the pelvis and take some pressure off the sciatic nerve.
3. Strengthen the core and reduce inflammation with pelvic tilts and kegel exercises.
4. Use a cold compress to provide cooling relief for back pain.
Medication taking whilst pregnant
As 50% of pregnancies are unplanned, a woman often discovers she is pregnant while already taking medication and visits a pharmacy which is easily accessible, to enquire if she has harmed her baby by this action.
Whilst studies show there may be a lack of adequate information regarding use of certain medications during pregnancy, it has been suggested that pharmacists should be able to integrate available information with their medication expertise, to make appropriate individual risk/ benefit decisions. This requires active engagement with pregnant women, rather than automatically referring them to their physician.
The trimester of the pregnancy often plays an important part in whether medications can be taken, for example some medicines can be dangerous to take in the first three months but safe in the second or third, or vice versa.
Current recommendations are that women should take 400mcg folic acid daily from before pregnancy until the end of the first trimester, and 10mcg vitamin D daily throughout pregnancy and while breastfeeding.
The role of folic acid in reducing the risk of neural tube defects and the value of vitamin D supplements in building bone formation in babies is well supported. Expectant mothers can therefore be reassured that it is not necessary to invest in expensive multivitamin supplements, and that eating a good balanced diet during pregnancy, along with folic acid and vitamin D supplements, should be all that is required to ensure the best possible health outcomes for both themselves and their unborn child.
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