Written by Shawn Shanahan, APRN-WHNP-BC, RDMS-WHE, CGCP, CMP
There are many reasons that a particular couple may not be able to conceive easily. When the wonders of reproduction are examined and understood in their complexity, it may be more surprising that anyone gets pregnant! The difficulty may lie in challenges for the egg or the sperm individually, transporting the egg and sperm to one another at the appropriate time, or with the environment needed to nurture a fertilized egg.
A healthy lifestyle is needed in order to support healthy sperm and eggs. This includes getting 7-8 hours of sleep each night, regular exercise that incorporates strength training, effective stress management, and healthy nutrition. The Mediterranean Diet is most recommended for good hormonal balance. Supplements that promote healthy gamete (the biology term for sperm and egg) production include CoQ10, B Complex, Zinc, methionine, and selenium. Eating 2-3 Brazil nuts per week will provide an adequate amount of selenium without a manufactured supplement. Vitamin D, also needed for healthy gametes, is actually a hormone rather than a vitamin. It is manufactured in our skin naturally from ultraviolet B rays from the sun. In Montana these rays are absent from the sun over our part of the globe October through April , so it can be supplemented at 5,000 IU a day for egg and sperm health during that time. Too much vitamin D can be unhealthy.
Vitamin D also helps the implantation of a fertilized egg into the uterus (womb). In order to prevent fetal birth defects of the neural tube, such as spina bifida or anencephaly where the spine or brain do not form properly, it is recommended that a mother-to-be start taking 400-800 mcg of folate (or folic acid) 3 months prior to conception. Iron supports a healthy blood supply, while DHA/omega-3 supports brain and eye development. All of these nutrients can be found in a good prenatal vitamin. No particular brand is needed.
Myo-inositol not only promotes healthy egg quality, but regular ovulation (the release of the mature egg from an ovary). It is often recommended for women with Polycystic ovarian syndrome (PCOS), as it may contribute to more effective hormone communication in the reproductive system. This can result in more regular reproductive cycles, which women with PCOS often do not experience.
Healthy eggs and sperm are just the start. They need to be able to get together! Ovulation occurs two weeks before the onset of a period normally, so it is important to time intercourse around that time.
Healthy eggs and sperm are just the start. They need to be able to get together! Ovulation occurs two weeks before the onset of a period normally, so it is important to time intercourse around that time. To maximize sperm count, it is recommended to withhold the release of sperm for two days prior to when sperm is needed, and not more than seven days. When that is too technical, lovemaking can be planned for every other day. If ovulation prediction tests are used, lovemaking should take place the night of a positive test and the following two nights. Ovulation prediction tests are sold over the counter where pregnancy tests are located. They are based on the luteinizing hormone surge that prompts the ovary to release a mature egg 24-36 hours after the surge. The reason for lovemaking these three consecutive nights is that sperm survive longer than the egg in optimal conditions. It is best to have sperm available to the egg before it is released by the ovary, as well as the day of ovulation, and the day after ovulation to cover the 24 hours that the egg is viable.
While timing lovemaking with ovulation may be carried out to perfection, conception may still be challenging if Fallopian tubes do not function properly. They may be blocked by inflammation or scar tissue. A special ultrasound test called a saline instilled sonogram or an x-ray test with dye contrast called a hysterosalpingogram can be performed to check for open tubes in a mother-to-be. A semen analysis would be the first test to check for presence and quality of sperm in a father-to-be. Sometimes the gametes need a little help getting together. An intrauterine insemination may then be recommended at the time of ovulation to place sperm high in the uterine cavity next to the Fallopian tubes where the sperm usually fertilize the egg.
Still a fertilized egg may not implant well into the womb for many reasons, or it may implant and not thrive. Structural/anatomical issues with the uterus can be detected by the same imaging tests mentioned to check the tubes. Genetic carrier screening is a blood test that a couple may want to consider prior to conception to detect possible gene defects in either parent that may be passed to a baby making it more likely for miscarriage or fetal health issues. Miscarriage occurs in approximately 15-20% of known pregnancies in the US, primarily due to fetal chromosomal abnormalities. The second leading cause of miscarriage is related to the mother’s health including medical, anatomical and immunological factors. Vaccinations are one way to strengthen the immune system to avoid communicable diseases that can affect the pregnancy and the baby.
Kalispell OB-GYN at The Falls offers a wide variety of services for reproductive care including fertility education, evaluations and management. We partner with many clinics around the country and even outside the USA to provide services leading to desired pregnancy. We can prescribe fertility medications, provide intrauterine inseminations, perform tests for women, and order basic tests for men. We keep an updated list of higher-level fertility clinics for in vitro fertilization, donor egg programs, and intracytoplasmic sperm injection – to name a few other treatment options. Please call us to help you through your family building journey at 406-752-5252. We would love to support you!
