Knocked Up Podcast - How can we prepare for pregnancy?
Before conception, how should we be preparing?
How can we prepare for pregnancy?
Before conception, how should we be preparing? Dr Raelia Lew takes us through how we can optimise our minds and bodies for conception and pregnancy.
Hosted by Dr Raelia Lew and Jordi Morrison
Dr Raelia Lew is a RANZCOG Board Certified CREI Fertility specialist, Gynaecologist and the Director of Women’s Health Melbourne.
Find us on Instagram - @knockeduppodcast
Have a question about women's health? Is there a specific topic you'd like us to cover? Email podcast@womenshealthmelbourne.com.au. We keep all requests anonymous.
TRANSCRIPT
Women's Health Melbourne is an innovative, holistic fertility and women's health practice. We are world leaders in IVF and egg freezing and provide our patients with every opportunity to achieve their goals. Our handpicked expert team provides the ultimate care experience for our patients. Reach us at women'shealthmelbourne.com.au and follow us at women's health melbourne and @doctorraelialew. Hello, and welcome back to Knocked Up, the podcast about fertility and women's health.
Jordi Morrison: You are joined as always by me, Jordi Morrison, and Dr Raelia Lew, CREI fertility specialist. Welcome, Raelia.
Dr Raelia Lew: Good morning, Jordi. How are you?
Jordi Morrison: I'm great. Thanks, Raelia. Today's episode of Knocked Up is a listener request, and it's on the topic of planning a pregnancy, things we should do before trying to get pregnant. It's not just for couples who have had problems. This is relevant to everyone trying to have a baby. So we've brainstormed a list. You've gone through everything that your patients ask you on this topic, and we'll be covering medical checks you should have before pregnancy, diet and lifestyle optimisations, and understanding your cycle to help you conceive, all with a lot more detail from Raelia. We'll also link to some useful episodes from our back catalogue because we've covered things that touch on this in the past. Raelia, first topic is adjust your lifestyle. What do you mean by lifestyle?
Dr Raelia Lew: It's a good word, isn't it, lifestyle? It's pretty broad, but really just the way that we live our lives and interact with the world. It can be related to our diet, and it's really important for both men and women trying to have a baby to have a healthy diet. When we're making a baby, we need to have all of the micronutrients required to make healthy eggs and healthy sperm and also to grow a baby. And it is a big endeavour for a woman to grow a baby. Every little molecule that is made up for the baby's body and the placenta and all the blood that circulates to the placenta that we have to make from scratch and all the physiological changes of pregnancy that we ourselves go through, like, for example, the growth of the uterus, the growth of breast tissue, our heart needs to increase in size and muscle capacities, that lots of things change in pregnancy, and we need all those building blocks to be able to accomplish that. Having a healthy diet can help you have a healthy pregnancy and a healthy baby. When we talk about lifestyle, I also think about exercise. If you're exercising a lot and you're trying to get pregnant, do you stop exercising? You moderate your exercise. So it's really good to do moderate exercise. It's very healthy for us. It helps us release natural endorphins. It helps us be mentally well as well as physically strong. But extreme exercise is often counterproductive when it comes to trying to have a baby because your body wants to, in order to be most fertile, know that you're not under physical duress or stress. And sometimes our body interprets extreme exercise as a risk in our environment that it might not be such a great idea if we got pregnant. So it's really important that exercise is not too extreme, and a lot of elite athletes actually lose their periods and stop ovulating. So if you are exercising to the point where your cycle is irregular, you definitely need to cut back. But exercise when you're trying to get pregnant in general terms is a good thing. Also with lifestyle, we've discussed this a little bit on the podcast before, and that's weight. To be clear, this is not about judgment being judgmental. We're absolutely accepting of all sizes and shapes. Why is weight something that we continually discuss when we talk about trying to have a baby? We know that when women are either overweight or underweight, pregnancy and fertility are harder to achieve. We also know, particularly when women are overweight, that there are lots of complications of pregnancy that are more common. And so having a weight in the healthy range is ideal prior to trying to conceive. It's also important to recognise that you can be healthy at different body weights, and achieving an excellent set point for yourself should be your goal rather than comparing yourself to other people. We wanna make sure that you have the lowest risk during your pregnancy, and things like having insulin resistance can predispose to gestational diabetes. And being overweight during pregnancy can also have increased risks of things like blood pressure in pregnancy or preeclampsia. Also, risks of having a baby that has grown too large, that's called macrosomia, which in turn increases your risk of needing to have an intervention for your birth and delivery. For example, induction of labour, forceps or vacuum delivery, or caesarean birth. So if we can ensure that we're at a healthy body weight or the most healthy body weight we can be before embarking on pregnancy, we reduce our risks of all those things happening during our pregnancy.
Jordi Morrison: We've done an episode on endocrine disruptors in the past. How does this relate to trying to get pregnant?
Dr Raelia Lew: When we're trying to get pregnant, we wanna clean up our environment, and that includes our household, And just do a bit of a survey of if there's any toxic chemicals that we're using regularly in our surrounds because we actually do absorb things through our skin such as cleaning products from our households, parabens and other chemicals in our makeup products, and shampoos and conditioners. Just doing a bit of a survey of the plastics that we might be using in our kitchen and trying to reduce the impact of these things. And I would ask anyone who's interested in going further into how endocrine disruptors can affect fertility and pregnancy to have a listen to the episode in our back catalogue specifically on this topic.
Jordi Morrison: A few of the things you touched on there about, weight in lifestyle also probably comes back to medical checks. So weight, we all kind of know what we maybe should weigh. What other things should we discuss with a doctor before trying to get pregnant?
Dr Raelia Lew: There are the general things that apply to everybody, and there are also specific things that might apply to an individual. So if you have any background medical conditions, like you have high blood pressure or you have diabetes or prediabetes or any other condition for which you're on medication, such as mental health concerns, anxiety, depression, epilepsy, any kind of autoimmune conditions. Really, the list is really long of what people can have in their medical background. One thing that's really important is that your background health problems are managed ideally and that you enter pregnancy in a stable condition so that thyroid disorders are adjusted, any hormone imbalances are corrected. So just going to see your GP and making sure that your background personal health problems are under control. If you require medications to control different problems, it's important that these may need to be adjusted to pregnancy friendly options. There are some medications that patients may be using that can be detrimental to a pregnancy or can cause even birth defects in a baby. So it's really important that we identify if a patient is on any of these medications that we call teratogenic. And there are usually safer options for pregnancy that we can recommend. Or if there is a medication that we know to be teratogenic, but that it's really important for the the mother's health that she remain on in pregnancy. It's important that the risk counselling for this occurs and that, we monitor for any concerns that might arise in a baby from conceiving on the necessary medication. We also do some general checks for everybody. That includes sexually transmitted infectious disease screening. Also, we do check if somebody is immune to particular viruses that we can vaccinate against, prior to pregnancy. Important ones are chickenpox and rubella. We have another episode in our back catalogue about infectious diseases that it's really bad to catch when you're pregnant. Chickenpox and rubella fall in that category, and I encourage everyone to go back to that episode and have a listen. But, basically, if you catch chickenpox and rubella during pregnancy for the first time and you don't have immunity, your baby can have severe birth defects. And that's why we like all women who are embarking on a pregnancy to have some immune protection if they can before they get pregnant. Another thing to discuss with your doctor is preconception genetic screening for recessive conditions. This can include things like thalassaemia screening, cystic fibrosis screening, spinal muscular atrophy, and fragile x screening. And there's also nowadays access to expanded panel genetic screening where you can actually screen in a pan ethnic relevant sense to 500 plus recessive conditions that are relevant to reproduction. What this helps us do is identify couples at risk of having a baby with a severe disorder that most people only find out about by having an affected child. Most people don't have a family history if they're in a high risk carrier couple because, individually, each of these disorders are quite rare. But modern technology allows us to pick up the risk. And there are things we can do during your pregnancy with natural conception and with IVF to avoid having a baby with a severe disorder of a genetic nature. So those are the the female health checks that we recommend prior to embarking on a pregnancy.
Jordi Morrison: Yeah. Everything we've talked about so far, I guess, some of it could be both parts of the couple, lifestyle factors. But is there anything men can be doing in preparation for getting pregnant?
Dr Raelia Lew: All of the lifestyle factors that apply to women also apply to men. One advantage that men have is they are constantly making sperm, and so all of the things in their lifestyle, control of underlying medical conditions, making sure that they have a good diet and a healthy environment for spermatogenesis means they're gonna be making better sperm, and that's gonna help their partner get pregnant. So some of the vices that we're gonna talk about in terms of things you should cut out, when trying to conceive, like too much alcohol, smoking, party drugs. All of these things are bad for sperm and, you know, making sure that we are replete in vitamins, folate, vitamin d, iodine, iron, ferment, selenium, zinc, magnesium. All of these things are important building blocks for making healthy sperm. So they're equally important for both partners.
Dr Raelia Lew: Going back to the medical checks, we also check things that are simple like a full blood examination to make sure that the mother is not anaemic. And we check general health, screening bloods, like looking at your liver function, kidney function, just to make sure that there's nothing underlying that we need to look at that we weren't aware of before you started trying as well.
Jordi Morrison: Should a man do a semen analysis before their partner tries to get pregnant?
Dr Raelia Lew: This is a bit controversial because the recommendations for doing a semen analysis is if you've tried to get pregnant for six months and you haven't been able to. But in my opinion, it's reasonable to ask your partner to do a semen analysis before you try and get pregnant if you would like to because six months to me is a really meaningful chunk of time, and I personally think it's reasonable when we check so many things from the female perspective to ask a man to do a semen analysis so that we know and have evidence that if there is a concern, we can act on it sooner. So to me, it makes sense. But, officially, the guidelines are that, after six to twelve months, if you haven't gotten pregnant whilst trying, that is definitely when a semen analysis is indicated.
Jordi Morrison: You touched before on some vices. Why are these important to cut out?
Dr Raelia Lew: It's really important to make sure that you're not introducing toxins to your body. With alcohol, we know that men who drink too much alcohol make unhealthy sperm. With smoking, we know that men who smoke, have partners' risk of miscarriage increase. And we also know that if babies are brought into a house where smoking happens, they have an increased risk of cot death or SIDS and an increased risk of asthma and allergy. We also know that if a woman smokes while she's pregnant as well as an increased risk of miscarriage, she has an increased risk of premature birth and intrauterine growth restriction of her baby. So, basically, you're poisoning your baby by smoking, whether it's the man or the woman, and it's best to cut it out. You would be horrified if someone gave poison to your baby, but that's what you're doing when you're smoking. In terms of other drugs like marijuana and cocaine and other party drugs, there is not one drug that is good for a developing baby, and most of these drugs cross the placenta and go into your baby's developing brain. So when you're trying to conceive, we really don't know we're pregnant for a few weeks, and it's really important to just cut out all those things. I'll just touch on vaping because people sometimes think vaping is not as bad as smoking. We know that vaping also harms your baby. It's best just to go complete cold turkey and cut out all of the above.
Jordi Morrison: You've also talked a bit about vitamins, and we certainly know that folate's important for a woman who is carrying a baby. What are the other vitamins that someone should consider taking?
Dr Raelia Lew: Folate is really important because we know that if you take folate for at least a month before you get pregnant, it really reduces your baby's risk of having what's called a neural tube defect, which means when the spinal cord doesn't fuse properly and they can have variants of things like spina bifida. But, it's really just important to be replete in all of the vitamins and minerals you need to be healthy. One thing that we talk about is iodine. Iodine is the building block of thyroid hormone, and the foetal thyroid does not form until twelve weeks into a pregnancy. So the baby's thyroid really isn't working at all for that critical period of development when lots of organ systems are forming, and the mother's thyroid has to compensate for that. So a 100% of thyroid hormone that the baby needs comes from the mother in the first trimester. If you've got low iodine levels, that's a building block for thyroid hormone, and you can have a low thyroid hormone level. So making sure that you've got the right building blocks to make enough thyroid hormones is really critical. And a TSH test, which is a thyroid stimulating hormone test, that's not actually a hormone made by the thyroid. It's made by the brain, but it kind of is like a bit of a thermostat of thyroid function. And we check that as part of your pre pregnancy screening blood panel as well. We also do do generally do a baseline hormone check of all the female hormones because that gives us an idea if someone's cycle is gonna be balanced. And in terms of other vitamins, a lot of people choose to take a multi. That's not strictly necessary or evidence based. It's a good way to get lots of trace elements altogether, but you can also get everything else you need from a balanced diet. We think the Mediterranean diet is a really good way of eating preconception and during pregnancy with a diet rich in whole grains, leafy greens, vegetables, eat the rainbow, fish, enough protein from whichever source you wish, but just making sure that you have that healthy variety of food groups.
Jordi Morrison: While we've just spoken about having a healthy diet, it makes me think about other lifestyle factors like sleep and caffeine. How are these important when it comes to conception?
Dr Raelia Lew: Sleep is important for every body process. And while sometimes it's difficult, good sleep hygiene and getting enough sleep will help you get pregnant. It helps women have a regular cycle. It helps us recover, replenish, refill our cup after every day. And if your body is in tip top shape, then you're more likely to conceive. Caffeine is a stimulant. It's an interesting topic. We know that an excess of caffeine is bad for you in terms of fertility and pregnancy. Women who in retrospective studies drank a lot of coffee, or had caffeine from other sources, such as soft drinks, have had a lower chance of getting pregnant and a higher risk of miscarriage. However, low amounts of coffee consumption, for example, the equivalent of one espresso a day has not been shown to have any detrimental effects. With caffeine, the message is moderation. You don't have to cut it out completely, but just don't have too much.
Jordi Morrison: What about mental health preconception?
Dr Raelia Lew: Some of us who have pre existing mental health concerns like anxiety and depression are more at risk than others of suffering perinatal depression and postnatal depression, which are exacerbations of underlying concerns that are hormonally driven in a pregnancy. Some people get perinatal and postnatal depression without having any predisposing factors. So it's not just people who have existing depression, but it is a very much an increased risk for you. If you have preexisting diagnosis of depression and anxiety, it's really good to be prepared. So having a perinatal psychologist and psychiatrist involved in your care from the beginning of pregnancy planning can help set you up with supports and strategies to optimise your experience of pregnancy from a mental health perspective and plan supports in case you need it and in the at risk periods, particularly after your baby's born, and also to support you through a pregnancy. Pregnancy can be challenging. Pregnancy can be physically difficult. It can be mentally difficult, and there's a lot of changes that happen in our body and our hormone levels that can influence how we feel. Setting you up with the right support networks preconception means that you're not at sea if you do get perinatal depression.
Jordi Morrison: Now to start trying for a baby, what are the few things we need to know beforehand? I guess, if our periods are regular is a good check?
Dr Raelia Lew: If your periods are regular, as a rule of thumb, it means you're ovulating regularly because it's the hormones of the ovulatory cycle that are the reason for a regular menstrual period. Educating yourself about your fertile window and how to have sex to get pregnant can be really helpful and reduce frustration when you're trying to have a baby. We And we talk all And we talk all about how to have sex to get pregnant during those episodes. But basically, the egg is released in the middle of your cycle, and sperm should be waiting there for the egg. Some signs that you might be getting to your fertile window, that you might be more sexually interested. There are cervical mucus signs that you can look for if you insert a digit and extract some cervical mucus. That sign is subtle. Most people don't notice it, and so you really have to go looking for that cervical mucus sign. So don't be frustrated if you can't find it. You do get a temperature rise after you ovulate. That's not particularly useful for getting pregnant, however, because it happens after the horse has bolted or after the egg has been released. So it's not a prospective sign, but it's a reasonable way of documenting when ovulation happened retrospectively. We can also do a blood test, and your GP can help you do a day twenty one cycle blood test if you wanna demonstrate progesterone rising, which is a hormone change that happens after ovulation. And so that is a confirmatory test that ovulation has definitely happened. Bottom line, if your periods are not regular, if you don't have a regular cycle, you are not regularly ovulating. And so that is the type of person who should seek advice from a fertility specialist before they even start trying. That could be because of polycystic ovarian syndrome, other hormonal imbalances, but there's always a reason for irregular periods. And the most important thing to recognise is irregular periods equals irregular ovulation. So it's really hard to know when you're ovulating, if it's not a clockwork event, and you should seek help immediately if that history resonates with you.
Jordi Morrison: Thinking about regular periods, we know your age impacts fertility very quickly. Why so?
Dr Raelia Lew: As women, we make all the eggs we're ever gonna make when we are ourselves a foetus. And so as we get older, we both start to run out of eggs, but also our egg quality declines rapidly. If you're trying to have a baby and you're 35, most people are pregnant within six months of trying if there's not a problem. There'll be some people who get pregnant in the subsequent six months if they have a mild problem. That is not a deal breaker, but I would say the most important thing is have a lower threshold to seek help if you're older. So if you're over 35, you've tried to have a baby for six months, most people without a problem will be pregnant by that time. Come and seek help immediately. And an important thing to point out is that when you do make an appointment to see a fertility specialist, it takes a little bit of time between when you ring up and make the appointment and when you see the doctor. So usually, you'll have that opportunity to try for a few months further after the six month mark before you're offered any deep investigations or interventions. But reaching out of that stage is really important to avoid retrospective frustration and anxiety if things do take longer and if you do need more serious help.
Jordi Morrison: Thank you so much, Raelia. There's a lot here we've touched on in more detail in the past, but this is such a great overview for anyone just thinking about getting pregnant and how to prepare.
Dr Raelia Lew: It's really important just to realise that pregnancy is a normal and natural phenomenon. It doesn't happen every single month. Even in the most fertile couples, the chance is one in five. Eighty percent of people will get pregnant by themselves for free in the bedroom without the help of a fertility doctor. If you are someone who has been trying for a long time, you feel like you've been doing everything right, and you would like some help, reach out to us at Women's Health Melbourne. We'd love to hear from you. It's our greatest pleasure to help people have babies.
Jordi Morrison: To support Knocked Up, leave us a review or recommend to a friend. Join us on Instagram at @knockeduppodcast and join Raelia at @doctorraelialew, and email us your questions to podcast@womenshealthmelbourne.com.au.