Over the past five years there has been growing scientific evidence that maternal health at conception and during pregnancy is a strong determinant of the health status of adults, especially in relation to their susceptibility to obesity, adult-onset diabetes and cardiovascular disease.
In recent years, the falling birth rate in Australia has drawn attention to fertility. While the impact of social change, such as people waiting un til their 30s and 40s to have their first baby and the increasing cost of living for families, is a topic of social and political debate, the rising incidence of clinically diagnosed infertility has brought the issue to a more personal health arena.
Current statistics indicate that one in six couples are infertile. Infertility is diagnosed when a couple have been trying unsuccessfully to conceive for six to 12 months. The most common treatment options include medically assisted conception procedures, such as in-vitro fertilisation (IVF) or intra-cytoplasmic sperm insertion (ICSI), which at times are met with apprehension by couples concerned about the invasiveness of treatment and/or fearful of any undiscovered side-effects on themselves and their babies. So are there any alternatives?
There is growing evidence that a "health optimising" or health promotion approach during the preconception period can increase the chance of natural conception for couples yearning for a child. This approach can also reduce the risk of problems in pregnancy as well as improve the health of babies and children as they mature into adults.
For most infertile couples, the challenge to conception exists as a collection of sub-clinical health issues that cannot alone cause infertility but, when grouped together, significantly reduce the probability of natural conception. The aim of the health-optimising approach is to resolve these sub-clinical health issues in each partner and in turn increase the probability or chance of natural conception. This method of treatment for infertility has proven successful for many infertile couples.
Preconception health promotion is also used by couples who don’t anticipate any difficulties with conception but simply want to enhance their chance of a positive pregnancy, birth and breastfeeding experience. It’s a time for couples to actively focus on themselves, their relationship and health, and to prepare for the changes that being pregnant and having a baby bring.
Over the past five years there has been growing scientific evidence that maternal health at conception and during pregnancy is a strong determinant of the health status of adults, especially in relation to their susceptibility to obesity, adult-onset diabetes and cardiovascular disease. Evidence shows that the health of our mothers during pregnancy is strongly associated with healthy development and general health as adults.
Preconception health is the health status of each prospective parent during the generation and maturation of the gamete cells that go on to form a baby; in the case of men, gamete cells are sperm, and in the case of women, gamete cells are ova or egg cells. Although it’s clear that health means different things to different people, since 1946 following the World Health Organization’s definition of health, concepts of health have focused on not just the absence of disease but on people’s physical, mental and social wellbeing. The health of individuals is determined by many factors acting alone or together in complex interplay, including environmental and genetic factors, attitudes and beliefs, lifestyle and behaviour as well as biomedical factors. The evolution of perceptions of health is referred to as holistic, as it is the whole person in their environment that is considered.
The concept of holistic health presents a change in perspective when viewing human diseases. In the case of infertility, problems sustaining a pregnancy, or poor birth outcomes such as stillbirth or neonatal death, health refers to the general health as well as the reproductive health of each (prospective) parent. By looking at the person and couple as a whole you can consider the interrelationships of parts of the body as well as the effects of emotions and conditions outside the body, such as the environment and social conditions.
Table 1
Factors routinely considered during preconception health
- Diet
- Nutrient content
- Nutrient assimilation
- Elimination
- Body weight
- Metabolic wastes and absorption of external toxins
- Exercise
- Frequency and type
- Social environment
- Living environment
- Genitourinary infections
- Use of social drugs including alcohol, caffeine and nicotine
- Exposure to chemicals, radiation, heavy metals
- Presence of infections (many without symptoms)
Attention is also paid to self-esteem and emotional health. It’s normal for a couple to feel stressed about infertility, and a tailored approach appropriate for the individual or couple is important. Education about the process of natural reproduction can give some control back to the couple as they start to appreciate that infertility is not usually as black and white as the medical profession sometimes presents. In most cases, there is the potential for natural conception and it’s rare that medical intervention is absolutely required; rather it’s an appropriate choice for some couples.
In a wider sense, social influences are also reflected upon in the preconception period. For example, reproductively mature women or men who have committed a lot of time and energy to work may not have thought realistically about the space in their life required for pregnancy, a baby and young family. Another influence may be the extended family, which could be either negative or positive. While it may seem obvious that these factors influence a couple’s ability to conceive and deliver a healthy baby, they are often overlooked in the general approach to infertility.
For men
For men, the preconception period is about 116 days before ejaculation for conception. It’s over this span of time that sperm are created and mature. They need to be strong enough to survive in a woman’s uterus and then swim through the tubes to discover and fertilise an egg. Although only a single sperm is required, a man needs to provide an large proportion of healthy sperm to increase the probability of conception. The health of the sperm can be investigated through semen analysis, which examines the number of sperm in the ejaculate as well as the sperm’s general condition including motility (the percentage that swim forward) and morphology (the percentage of normally shaped sperm).
It’s not uncommon to see semen analyses that show inadequate levels of healthy sperm. Recent estimates indicate the sperm of about one in 10 men has significantly reduced probability of being able to naturally fertilise an egg. Spurred by the corresponding increased incidence in testicular cancer in areas of lower sperm averages, it’s not until recently that research into average sperm counts has been undertaken. Causes of the reducing average sperm counts are contentious, although some suggest increased concentrations of oestrogenic compounds in the environment, such as those in certain pesticides and herbicides used during the late 1940s through to the 1970s, are implicated due to their potential to disrupt developing hormonal systems in males. Other causative factors include those that increase testicular heat such as non-specific infections and problems with testicular blood flow.
Although women have their full complement of eggs as a three-month-old embryo, it’s not until the final stages of maturation, following the onset of puberty and subsequent regular ovulation, that eggs are exposed to the general circulation. This affords eggs some protection for four to six months before ovulation, or the release of an egg. Once conception has occurred, however, the rapidly dividing cells of an embryo and foetus are very sensitive to toxic substances and nutrient deficiencies, either of which can have minor to devastating effects.
Since the eggs and sperm that develop during the preconception period contain DNA that each make up 50 per cent of the baby’s DNA, in order to ensure the baby’s best health, it’s important that the DNA is as healthy as possible. It’s essential that all the nutrients required to build healthy eggs and sperm are available and that they’re not exposed to toxic substances that can damage the DNA or other components in the cell membrane or mitochondria of sperm or egg cells.
The effects of environmental chemicals on reproduction and the health of humans is controversial, with some studies showing impaired reproductive systems, reduced fertility rates, increased incidence of congenital malformations and foetal deaths in groups of people exposed to certain chemicals, though other research shows none or limited effects. One of the limitations of research is that most conclusions rely on population-based retrospective data due to the ethical challenges prospective studies attract in this field of research. It isn’t considered ethical to deliberately expose a group of people to a known or suspected toxic substance to see what happens to their reproductive system and babies. However, strong evidence based on individual exposure exists, although it is somewhat difficult to develop absolute outcome-based analyses due to its subjective nature and variance of individual experience.
Identified hazards
Several chemicals have been identified as hazardous to human reproductive systems, including pesticides, polychlorinated biphenyls (PCBs) in some plastics, phenols in some disinfectants and dioxins in many new materials such as new carpets and furniture. Some toxicants have a rapid and marked effect that is easily noted, though the effect is often more subtle and may only be discovered following detailed investigation.
One of the main causes of damage to eggs and sperm comes from oxidative stress caused by the accumulation of free radicals. A free radical is an atom or molecule that has one or more unpaired electrons in its outer orbital. The free radicals most commonly found in biological tissue are those derived from oxygen. The electron imbalance makes free radicals unstable and highly reactive with healthy molecules in cells. Free radicals are produced in the body during the process of normal metabolism and during the inactivation of bacteria and viruses by the immune system. External factors that can generate free radicals include air pollution, radiation and herbicides.
The interaction of free radicals with many molecules within cell membranes can cause irreparable oxidative damage. There is the added potential for free radicals to cause changes in protein structures, the most critical being damage to DNA and RNA, as the effects are amplified during cellular replication. Judy Ford, a geneticist in South Australia, argues that free radical damage to the DNA in sperm cells up to six months before fertilisation can lead to miscarriage or the birth of an infant with congenital anomalies. Although there are internal mechanisms the body uses to control free radical damage, including specific enzymes and the utilisation of other antioxidant compounds, tissue changes can occur if the concentration of free radicals exceeds the body’s antioxidant capacity.
Table 2
Internal antioxidants
- Bilirubin – Produced from the breakdown of red blood cells
- Urate – Produced from the breakdown of protein
- Superoxide dismutase – Specific antioxidant enzyme produced in the liver, containing zinc and copper
- Glutathione peroxidise – Produced in general cells, contains selenium
Antioxidant compounds found in food
- Vitamin A – (or its precursor beta carotene)
- Eggs, yellow fruits and vegetables, dark green fruits and vegetables Vitamin C
- Citrus fruits, rosehips alfalfa, berries including strawberries, tomato, pineapple, kiwifruit
- Vitamin E
- Phytochemicals
- Zinc
- Selenium
- Cold-pressed oils, wheatgerm, avocado, leafy vegetables Garlic, onions, broccoli, grapes, legumes, flaxseed, tomato, green tea Sunflower seeds, oysters, lean red meat Wheatgerm, wholegrains, sesame seeds
Seasonal whole fresh food contains the greatest nutrient density and those produced through organic farming methods contain even higher concentrations and no toxic chemicals used as pesticides or herbicides. Food that is generally available is often deficient in nutrients due to poor soil concentrations, prolonged storage, particularly refrigeration, and gas ripening used by large supermarket chains.
As an adjunct to a healthy diet it’s important that the body is efficient in its absorption of nutrients and elimination of waste products. This is particularly the case in the body’s absorption of not only essential vitamins and minerals but also the macronutrients, especially protein. Protein provides the building blocks for the generation of healthy new cells including sperm and eggs, as well as a developing baby.
In regard to elimination, the most essential molecules for the body to rid itself of in the preconception period are toxic metals including lead, mercury, cadmium and aluminium. These elements are absorbed into cells and are capable of severely damaging the DNA of sperm, eggs and a growing baby, possibly resulting in infertility, miscarriage and foetal malformations.
Naturopathic consultations
A naturopath specially trained in natural fertility management can conduct preconception consultations. This can be done in conjunction with a conventionally trained medical doctor who carries out tests and monitors the effect of natural treatments. One centre that offers such services is The Jocelyn Centre in Sydney. This is a clinic offering a specialised preconception healthcare program. Although there’s always variation between couples, specific natural treatments have been shown to resolve common reproductive challenges. Natural treatments include dietary adjustment, vitamin and mineral supplements, herbal medicine and exercise.
Symptothermal charts provide information in relation to intercourse timing for conception or contraception, daily hormonal balance for women and the observation of a non-viable pregnancy. Early pregnancy loss is estimated to occur in one in three conceptions and, naturally, the approach varies in such cases with the inclusion of anti-miscarriage treatments.
When used in conjunction with medical treatments such as IVF or ICSI, the aim of preconception healthcare is to promote the woman’s health as much as possible before commencing drugs so she has a greater chance of producing good numbers of healthy eggs and to lower the risk of some of the common side-effects such as stress. It’s important for the man to maintain optimum health during the leadup and throughout the stimulated cycle. If pregnancy is achieved it’s advised that the man maintain optimal health until the risk of miscarriage is reduced at the end of the first trimester.
Couples use preconception healthcare to:
- Optimise their health and the health of their children before conceiving
- Explore the reasons for infertility
- As an alternative to medical treatment such as IVF or ICSI
- Use in conjunction with medical treatment to reduce risks and increase the chance of success
- Reduce their risk of a complicated pregnancy, including miscarriage
Conditions frequently encountered and treated by natural fertility management centres:
- Low sperm count
- Low percentage of motile sperm
- Low percentage of normally shaped sperm
- Varicocele
- Irregular menstrual cycles
- Candida/thrush
- Sperm antibodies
- Stress
- Endometriosis
- History of miscarriage
- Ovarian cysts
- Poly cystic ovary syndrome
- Fibroids
- Pelvic inflammation
- Blocked fallopian tubes
References
Barker D.J.P. 1998 Mothers, Babies and Health in Later Life, Churchill Livingstone
Cefalo, R.C. Moos, MK. 1988 Preconceptional Health Promotion, Aspen Publications
Ford, J. 1997 It Takes Two; Reproducing Naturally Today, Environmental and Genetic Solutions
Naish, F. Roberts, J. 2001 The Natural Way To Better Babies, Random House Naish, F. 2002 Natural Fertility, Sally Milner Publishing
