Scott Webb (Host): The road to conception for some women and couples can be a little bumpy, but my guest today wants everyone to know that help is available. I'm joined today by Dr. Ann Lo. She's a gynecologist and ambulatory service lead with Southern New Hampshire Health, and she's got some great tips and suggestions to help folks who are thinking about trying to conceive.

This is Your Wellness Solution, the podcast by Elliot Health System and Southern New Hampshire Health, members of SolutionHealth. I'm Scott Webb. 

Doctor, it's nice to have your time today. We're going to talk about, you know, the road to conception, right? Essentially, but not necessarily infertility, but really more about how to prepare for, let's call it a planned pregnancy, if you will. So, what are the most important steps to take before trying to conceive? And when should couples start preparing?

Ann Lo, MD: So, I always tell my patients that the fact that they're coming into the office to talk about planning for a pregnancy is already an excellent start. It tells me that they're trying to take control of your health and the most important thing is before planning for pregnancy is to be as healthy as possible.

So, a lot of women have chronic medical conditions and they need to be actively working with the other healthcare providers that they're seeing to optimize that. So, if you have chronic hypertension make sure that the medications that you're taking are safe for conception. Most medications are safe for conception, but that's why it's important to have that conversation because some medications are not. And if you have mental health conditions, which a lot of people do, I always caution patients that that's also an important chronic medical condition, and there is no reason to abruptly stop medication without consultation with whoever's prescribing and caring for you.

One very important, thing to discuss is obesity. Extremes of weight, being extremely underweight or being overweight and obese will affect fertility, and I think that, you know, in this society, it's hard to talk about it without patients feeling self-conscious, maybe judged, but it is extremely important to talk about how it relates to being able to get pregnant and having a healthy pregnancy.

So, just some statistics in New Hampshire, you know, over 30 percent of our population is considered obese, which if you look on your body mass index chart, is going to be a BMI of over 30. In Massachusetts, which we're on the border of it's 27%, which is actually one of the lower states in the country.

The reason why this is important is because obese women are going to have a greater than 30 percent reduction in their monthly fertility rates and in in-vitro practices, obese women are going to have less eggs that they can produce. It is definitely also a higher relationship with more pregnancy losses when they do get pregnant.

And obviously, when you do become pregnant, obese women are going to have higher complications and higher risks. So, that's why I think having this conversation and knowing it's not just about dropping your number so you can fit a certain size on the scale, but it's really about being healthy so you can get pregnant; and once you are pregnant to having the healthiest pregnancy possible. 

One other thing to be aware of is that obese moms are more likely to have obese children and lifelong complications of increased risk of childhood diabetes and so forth.

Host: Yeah. So then let's talk about lifestyle factors, be they diet, exercise, sleep, all those things that you know, help us to be healthier, to feel healthier. How do those factors, if you will, impact fertility for both partners?

Ann Lo, MD: This is a nice segue into that. For women who are normal weight, we don't have a particular diet that makes them more fertile. We just advise a healthy, well balanced diet. Usually I refer to the USDA's, it's now called myplate.gov to figure out how to eat a healthy meal and how to plan for a healthy meal.

Obviously, for women who are trying to get pregnant, we don't want them to eat a diet that's very, very heavy in mercury, and that usually is just limited to two servings, six ounces of seafood, but there are certain types of seafood that are very high in mercury content, which would be like the large fishes. Other things to really pay attention to is to avoid excessive caffeine and alcohol consumption. Obviously, we recommend that women who are trying to get pregnant to try to cut down on smoking. During pregnancy, we are going to recommend that ideally to hopefully be able to completely stop smoking.

This also bridges over to other substances, some of which are legal in Massachusetts, which would be marijuana. We don't recommend marijuana use during pregnancy. So that's something to pay attention to if that's being done recreationally to cut down and it would be recommended to stop completely once you are pregnant.

And obviously anybody who is using other, you know, substances such as heroin and anything else, we have lots of programs in our hospital to help people cut down and try to stop completely. In terms of other lifestyle things that you can prepare for, there are certain vaccinations that we recommend.

At all stages in pregnancy, we recommend getting the flu shot when it's flu season and also to get your COVID booster. There are some questions about, oh, is it safe? Should I get it you know, before I get pregnant? Absolutely. So, if there's a COVID booster and you're somebody who gets that, that it is totally safe pre conception and also during pregnancy.

Other specific vaccinations that would be helpful is to make sure you're up to date on your measles, mumps, rubella vaccination, which most people have gotten during childhood, and also chickenpox. If you haven't gotten chickenpox, to make sure you get a chickenpox vaccination. Vaccinations are optional. I always tell patients the reason why we recommend those specific ones is because getting those diseases during pregnancy may severely affect the fetus.

Host: Sure. Yeah, and how about vitamins and supplements? You know, when I walk the aisles, Doctor, there's just so many, you know, and it's great to have you here and great to have your expertise. So, for those individuals trying to conceive, what do you recommend?

Ann Lo, MD: So, I don't have a brand that I recommend, but definitely it is important for any woman who is not using an effective form of birth control to assume that you're just going to be able to get pregnant. And so, any women's multivitamin should contain at least 400 micrograms of folic acid. Prenatal vitamins contain a bit more which is safe and totally fine.

I tell patients either a women's multivitamin because most likely it will contain the adequate amount of folic acid or just a prenatal vitamin. Some women may not want to advertise that they're trying to actively conceive, so I think a women's multivitamin will be fine.

Another important supplement to make sure that your multivitamin contains is iron. We generally recommend about 27 milligrams of iron daily, which is above the normal amount for non-pregnant women. So typically, we recommend that you go on prenatal vitamins about a month before you start to try to conceive.

There is some very hopeful data that if you are on folic acid about three months prior to pregnancy, it may decrease your pregnancy related nausea. So that's also another nice, incentive to go on the supplements.

Host: I mentioned before we got rolling that our road to having our second child, our daughter, was a little bumpy and frustrating, and it's the reason why she's four and a half years younger than her older brother, and when we finally did get pregnant, my wife, who was 36 at the time, was told that she was of advanced maternal age, which sort of came as a shock to both of us.

So, I just want to talk to you a little bit about age and fertility and how someone in their late 30s or early 40s, you know, it can maximize their chances of conceiving.

Ann Lo, MD: I always tell my patients who are advanced maternal age, and I was too for my second pregnancy, that sometimes it feels like in this day and age that the 30s are the new 20s.

Most households are dual income and most women work. Not that that always delays things. I always tell women, unfortunately, there is an age related decline in fertility. And that is something that we can't avoid. Women are born with a set number of eggs and unfortunately, it's not just the quantity, but it's the quality of the eggs that decrease over time. 

But I always reassure my patients that there's a lot more to having a child, you need to feel financially and relationship-wise ready. And whether that's with a partner or without a partner and there are other factors that go into making this very important decision. I always reassure women that just because you're older, it doesn't necessarily mean you can't get pregnant, but unfortunately your personal fertility, age 35 is going to be lower than when you were 25. But I always tell women, we're not like Amazon warehouses where we get restocked with our eggs. However, your warehouse may be very well stocked. So, I always tell them, you know, you at 37 may be more fertile than me at 25.

So, it's a relative decline to yourself, but you don't need 20 million eggs to have one healthy child.

Host: Right. Right. 

Ann Lo, MD: But the process may be longer or not, or not. But it is very important to know that as you age, unfortunately, you know, generally people's weight goes up. They may develop other chronic medical conditions. So, if you are pregnant and all you have going is that you are advanced maternal age and older, you are going to be at higher risk for developing pregnancy-related hypertension and gestational diabetes.

And also you may be at higher risk for having a baby with chromosomal number problems, but we do have excellent tests to check for that, now, that insurance actually covers pretty well. And lots of women who are advanced maternal age are going to be able to have healthy pregnancies and healthy babies.

Host: So, Doctor, I wanted to ask you about the fertility window, in other words, that there's a window of time that's really ideal for most women or perhaps couples. And what can we do to improve our chances or just generally increase our chances of being more fertile and conceiving?

Ann Lo, MD: Right, so there is definitely a fertile window and the wonderful thing is there's a lot of great period trackers and apps that are free that women who have regular cycles can completely take advantage of. Usually, you will be ovulating about 14 days before the start of your period. So, if you have 28-day cycles, you're going to be ovulating generally on cycle day 14, cycle day 1 being the first day of your period.

You're actually most fertile for the six days before you ovulate. So that's, generally how the app trackers are going to be determining when your fertile window is, and one thing that I tell patients, having intercourse multiple times in one day actually doesn't help you. The ideal frequency is going to be every day, every other day.

There are not any particular positions that make you more fertile. Sperm should be able to track to get to the female reproductive tract within minutes. And one thing that I think is very interesting is that there are certain lubricants that actually decrease sperm motility. And that would be very common things like Astroglide, KY jelly, KY touch, and olive oil.

So, there are certain lubricants that are going to not affect sperm as much such as, I think canola oil. So pay attention to which lubes you're using. For male partners, excessive tobacco and marijuana are also things that are known to affect sperm quality. So, those are things that I think would be helpful. 

Now for the woman who doesn't have regular cycles, you're going to have a larger fertile window, right? Because you may ovulate on cycle day 14. You may ovulate on cycle day 21. Who knows? So, I tell patients not to worry and just to extend that to when they think their next period will be and extend their fertile window and then just have sex a couple times per week, and that way they can take advantage of whenever they do ovulate.

Host: Right. Yeah, it's definitely not a one size fits all. Obviously, you've given us a lot great tips and information today. Just want to finish up and talk about some of the misconceptions or myths maybe about fertility. I'm sure you encounter those frequently in the office. What's the truth behind those, Doctor?

Ann Lo, MD: A lot of people automatically stop certain medications they're taking without consulting their original prescribers. I think that that's an important conversation for example, certain antidepressants, you can't just stop it abruptly. You need to taper it down. So, that's something that I think is important is, yes, have a plan, but make sure before you execute that plan you want to talk to whoever prescribed it, or your primary care doctor, to make sure that you're doing this safely and you don't exacerbate other conditions going on.

It is okay to get your COVID booster and your flu shot, just like everybody else.

And to go on your prenatal vitamins and to keep exercising, decreasing stress, get adequate sleep, and optimize your weight. Those are kind of the main things that I encourage people to do.

Host: Yeah, I think you're so right. It does feel like when it comes to medications or vaccinations, those are questions and concerns that women and couples have, and that's why it's great to have experts, right? So, when in doubt, speak with your provider. As you say, once somebody walks through the door and they say, we think we want to have a child, right? So that's the first step. But there's things that we can do along the way to maybe improve our chances of conception. So, good stuff today. Thank you so much.

Ann Lo, MD: You're welcome. Have a great day. 

Host: And for more information, go to snhhealth.org/foundationobgyn.

And if you enjoyed this podcast, please be sure to tell a friend and share on social media. This is Your Wellness Solution, the podcast by Elliot Health System and Southern New Hampshire Health, members of SolutionHealth. I'm Scott Webb. Stay well, and we'll talk again next time.