But while BMI is one of the most commonly accepted measurements of health, this calculation has a problematic history and a flawed application. Let’s break down the fraught history behind BMI.

BMI: The backstory

BMI (first called the Quetelet Index) was invented by a Belgian mathematician named Lambert Adolphe Jacques Quetelet in the early 19th century. He set out to find the “average man” by studying the height and weight of (mostly) European men. His work did not include women or people of color. 

A century later, BMI — a calculation of weight (in kilograms) divided by height in (meters squared) — was picked up by health insurers and medical providers in the U.S. They used BMI to create weight categories (underweight, normal weight, overweight, obese, and morbidly obese) in order to determine individuals’ insurability.

Okay, this sounds questionable, but does it work?

BMI is not a very useful health indicator. There are a few reasons why.

1. BMI was originally created to indicate population health, not to determine individual health.

Quetelet was a statistician. His intention was to collect large amounts of data to uncover population-level trends, not to assess an individual’s health or risk factors.

2. These categories are problematic for individuals who were left out of the original studies

Given the fact that so many groups were excluded from the development of BMI in the first place, it doesn’t make much sense to apply it to them retrospectively. Further, BMI suggests that there is an ideal height/weight ratio. This is simply not true.

3. BMI equates muscle, fat, and bone

The body is made up of (among other things): bones, muscles, and fat. BMI groups all these categories together into one, treating bone, muscle, and fat the same. Not only that, but which out of these three parts of the body weighs the most? Bone. The least? Fat.

So is there a better way to calculate health?

There are alternative calculations of health informed by weight, but the issue at play here goes far beyond the biased history of BMI or its misguided application to individuals. Even weight itself is not a strong indicator of health and research has shown that simply changing one’s body weight is not a reliable measure of improvement in one’s health. 

If you’re looking to feel stronger and healthier, there are things you can do, like starting a health promoting behavior. 

Here are a few examples of health promoting behaviors

• Setting a goal to drink more water
• Figuring out what type of exercise you enjoy and doing it consistently
• Finding a mindfulness practice that helps you tune into your inner needs
• Intuitive eating: listening to your body’s requests for nourishing food

Setting goals like these – that are based on how you feel, how your body functions, and what you personally need to be living in a healthier body – is more reliably associated with improvement in overall health. 

Providers that rely too heavily on BMI might be missing the whole picture of your health. If you’re concerned that your provider isn’t understanding the whole picture of your health, seek out a HAES (Health At Every Size) aligned healthcare provider. There are therapists, body image coaches, doctors, nurses, and dietitians who are all trained in HEAS. You deserve to feel seen and cared for by your provider, regardless of your BMI or the size of your body. 

Reviewed by the Ovia Health Clinical Team

Read more

• TTC in a bigger body
• Body acceptance when TTC

Sources

• Brazier, Yvette. “How Useful Is Body Mass Index?” Medical News Today. MediLexicon International. September 6, 2021. https://www.medicalnewstoday.com/articles/255712.    
• Jackson-Gibson, Adele. “The Racist and Problematic Origins of the Body Mass Index.” Good Housekeeping. Good Housekeeping. November 1, 2021. https://www.goodhousekeeping.com/health/diet-nutrition/a35047103/bmi-racist-history/. 
• “Adult BMI Calculator.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention. January 21, 2022. https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/english_bmi_calculator/bmi_calculator.html. 
• “About Adult BMI.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention. August 27, 2021. https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html. 
• The MNT Editorial Team. “BMI calculations and charts.” Medical News Today. Medical News Today. May 3, 2021. https://www.medicalnewstoday.com/articles/323586. 
• Devlin, Keith. “Top 10 Reasons Why the BMI Is Bogus.” NPR. NPR. July 4, 2009. https://www.npr.org/templates/story/story.php?storyId=106268439. 
• Eknoyan G. Adolphe Quetelet (1796-1874)–the average man and indices of obesity. Nephrol Dial Transplant. 2008 Jan;23(1):47-51. doi: 10.1093/ndt/gfm517. Epub 2007 Sep 22. PMID: 17890752.

What you can control

Timing of intercourse or introducing sperm

Making a baby is all about timing and, thankfully, you have control over how often and when you have sex or introduce sperm. Checking your cervical fluid and tracking your basal body temperature can help you know when you are ovulating to maximize your chances of success. For couples TTC through intercourse, the highest rates of pregnancy happen for those who have sex every day or every other day during the fertile window, which is the day of ovulation plus the 5 days beforehand. 

Your health

Having a healthy body is important overall, and it’s no different for baby making. This goes for your partner too. Having healthy habits such as eating nutritious food and integrating movement into your day can help prime your body for when you finally do get that positive test. Cutting down on alcohol and caffeine, avoiding smoking, and taking a folic acid supplement can help in your efforts to get pregnant.

Your mindset

It’s common to feel sad or frustrated when you’ve been TTC for a while with no results. Even if it’s taking a little longer than expected, with practice you can aspects of how you think about the situation. Staying relaxed and having a positive attitude can help make the process a little easier. And if you just rolled your eyes, we hear you. There are some specific things you can do to improve your mindset like talking to a therapist and setting boundaries around work. Even spending time outside has been shown to increase happiness.

Things you can’t control

How long it will take

Although it would be nice to have a crystal ball and know exactly when conception will happen, unfortunately there’s just no way to know for sure. Studies show that most couples (about 84%) will get pregnant within their first year of trying. This is reassuring, but of course, every person is different. Some may get pregnant on their first try while others may take 6 months or more.

Your fertility

Having a condition that affects fertility is not your fault. About 12% of women ages 15- 44  have difficulty getting pregnant or carrying a pregnancy to term. And even though it’s common, struggling to conceive can feel extremely isolating. It’s essential that you have a support system and/or a professional to speak with. 

When your friends get pregnant before you

When you’ve been TTC with no luck, hearing of a friend’s pregnancy can be bittersweet. Of course, you’re happy for your friend, but you may also feel a sense of sadness. Acknowledging your feelings, focusing on self-care, and remaining optimistically realistic can all be helpful in moving forward.

Reviewed by the Ovia Health Clinical Team

Sources

Mayo Clinic Staff. “How to get pregnant.” Mayo Clinic. Mayo Clinic. October 5, 2019. https://www.mayoclinic.org/healthy-lifestyle/getting-pregnant/in-depth/how-to-get-pregnant/art-20047611.

“Trying to get pregnant.” National Health Service. NHS. December 2, 2020. https://www.nhs.uk/pregnancy/trying-for-a-baby/trying-to-get-pregnant/.

“How long does it usually take to get pregnant?” National Health Service. NHS. September 4, 2018. https://www.nhs.uk/pregnancy/trying-for-a-baby/how-long-it-takes-to-get-pregnant/.

Here, we’ll break down the basics of male fertility and what to do if you and your male partner are having trouble getting pregnant.

What typically happens when sperm meets egg

A healthy male produces tiny reproductive cells called sperm, which are made in the testicles. When he ejaculates, the sperm mixes with fluid from the prostate, forming semen. During vaginal intercourse, ejaculation carries the semen into the vagina where it travels through the cervix and into the uterus and fallopian tubes. During ovulation, an egg is released from the woman’s ovary and, if fertilized by the sperm, a ball of cells (called the oocyte) is formed. Fertilization occurs in the fallopian tube and the embryo then implants inside the uterus. If the egg is not fertilized, it disintegrates and sheds during the next menstrual period.

When to see a doctor

It’s generally recommended to see a doctor for a fertility evaluation if you and your partner have been trying to conceive for at least a year with regular, unprotected sex with no success. Depending on your and your partner’s medical history, your doctor may decide to check one or both of you for a fertility workup. You may want to seek care sooner if the female partner is over 35 years old or if the male partner has certain medical conditions such as:

• Past surgery on the groin, testicle, scrotum, or penis
• A history of testicular or prostate problems
• Problems with erection or ejaculation, low sex drive, or other issues with sexual function
• Pain, lumps, or swelling in the testicular region

What to expect when seeking care

For men having trouble with infertility, a doctor may order tests to  measure the amount and quality of the sperm. This is called a sperm analysis. Your partner will provide a semen specimen at the doctor’s office and the doctor will look at the sperm under a microscope. There are 3 factors doctors look for in a sperm analysis. 

• Sperm count: This shows the amount of sperm produced in an ejaculation. A healthy number is 20 to 150 million sperm per milliliter of semen.
• Sperm motility: This test shows how well sperm are moving. At least 60% of sperm should have normal forward motion. Sperm that move erratically or not at all can affect the ability to conceive.
• Sperm morphology (size and structure): Normal sperm have an oval head with a long tail. Damage to any part of the sperm can affect fertility by decreasing the ability to reach and penetrate an egg. Many conditions affecting the shape of sperm are genetic.

Remember that infertility is no one’s fault. It can be difficult and frustrating to experience any kind of fertility troubles on your journey to getting pregnant. Communicating and empathizing with your partner can help make the journey to parenthood a little easier.

Reviewed by the Ovia Health Clinical Team

Sources

“How common is infertility?” National Institutes of Health. National Institutes of Health. February 8, 2018. https://www.nichd.nih.gov/health/topics/infertility/conditioninfo/common

Mayo Clinic Staff. “Male infertility.” Mayo Clinic. Mayo Clinic. August 13, 2021. https://www.mayoclinic.org/diseases-conditions/male-infertility/symptoms-causes/syc-20374773

“What is male infertility?” Urology Care Foundation. American Urological Association. n.d. https://www.urologyhealth.org/urology-a-z/m/male-infertility

Cedars-Sinai Staff. “Optimizing male fertility.” Cedars-Sinai. Cedars-Sinai Medical Center. May 31, 2017. https://www.cedars-sinai.org/blog/optimizing-male-fertility.html

Bradley D. Anawalt & Stephanie T. Page. “Patient education: Treatment of male infertility (beyond the basics).” UpToDate. UpToDate. November 11, 2020. https://www.uptodate.com/contents/treatment-of-male-infertility-beyond-the-basics

How long does it take (on average) to get pregnant?

Many factors can influence how long it takes to get pregnant, including your cycle, general health, fertility conditions, age, and lifestyle.

Getting pregnant faster

Although it takes the average female up to six months to conceive, there are ways to improve fertility health and reduce time to pregnancy. Staying healthy through diet and exercise and taking folic acid supplements can greatly increase your chances of conceiving, relative to those who don’t do these things. Individuals who track their fertility data to pinpoint their ovulation are also able to speed up their time to conception. Even your mood might help with your fertility: some studies have found that happier emotional states correlate with faster conception.

How long is too long?

Although any female without a condition of infertility or sterility can get pregnant naturally before menopause, some may take a bit longer than others. Doctors recommend that couples who have not conceived after one year of trying seek a fertility consultation to determine if an alternative route to conception might be explored, whether it’s in vitro fertilization (IVF), surgery, or fertility medication. It’s recommended that women over 35 should seek a fertility consultation after six months of trying.

If you have any questions about trying to conceive or your fertility health in general, don’t hesitate to reach out to your healthcare provider for more information.

Read more

• Does pregnancy loss impact future conception?
• Trying to get pregnant for more than a year

Sources

• Dr. Walter Willett. “Nurses’ Health Study II.” National Institutes of Health. United States, 1989-. Web.
• “Nutrition During Pregnancy: FAQ001.” ACOG. American College of Obstetricians and Gynecologists, 4/15/2015. Web.

Jennifer Heinen, MS, RDN, LDN Founder, Nourish for Life

As couples begin their journey toward pregnancy, they may consider making changes to their lifestyle. Many are aware that a nutritious diet, exercise, stress reduction, and improving sleep habits are keys to preparing the body for reproduction. However, after 6 months to a year of trying without becoming pregnant, it’s time to start looking at what each partner can do to improve their chances of conceiving. As information directed at women and fertility is abundant and readily-available, we are going to focus instead on what male partners can do on their own.

If you’re looking to boost male fertility, consider these diet changes

According to research, male factor infertility is the cause of infertility about 40% of the time, and yet less than 15% of people in this category seek independent medical advice for infertility. Considering that it takes both partners to make a baby, male lifestyle and diet also play a role in TTC. The good news is that men can take some control over their reproductive health by making simple changes to daily habits.

Maintaining a healthy weight is one way to improve fertility for men. Obesity and being overweight are acknowledged risk factors that can impact male fertility, as they can lead to lower testosterone levels and reduced semen quality. According to one study, the chances of infertility increase by 10% for every 20 pounds a man is overweight. Following a healthy eating plan and getting regular exercise to help manage weight can be a first step towards improving a couple’s chances of getting pregnant.

But not all men struggling with infertility are overweight. Even those at a healthy weight can practice unhealthy behaviors. For instance, smoking, drug use, and excessive alcohol intake can negatively affect chances of conception. Men at a normal BMI that do not eat a well-balanced diet may not reap the benefits that good nutrition could have on their fertility.

Add more produce to the mix

So what is a fertility-friendly meal plan for men? Begin by eating more fresh produce. This can easily be done by getting at least one serving at each meal and snack, or filling half the plate with fruits or vegetables. Focus on the most colorful veggies, which are packed with antioxidants like Vitamin E, Vitamin C, and beta carotene. Also, enjoy fatty fish, like salmon, sardines, and mackerel on a regular basis. They are high in DHA, a fatty acid that is found in sperm. Other healthy foods to focus on are chicken, low-fat dairy, and whole grains.

Reduce consumption of processed meats

Some research suggests that certain foods have a negative effect on fertility in men. These include processed meats (like hot dogs, deli meats, bacon, and canned meats), sweets, fatty foods (especially trans-fats and saturated fats), and other highly processed foods. Replacing these with healthier options may increase sperm motility and quality.

Although the research around male fertility and diet is limited, following a healthy eating pattern and managing weight is a solid recommendation – not only to benefit conception, but the overall health for the father-to-be. Men play an important role in baby-making, so discuss ways you can help make changes and support each other in your journey towards starting a family.

Reviewed by the Ovia Health Clinical Team

Read more

• Finding a fertility specialist
• What you need to know about fertility and perimenopause

Sources

• Myriam C. Afeiche, et al. “Meat intake and reproductive parameters in young men.” Epidemiology. 2014 Oct. 1. 25(3): 323-330. Retrieved September 19 2017. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4180710/.
• Phil Berardelli. “Sugar and Sperm Don’t Mix.” Science. American Association for the Advancement of Science, May 3 2007. Retrieved September 19 2017. http://www.sciencemag.org/news/2007/05/sugar-and-sperm-dont-mix.
• Giahi L, et al. “Nutritional modifications in male infertility: a systematic review covering 2 decades.” Nutr Rev. 2016 Feb;74(2):118-30. https://www.ncbi.nlm.nih.gov/pubmed/26705308.
• Katib, A. “Mechanisms linking obesity to make infertility.” Cent European J Urol. 2015; 68(1): 79–85. Retrieved September 19 2017. https://www.ncbi.nlm.nih.gov/pubmed/25914843.
• Sallmén M, et al. “Reduced fertility among overweight and obese men.” Epidemiology. 2006; 17: 520–523. Retrieved September 19 2017. https://www.ncbi.nlm.nih.gov/pubmed/16837825.
• Nancy Shute. “Fatty Foods Bad for Sperm.” NPR. NPR, March 14 2012. Retrieved September 19 2017. http://www.npr.org/sections/health-shots/2012/03/13/148540108/fatty-foods-bad-for-sperm.
• “Infertility FAQs.” Centers for Disease Control and Prevention. U.S. Department of Health and Human Services, March 30 2017. Retrieved June 7 2017. https://www.cdc.gov/reproductivehealth/infertility/index.htm.
• “Less processed meat, more fish and exercise may boost sperm count, quality.” Harvard School of Public Health. The President and Fellows of Harvard College. Retrieved September 19 2017. https://www.hsph.harvard.edu/news/hsph-in-the-news/less-processed-meat-more-fish-and-exercise-may-boost-sperm-count-quality/.
• De Jonge CJ, Gellatly SA, Vazquez-Levin MH, Barratt CLR, Rautakallio-Hokkanen S. Male Attitudes towards Infertility: Results from a Global Questionnaire. World J Mens Health. 2023 Jan;41(1):204-214. doi: 10.5534/wjmh.220099. Epub 2022 Aug 16. PMID: 36047077; PMCID: PMC9826912.

Healthy snack alternatives to help with fertility

Whether your getting ready to eat for two, or eating just for you, you’ll want to keep your snacking healthy and part of a regular nutritious diet. But, of course, sometimes it’s easier to reach for something that’s a little less than healthy. Having healthy snack alternatives in mind to swap in can help you satisfy your not-so-healthy cravings while giving you a fertility boost.

When you’re craving something savory, try:

• Popcorn: Certainly if it’s covered in butter and salt, the nutrition can be questionable, but popcorn can actually be very healthy! Popcorn is a whole grain that provides a wealth of fiber, which helps to increase fullness, reduce blood sugar spikes, decrease constipation, and improve digestive health and mobility. It also includes a ton of vitamins and minerals – like various B vitamins, iron, magnesium, potassium, zinc, and manganese – and polyphenol antioxidants. And you can spring for healthy toppings like a drizzle of olive oil, a pinch of salt, herbs, or grated parmesan cheese.
• Nuts: These snack all-stars provide fiber, protein, and a ton of healthy, unsaturated fats – including omega-3 and omega-6 fatty acids – which are an important source of energy, help you metabolize a number of important vitamins, and can help lower cholesterol.
• Whole wheat pretzels with flax: The complex carbs found in whole grains provide not only fiber, but also long lasting energy. Whole grains can also provide nutrients like the antioxidant vitamin E and the mineral selenium. And the addition of flax can provides good unsaturated fat.
• Baked sweet potato fries: These might take some prep, but sweet potatoes are more than tasty – they also provide fiber, folate, vitamin-C, and beta-carotene, which converts to vitamin A in the body.
• Whole grain toast with hummus, plain Greek yogurt, nut butter, or avocado: Again, there are lots of goodies to be found in those whole grains, and all of these creamy options you can spread on top provide even more of a nutritional boost. The garbanzo beans in the hummus, much like other all beans, provide you with protein, which helps provide amino acids, fiber, and a number of other nutrients, like large amounts of folate (B9), iron, calcium, and zinc. The yogurt provides calcium, phosphorus, various B-vitamins, magnesium, and zinc. It also provides probiotic bacteria, which supports digestive health. Nut butters have all the health benefits of nuts, and the avocado contains unsaturated fats, folate, potassium, vitamin C and vitamin B6.
• Hard boiled eggs: Eggs are a powerhouse, providing you with protein, healthy fats and amino acids, and vitamins and minerals like choline, potassium, magnesium. Eaten with a pinch of salt, herbs, or hot sauce, they’re a tasty snack option any time of day.
• Edamame: Soy beans provide all the goodies mentioned when talking about hummus, as well as a ton of antioxidants, and vitamins C and A.
• Hummus or guacamole with vegetables or whole grain crackers: Again, you’ve already heard about the wonders of hummus, guac, and whole grains, but veggies are real stars, too. They provide not just great flavor and satisfying crunch, but a wealth of vitamins and minerals. Aim for a variety of color – green, red, orange, yellow, and purple!
• Cheese: Is packed with calcium, protein, and vitamin D. (Just skip soft, unpasteurized cheese because of the risk of Listeria if you’re TTC.)

All of these options will help you bypass the large amount of trans fats and high amounts of sodium that can be found in chips and dip.

When you’re craving sweets, try:

• Fresh fruit: From bananas and apples to cherries and grapes, fruit provides fiber along with vitamins and minerals like folate, vitamin C, potassium, and beta carotene.
• Dried fruit: These provide all the same nutrients as the fresh stuff, but sometimes can travel more easily. Mango, apricots, and dates are all great choices!
• Dark chocolate: If you really want a chocolate fix, go for a small piece of dark chocolate, which is typically lower in fat and sugar than other kinds of chocolate, contains some good fats, provides antioxidants, which improve immunity, and also contains nutrients like iron and magnesium.

When you’re craving sugary drinks, try:

• Ice water with fruit: You already know that staying hydrated is a healthy part of any diet, but the addition of fruit can add a touch of flavor and sweetness to jazz up your usual H2O.
• Iced tea with honey: Whether you opt for caffeinated or caffeine-free, tea sweetened with a touch of honey, which provides some vitamins and minerals – can be a real sweet treat and a far healthier option that the amount of sugar in soda. (As above, if you’re TTC, just make sure your honey is pasteurized.)

When you’re craving something cold, sweet, and creamy, instead of ice cream, try:

• Fruit with yogurt and honey
• A blended fruit and Greek yogurt smoothie
• Pureed frozen fruit with yogurt: You’ve already heard about all the good in yogurt and fruit, but a chilled treat like this will provide you with a tasty bowl or glass full of fiber, calcium, and vitamins.

When you’re craving a sugary breakfast cereal, try:

• Oatmeal with fruit and honey: The fruit and honey? Yummy and nutritious. The oatmeal? It provides you with more of those same goodies in whole grains, plus the oat bran can help lower cholesterol levels.

Eating healthy isn’t all-or-nothing, it exists on a scale, and the more nutrients, and the less empty calories, you can fit into every snack, the further towards the “healthy” end of the scale you’re going to move.

Sources

• Mayo Clinic Staff. “Pregnancy nutrition: Healthy-eating basics.” Mayo Clinic. Mayo Foundation for Medical Education and Research, February 15 2015. Retrieved August 28 2017. http://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/pregnancy-nutrition/art-20046955.
• Mayo Clinic Staff. “Pregnancy diet: Focus on these essential nutrients.” Mayo Clinic. Mayo Foundation for Medical Education and Research, February 15 2015. Retrieved August 28 2017. http://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/pregnancy-nutrition/art-20045082?pg=1.
• Mayo Clinic Staff. “Prenatal vitamins: Why they matter, how to choose.” Mayo Clinic. Mayo Foundation for Medical Education and Research, September 13 2016. Retrieved August 28 2017. http://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/pregnancy-nutrition/art-20045082?pg=1.
• “Good Nutrition During Pregnancy for You and Your Baby.” Cleveland Clinic. The Cleveland Clinic Foundation, June 15 2015. Retrieved August 28 2017. https://my.clevelandclinic.org/health/articles/good-nutrition-during-pregnancy-for-you-and-your-baby.
• “Nutrition During Pregnancy.” The American College of Obstetricians and Gynecologists. American Congress of Obstetricians and Gynecologists, April 2015. Retrieved August 28 2017. https://www.acog.org/Patients/FAQs/Nutrition-During-Pregnancy.

Trying to conceive? What you should know about prenatal vitamins

Getting all the nutrients we need from the food we eat should be possible, but during pregnancy, there can be gaps that even the most careful person can’t avoid. According to the Dietary Guidelines for Americans, the U.S. population generally does not meet daily requirements for many nutrients.

Let’s start with a big one. Folic acid is a water-soluble vitamin that protects against neural tube defects like spina bifida. Getting enough folic acid through supplementation and diet is critical before becoming pregnant and when the neural tube is developing in the early days of pregnancy. Your supplement should have at least 400 mcg of folic acid. You can also consume foods high in folic acid, such as beans, leafy green vegetables, cereals, and enriched or fortified grains. Although you can buy prenatal vitamins that contain “folate,” folic acid is the only supplement that has been researched and shown to reduce the incidence of neural tube defects.

Iron is important for those who plan to become pregnant or who are pregnant. Iron deficiency anemia is the most common nutritional deficiency in the world, and in pregnancy, it can lead to preterm labor, low birth weight, or infant mortality. Unfortunately, getting enough iron from foods can be difficult, so your provider or midwife may suggest taking a supplement while trying to conceive and during pregnancy. Women 19 to 50 years old who are not pregnant need 18 mg of iron per day, and pregnant women need 27 mg per day. Meats, poultry, and fish are good sources of iron, as are many of the foods listed above that are high in folic acid. Having a source of vitamin C can make iron easier to absorb, so consider adding some strawberries to your spinach salad, red bell pepper to your broccoli, or taking your iron supplements with a small glass of orange juice. Iron can be constipating in supplement form, so you may need to experiment with which brand or type works best for you! When you’re ready to start TTC, you can also ask your provider to check your iron levels with a blood count and ferritin level.

Other things to consider

Each woman has individual needs, so talk with your provider or midwife before starting a supplement. You may need additional vitamins or minerals, and your provider can help identify the best options for you based on your health history and available lab work. Folic acid and iron can be found in prenatal vitamins, regular multivitamins, or sold individually. Remember, supplements are meant to do just what they say – supplement our diets. Taking vitamins shouldn’t replace healthy foods in your diet, like vegetables, fruits, whole grains, and protein. By enjoying a variety of healthy foods, you can maximize your nutrition and fertility while trying to conceive!

Sources

• Institute of Medicine. Food and Nutrition Board. Dietary Reference Intakes (DRIs): Recommended Dietary Allowances and Adequate Intakes, Vitamins Food and Nutrition Board, Institute of Medicine, National Academies. Available at: https://www.nal.usda.gov/fnic/dri-tables-and-application-reports. Accessed May 31, 2017.
• U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015 – 2020 Dietary Guidelines for Americans. 8th Edition. December 2015. Available at http://health.gov/dietaryguidelines/2015/guidelines/.
• “Neural Tube Defects.” march of dimes. March of Dimes Foundation, April 2016. Last reviewed: February 2022. https://www.marchofdimes.org/find-support/topics/planning-baby/neural-tube-defects

Jennifer Heinen, MS, RDN, LDN Founder, Nourish for Life

If you have been told that you have low iron stores or are anemic, you are not alone. Iron deficiency anemia is the world’s most common nutritional deficiency, and the WHO estimates that anemia affects 29.4% of people of childbearing age globally.

Diet changes that can help with anemia or iron deficiency

Although it is not clear how iron deficiency may affect fertility, a few studies have suggested that your chances of becoming pregnant may increase if you improve your iron status.

So why is your iron status important for TTC? Starting out your pregnancy with low iron can increase the risk of pregnancy anemia, which may lead to preterm labor, low birth weight, and infant mortality. In addition, during pregnancy you need more iron due to an increase in your blood volume, which provides oxygen to you and your baby. Although this may seem worrying, the good news is that there are many ways to improve your iron by consuming iron-rich foods in your diet!

There are two different kinds of iron in foods: heme and non-heme. Heme iron comes mainly from animal proteins, while non-heme iron can be found in plant-based foods. Heme iron is more easily absorbed by the body, which is why vegetarians may need even more iron than meat-eaters. Below are a list of iron-rich foods:

Heme:

• Red meat
• Poultry (especially dark meat)
• Pork
• Fish and seafood (like oysters, sardines and tuna)
• Eggs

Non-heme:

• Fortified breakfast cereals, bread, pasta
• Beans, legumes, seeds, and nuts
• Whole grains
• Enriched flours
• Cooked dark leafy greens
• Some dried fruit (mango, apricot)
• Dark chocolate

To get the most iron out of vegetarian-based meals, enjoy them with foods that have vitamin C. This combination helps absorb the non-heme iron. For example, eat broccoli with tomatoes, breakfast cereal with an orange, or bean salad with bell peppers and pineapple. On the flip-side, calcium can reduce the absorption of iron, so it is best to separate calcium food and supplements from your iron foods when you can. 

Even though many foods have iron, your doctor may recommend taking a supplement. If so, look for a supplement that contains vitamin C to increase absorption, and to avoid constipation and stomach aches that may come with taking iron, you can usually take it every other day. The Recommended Dietary Allowance of iron for women 19 to 50 years old is 18 mg per day, going up to 27 mg per day for pregnant people.

As you can see, it’s possible to improve your nutrition just by enjoying yummy foods! Talk with your healthcare provider if you have questions about your iron levels, anemia, or before making any changes to your diet or supplementation.

Reviewed by the Ovia Health Clinical Team 

Read more 

• What you need to know about iron deficiency anemia
• Why preventive health is essential for better health

Sources

• Aranda N, et al. Pre-pregnancy iron reserves, iron supplementation during pregnancy, and birth weight. Early Hum Dev. 2011 Dec;87(12):791-7.
• Chavarro JE, et al. Iron intake and risk of ovulatory infertility. Obstet Gynecol. 2006 Nov;108(5):1145-52.
• Institute of Medicine. Food and Nutrition Board. Dietary Reference Intakes (DRIs): Recommended Dietary Allowances and Adequate Intakes, Vitamins Food and Nutrition Board, Institute of Medicine, National Academies. Available at: https://www.nal.usda.gov/fnic/dri-tables-and-application-reports. Accessed May 31, 2017.
• Kaiser LL, Campbell CG. Practice Paper of the Academy of Nutrition and Dietetics Abstract: Nutrition and Lifestyle for a Healthy Pregnancy Outcome. J. Acad. Nutr. Diet. 2014; 7:1099-1103.
• WHO. The global prevalence of anaemia in 2011. Geneva: World Health Organization; 2015.
• U.S. Department of Agriculture, Agricultural Research Service. USDA National Nutrient Database for Standard Reference, Release 28. Accessed May 31, 2017.

From folic acid to DHA, here’s a list of the essentials

Folic acid for preconception 400 mcg, for pregnancy 600-800 mcg:

• Folic acid is the most important vitamin to take while trying to conceive, since ensuring you are getting folic acid for at least one month prior to conception will help reduce the risk of neural tube defects, complications and pregnancy loss. Although you can buy prenatal vitamins that contain “folate,” folic acid is the only supplement that has been researched and shown to reduce the incidence of neural tube defects. 

Iron 27 mg

• Getting enough iron while trying to conceive is important to reduce the risk of pregnancy anemia if you don’t eat enough dietary iron. Take this along with Vitamin C to increase absorption. Note that gummy vitamins usually do not contain iron.

Calcium 1000 mg

• Because calcium and iron should not be taken at the same time, you may want to take a separate calcium supplement or focus on calcium-rich foods throughout the day, like dairy, dark leafy greens, and fortified juices. Your body will best absorb calcium with Vitamin D, and in doses of 500 mg or less.

Vitamin D 400-600 IU

• Not only does Vitamin D help absorb calcium, but it also helps support a healthy immune system! Double whammy! Many OB providers will check your Vitamin D level during a preconception visit or pregnancy, and may suggest higher supplementation amounts if your stores are low.

Choline 450 mg

• Similar to folic acid, choline helps protect infants from developmental defects. Choline is tough to get through diet alone.

Iodine for preconception 150 mcg, for pregnancy 220 mcg:

• Adequate iodine early in pregnancy can help prevent hypothyroidism for the baby.

Vitamin B6 – 1.9 mg

• B6 can reduce the risk and severity of morning sickness when taken before and during pregnancy. It is also important for metabolism and neurological development.

Vitamin A 4000-5000 IU

• Look for Vitamin A in the form of beta-carotene. Do not take more than 10,000 IU per day, as this can increase the risk of birth defects. Many prenatal vitamins sold today contain between 3000 and 5000 IU.

Zinc 11 mg

• Zinc is an important mineral for reducing oxidative stress, and it may also be important for fertility in women (and men!).

DHA 200 mg

• Although there is some debate about the benefits of DHA supplementation, many prenatal vitamins now offer this in their formulas. If you are not eating at least three servings of fish per week, you should ask your provider if you need to take an omega-3 supplement.

Other tips to help choose the right supplements

Check the serving size!

Some vitamins are monster pills meant to be taken once per day, while others split the dose into several pills to be taken throughout the day. Either is nutritionally fine, but look at the supplement facts label to ensure you take your vitamins correctly. It’s also okay to choose based on what you can tolerate without nausea, or remember to take consistently!

No need for the extra stuff

Some prenatals may contain extra B6 or ginger to help combat morning sickness, or probiotics and herbal blends to soothe your stomach. These may be something you want, but aren’t necessary for fertility or healthy fetal development. In fact, steer clear of any vitamins that contain a “proprietary blend,” which is a fancy way to hide ingredients.

Understand testing 

Finally, the FDA does not inspect vitamins for quality, safety or effectiveness. Each manufacturer is responsible for testing its own products. You can consider purchasing products that have been tested by a third party, such as the U.S. Pharmacopeia, NSF International or Consumer Lab.

Get support, if needed

Even though this may be a lot to consider, any prenatal you choose will be fine, as long as it has enough folic acid and you are eating a well-balanced diet. If you are still unsure which prenatal vitamin is right for you, talk with your healthcare provider.

Sources

• Kaiser LL, Campbell CG. Practice Paper of the Academy of Nutrition and Dietetics Abstract: Nutrition and Lifestyle for a Healthy Pregnancy Outcome. J. Acad. Nutr. Diet. 2014; 7:1099-1103
• Nutrition During Pregnancy. American College of Obstetrics and Gynecology.
• Office of Dietary Supplements – Dietary Supplement Fact Sheet: Calcium. Available at: https://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/.
• Information for Consumers on Using Dietary Supplements. U.S. Food and Drug Administration. https://www.fda.gov/Food/DietarySupplements/UsingDietarySupplements/default.htm Accessed May 31, 2017.

1. Everything in moderation

There’s no need to completely eliminate any type of food — especially if it brings you joy. In fact, eliminating entire food groups, or macros like carbs can rob your body of essential nutrients. And restricting favorite foods can actually lead to feeling out of control around that food which is harmful to your relationship to food. Intuitive eating is a great alternative approach to restrictive eating or dieting. You can depend upon your body to tell you which foods you need and how much is enough. It takes practice, but can be a very freeing philosophy around all foods. 

2. Keep hydrating

The more hydrated you are, the more hydrated your cervical fluid is, making it easier for sperm to travel through your cervix and into your uterus and fallopian tubes. This is especially important when you’re exercising, and/or living in warmer climates. If it’s difficult for you to drink water, try adding a squeeze of lemon or orange into your water, or get some flavor drops. It can be motivating to get a water bottle with goals written on it according to times of day. Eating foods that are high in water content, like grapes, cucumbers and celery, will help with your hydration as well.

3. Limit trans fats

Trans fats play a role in causing infertility for some people. In one study, those who ate 4 grams of trans fats a day (as part of a daily 1800 calorie diet), had an increased risk of irregular ovulation. If you don’t ovulate, you can’t get pregnant, so it’s best to avoid these when possible. Trans fats are primarily found in fried foods, some commercial baked goods, and some margarines. Alternative sources of fats you can turn to are olive oil, avocado, and fish. 

4. Boost protein

Protein is an important macronutrient for hormonal regulation as well as blood sugar stabilization. It’s a good idea to have a variety of protein sources each day, like lean meats, fish, eggs, and dairy products like yogurt. If you’re finding it difficult to prepare protein-rich meals, try occasionally adding whey or plant based protein powder to a smoothie or shake.

5. Decrease refined carbohydrates

Carbohydrates get a bad rap. But let’s face it, they are our bodies’ main energy source and we all need carbs in our lives. They also help us feel satisfied. Eating refined or simple carbohydrates causes a greater increase in blood glucose levels (and thus in insulin levels) than complex carbohydrates do. So, refined or simple carbohydrates can negatively impact ovulation.

Some of the most common simple or refined carbohydrates include white bread, and foods with added sugar, including juices made from concentrate. Alternatively, complex carbohydrates energize your body while also providing fiber and starch. These are foods like fruit, vegetables, beans, and whole grains. So try swapping your bagel for some whole grain toast, or your pasta for some whole wheat pasta or chickpea pasta if that feels right for you. 

6. Fill up with fiber

Fiber is excellent for regulating blood sugar and maintaining a healthy gastrointestinal (GI) system. It helps move waste through our bodies effectively and contributes to healthy cholesterol levels. It’s a good idea to have about 25 grams of fiber everyday. Fruits, vegetables, nuts, and beans are excellent sources of fiber. 

7. Choose full-fat dairy

Full-fat dairy foods provide the building blocks for the hormones necessary for fertility: estrogen and progesterone. Hormones require cholesterols (fats) from our diet in order to be made. If your diet is lacking in fat, you may not be able to make the hormones necessary to have a regular menstrual cycle and thus, ovulate and get pregnant. So add in some yogurt, whole milk or cheese to be sure you’re getting what your body needs!

8. Be mindful about alcohol

Enjoying a cocktail once in a while or a glass of wine with your meal is all part of balance. And there isn’t any solid evidence that occasional social alcohol use is associated with infertility. However, moderate alcohol intake (3-6 drinks per week) or more can significantly increase your risk for infertility. Enjoying a mocktail every once in a while can help get you ready for eliminating alcohol altogether once you get that positive pregnancy test!

9. Start your multivitamin

A multivitamin helps you achieve the recommended daily amounts of folate (folic acid) and iron. Both are essential micronutrients in the early stages of pregnancy. In fact, having enough folic acid on board at the time of conception through the first 8 weeks of pregnancy is associated with a significantly lower risk of baby having a birth defect called spina bifida. Often, people find out they are pregnant too late to take action on this, which is why it’s a good idea to start your prenatal vitamin around three months before you anticipate conceiving. 

Reviewed by the Ovia Health Clinical Team

Read more

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Sources

• Katz DF, Slade DA, Nakajima ST. “Analysis of pre-ovulatory changes in cervical mucus hydration and sperm penetrability.” Adv Contracept. 13(2-3):143-51. Web. June – September 1997.
• Lee CH, Wang Y, Shin SC, Chien YW. “Effects of chelating agents on the rheological property of cervical mucus”. Contraception. 65(6):435-40. June 2002.
• Harvard School of Public Health. “Changes to Diet and Lifestyle May Help Prevent Infertility from Ovulatory Disorders”. Harvard.edu. Harvard School of Public Health. October 31, 2007.
• Jorge E. Chavarro, M.D. et all. “Protein intake and ovulatory infertility” Am J Obstet Gynecol. 198(2): 210.e1–210.e7. March 2011.