Your Current Health and Future Fertility: Why the Preconception Period Matters

Getting to know your cycle in your teens, 20s and 30s isn’t just about avoiding being caught off guard without the right protection. The menstrual cycle is a vital sign that can signal to women information about her overall health and may point to potential future her fertility health.

The ebb and flow of hormones through the cycle releases an egg at ovulation and grows the uterine lining to prepare for pregnancy. If these events don’t happen in a timed fashion or are painful, it may point to underlying health conditions that can impact a woman’s future fertility. Eggs (or oocytes) are carried with a woman from birth, meaning that a woman’s health history and health behaviours can have a significant impact on her future fertility. These two pieces of a woman’s fertility: her cycle health and her egg quality, can be supported with steps such as cycle tracking, healthy nutrition and nutritional supplements years before a woman is ready to fall pregnant.

Getting to know your cycle through a fertility lens

Many women are tracking their menstrual cycle with a menstrual app to note the arrival of the menstrual period each month. Besides tracking the days of flow, other insights such as tracking cervical mucous, changes in body temperature and other symptoms experienced through the cycle can help understand if the cycle is on track from a fertility perspective. Tracking also identifies if other symptoms such as pain are occurring often and can help women flag if they need further testing or support for their cycle. Symptoms during the menstrual cycle that may be related to fertility include irregular cycles (shorter than 24 days or longer than 35 days), spotting or irregular bleeding though the cycle or painful periods that require medication to manage. Irregular cycles may point towards polycystic ovarian syndrome¹ while painful periods should prompt an investigation into endometriosis². Both of these conditions can impact a person’s fertility future. Many women’s health concerns are treated initially with the oral contraceptive pill. Although the pill may support symptoms in a woman’s younger years and the pill itself doesn’t have a negative impact on fertility³, it also can mask underlying fertility concerns until a woman is ready to fall pregnant.

The impact of nutrition on future fertility.

A woman’s eggs are carried in her body from the moment she is born to the moment they are ovulated, meaning that a woman’s lifetime of nutrition and lifestyle influence the health of her eggs and impact her future fertility. Nutritional behaviours such as eating enough fruit, making leaner protein choices and including plant based protein can improve a woman’s fertility health⁴, while factors such as trans fats⁵, refined carbohydrates⁶ and consuming alcohol⁷ may have a negative impact on a woman’s future fertility. The ovaries are stimulated to release an egg each month through hormone signalling, which can be disrupted when women are above their ideal body weight, consume a diet high in refined sugars and saturated fats or are low on markers of the Mediterranean diet such as nuts and legumes^8,9. Ovarian health is also impacted by the level of antioxidants in the diet, with higher fruits and vegetable based diets¹⁰, higher dairy intake¹¹ and diets offering an array of antioxidants and micronutrients reducing cell damage and improving egg quality¹⁰. Overall, when women and couples are coached to eat more fruits and vegetables prior to conceiving their fertility is improved and couples achieve pregnancy faster and need less fertility medical care^4,12. These simple steps can be part of a proactive preconception plan to support women and couples well before they are ready to conceive.

Nutrient deficiencies commonly seen during the preconception phase 

Even given widespread knowledge about the benefits of taking a prenatal vitamin, many women do not begin taking a vitamin including folic acid in the preconception period¹³. Although folic acid is an important preconception nutrient to improve the health of a couple’s baby, the addition of folic acid helps to prevent neural tube defects. Women can take a proactive approach to their fertility by including micronutrients in her diet and supplements to support pre-conception planning and overall health.  

A proactive approach to fertility 

Women in their 20s and 30s can have an impact on their future fertility through health behaviours, even if they are not quite ready to try for a baby. Getting to know the signs and symptoms of a healthy menstrual cycle can help women get tested and supported before they try conceiving and adopting a healthy nutrition pattern can support overall health. Specific nutrients such as folic acid can also support healthy pre-conception in women and support a woman’s overall health and wellness years before she’s ready to conceive.  

1. Rasquin Leon, L. I. & Mayrin, J. V. Polycystic Ovarian Disease. in StatPearls (StatPearls Publishing, 2021).
2. Tsamantioti, E. & Mahdy, H. Endometriosis. StatPearls (2021).
3. Girum, T. & Wasie, A. Return of fertility after discontinuation of contraception: a systematic review and meta-analysis. Contracept. Reprod. Med. 3, (2018).
4. Oostingh, E. C. et al. Mobile Health Coaching on Nutrition and Lifestyle Behaviors for Subfertile Couples Using the Smarter Pregnancy Program: Model-Based Cost-Effectiveness Analysis. JMIR MHealth UHealth 7, (2019).
5. Chavarro, J. E., Rich-Edwards, J. W., Rosner, B. A. & Willett, W. C. Dietary fatty acid intakes and the risk of ovulatory infertility. Am. J. Clin. Nutr. 85, 231–237 (2007).
6. Chavarro, J. E., Rich-Edwards, J. W., Rosner, B. A. & Willett, W. C. A prospective study of dietary carbohydrate quantity and quality in relation to risk of ovulatory infertility. Eur. J. Clin. Nutr. 63, 78–86 (2009).
7. Eggert, J., Theobald, H. & Engfeldt, P. Effects of alcohol consumption on female fertility during an 18-year period. Fertil. Steril. 81, 379–383 (2004).
8. Kazemi, M. et al. Obesity, Insulin Resistance, and Hyperandrogenism Mediate the Link between Poor Diet Quality and Ovarian Dysmorphology in Reproductive-Aged Women. Nutrients 12, (2020).
9. Vujkovic, M. et al. The preconception Mediterranean dietary pattern in couples undergoing in vitro fertilization/intracytoplasmic sperm injection treatment increases the chance of pregnancy. Fertil. Steril. 94, 2096–2101 (2010).
10. Pearce, K. & Tremellen, K. Influence of nutrition on the decline of ovarian reserve and subsequent onset of natural menopause. Hum. Fertil. Camb. Engl. 19, 173–179 (2016).
11. Moslehi, N., Mirmiran, P., Azizi, F. & Tehrani, F. R. Do dietary intakes influence the rate of decline in anti-Mullerian hormone among eumenorrheic women? A population-based prospective investigation. Nutr. J. 18, 83 (2019).
12. Oostingh, E. C. et al. The impact of maternal lifestyle factors on periconception outcomes: a systematic review of observational studies. Reprod. Biomed. Online 38, 77–94 (2019).
13. Toivonen, K. I. et al. Folic acid supplementation during the preconception period: A systematic review and meta-analysis. Prev. Med. 114, 1–17 (2018).
14. Agrawal, R. et al. Prospective randomized trial of multiple micronutrients in subfertile women undergoing ovulation induction: a pilot study. Reprod. Biomed. Online 24, 54–60 (2012).
15. Nouri, K. et al. The Impact of a Standardized Oral Multinutrient Supplementation on Embryo Quality in in vitro Fertilization/Intracytoplasmic Sperm Injection: A Prospective Randomized Trial. Gynecol. Obstet. Invest. 82, 8–14 (2017).
16. Grieger, J. A. et al. Maternal Selenium, Copper and Zinc Concentrations in Early Pregnancy, and the Association with Fertility. Nutrients 11, (2019).
17. Moridi, I., Chen, A., Tal, O. & Tal, R. The Association between Vitamin D and Anti-Müllerian Hormone: A Systematic Review and Meta-Analysis. Nutrients 12, (2020).
18. Chu, J. et al. Vitamin D and assisted reproductive treatment outcome: a systematic review and meta-analysis. Hum. Reprod. Oxf. Engl. 33, 65–80 (2018).
19. Andersen, L. B. et al. Vitamin D insufficiency is associated with increased risk of first-trimester miscarriage in the Odense Child Cohort. Am. J. Clin. Nutr. 102, 633–638 (2015).
20. Zhang, H. et al. Meta-analysis of the effect of the maternal vitamin D level on the risk of spontaneous pregnancy loss. Int. J. Gynaecol. Obstet. Off. Organ Int. Fed. Gynaecol. Obstet. 138, 242–249 (2017).