Preconception Care: Optimizing Fertility and Hormone Balance

One of the things I love about naturopathic preconception care is that a couple can find pertinent information and support before trying to conceive in order to optimize health in preparation for conception. Preconception care is one of the best ways to support the likelihood of pregnancy, while also offering children and families the best possible chance for a healthy future.

preconception care

Infertility now impacts 1-in-8 couples trying to conceive. Infertility is diagnosed when a couple has not achieved a pregnancy after one year of attempting to conceive or at six months if the couple is 35 or older. Waiting a whole year before receiving a diagnosis and care can lead to unnecessary stress, and concern. Naturopathic preconception care can reduce the lengthy waiting and naturopathic medicine helps couples who have already been struggling to have a baby for some time.

Preconception Care for Lily and Zach

Lily came to see me once she and her husband, Zach were ready to start creating a family. Both wanted to take steps to prevent difficulties with infertility they had heard about from friends and in the media. They were both active, in good shape, and seemingly healthy. They also wanted to take all the steps to support the health of their future baby. Lily was a 35-year-old who often practiced yoga, and was an avid cyclist which helped with her anxiety and stress. Her husband, Zach 37, was a daily runner. Two years prior to our visit, Lily began to switch to a more plant-based diet. She felt her digestion improve, it was more affordable, she lost weight and also found her libido improved eating a plant-based diet. Zach missed animal foods but followed the plant-based plan because he was interested in the health benefits.

The couple regularly had one-to-three drinks about four nights a week and drank their fair share of coffee to help get through their busy work days. Their diet consisted mainly of fruits, veggies, and grains with the addition of nuts and seeds. Breakfast was oats, a mix of fresh and dried fruits, nuts, seeds, and spices. Lunch was usually gluten-free grains with veggies, and dinner was often a large salad. They snacked on veggies and popcorn.

Lily had regular monthly cycles about every 28 days. She struggled with hormonal acne and breast tenderness before her cycle began. Both Lily and Zach had challenges with anxiety, while Zach complained of fatigue.

As part of my fertility work, one of the first steps is to identify a woman’s fertile window. Lily started to do basal body temperature charting as well as use LH strips to help identify her fertile window. Over the next couple of months, we found that Lily was not ovulating every cycle. Sometimes, when she did ovulate, it was not until very late in her cycle, leading to a short luteal phase (less than eight days). Although her periods were very regular every 28 days, her ovulation patterns were not predictable, which is not optimal for fertility.

We followed this up with testing to learn more about what was happening with Lily’s hormones. Lily’s follicle-stimulating hormone (FSH) and estradiol came back in a good range with no signs of approaching early menopause. Her AMH (anti-Mullerian hormone, a rough marker for follicle count) was elevated at 13.6 ng/ml. This number tells us that Lily had a large number of developing follicles. Elevated AMH is seen in women undergoing fertility treatments and also in polycystic ovarian syndrome (PCOS). PCOS was consistent with her pattern of irregular ovulation, shortened luteal phase, and jawline hormonal acne.  Zach had a  complete semen analysis to ensure that there were no issues there that could impact conception, there were none found.

Levels of insulin can also impact ovulation and hormonal balance in the ovarian environment. Although Lily and Zach had a seemingly healthy diet, the high carbohydrate load may not have been ideal for their reproductive potential. I recommended that they reduce their carbohydrate consumption by avoiding and limiting tropical fruits and reducing grains to just one serving per day. I also suggested increasing their protein and fat intake to offset the missing carbohydrate calories.

At our two-month follow-up, they both reported being so surprised by the amount of sugar that had crept into their diet. Still, Lily and Zach found it challenging to maintain their energy levels. They were also starting to lose weight due to the reduction in carbohydrates. I asked them to consider adding in meat and eggs to their diet, to track their caloric intake, and to add break weeks into their physical exercise training schedules. Zach was thrilled by my suggestions. Lily was a little nervous about reducing her biking miles as long rides helped keep her anxiety in check. The couple added in eggs regularly, (a favorite of Zach’s.). They also introduced red-meat and poultry. They both felt these recommendations made sense, they kept portion size small and enjoyed the new variety to their diet.

Further, I recommended avoiding regular and excessive alcohol consumption. Alcohol is a known source of oxidative stress and has been shown to have an impact on hormone balance and to reduce the chances of conception. Lily made every fifth or sixth week of training lighter to support recovery and improve energy levels.

After two months with the new diet and a number of botanical medicine prescriptions to support Lily’s hormonal balance, Lily and Zach achieved a positive pregnancy test. They followed up with an email thanking me for the support with their new developments but also were so grateful for improvements they felt with emotional health. It turns out the dietary changes also significantly improved their anxiety levels. They were feeling more at ease, ready to welcome their new baby home.

Ideal Diet for Conception?

Many times when I’m interviewing patients, they report that their diets are healthy. When we dive in, we find that although the foods eaten are “healthy,” they may be lacking in areas or have too much of one thing, not enough of another, which can lead to imbalances. I don’t recommend that all my clients start eating more eggs and red meat and with others, I may recommend the exact opposite. Naturopathic medicine is a customized approach based on the individual patient’s needs. NDs uniquely bring to bear their specialized education, training, and experience in a whole-person patient-centered approach that emphasizes prevention, behavioral medicine, and social and other determinants of health. With this approach, NDs work to educate, inspire, and support our patients in all these areas of emphasis, including, for example, food and lifestyle changes that can help patients reach their optimal health from their extensive training in nutrition, in this case, their pregnancy goal.

Naturopathic preconception care is the ultimate in preventive medicine. Starting early in a couple’s journey by promoting optimal fertility saves time, reduces stress, and the financial costs associated with infertility treatments and can offer a way to a healthy start for the whole family. 

Click Here for More on Preconception Health and Wellness 

See How the Father’s Health Impacts Baby’s Health

BreAnna M. Guan, ND, is the owner of the fertility and women’s health practice, Balanced Natural Heal. Dr. Guan provides support virtually to families across the country. She served as the president of the Indiana Association of Naturopathic Physicians. In 2018, she created the first-ever Nourish Women’s Health Conference to raise awareness of naturopathic medicine and inspire women towards health. Dr. Guan’s mission is to empower women and families to thrive during fertility, pregnancy, and parenthood, to positively impact generations to come. For more information, contact:

This article is sponsored by the Institute for Natural Medicine, a non-profit 501(c)(3) organization, partnered with the American Association of Naturopathic Physicians. INM’s mission is to transform healthcare in America by increasing both public awareness of naturopathic medicine and access to naturopathic doctors for patients. INM believes that naturopathic medicine, with its unique principles and practices, has the potential to reverse the tide of chronic illness that overwhelms existing health care systems and to empower people to achieve and maintain their optimal lifelong health. INM strives to achieve this mission through the following  initiatives:

  • Education – Reveal the unique benefits and outcomes of naturopathic medicine
  • Access – Connect patients to licensed naturopathic doctors
  • Research – Expand quality research of this complex and comprehensive system of medicine

INM's team is made up of naturopathic doctors and health journalists.

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Deb Hubers

Debra Hubers is a serial entrepreneur and has started seven businesses; ranging from an advanced genomics to an employer health care purchasing cooperative. Deb has over 35 years of experience in healthcare finance, education, technology, and pharmacogenomics.

Ms. Hubers has dedicated her career to measuring and improving healthcare outcomes. Her expertise is leveraging technology to deliver personalized, preventative medicine. Ms. Hubers co-founded La Vita Compounding Pharmacy in 2007. Collaborating with her business partner, physicians and strategic partners, Deb has grown La Vita to be one of the most respected and sought-after personalized medicine providers on the west coast. She is also Co-Founder of EpigeneticsRx, a leading provider of precise, personalized, prevention which positively impacts genetic expression.

Alex Keller, ND

Dr. Alex Keller, ND, AFMCP is a graduate of the University of Ottawa with an Honours Bachelor in Health Sciences and Psychology. Although originally intending to attend conventional medical school, following a three-month volunteer internship at a rural Kenyan hospital where he observed how doctors used local food to treat patients, he shifted his career goals and pursued a degree in naturopathic medicine at the Canadian College of Naturopathic Medicine in Toronto.

After one year of practicing with the esteemed Dr. Chris Pickrell, ND, RH in a community acupuncture setting, in 2015 he and his wife Dr. Jenn Keller, ND moved to rural Ottawa, Canada where they started an organic farm and retreat center. In the same year, Alex and his athletic therapist sister Jess Keller combined their practices to form Keller Active Health, an integrative physical therapy clinic.

Ever curious and passionate about the education of evidence-based natural medicine, in 2017, Dr. Keller joined a fledgling Ottawa-based health tech startup named Fullscript. He serves as its Medical Director and oversees the development of medical education content for practitioners across North America.

Prior to medicine, Alex worked in the renewable energy sector, where he developed a deep passion for sustainable agriculture and environmental stewardship. This connection between medicine and agriculture now drives Alex to focus much of his energy on bringing awareness to the quality and sourcing standards in the supplement and organic agriculture supply chains.

Today, he splits his professional time practicing as a clinician, working for Fullscript, and expanding the farming operation while chasing his kids with Jenn and occasionally running ultra-marathon trail races. He is also currently completing an Executive MBA through the Quantic School of Business & Technology with a focus on supply chain innovation.

Pamela Snider, ND

Pamela Snider, ND, is Executive and Senior Editor for the Foundations of Naturopathic Medicine Project, producing a first of its kind international textbook of Naturopathic medicine through a series of international retreats and symposia. A nationally recognized integrative health and policy leader, she is active in both national and regional integrative health initiatives. Dr. Snider serves on the Board of Directors, was founding Executive Director and co-founder of the Academic Consortium for Integrative Health (ACIH/ACCAHCa consortium of the councils of schools, accrediting agencies and certifying bodies of the licensed, traditional and emerging integrative health professions, and is currently Vice Chair and co-founder of the Integrative Health Policy Consortium (IHPC).  Dr. Snider served as a founding Board Member of the Academy of Integrative Health & Medicine from 2014-2016. Her public policy work includes completing a two year appointment to the DHHS Center For Medicaid and Medicare Services (CMS) Medicare Coverage Advisory Committee (MCAC); serving as a Steering Committee Member for  the HRSA funded American College of Preventive Medicine NCCIM Integrative Medicine in Preventive Medicine Residency program, co-directing in USPHS Region X the Building Bridges Between Provider Communities Group, an exploration of interdisciplinary collaboration and common ground between public health and CAM; serving for 22 years on Washington State’s Health Professional Loan Repayment and Scholarship Program Advisory Committee (HPLRSP); providing technical assistance to and developing key language for the enabling legislation for NIH Center for Complementary and Alternative Medicine (NCCIH/NCCAM); and staffing Joseph Pizzorno ND during his appointment as Commissioner on the White House Commission on CAM Policy.

From 1994-2003, Dr. Snider served as Associate Dean for Public and Professional Affairs and Naturopathic Medicine at Bastyr University, dividing her work between academic and public affairs activities, including chairing the Naturopathic Medicine Program Curriculum Review Committee.  Dr. Snider has been teaching, publishing and lecturing widely on Naturopathic philosophy, theory integrative health, public policy, and other topics for over 30 years. Currently, an Associate Professor at National University of Natural Medicine (NUNM) in Portland, OR, Dr. Snider also continues at Bastyr University in her 22nd year as a faculty member teaching naturopathic medicine history, clinical theory, and global context. Among her Naturopathic medicine professional roles she serves on the Institute for Natural Medicine’s Leadership Council.  In 1989, she co-led the naturopathic profession with Dr. Jared Zeff, in developing a unifying definition of naturopathic medicine and its principles of practice adopted unanimously by the American Association of Naturopathic Physicians (AANP) House of Delegates. She was a co-investigator in the 2004 NIH NCCAM research study, the North American Naturopathic Medical Research Agenda and CAM Advisor in NIHCCAM’s Financing Integrative Health Care (University of Washington).  Her areas of experience include healthcare education; naturopathic and interdisciplinary clinical theory, curriculum development; clinical practice; government and legislative affairs, public policy, interdisciplinary collaboration, and community organizing.  Dr. Snider has received the Ontario Naturopathic Physician of the Year Award, the Physician of the Year Award from the AANP, the President’s Outstanding Vision Award and Distinguished Alumnus Award at Bastyr University, AANP’s President’s Award, an honorary Doctorate of Naturopathic Philosophy from the Canadian College of Naturopathic Medicine (CCNM), the William A Mitchell Vis Award from the AANP and The Gathering – NMSA’s Beacon Award. She received her ND degree in 1982 from Bastyr University of Natural Health Sciences and is a licensed naturopathic physician in the State of Washington. She lives with her husband and children at their homestead in North Bend Washington, in the beautiful mountain to sea landscape and home of The Revival – Restore the Vis, an annual student-led community gathering.

Susan Haeger

Susan Haeger is Founder/Principal of Transformative Health Solutions Inc. She has applied her twenty plus years in executive leadership to help shape and drive adoption of progressive health policy for whole person healthcare. She was a section contributor to the 2021 INM/AANP published professional white paper, Naturopathic Physicians as Whole Health Specialists: The Future is Whole Person Health Care that provides supporting evidence for the profession’s significant and unique contributions to preventive, whole person care and models of integrative clinical practice.

Bruce Barlean

Bruce Barlean is an owner and founder of Barlean’s, a global dietary supplement manufacturer located in the Pacific Northwest in Ferndale, WA. Bruce has been actively involved in the Natural Products industry since 1989 and is passionate about making a difference in the world and positively impacting the lives of others.

Bruce believes that people can make a difference in the world through ordinary purchases. He is committed to improving the quality of life for every person on the planet by making the best products and by using the profits to support outreach programs. Bruce summarizes it simply, “We make good stuff to do good stuff”.

In the late 1980’s Bruce became passionate about how health could be dramatically improved with Flax Oil Supplementation. Bruce along with his entrepreneurial parents saw the potential to improve the lives of many people and in 1989 they began selling Flax Oil under the Barlean’s name. From 1989 – 2000 the business grew an average of 40% year over year. While most companies saw a decline in business in the 2001 recession, Barlean’s continued to grow and soon became America’s #1 selling flaxseed oil and continues to be to the present. The brand has since expanded to include additional oils, green food concentrates and other premium supplements. Bruce continues to drive innovation and over the years his products and company have won countless awards including: Eight consecutive Vity Awards for #1 EFA, Six consecutive Vity Awards for #1 Greens Food Supplement, Natural Choice Award for Best Specialty Supplement, Best Product of the Year, Best New Product, Gold Medal Taster’s Choice Award, Gold Medal American Masters of Taste Award, #1 Health Food Store Brand for Consumer Satisfaction by Consumer Lab, and Manufacturer of the Year.

In 2013 as the company was on the eve of celebrating the 25th year in business Bruce and his parents decided to take their desire to help people to a new level that they call Pathway to a Better Life – which is now seen in the Barlean’s logo. Bruce and his parents had always been generous in their giving and support of charities, but as part of the Pathway to a Better Life they decided to increased partnership with charitable organizations such as: Vitamin Angels, Compassion International, KidsTown International, Autism Hope Alliance, Engedi Refuge, Project 92, and others. And because so many people are unable to meet basic nutritional needs, Bruce created a comprehensive Omega-3 and multivitamin formula that he distributes free-of-charge to local food banks. In addition, Bruce decided the company would supply food banks with organic coconut oil to provide people with a health alternative to standard cooking oils.

Always generous with his time Bruce has served as a youth leader for his local church for several years and continues to mentor youth. He has been on several not for profit boards including; Whatcom County Pregnancy Center (2003-2006), Natural Products Association (dates?), and the Institute for Natural Medicine Leadership Council (presently).

The Barlean family have been avid supporters of Bastyr University since the 1990’s and in 2013 were given Bastyr’s most prestigious honor, the Mission Award, which recognizes their leadership over time in improving the health and well-being of the human community.

Bruce currently resides in Ferndale, WA with his wife Lisa and their two dogs: Heinz & Shadow. When he’s not helping others he can be found fishing (catch & release).

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Michelle Simon

Michelle Simon, PHD, ND

President & CEO

As president and CEO of INM, Dr. Simon brings her passion for working with organizations dedicated to improving the quality and delivery of healthcare. This desire stems from her years of practice as a licensed naturopathic physician. In addition to holding a Naturopathic Doctorate from Bastyr University she also holds a PhD in Biomedical Engineering from the University of North Carolina at Chapel Hill.

She has served on boards for the American Association of Naturopathic Physicians (AANP), the Naturopathic Physicians Research Institute (NPRI), and several advisory boards. Dr. Simon served nine years on the Washington State Health Technology Clinical Committee, as Ambassador to the Academy of Integrative Health and Medicine (AIHM) and was recognized as 2018 AANP Physician of the Year. Dr. Simon shares with her husband a passion for adventure travel, preferably by boat or motorcycle. She also enjoys teaching a women’s off-road motorcycling class.