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Preconception Care: Optimizing Fertility and Hormone Balance

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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. 

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This article is provided by

The Institute for Natural Medicine, a non-profit 501(c)(3) organization. INM’s mission is to transform health care in the United States by increasing public awareness of natural medicine and access to naturopathic doctors. Naturopathic medicine, with its person-centered principles and practices, has the potential to reverse the tide of chronic illness overwhelming healthcare systems and to empower people to achieve and maintain optimal lifelong health. INM strives to fulfil this mission through the following initiatives:

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

About The Author(s)

Author Medical Editor

BreAnna M. Guan, ND

BreAnna M. Guan, ND, is a licensed naturopathic physician specializing in women’s hormone health. Through her virtual consulting practice, she has helped hundreds of women naturally transform their health, hormones, and fertility. For more information, visit

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