Many couples are blindsided when they have difficulty getting pregnant after a successful first pregnancy. Secondary infertility refers to difficulty getting pregnant after the birth of one or more babies and affects over 3 million couples in the US alone. Many of the same factors that cause primary infertility can cause issues in subsequent pregnancies, such as sperm abnormalities, endometriosis, and PCOS. However, there are changes in age, diet, weight, and lifestyle factors that can contribute to increased time to conception between pregnancies, factors that can easily be addressed to improve chances of success whether you are trying for your second, third or sixth pregnancy.
AGE – Most of us are well aware of the negative impact aging has on fertility. This change starts after 30, such that the chance of unassisted pregnancy after age 40 is 5%. As age increases, so does the risk for miscarriage, genetic disorders, and pregnancy complications. While one may get pregnant quite easily the first time, subsequent attempts can take longer. We’ve all heard of that best friend’s sister’s boyfriend’s brother’s wife who got pregnant by accident at age 42…this does happen, it just doesn’t happen often. It is important to remember that infertility is defined as no pregnancy within 12 months if under 35 and 6 months if over 35. Before that, getting basic labs to rule out nutritional deficiencies and/or hormonal imbalances and doing acupuncture are great ways to improve your chances of success at any age. Thyroid dysfunction and inadequate progesterone production increases with age and should be ruled-out. In addition, there are specific supplements that can improve egg quality and are safe to use while trying to conceive. It is important to remember that breastfeeding causes hormonal changes that can interfere with pregnancy; nature’s way of child-spacing. While many women will reestablish normal ovulatory cycles while breastfeeding, many will not be able to conceive until hormone balance is restored after lactation has ceased. Men over 35 are also at risk for declining hormones and should have a semen analysis when conception is delayed even if there has been a prior pregnancy. I recommend that most women over 35 have basic lab testing and start an individualized supplement and acupuncture protocol to improve chances of natural conception.
DIET – No matter how healthful a diet is, taking a prenatal vitamin for months prior to pregnancy can decrease time to conception, risk of miscarriage, labor complications, and developmental problems in children. As such, I recommend that all women with plans for future pregnancy stay on a high-potency prenatal vitamin through breastfeeding, between pregnancies, and ideally until age 50 when an alternate form of multivitamin can be started. In addition, simple lab tests can identify nutritional deficiencies that may require additional supplementation on top of a prenatal, especially after months of prior pregnancy and lactation. Male partners should similarly be on a high-quality multivitamin to support sperm health. Typically, I recommend couples focus on a low-sugar, whole foods, Mediterranean-style diet, incorporating organic fruits and vegetables, meat, nuts and seeds, and dairy. Limiting caffeine to one cup per day and avoiding alcohol can also help. This is an excellent diet for pregnancy, breastfeeding and between pregnancies. For patients and families that could benefit from more guidance or assistance with meal prep, I will often recommend a local registered dietician like Rachel Masser of Tailored Bites.
WEIGHT – Being overweight or underweight can contribute to fertility issues, although it is more often the case that women gain weight during pregnancy and go into each subsequent pregnancy heavier than they were before. Most women only need to gain 25-35 pounds during pregnancy and overweight women are often advised to gain even less. With extra weight comes the potential for fertility delay, miscarriage, and pregnancy complications such as blood pressure and blood sugar issues. In addition, it has been shown that obesity in pregnancy can predispose children to being overweight and at increased risk of diabetes even in childhood. Using the months between pregnancies to establish a healthy weight will help one enter into the next pregnancy as healthy as possible. This doesn’t require restrictive diets or cleanses; oftentimes losing even 10% of body weight when overweight can decrease time to conception and improve pregnancy outcomes. Staying active during and between pregnancies is critical for general health and to prevent excess weight gain. Fit4Mom is a local business that offers classes for women during pregnancy, with and without babies in tow, and Modern Milk and Bar Method offer childcare.
LIFESTYLE FACTORS – Sleep is such an important component of health at every stage of life including during and between pregnancies. Poor sleep can interfere with fertility by contributing to hormone imbalance and increased weight. Support from family, friends, and postpartum doulas can help you get the rest you need. Stress, while being an independent exacerbating factor for poor sleep, can have a significant negative impact on fertility. Difficulty getting pregnant often compounds the stress of everyday life, but getting proper sleep, exercise, nutrition, meditation, and acupuncture can help improve both sleep and stress. In addition, anxiety and depression are often side effects of fertility issues and can independently negatively affect fertility; I often refer to local therapists like One Breath Healing for women and couples who need extra support. Medications have been shown to be safer than suffering with an untreated mental health condition.
Please feel free to check out my website at Arcadia Women’s Wellness for more information on how integrative medicine & acupuncture can support your fertility goals.