31st October 2012 | by Dr. William Buckett
My husband and I are in our mid-30s, and are hoping to get pregnant next year. We both have pretty high stress jobs and were wondering if there is anything we can and should be doing now, to increase our chances of being fertile and getting pregnant more easily when we start trying to have kids next year?
Written by our medical expert, William Buckett, M.D.
First of all, if either of you have any pre-existing disease this needs to be well-controlled. This is certainly the case for severe illness such as cardiac, renal, or autoimmune disease in which case you should inform your treating physician of your plans to conceive and he or she will work together with the appropriate high-risk obstetrician to plan for your care. This is also the case with less severe disease such as diabetes, hyper- and hypo- thyroidism, or mental illness for which you are on medication including depression and anxiety disorders. If you are taking any medication, the reasons for this and the possible risks need to be addressed.
Happily most couples are healthy. However, any weight issues should be addressed. Maternal obesity is associated with multiple obstetrical risks – there are increased risks for miscarriage, gestational diabetes, gestational hypertension, difficulty with fetal monitoring, complications from anaesthesia, large birthweight babies, and stillbirth. The rate of caesarean delivery is also increased and, after delivery, there are heightened risks for increased blood loss, infection, wound break-down and venous thromboembolism [1]. In women who are overweight, increasing exercise and decreasing dietary intake – often within a structured weight-loss program – is recommended prior to trying to conceive.
Your ages are also important. Natural fertility (and also success with infertility treatments such as IVF) is significantly lower for women in their late 30s and 40s and this decline begins after the age of 35. The rates of miscarriage and fetal abnormality begin to rise after 35 years as well. Advanced paternal age (particularly over 40 years) seems also to be associated with an increased risk of miscarriage [2].
All women planning to conceive should take folic acid supplementation starting at least 3 months prior to conceiving – either 1mg/day for most women and 5mg/day for high-risk women. This has been shown to reduce the incidence of neural tube defects and other congenital abnormalities in babies born [3]. Similarly smoking and illicit drug use should be stopped prior to conceiving. Data concerning the use of alcohol while trying to conceive and during pregnancy is less clear. However, no pattern of consumption or lower limit of alcohol exposure has been found to be safe, so medical guidelines recommend abstinence during pregnancy and while attempting to conceive [4].
Finally, how much impact does stress have? This is a very difficult question to answer. Many studies and reviews have shown a small association between not becoming pregnant (either spontaneously or with treatment) and higher levels of stress [5]. However, it is difficult to know whether there is any causative effect. Most couples (even those with stressful jobs) continue to work and have no problems conceiving. However, as noted above, tobacco use, alcohol use, and other poor lifestyle factors (including some medications) all of which may often be increased in couples with stressful jobs may reduce your chances of becoming pregnant.
References
1. Lee CY, Koren G. Maternal obesity: effects on pregnancy and the role of pre-conception counselling. J Obstet Gynaecol 2010; 30: 101-106.
2. Reproductive Endocrinology and Infertility Committee; Family Physicians Advisory Committee; Maternal-Fetal Medicine Committee; Executive and Council of the Society of Obstetricians, Liu K, Case A. Advanced reproductive age and fertility. J Obstet Gynaecol Can 2011; 33: 1165-1175.
3. Wald NJ, Gilbertson MP. Folic acid in prevention of neural tube defects. Lancet 1995; 345: 389.
4. Alberta Medical Association. Guideline for the diagnosis of fetal alcohol syndrome (FAS). Available here.
5. Matthiesen SM, Frederiksen Y, Ingerslev HJ, Zachariae R. Stress, distress and outcome of assisted reproductive technology (ART): a meta-analysis. Hum Reprod 2011; 26: 2763-2776.