The State of Pre-pregnancy Wellness in America

The top question females asked about preconception:

How will I know if I am ready to conceive? 

This is such a great question with a not-so-straightforward answer. 

Technically, it’s impossible to know whether an attempt to become pregnant, whether naturally or with assistance, will be successful. There are so many factors at play that all have to fall perfectly into place for conception to occur.

However, the good news is there is so much within your control when it comes to preparing for conception. Your OBGYN might tell you all you need to do is start taking prenatal vitamins. 

But, optimal pre-pregnancy preparation involves more than a prenatal vitamin.

Here is what most females have been told pre-pregnancy preparation is:

Here's just a taste of what optimal pre-pregnancy preparation actually is: 

Anything that improves your overall health and well-being will also improve your fertility and optimize outcomes. There are so many immediate actions you can take to physically, mentally, emotionally, and financially prepare for this next stage of your life. 

And, it doesn’t have to be such a guessing game. There are things that you can look at - both qualitatively and quantitatively to assess your pre-pregnancy wellness. 

What is Pre-pregnancy Wellness anyway? 

Pre-pregnancy Wellness is the state of your health immediately prior to getting pregnant (usually 1 year beforehand) that influences your fertility and the health of your future pregnancy and baby. 

Despite the prevailing narrative that “Age Trumps All” when it comes to pregnancy health, pre-pregnancy wellness is affected by many factors beyond age. You can’t control your chronological age (age in years) but you can manage your biological age (vibrancy of your cells). 

Your fertility is an extension of your overall health - which includes 5 core categories (blood status, immune status, nutrient status, hormone status and metabolic status). To date, fertility has been binary - baby, no baby. Now, we can measure these 5 areas of health to get a proxy for your overall health status and by extension, your fertility. 

Experts agree that better pre-pregnancy wellness leads to easier conception, healthier pregnancies, and healthier babies.

Pre-pregnancy wellness is the newest kid on the wellness block and we are here to help educate and help you along the way.

Getting pregnant is a black box until you try... but it doesn't have to be this way

~20% of females surveyed, who were not on hormonal birth control, reported they don't have regular periods. 

When it comes to talking about your body being baby-ready, we always start by asking about your monthly cycle. We can learn so much about your reproductive health by looking at the regularity of your cycle and any symptoms that may come along each month.

Having a regular period with few symptoms is not only a critically important indicator of hormonal health, but it also is necessary when it comes to determining the optimal time for baby-making.

Over 50% of the females surveyed don't know if they ovulate each month.

Just like a regular cycle, knowing whether you ovulate is a key indicator of reproductive health. Each month there is a short window of when you can fertilize an egg leading up to and the day of ovulation. 

Did you know...

that there is a 6-day fertile window every month.

Fertile window = 5 days prior to ovulation + day of ovulation 

Understanding your own fertile window is key to getting the timing right. Being aware of ovulation timing can also help you become more in tune with symptoms you might experience throughout your entire cycle, not just when you have your period.

Did you know...

that just because you had your period, that doesn't mean you ovulated? You can have a period without ovulating - this is called an "anovulatory cycle" and is more common than you might think. 

Preconception tip: 

Oftentimes luteinizing hormone (LH) is an imprecise indicator of ovulation, so we recommend testing both LH and progesterone levels each month. This way, you can confirm whether you ovulated during that cycle or not.

Suffering from symptoms before or during your period can give us some clues about your hormonal health. It is very common for females to suffer from a variety of symptoms - see the chart below. But we want to make the distinction that just because symptoms are common, that doesn’t necessarily mean they are normal. Each symptom can be a sign of an underlying imbalance that we want to get to the root of to correct and restore harmony.

Majority of females are not eating a fertility-friendly diet

~75% of females are not eating enough fertility-friendly foods like green, leafy vegetables and are consuming too many fertility foes, such as packaged foods and sugars of all types.

Did you know...

that almost every ancient tribe had preconception rituals? Many ancient tribes had intentional dietary and lifestyle practices prior to conception. In her book, Deep Nutrition, Dr. Catherine Shanahan shows us the wisdom of these conception preparation practices: 

Around the world, traditions reflected extensive use of special foods to boost a woman’s nutrition before conception, during gestation, for nursing and for rebuilding before the next pregnancy. Some cultures thought it prudent to fortify the groom’s diet in preparation for his wedding ceremony...The Maasai allowed couples to marry only after spending several months consuming milk from the wet season when the grass was especially lush and the milk much denser in nutrients. In Fiji, islanders would hike miles down to the sea to acquire a certain species of lobster crab that ‘tribal custom demonstrated [to be] particularly efficient for producing a highly perfect infant’.

Are you eating a fertility-friendly diet?

A balanced and nutritious diet is just as critical for conception as it is for pregnancy. Improving your food intake now not only has the power to improve your chances of a healthy pregnancy, but also to improve your chances of healthy conception.

Eating for fertility is not quite the same as eating for daily life. Nim Barnes, the founder of Foresight, sums it up well: “...it has been found that in all types of animal life, from insect to mammal, a diet which supports normal adult life is not necessarily sufficient to support reproduction.”  

Barnes continues, “Besides taking in extra calories for growth and energy, you need extra vitamins, minerals, essential fatty acids, and amino acids.” Moreover, females on nutrient-rich, macronutrient-balanced diets have been shown to have better pregnancy outcomes than those on nutrient-poor diets.

Given that, what is a healthy diet in the context of fertility?

In general, a fertility-friendly diet is moderate to high fat intake, moderate complex carbohydrate intake, and moderate protein intake. 

At a high level, a “fertility-friendly” nutrition plan would include: 

Adequate, high-quality sources of unsaturated fat (e.g., animal fats such as oily fish; plant fats such as avocados, olives, nuts, and seeds) and saturated fat (e.g., animal fats such as dairy, eggs, beef, pork, and lamb; plant fats such as coconut, cocoa butter, and palm products)

Moderate amounts of “slow carbohydrates” (including lots of colorful, organic produce)

Clean sources of animal protein (e.g., grass-fed, pastured, organic, wild) and plant protein

Fat is your friend when it comes to your fertility.

Those who follow the principles of a fertility-friendly diet reduced ovulatory infertility by 80-90%. Diet is your first line of defense when it comes to fertility.

Preconception tip: 

Did you know that a fertility-friendly diet is not the same thing as what's trending at the moment (such as keto or vegan or vegetarian)? In fact, many popular diets can actually be detrimental to fertility since they minimize or exclude key nutrients necessary for optimal hormone production. A fertility-friendly diet is a higher fat, moderate protein, and moderate carbohydrate - and very nutrient-dense! 

A multivitamin alone is not enough for optimal fertility and pregnancy health anymore

45% of females we surveyed are already taking a multivitamin as part of their wellness routine, but a multivitamin is not enough. 

We couldn’t agree more that taking prenatal vitamins is an essential part of pregnancy preparation. That being said, a prenatal vitamin or multivitamin alone is not enough for optimal fertility and pregnancy health anymore. 

You’ve probably heard about an important nutrient for pregnancy called folate. But did you know there are numerous other nutrients that are just as important for your future baby’s health? A prenatal vitamin is basically a multivitamin with an increased focus on certain nutrients that are particularly relevant for the demands of pregnancy (e.g., folate, iron).

Why do I need more?

The majority of reproductive-age females are micronutrient deficient (i.e., do not have adequate levels of key vitamins and minerals). Nutrient deficiencies can cause problems both getting pregnant and carrying a pregnancy to term, as well as affect the baby’s future health trajectory. 

To prime your body for a baby, you need a comprehensive array of micronutrients (vitamins and minerals) to ensure the health of your baby and to reinforce your own health; the best way to ensure that is with a high-quality diet plus high-quality micronutrient supplementation.

Did you know that your baby is not a parasite? Despite popular opinion, your body will preferentially take care of your nutrient needs over your baby's nutrient needs. This is why it's ideal to address any nutrient deficiencies with diet and supplementation prior to pregnancy so that you and your baby can thrive during those early months when your baby is rapidly developing. 

Being both underweight or overweight negatively impacts fertility but for different reasons 

~50% of females surveyed are not in the optimal weight range for fertility (either underweight or overweight/obese). 

Many females find that once they address other factors like managing chronic disease, optimizing diet and movement, and adopting stress management practices, their body composition naturally returns to within the ideal range.

While we don’t love BMI as a measurement of weight, it is the most cited clinical measurement. An even better measure of optimal weight for fertility is a body fat measurement. Body composition is important for any fertility discussion because fat tissue affects hormones.

Did you know...

that fat is not inert tissue? It's actually hormonally-active tissue. The more body fat you have, the more estrogen your body produces.

Research has shown that the ideal BMI range for fertility is between 18.5 - 24.9 or body fat between roughly 20 - 26%.

Preconception tip: 

Weight optimization should take place BEFORE you get pregnant. Trying to lose weight during pregnancy creates a risk of insufficient nutrients for the baby and the release of toxins that may be stored in fat tissue.

Being underweight can also affect fertility. Having too low body fat sends a signal to your body that you’re “starving”. Instead of focusing on making important sex hormones, it instead produces stress hormones. Eventually, your ovulation and overall cycle will be affected by the change in hormones. If you think about it, it isn’t an optimal time to be procreating if there is famine, so your body has adapted to downregulate reproductive function in times of resource constraint (or when it believes that there is a resource constrained environment - read: crash diets, food restriction, nutrient depletion, etc.).  

Sex and stress are incompatible

60% of females perceive stress as a leading factor affecting their ability to get pregnant. In fact, over 50% of females reported being moderately to very stressed. 

You know that really unhelpful advice to "just relax" when it comes to trying to conceive? Well, as patronizing as it may be, there is some wisdom to it. Here's the scientific explanation... 

Your sex hormones and your stress hormones are in the same biochemical pathway. From an evolutionary perspective, your body will always prioritize survival over procreation. 

Practically speaking, this means that when we are constantly “stressed” (whether from a long commute or regimented marathon training or significant financial obligations), our bodies divert the raw materials needed to make sex hormones (e.g., testosterone, estrogen) to instead make stress hormones (e.g., cortisol, adrenaline). Over time, that means that we don’t have the necessary sex hormones to get pregnant or sustain a pregnancy.

Did you know...

that we can actually measure how "stressed" your body is? One way is to measure a hormone called cortisol, which gives us a peek into how your body is adapting to stressors in your life. 

We asked females, based on the factors listed below, which they think affects their ability to get pregnant.

The reality is, that all of these lifestyle factors are important! However, certain factors may play a much larger role than others for a specific individual, but they can all contribute in some way. Don’t let this intimidate you though! There are so many ways to address each of these factors to improve your chances of having a healthy conception and pregnancy. 

Fertility is an extension of your overall health, not just your hormones.

Optimal preconception preparation involves getting your whole self ready for conception - not just your hormones. At Poplin, we look at your immune status, metabolic status, nutrient status, blood type & status in addition to your hormone status. This gives us a much better window into what might be going on “under the hood” so to speak and any potential areas that might interfere with your ability to conceive easily and have a healthy pregnancy and baby.

Despite what we’ve been told for years and years, most consumers recognize that age isn’t the only determining factor in fertility.

Toxins contribute to fertility challenges - and no one is paying attention to this

30% of females surveyed had significant daily toxin exposures 

Did you know that your environment plays a big role in your overall health? This includes your environmental toxin load (e.g., from food, water, medications, personal care products, and more) and your ability to detox that toxin load (e.g., by sweating and bowel movements).

13% of females surveyed are taking a great first step by choosing organic food (produce and animal products) at least half of the time. And more than 62% opt for filtered water the majority of the time.

Food and water are great places to start when looking to lower the toxic load. Opt for organic food whenever possible. When it comes to water, get yourself an at-home water filter and drink from a glass or stainless steel to avoid exposure to harmful plastics.

21% of females didn’t know if their personal care products are natural/non-toxic.

Luckily non-toxic personal care products have come a long way. Try entering your current favorite products into the Environmental Working Group's Skin Deep database to see how they score. When you use up what you currently have, do some research to find a natural and non-toxic swap.

What does detox actually mean?

Clever marketing campaigns probably have you thinking that you need juice cleanses or teas to help you detox. But did you know that your body is actually designed to detox naturally? Given the higher toxin load that comes from our modern environment, sometimes we need to give our bodies a little extra support. You can skip the gimmicky products though. 

To support overall detox capacity, focus on a combination of diet, supplementation, and lifestyle practices. 

Did you know...

That not having a daily bowel movement is considered constipation? When the gut is healthy and operating optimally, it is normal to have 1 - 3 bowel movements per day. Bowel movements are a key way your body detoxifies so it’s important to make sure your gut is happy and you’re having regular bowel movements.

Chronic conditions are under-diagnosed and under-managed for optimal fertility

40% of females are on medications for a health condition.

Certain medications are known to interfere with fertility. This is why the American College of Obstetricians and Gynecologists (ACOG) recommends that “All prescription and nonprescription medications should be reviewed during prepregnancy counseling. This review also should include nutritional supplements and herbal products that patients may not consider to be medication use but could affect reproduction and pregnancy.”

If you are managing a chronic health condition, it’s important to let your doctor know that you're starting the preconception process so that they can evaluate whether any medications you’re taking may impact libido and are safe for fertility and pregnancy. It is also important that your health condition is well-managed.

More than half of females reported being diagnosed with a mental illness like depression or anxiety. 

Fertility is an extension of your overall health, including your mental health. Ensuring that you have the right resources and support system in place to manage your mental health is an important part of pregnancy preparation. This is something that you can discuss with your doctor. Managing your mental health is an ever-evolving journey and it's something that pays dividends for both you and your future children. 

Optimizing your health regardless of the condition will help make conception and pregnancy much easier.

~12% of females reported being diagnosed with an autoimmune condition or a thyroid condition. 

Did you know that if not properly managed, both of these conditions can lead to recurrent miscarriages?

This also applies to those who are dealing with symptoms daily but avoid going to the doctor. It’s better to catch any issues early on so they can be addressed and hopefully reversed before you start the baby-making process.