Preconception Preparation in Your 30s and 40s: Part 1
I have been an (over-eager) preparer my entire life. As a kid, I would write packing checklists weeks before trips and double (and triple) check them constantly. I’d pack well in advance, meticulously going through my checklists as I placed each item caringly into my suitcase. And I loved it. Absolutely loved it.
I’m a bit more lax now when it comes to packing for trips (though I definitely pack well before my husband or best friend even consider doing so), but there are some areas where preparing seemingly too early is still my modus operandi. Preparing for motherhood is one of those areas.
You see, I’m well past 30 and still have no clue when we’ll begin trying to conceive. But the good news is, I don’t need to know when I’ll start trying to begin preparing now.
We don’t have to wait until we’re actively trying to conceive to begin preparing for pregnancy, we can begin to prepare while we wait to try. I would even say the latter is preferred.
The two videos below set the stage for future videos and blog posts where I’ll explore movement/ exercise, nutrition, mindset, and other topics as they relate to preconception preparation. I hope you enjoy them and find them helpful on your journey.
Video: What is preconception prep, why is it important, and when should you start preparing for pregnancy?
Timestamps
00:00 Intro
01:02 What is preconception preparation?
01:39 Why is preconception preparation important?
03:25 When should you start preparing for conception and pregnancy?
06:29 Reflection Questions: What thoughts and feelings come up as you consider preconception prep? Why does preconception preparation feel important to you?
07:19 Outro
Video Transcript
Hi there, Kendra Tolbert here. I'm a registered dietitian and yoga teacher and I specialize in women's health and fertility.
And today you and I are going to begin to explore a very important topic. And that topic is preconception preparation. Actually, for the next three to four months you and I are going to take a deep dive into the topic of preconception preparation. So I will be providing step-by-step instructions and advice and inspiration to help you prepare for a pregnancy. But in this video, we're going to introduce the topic, explore some foundational questions and answers so that we're all on the same page.
So for this video, I'm going to answer the following questions:
First question is: What is preconception preparation?
The second question is: Why is preconception preparation important?
And the third question is: When should you begin to prepare for conception and pregnancy?
So let's dive right in and get started!
First question: What is preconception preparation?
I define preconception preparation as, “the intentional preparing of your mind, your body, and your life for conception, pregnancy, the postpartum period, and parenting.”
So it's all about taking a close look at your health, at your life, at your community, at your environment, and making any necessary changes to optimize all of those areas so that you can have the ultimate, hopefully the ultimate, outcome that you were looking for. And that's being an amazing parent to an amazing child.
Second question: Why is preconception preparation so important?
So I'm a firm believer that how you go into pregnancy has a huge impact on how you go through pregnancy, how you come out of pregnancy, and on the health of your future child.
We know that there is a connection, there are correlations that have been established, between your health and your behaviors before you start trying to conceive and the likelihood of you actually conceiving. And how likely you are to have a healthy pregnancy, and a healthy labor and delivery, and a healthy postpartum period. And all of that impacts the health of your child. There's so much that you and I can do before trying to conceive that is going to have an impact well down the road on not just your child's health, but even your children's children's health. Right, so there's, there's a lot that you and I can do now that's going to impact the future well down the road.
Another reason why it's so important to prepare for conception is that preparing gives you an opportunity to address concerns before they become major problems. So let's say in the preconception preparation phase you discover that your irregular cycles are due to PCOS. Then you are able to make changes that will support ovulation, support healthy insulin sensitivity, or any other changes that you might need to make before you start trying to conceive. So starting early, planning early, preparing early gives you an opportunity to assess and address any concerns and that's important.
Last question: When should you start preparing for conception and pregnancy?
So you will find a lot of recommendations to start preparing about three to four months before you actively start trying to conceive. And I love that guideline. I think it's a great guideline. And I think it can be an even better idea to start preparing well before then.
And I say that for a number of reasons.
One reason is that it takes time to make changes to behaviors, to make changes to our health, and I think the more time you give yourself, the less pressure you're under and the more ease you get to experience as you make those changes. Because you don't have this tight timeline to make it happen in a shorter amount of time.
Another reason is because it can take time to get the doctor's appointments or any other sort of health-related appointments that you may want to explore before you actively start trying to conceive.
So here's an example, let's say you realize you haven't gone to the dentist in quite some time and you are due for a checkup. Well past due maybe. It happens, it definitely happens. So you call up the dentist and you're like, “Okay I need to have a comprehensive exam.” and they tell you, “Great. It'll be six months from now before you can come in.” So now it's taking six months before you can even get an exam with your dentist. You get to the dentist and you find out that you've got some periodontal disease.
Now I hope this isn't true, this is all hypothetical okay, this is about someone else. So you get there and you have now discovered that something that has the potential to impact your ability to conceive or the likelihood of conceiving, right because there is a correlation between oral health and risk of infertility. There is a connection between the two. And something that has the potential to negatively impact a pregnancy is also going on in your mouth, right because again, there's a connection between our reproductive health and our oral health. There's a connection between every bit of our body and every other bit of our body. So it's not a big surprise one thing will always impact another. It's the domino effect in the body.
So anyhow, so perhaps you or someone else, discovers that they have periodontal disease. So it took six months to discover that because they couldn't get an appointment before that point. Now they have to wait for treatment. What if it takes another two months to get the full treatment that they need? So now you're or sorry, the other person, is eight months, you know down the line. That's a lot longer than three to four months.
So if you can give yourself more time, give yourself that gift of more time.
Now if you don't have more time, do the best with whatever you have. Even if it's less than three to four months. Any bit of preparation is better than none.
So I have answered three foundational questions and I hope that it's got you a little bit excited about the topics that we're going to cover down the road.
And before we end this video I do want to leave you with two questions for you to explore perhaps by journaling or by chatting with your community or through prayer or however else you'd like to explore these two questions.
So question number one: What thoughts and feelings come up as you consider preconception preparation and planning?
Why does preconception planning and preparation feel important to you?
Okay so I hope you have fun exploring those questions or at least maybe some insight comes up for you that can help you along this journey. Feel free to leave the answers to these questions that came up for you in the comment section below. I'm always happy to hear from you, but of course, feel free to keep it private. I would respect that as well. Alright enjoy the rest of your week and I will see you next week as we take a look at some of the appointments, and labs, and exams, and of course, providers that you may want to meet with or have completed before you actively start trying to conceive.
Enjoy the rest of your week, now we can get to that, and be well, and bye for now.
Video: Preconception Preparation Labs, Appointments, and Providers
Timestamps
00:00 Intro
01:19 Providers to see before TTC
09:19 Preconception Labs
16:37 Outro
Video Transcript (unedited)
Hi there, Kendra Tolbert here. I'm a registered dietitian and yoga teacher and I specialize in women's health and fertility. And today we are diving into the second part of our multi-part series all about preconception preparation.
In this video, we are going to be going over the providers that you may want to schedule appointments with before actively trying to conceive and some of the lab work that they may or may not do to help to assess where you are and what might need to be addressed in order to get you to where you would like to be. And that of course is to conceive, and have a healthy happy pregnancy, and a healthy and happy baby.
Before we take a look at those providers and the appointments and the labs that you may want to consider, I do want to say that I know that healthcare can be very, very expensive and very, very complicated. And I by no means am suggesting that you absolutely have to have access to all of these providers and all of these labs or you won't get pregnant, or you're not doing enough, or any of that. I just want to make sure that you are aware of all of the things that are available to you to support you on your journey to baby.
Okay, so now that that is out of the way, let's go ahead and start talking about all of the providers and support people that may be beneficial for you to explore.
Providers to see before TTC
So the very first person is your primary care provider or they may be called your general practitioner, your GP depending on where you are in the world. So this is the person that you likely go to for the basics. They may be the person who does your annual checkup, your vaccines. The person you call if you're, you know you have symptoms of a cold or the flu or anything like that. And they're likely the person that you go see first before you go to see a specialist because they will often provide the proper referrals that you need in order to see the specialist. And that's why I think they are a great first stop. Because they are the ones who can write the referrals that you may need.
Sometimes insurance requires that, sometimes a specialist requires a referral from a general practitioner before they will even see you or before the insurance company will cover the services provided by the specialist. So they are a great person to go to first.
They can also get the ball rolling on a lot of things like getting lab work done, helping you to determine who would be the best person for you to see next based on your family history, your health history, and what your labs currently say.
The next person in our starting five, is the Women's Health provider and that may look different for you depending on which model of care you prefer. I have seen women's health nurse practitioners, certified nurse midwives, and ObGyns for my pap smears. The ObGyn is who we tend to think of as performing these duties but they're not the only option, although they are an excellent option. So if one of the other models of care actually resonates with you more, then that may be the person that you decide to see for your women's health concerns.
This person will do your paps, this person can do STI screenings, they can do pelvic exams, they can do all sorts of things that are very beneficial before you actively start trying to conceive.
Another benefit in seeing this person is they may be someone who can also provide prenatal care and postpartum care so you're already building that relationship with them before you conceive. And that way they know you well and you know them well. And you have some time to kind of shop around even before you get pregnant to choose someone who you would want to continue to work with well down the line.
The next person is your dentist. That may not be the person you were expecting to hear but if you saw the first video in the series you might not be all that surprised because there are associations between our oral health and our reproductive health. In fact periodontal disease increases the risk of experiencing infertility and prenatal complications, so you definitely want to go see your dentist as soon as possible.
If you haven't seen them in six months to a year or even longer than that, it's likely time to schedule a dental exam so that you can decrease your risk of experiencing infertility and decrease your risk of experiencing prenatal complications just by taking care of your mouth. It's amazing.
Next up we have a dietitian. Now, I am a dietitian, so you know I'm definitely going to make a plug for us. But beyond that, there's so much confusing information out there about fertility nutrition and reproductive health nutrition. And I say just go to the source. Like the internet searches can lead you all sorts of all over the place. And sometimes the information on the internet is absolutely accurate but maybe not the right information for you. And a dietitian is well-equipped at helping you determine what is right for you, what is actually going to work in your life. Because it doesn't matter if the information is right, but you can’t apply it. So I highly recommend working with a dietitian who specializes in reproductive health, women's health, you may see someone who focuses on preconception or fertility, but someone who has some sort of specialty in the area that you want to focus in on.
And our fifth person, a mental health specialist of some sort. So I think it's really really important to visit with a mental health counselor or therapist, psychologist, psychiatrist whatever is the right fit for you before trying to conceive for a number of reasons.
One of the main reasons is that they can help you address things that may have gone on in your childhood, that you may have experienced in how you were parented that you may not want to carry on into your parenting with your child. And they can help you assess that, take a look at that, determine if there's anything that you would like to change in parenting behaviors so that you're passing down good parenting behaviors to your child as well.
Another thing that they can do is help you assess your stress, see if there are any sorts of stress management techniques that you may want to learn and start to implement before you start trying to conceive, before you're pregnant, before you're a parent because that can only help you along the way.
The journey to conception is not always easy, so if you already have tools in your toolbox to support you, you're going to feel a lot better along the journey no matter how long or short it is.
The other thing that they can help you do is take a look at your values. What are the things that you are looking forward to passing on to your child? So I think it's great to have someone on your team who can help you think about how you want to parent, what you want to pass on, what you don't want to pass on.
They can also be very, very helpful if you are trying to stop using recreational drugs, if you are trying to reduce your alcohol consumption, or stop drinking alcohol and could use some assistance with that.
A mental health provider can provide assistance with that as well, oh, and the last thing, of course, if you are currently partnered and you are going to be trying to conceive with said partner, they can also help to support that relationship. And I think that that's incredibly important as well.
And like I said, this is really about making sure that you are aware of all of the different types of support people. Maybe not even all, some of, because there's so many more different types of support people that you could be reaching out to to support you. So I'm just going to list a few more and you can decide if this is right for you, if these people are people that you want to include in your care team:
a spiritual advisor
a parenting coach
a fertility awareness educator
a fertility doula
a genetic counselor
a traditional medicine provider of some sort
an herbalist, and
a pelvic floor physical therapist
I just want to make a special note about pelvic floor physical therapists because I don't think that they get nearly enough attention in the preconception preparation world.
They are amazing to have on your team. During pregnancy, there are a lot of shifts that occur in your pelvis and your pelvic floor, in your hips. And if you can, as much as possible, make sure that you are balanced before trying to conceive and before getting pregnant with the help of a pelvic floor physical therapist, that is going to pay dividends during your pregnancy and during the postpartum period.
They can also help with things like constipation, they can help with things like painful intercourse. Of course, if you are feeling like you have to avoid intercourse but you're trying to conceive you can see how that can kind of serve as a barrier to your goal. So if you can work with a pelvic floor physical therapist before actively trying to conceive to address that issue, to address that concern, can absolutely help you along the way.
Preconception Labs
Okay so now we'll take a look at some of the labs that you may want to have completed by your provider or that your provider may order for you.
Different providers like to do different things and I don't think there's one right or wrong way to do anything. So I just want you to be aware of some of the labs that I often recommend that my clients have completed before working with me when we're working on preconception preparation. And sometimes the providers are like, “Absolutely not. I'm not doing all those.” And that's fair, that's allowed. We work with what we have, but I do want you to be aware of what is available to you. And this list is not exhaustive. There are things that your provider may do that I don't list. So again this is just about getting you thinking about the fact that there's a lot that you can do before trying to conceive.
Okay, so the first group of labs are labs that are going to assess your sex hormones and related labs.
So first up we have estradiol, which is a form of estrogen. It's produced in your ovaries by your follicles and it's responsible for things like breast tissue growth, accumulation of fat on your hips and on your buttocks, as well as building up your uterine lining.
Next, we have follicle-stimulating hormone, which is produced in your brain and causes your follicles to further develop and eventually give rise to dominant follicles, one of which will become the egg that you ovulate.
Next, we have luteinizing hormone, LH, which is also produced in the brain and it is going to trigger ovulation. It's going to cause that dominant follicle to burst forth and release an egg.
We also have testosterone and DHEA-S. Testosterone we don't often think of as a female hormone but it absolutely is. Everyone has testosterone and it is very necessary and needs to be within balance to support your reproductive health. Same with DHEA-S.
Then we have AMH, which gets a ton of attention in the fertility world. And I would say it gets a little too much attention in the fertility world. Anti-Mullerian Hormone, I always mispronounce that, so forgive me if I mispronounced it once again. AMH does not predict fertility or infertility. Having a low AMH does not mean that you can't or won't conceive. Having a high AMH or normal AMH is not a guarantee that you can or will conceive.
It can give you an idea of, you know, the number of follicles that you still have in your ovaries, that's pretty much it. That's all it can absolutely tell you. It doesn't tell you much more than that.
It doesn't tell you egg quality, it doesn't tell you, you know if your uterine lining is building up well, it doesn't tell you anything about certain like, it just doesn't tell you so much that I don't think we should be treating it like the end-all-be-all. And I know there are some direct-to-consumer tests that kind of treat it like a predictor of fertility or infertility and I'm here to tell you they are wrong.
Okay. let's move on.
Next up we have Sex Hormone Binding Globulin. And your provider may also take a look at the ratio of LH to FSH. And of course, we have progesterone. I don't know how I almost forgot that one. Forgive me. So we have progesterone, which rightfully so gets a lot of attention when talking about menstrual cycle health and fertility. So progesterone is produced in large amounts after you ovulate. And I really emphasize after you ovulate because if your provider is testing your progesterone or you are using one of those progesterone measuring sticks that now exist out in the world, they're pretty cool, um before you ovulate it's going to be low and that's not because something is wrong. That's because it's the wrong part of your cycle to be testing it in.
So do make sure that you are having your progesterone tested after you ovulate.
So that may mean that if your provider is testing it on day 21 because the assumption is that people ovulate on day 14 because that's what the textbooks say, um, you actually ovulate on like day 27. So you needed to be tested on like day 34 of your cycle, not day 21 of your cycle because you don't ovulate according to a textbook because you're not a robot. You're a human.
The next set of labs are ones that are very important to me as a dietitian and in the work that I do but I think they're important even if you are not going to be working with a dietitian one-on-one.
Some of these labs are going to give you an idea of your nutrition status to let you know if you have deficiencies of specific nutrients; some of which if you are deficient in them have been linked to an increased risk of infertility.
Some of these labs are going to tell you how other parts of your body may be working and those other parts have an impact on your reproductive health, such as your thyroid.
And then some of them are going to tell you about your insulin sensitivity which is super important. There's actually some research now that shows that there is some sort of a connection between insulin sensitivity and reproductive health. So we definitely want to take a look at that. And besides if you already have some issues with insulin sensitivity and we can address that before you get pregnant then we can reduce your risk of gestational diabetes which we absolutely want to do.
So let's dive into what those labs are. First up we have:
vitamin D, we have
iron
a lipid panel
thyroid panel
fasting insulin
fasting glucose
hemoglobin A1c
oral glucose tolerance test, especially if you have PCOS, and
liver function tests especially if you have PCOS
I do want to make a note about the thyroid panel one, and this is something that you would want to discuss with your provider, of course. If you are taking any sort of biotin-containing supplements or powders or drinking energy drinks that also contain biotin, you may want to stop taking those leading up to having your thyroid panel completed. And that's because biotin interacts with the test in such a way that it leads to false results and of course, you want to know what the real results are.
And finally, we have vaccine titers. I think it's a really good idea to know if there are any boosters that you may need or if there are any vaccines that you may need because some of them are actually recommended that you don't get during pregnancy but that you already be vaccinated with before pregnancy and before actively trying to conceive. So you want to know if you need those boosters or if you need those vaccines before trying to conceive and before becoming pregnant.
All right so that was a lot. I hope it was helpful. I hope it wasn't overwhelming.
I do again want to emphasize that this is by no means saying you have to do all of these things to earn your baby or you have to do all of these things or your baby won't be healthy or you won't get pregnant. That's not what I'm saying.
I just want you to be aware that there are lots of things that you can do to optimize your chances or lots of things that you can do to feel your best going into what can be a bumpy journey. That's it.
This is just about fortifying you and building you up and empowering you. This is not about giving you a long list of shoulds and to-do's.
Okay cool, we're in the same boat, I hope so. Same boat, same page. You know what I'm trying to say. We're seeing eye-to-eye. Yes, yes, okay.
So I would love to know and you can let me know in the comment section below if there are any other providers that maybe I missed or other things that you think could be really important to take a look at before trying to conceive. And if you'd like to, you can also let me know what you plan to do, like what's your first next step?
Is it taking a look at when was the last time you had a Pap and scheduling your pap smear? Is it scheduling a dental appointment? Whatever it might be, know that I'm rooting for you and I want to see you as healthy as humanly possible.
All right, so enjoy the rest of your week and I will see you next week for our next video, where we will start to talk about cycle tracking. I've done some videos on cycle tracking before but we're taking a deeper dive into it.
All right enjoy the rest of your week, be well, and bye for now.
References and Resources
https://www.cdc.gov/preconception/planning.html
https://www.womenshealth.gov/pregnancy/you-get-pregnant/preconception-health
https://www.nichd.nih.gov/health/topics/preconceptioncare/conditioninfo/tests-before-pregnancy
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8548671/#:~:text=Serum%20AMH%20levels%20have%20poor,not%20associated%20with%20reduced%20fertility.
https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/04/the-use-of-antimullerian-hormone-in-women-not-seeking-fertility-care
https://www.pennmedicine.org/news/news-releases/2019/december/direct-to-consumer-fertility-tests-confuse-and-mislead-consumers-penn-study-shows
