Women’s Health: Mama-in-the-Making

Fertility and prenatal health have been on my mind a lot recently. These are really important topics we need to know more about. In this post, I will share some information that single women should be aware of. Feel free to add anything I may have missed in the comments below. Also, please note that this is not medical advice and you should speak to your doctor before taking any supplements or starting any type of treatment.

 

Gynecologist. It’s important to get regular pelvic exams at your gynecologist to check that everything looks normal anatomically.

 

Tracking your cycles. You should track your monthly cycles so you notice any patterns or changes. I use a free app called Period Tracker. If you notice your cycle shortening over a few months, ask your doctor if you need any further testing for diminishing ovarian reserve. It could be normal fluctuation, but better to be safe and check. Longer cycles or skipped cycles should also be noted.

The different stages of the menstrual cycle have distinct names and characteristics. It’s really interesting to learn about the different hormones and what dominates when. And important! Even if you’re not trying to get pregnant now, it’s helpful to learn what’s going on in your body and whether your body needs any help producing more or less of the different hormones.

 

Folic acid/folate. In the earliest stages of fetal development, the B vitamin folate is crucial for the formation of the neural tube, which is the precursor to the baby’s brain and spinal cord. Since the baby needs folate for development at such an early stage, women who may become pregnant within the next few months (some say up to a year) should take a daily supplement. Folic acid is the synthetic form of folate that many women can take without a problem. However, some women don’t process folic acid properly so supplements are also available in a more natural form, methylfolate. As a general rule, 400mcg per day is recommended, but you can increase it to 600-1000mcg per day to prep for an egg freezing cycle.

 

Fertility assessment. A woman is born with all the eggs she’ll ever have. As time passes, both the quantity and quality of the eggs decrease. At this time, there is no way to measure egg quality before attempting to fertilize an egg. However, there is a blood test to measure the level of AMH, or anti-Mullerian hormone, in the bloodstream, which is released by ovarian tissue surrounding the eggs and provides the best available indicator of a woman’s ovarian reserve. Typically, the higher the AMH, the higher the egg count. AMH levels are normed based on age and every woman is different; some may have high AMH for their age and some may have low. A very low AMH indicates diminished ovarian reserve and possibly premature ovarian insufficiency. A very high AMH can indicate PCOS. AMH levels can fluctuate slightly month to month. This doctor recommends that every woman have their AMH tested by age 25 to give them an idea of how their egg supply is doing and whether they should consider freezing eggs sooner rather than later. Additionally, if a woman has a family history of early menopause (menopause by age 45; before age 40 is premature menopause), she should test her AMH level by around age 21. You might not know when your mother or grandmother went into menopause but it is a good idea to find out.

 

Vitamin D. This is the wonder vitamin and frum people are often deficient (see here and here). Low vitamin D may be related to low AMH. You should get your level tested whether you’re freezing eggs or not, and start on the dosage your doctor recommends, because vitamin D is just so important — for pregnancy, cancer prevention, heart health, musculoskeletal health, mental health, you name it.

 

Prepping for egg freezing. Ovaries mature eggs over a period of 3-4 months. If you are considering egg freezing, start prepping your body 3-4 months in advance if you can. Prep might include supplements, diet, and acupuncture. Whatever you can do is good!

 

Supplements for egg freezing. These supplements are recommended starting 3-4 months ahead of your egg freezing cycle (but some is better than none!). Always ask your doctor before you start taking supplements.

CoQ10 – the most strongly recommended, 200mg three times a day. Some take it in the form of ubiquinol which is more absorbent (and expensive). CoQ10 is also linked to slower ovarian aging so you can start taking it even if you aren’t considering freezing your eggs yet.

DHEA – recommended in conjunction with CoQ10 (but not for everyone because there are possible side effects, ask your doctor), 25mg three times a day. This does not have a hechsher, I asked a shaila and was told I could take it.

Vitamin D – 2000iu a day seems like a pretty standard recommendation, but you might need more depending on your levels.

Fish oil – 1000mg a day, combination of DHA and EPA. Or eat salmon some days instead.

Prenatal vitamins, including folate – 600-1000mcg a day, selenium – 60 mcg a day, I get this from eating 1-2 Brazil nuts a day (you do not need more, it can be toxic!), B12 – 2.6mcg, zinc – 8mg, and iodine – 150mcg.

Melatonin – 3mg at bedtime.

 

Diet. The Mediterranean diet is recommended for fertility. It’s low in sugar and refined carbs (insulin spikes may be detrimental to egg development) and high in fruits, vegetables, legumes, fish, olive oil (healthy fats) and includes some chicken and beef. So while you’re on this egg freezing thing, you can entirely revamp your eating habits, hurray! You also want a lot of antioxidants in your diet so things like dark chocolate, blueberries, kale and spinach are great. There are a million lists online of foods that are good or bad for fertility, of course check your sources. Basically everyone will tell you to cut out caffeine and processed foods as much as possible and to pile on the nuts, legumes, and produce.

 

Now is also a good time to focus on getting your TSH (thyroid stimulating hormone) to a good level. If it’s above 2.5 but still below 4.5 you have subclinical hypothyroidism, which basically means that your thyroid is underactive but not so much that your doctor is putting you on medication. (This is fairly common). It could mean that you would benefit from using iodized salt so you’re getting enough iodine, and getting enough selenium and zinc. And possibly that you are sensitive to gluten and dairy. Gluten sensitivity has also been linked to low AMH.

 

Acupuncture. Yes, I started going for acupuncture. Studies show it can help improve outcomes during fertility treatment. (Participants in these studies had generally had 3 months of acupuncture, or around 15 sessions. Again, some is probably better than none!). I never did anything like this before and didn’t know where to start so I literally Googled “fertility acupuncture + [name of WASP-y town]” and found someone with great Google reviews. And she is now my acupuncturist.

 

So that’s what I got on the subject, feel free to add! And remember that davening for healthy, beautiful children is the most important part!!