Preconceptional Medicine and Infertility, Periconceptional Care
Childbearing does not begin at the moment of conception – according to the modern approach of reproductive medicine, the months preceding conception play a crucial role in laying the foundation for a healthy pregnancy and fetal development. This period is known as the periconceptional period, encompassing the 3–6 months before conception, as well as the implantation and early embryonic development phases.
During this sensitive phase, preparation of the female and male body involves several factors:
- Restoring hormonal balance
- Improving gamete quality
- Optimizing the uterine environment
- Balancing systemic conditions (e.g., metabolic, immunological)
What qualifies as infertility?
Medically, infertility is defined as the failure to conceive despite regular, unprotected sexual intercourse:
- within 12 months for women under 35 years,
- after 6 months for women over 35,
- and for women over 40, evaluation is recommended even after a few unsuccessful months.
It is important to emphasize that infertility is not solely a female issue: in approximately 40–50% of couples experiencing fertility difficulties, a male factor is also identified, thus both partners must be evaluated.
The Importance of Preconception Lifestyle
A proper lifestyle and diet before conception are critical. They influence both egg and sperm quality and conception capability, and also impact the child's development and long-term health. The first 1000 days from fertilization are particularly decisive, during which the risks of future conditions such as obesity, hypertension, diabetes, urinary infections in pregnancy, gestational diabetes, and birth complications can be reduced. Also, the mother's nutrient stores must be replenished in time to prevent depletion (e.g., calcium loss from bones) during pregnancy and lactation.
The goal of periconceptional interventions is to ensure the body – on both the female and male side – is in its best possible biological and health condition to support fertilization and subsequent development.
An optimal preconception lifestyle includes:
- Weight normalization (both underweight and overweight impair fertility)
- Improved nutrient intake: folic acid, vitamin D, omega-3 fatty acids, antioxidants
- Elimination of alcohol and smoking
- Stress management and improved sleep quality
- Regular, moderate-intensity physical activity
- Proper control of chronic conditions (e.g., thyroid disorders, insulin resistance, autoimmune diseases)
Conscious preparation not only increases the chances of conception but also contributes to the prevention of miscarriage, pregnancy complications (e.g., preeclampsia, GDM), and congenital anomalies.
The Role of Periconceptional Medicine in Assisted Reproduction Success
Assisted reproduction techniques such as in vitro fertilization (IVF) and intrauterine insemination (IUI) offer many couples the possibility of having a child. However, the success of these procedures largely depends on the biological and endocrine state of the body before conception – this is where periconceptional medicine plays a key role.
Gamete Quality – Modifiable Factors
Egg Quality
Egg quality is essential for successful fertilization and viable embryo development. Although it is primarily age-dependent, several modifiable factors influence it:
- Reducing oxidative stress with antioxidants (e.g., CoQ10, vitamin E, myo-inositol)
- Improving insulin sensitivity (especially in PCOS), which supports ovulatory cycle regulation
- Restoring hormonal balance (e.g., thyroid, prolactin, cortisol)
- Anti-inflammatory lifestyle – subclinical inflammation negatively affects oocyte maturation
Sperm Quality
Sperm parameters (concentration, motility, morphology, DNA integrity) are equally critical in ART. Male fertility can also be improved through targeted periconceptional interventions:
- Lifestyle changes: avoiding smoking, alcohol, excessive heat exposure, and obesity
- Antioxidant therapy (e.g., vitamins C and E, L-carnitine, zinc, selenium)
- Reducing DNA fragmentation: balanced diet, good sleep hygiene, stress management
- Treating endocrine disorders (e.g., hypogonadism, insulin resistance)
Implantation – Optimizing the Uterine and Systemic Environment
Successful implantation of the fertilized egg (embryo) into the endometrium is one of the most critical steps of ART. Key factors for successful implantation include:
- Endometrial thickness and receptivity: appropriate estrogen and progesterone levels, uterine blood flow, immune balance
- Immunomodulation: correction of autoimmune disorders, NK cell activity, cytokine balance
- Diagnosis and treatment of subclinical inflammation (endometritis)
- Diagnosis and treatment of uterine anomalies (e.g., polyps, septum, synechiae)
- Restoring microbiome balance: importance of vaginal flora and endometrial microbiota
Precise timing between embryo viability and maternal receptivity is essential for implantation – this must be achieved during the so-called "window of implantation" (WOI), which can be fine-tuned with appropriate hormonal preparation.
Main Pillars of Periconceptional Care
Periconceptional care is based on a comprehensive, personalized approach, covering the following areas:
1. Health Assessment
- Detailed history (gynecological events, family medical history, infertility, miscarriage)
- Laboratory tests: hormone profile, blood glucose, thyroid function, vitamin and mineral levels
- Lifestyle analysis: nutrition, exercise, sleep, stress, harmful habits
2. Nutritional and Lifestyle Counseling
- Targeted dietary advice to prevent deficiencies and optimize metabolism
- Adjusting BMI, especially addressing the effects of obesity and insulin resistance
- Integrating physical activity to support hormonal balance
- Improving sleep and reducing stress – controlling cortisol's effect on fertility
3. Vitamin and Micronutrient Supplementation
- Folic acid: prevention of neural tube defects (starting before conception)
- Vitamin D: supporting immune and endocrine balance
- Iodine, B12, iron, omega-3 fatty acids: supporting fetal nervous system and cell division
4. Chronic Disease Management and Medication Optimization
- Stabilizing thyroid disorders, insulin resistance, diabetes, PCOS, autoimmune conditions
- Reviewing current medications and switching to pregnancy-safe alternatives if needed
5. Infection Screening and Vaccination
- Screening and prevention of infections (e.g., toxoplasma, CMV, rubella, HPV)
- Updating immunizations, especially rubella, varicella, hepatitis B
- Treating gynecological inflammation and restoring vaginal flora to support implantation
Dietetic Services
Services Include:
- Nutritional counseling
- Meal planning
- Nutrition-related lab testing (e.g., allergies)
Who is it recommended for?
- Healthy individuals for preventive purposes
- IVF patients to enhance fertility
- Recurrent miscarriage cases
- Following multiple failed embryo transfers
- Male infertility
- Patients requiring specific diets (e.g., metabolic disorders, food allergies, intolerances, GI diseases, PCOS, insulin resistance, endometriosis)
- Pregnant women for their own and their child's health
Dietary counseling includes:
- Medical history collection
- 3-day food diary
- Assessment of nutritional status and needs
- Personalized consultation (discussing food groups and preparation methods)
- Outpatient report and support materials
- Follow-up evaluations
- Referral to gastroenterologist if needed
The Role of Body Weight from Conception to Birth
Preconception and pregnancy body weight – typically measured by Body Mass Index (BMI) – significantly influences fertility, pregnancy outcomes, and the child's long-term health.
BMI Classifications:
- Normal weight: BMI 18.5-24.9 kg/m²
- Underweight: BMI below 18.5
- Overweight: BMI 25-29.9
- Obesity: BMI 30 or above
Underweight Risks
Too low body weight can be a serious barrier even before conception. Underweight women often experience ovulation disorders, irregular cycles, and reduced ovarian function. During pregnancy, low BMI can affect blood vessel development, increasing the risk of preterm birth, infant mortality, and intrauterine growth restriction (IUGR).
Obesity Concerns
Obesity raises significant concerns. Even in the planning phase, it significantly reduces fertility, especially if accompanied by hormonal imbalance. Obese women have higher infertility rates and lower success in ART procedures. During pregnancy, risks of gestational diabetes, hypertension, preeclampsia, and deep vein thrombosis increase, endangering both mother and fetus.
Adequate Nutrient Intake
Proper nutrient intake plays a key role in maintaining hormonal balance, improving gamete quality, preparing the endometrium, and preventing birth defects. Micronutrient intake should begin during baby planning, as the first weeks – often before a woman knows she is pregnant – are vital for embryonic development.
Key Nutrients:
The Consequences of Harmful Habits
Smoking
Smoking has severe and multifaceted impacts on both general health and fertility. It impairs biological processes in both sexes, reduces natural conception chances, worsens implantation conditions, and significantly lowers ART success, especially IVF.
Studies show smoking reduces IVF success by 30–50%, and even passive smoking has detrimental effects. Quitting at least 3 months before conception significantly improves outcomes.
Alcohol
Even moderate alcohol consumption negatively affects fertility, implantation, pregnancy outcomes, and ART success. There's no safe level of alcohol before or during pregnancy. In women, alcohol disrupts hormone signaling, ovulation, and endometrial preparation.
Complete abstinence is recommended starting before conception.
Caffeine
High caffeine intake (above 300 mg/day) may impair fertility, implantation, and pregnancy outcome. It disrupts hormone function and reduces uterine blood flow, potentially affecting endometrial receptivity and embryo development.
For both sexes, especially during ART, less than 300 mg/day caffeine is recommended.
Comprehensive Preconceptional Care
Our integrated approach to preconceptional medicine ensures that both partners are optimally prepared for conception, improving the chances of successful pregnancy and healthy child development.
