For as far as we’ve come in technological advancements to help people conceive, fertility is still – largely – something we cannot control.
Unless, that is, you believe what you might hear in one of the thousands of videos about trimester zero on social media.
Describing the three-to-six-month period of preparation before a couple starts trying for a baby, trimester zero has emerged as a popular – and profitable – concept among wellness and parenting influencers, some who claim that by following certain rules or protocols, you can prevent future fertility issues.
It’s an attractive concept. But is it true?
What is trimester zero?
Coined by American sociologist Miranda R Waggoner in 2017 to describe the shift in emphasis on preconception care in public health approaches to women of childbearing age, she argued trimester zero creates undue pressure for women to be in a perpetual state of “pre-conception”.
Since then, the idea has been co-opted by the wellness industry, which pedals expensive and extensive guides, supplements and toxin-free products with the message that in buying and using them, you can prevent future fertility issues.
Often, the emphasis is on what women can do in this preconception period but, as Dr Jessica Dunleavy explains, men have just as big a part to play.
“Men’s preconception health has a huge impact on not only fertility, but the health of the pregnancy and the health of the offspring,” explains Dunleavy, a fellow in School of BioSciences at the University of Melbourne, noting that male factors account for an estimated 50 per cent of infertility issues.
What does the evidence say?
It’s true that if you’re preparing to try to conceive, starting three to six months out is a good idea.
The main things that will impact your fertility are age, weight and genetics. Most supplements, guides and strict advice pedalled by influencers about trimester zero are not backed by science and will not make a difference in your efforts to conceive.
But there are some things you can do to put yourself in the best position to try to fall pregnant.
In this time, you should stop drinking, smoking, vaping or doing drugs. Smoking has been proven to be detrimental to egg and sperm health. Alcohol consumption can be detrimental to sperm quality, lower testosterone production, and make it harder to achieve an erection.
For women, there is no established safe level of alcohol consumption, so experts recommend stop drinking altogether when you start trying, says Dr Vijay Roach, an obstetrician, gynaecologist and former president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists.
He notes that age is one of the biggest determining factors in a woman and man’s fertility and due to the rising average age of first parenthood, it’s more relevant than ever because the older you are, the more likely you are to have put on weight, develop high cholesterol or be at greater risk of diabetes in pregnancy or preeclampsia. “So getting older is not necessarily helpful for somebody who’s planning to be pregnant.”
Likewise, sperm quality is closely correlated with age. “Males produce sperm for their whole life, but sperm quality does decline with age,” Dunleavy says.
Most experts say the best advice for any couple thinking of having a baby is to start trying naturally.
If you’re under 30 and don’t fall pregnant after 12 months, go to your GP to investigate further. If you’re over 35, you should investigate if you haven’t conceived naturally after six months.
The best place to start is with a visit to their GP or specialist, says Dr Kath Whitton, gynaecologist and specialist with IVF Australia: “Get a comprehensive screening for your medical history, review medications and get infection screens for immunity to certain things like chickenpox and rubella.”
Genetic carrier screening is also recommended. One option is a test for the woman to see if she is a carrier for cystic fibrosis, spinal muscular atrophy and fragile X syndrome, which is covered by Medicare.
Expanded genetic carrier screening for both partners is also available, checking whether the couple carry the same genetic mutations, therefore putting them at risk of having a child with a genetic disorder. The out-of-pocket cost for this can be between $700 and $1500.
Put on your own oxygen mask
The importance of the psychosocial health of wannabe parents can be an underestimated factor of preparation says Julie Borninkhof, clinical psychologist and chief executive of Perinatal Anxiety & Depression Australia (PANDA).
“You can’t give from an empty basket. So if you’re worn out, if you’re overwhelmed, your ability to help seek is lessened,” Borninkhof says.
Roach agrees that when you visit your GP or specialist, they should be screening for your psychosocial history: “That might include their family history or own experiences of anxiety and depression in the past. And always, always, always screen for domestic violence because following the birth of a child is one of the highest risk times for domestic violence.”
What to eat and how to train
Changes to diet and exercise can have a positive effect on your overall health, but for women, they won’t improve the quality of your eggs, says Roach.
“Having a more balanced diet in terms of our nutrient intake might improve your general health, but your fertility will only be improved via weight,” he says.
In women, weight and body mass index (BMI) has been found to affect the hormonal balance that regulates the menstrual cycle. As such, studies have found that women with a BMI over 27 are three times more likely to struggle to conceive naturally.
This is why women with type 2 diabetes or PMOS can struggle with fertility: both are often linked with obesity.
Commonly, the first line of treatment for these conditions is working with a personal trainer or dietician because in modifying their diet or exercise routine, they lose weight, which will balance their hormones, resulting in a more regular menstrual cycle and improved fertility.
The exact causes of male infertility are still unknown, but Dunleavy says in roughly 50 per cent of cases, they believe it’s genetic. So for those men, you can be the picture of health and still run into problems.
Sperm are, however, more sensitive to environmental insults, making it especially important for men to be eating well and looking after themselves. Given sperm are made every three months, these lifestyle choices can have an impact on sperm quality.
Dunleavy says prolonged excessive heat exposure is damaging for sperm, so best to avoid
“sitting your laptop on your lap and spending 10 hours in the spa”. She also recommends avoiding microwaving food in plastic as the chemicals can interfere with their endocrine system.
For both women and men, having a well-rounded diet that incorporates healthy vegetables, fruits, protein, fibre and healthy fats is beneficial. As such, the Mediterranean diet is most commonly recommended.
Likewise, there aren’t any particular exercise routines that will impact your fertility, but general advice is to hit the recommended 150 minutes of vigorous exercise per week.
What about supplements?
Women should start taking a supplement with folic acid and iodine as soon as they’re thinking of trying to conceive, says Whitton.
“Folic acid supplements should be started at least one month before conception, but we like to see it started about three months prior,” Whitton explains.
“Data suggests that it significantly reduces the risk of neural tube defects, which form from the very beginning of pregnancy.
“Iodine is much the same; it’s about thyroid hormone production, which is really important because that drives foetal brain and nervous system development, and deficiencies in pregnancy can be linked to impaired cognitive development in children.”
For men, Dunleavy says there are no broad guidelines as the data is limited and somewhat mixed. “Focusing on a well-balanced, healthy diet is best as opposed to relying on any supplements.”
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