143. Trying to Conceive? Here Is What Both Partners Need to Do

When a couple struggles to conceive, the focus almost always falls on the woman. Her labs. Her cycle. Her body. But conception is a team effort — and the three to six months before trying to conceive may be the most important and most overlooked window in the entire fertility journey.

In this episode of Cycle Wisdom, Dr. Monica Minjeur makes the case for proactive, intentional preconception care for both partners — before a single failed cycle happens. Through the story of Mia and Daniel, a couple labeled with unexplained infertility after 18 months of trying, you will see how a complete evaluation of both partners revealed a very clear picture — and a very clear path forward.

You will learn:

• Why a normal semen analysis does not mean male factor has been ruled out — and what a complete evaluation actually looks like
• How the three to six months before conception shape egg quality, sperm quality, and even the long-term health of the baby
• What preconception care looks like for each partner — from cycle charting and hormone testing to DNA fragmentation and gut health

If you have been trying to conceive without a complete evaluation of both partners, this episode will change how you think about your next step. Learn more or schedule a free discovery call at radiantclinic.com

Transcript

Speaker 0:01

When a couple struggles to conceive, the focus almost always falls on the woman, her labs, her cycle, her body. But conception is a team effort, and both partners' health in the months before pregnancy shape the outcome more than most people realize. Today, we're going to be talking about what both men and women need to consider prior to trying to conceive and how to optimize your health to improve your chances for a healthy pregnancy. I'm Dr. Monica Minjeur, the host of Cycle Wisdom, where we help women and couples restore hormonal balance and reclaim their well-being through personalized healthcare grounded in clinical excellence. So let's start off today with a story about a couple that we will call Mia and Daniel. Now, Mia came to us organized, ready to conceive. They had been trying for the past 18 months. She was health conscious. She had her cycles mapped out to a T, and Daniel had had a semen analysis done and was told it was normal. They came in with a diagnosis initially of unexplained infertility, and Mia especially felt anxiety every month around the time of ovulation. She was concerned that they couldn't explain feeling why they hadn't been able to get answers. Daniel felt helpless and sidelined because he had been told,"Your labs are normal, so it's definitely not you." After many failed cycles with no new answers, a friend sent Mia and Daniel our way and told them that we would look at both male and female factor when it came to their fertility concerns. We started off with evaluation of both partners from day one. We began with some lab work for Mia that showed that she had low progesterone and some borderline iron deficiency, as well as vitamin D deficiency. She was ovulating based on her charting, but showed that she had a short luteal phase. Daniel's seminal fluid analysis was technically normal, but there was some mild insulin resistance that was identified and some concerns for the possibility of hormone imbalance and sperm quality issues. Together, their results told a story that was nowhere near an unexplained infertility diagnosis. Now, either one of these diagnoses alone may not have been enough to be significantly impactful when it came to their fertility, but again, when it comes to fertility, we need to look at both sides of the couple. And when they both had some issues going on, even though they were fairly mild, it did create significant problems for them trying to conceive. Over the course of the next few months, we worked on treatment for both Mia and Daniel in order to improve their vitamin levels, fix any underlying hormone imbalances, and ultimately improve sperm quality, even though Daniel's original numbers looked to be normal. Within that timeframe, they also found that they had more energy, their health had improved, their sleep had improved, and they felt more hopeful throughout this whole process. They were able to conceive about seven months into treatment and for the first time felt excited not only about being pregnant, but about having a better understanding of their overall health. Now, when it comes to male factor infertility, we estimate that male factor contributes at least about 50% of infertility cases, yet men are oftentimes cleared with one basic seminal fluid analysis and removed from the conversation. Now, there is so much more to semen analysis than just the numbers and the count and the motility. In fact, I did a whole episode about this recently, episode number 139, that talks about different things that we look at when we are trying to decode what's going on with a semen analysis, looking for things like infection or inflammation or other concerning features which may also be playing a role when it comes to overall men's health and thus their fertility. Research studies over the past 15 years have been able to make some light of the importance of dad's DNA when it comes to pregnancy. For example, most of these studies were done on animals, but can be extrapolated to humans and potentially further testing in the future. But back in 2013, there was an animal study done on horses and donkeys and mules that showed that both mom and dad's DNA came together obviously to create the baby, but dad's DNA is more favored with the production of the placenta. Now, we know the placenta is incredibly crucial when it comes to baby's growth, fetal development, and things later on in pregnancy like preeclampsia or intrauterine growth restriction. Other things are areas where the placenta might not be able to continue to support the long-term health of that pregnancy if dad's DNA was not strong from the first. Another study in 2021 showed that dads with metabolic syndrome, so things like diabetes or heart disease or obesity, those children had a 19% increased risk of having a preterm birth. There was also a 23% increased risk of low birth weight and 28% higher chance of NICU stays, and this was all adjusting for mom's health. So just based on dad's overall health, we had significant changes as far as the health of baby early on during their first few days. And then most recently in 2024, there was a study done on mice that showed that the gut microbiome from dad made a significant difference in low birth weight, shorter lifespan, and smaller size overall. In fact, the male mice that had induced gut microbiome issues had smaller testes and lower sperm counts. Most fascinating though is that this is reversible. Within eight weeks of improving their GI health, they found that the mice that were born of offspring from dads with a good gut microbiome went back to completely normal baseline as far as birth weight, lifespan, and smaller size. So we haven't done exactly all of these research studies on men at this point in time, but these cases point to significant influence when it comes to male factor well beyond just the count of the sperm themselves. The three to six months before conception when eggs and sperm are maturing really are impacted by the quality of the environment shaped by both partners. And paternal health of the father, specifically at the time of conception, does have a significant influence on the programming of the embryo that's developing in regards to their genetics, and this is ongoing, important research that rarely is reaching to couples. And so we have to continue to escalate this idea that it is not just about mom's health, but also about dad's health. When we address the preconception window intentionally, it can help to not only identify, but also resolve problems before they become months or years of failed attempts. So there's a couple of myths that I just wanna address before we move on to female factor when it comes to preconception. And with men, normal semen analysis does not necessarily mean that male fertility isn't the issue. Standard testing typically is going to overlook things like evaluating metabolic factors, hormone levels, DNA fragmentation, oxidative stress, other pieces that we can evaluate to take a look and see what is going on from dad's overall health standpoint and what is the health and the quality of the sperm that's being presented. And another common misconception that we address is that preconception care does not mean just go take a bunch of vitamins. It goes much deeper to evaluate both partners and discern if there are any underlying correctable factors that should be fixed ahead of time Ideally, we look for what we call kind of a three-month window. And why this is important is that sperm can take anywhere from two and a half to three months to fully mature. So any lifestyle changes you make today won't necessarily be reflected in the quality of sperm improvements until two to three months later. Egg quality is similarly shaped by the nutritional and hormonal environment over that same timeframe. And so optimally, if patients come in preparing to try and conceive, we recommend starting this process three to six months before attempting conception. Now, conventional medicine takes a bit of a different approach in that typically they will wait for any evaluation until you've been trying to conceive for 12 months or more. In the world of restorative reproductive medicine, we back it up significantly and we say,"No, let's identify any issues ahead of time. Let's be proactive about care," because even if you're able to conceive, if your health is poor at the time of conception, your pregnancy and subsequently possibly your baby may have more health concerns if we didn't fix your underlying health conditions first. This is further demonstrated in a 2018 study published in Fertility and Sterility that identified that the dietary patterns in both partners impacted fertilization rates and embryo quality. So again, why would we want to wait until you've been trying to conceive for a year before we even start this process? So what does it look like for each partner when we are going through this process of trying to evaluate what we need to look at? For women, as you've heard us talk about frequently, we are always starting with charting. We wanna confirm ovulation, assess the luteal phase, and most importantly, assess for optimal ovulation. So looking at things like the luteal phase progesterone and estradiol, identifying any underlying abnormalities with thyroid panel, especially including thyroid antibodies, doing a nutritional assessment to look for things like iron deficiency, vitamin D, vitamin B12 deficiency, screening for other metabolic disturbances like insulin resistance. All of these things can have a significant impact, not only on the ability of ovulation to occur, but on the quality of that ovulation event. Again, we want to do targeted therapy based on what your labs show, and this is why it does not make sense to just do a blanket approach and give everybody the same supplements For male preconception evaluation, we always want to be looking at a detailed semen analysis, and in our world, that means it has to include looking for things like agglutination, white blood cells, pH, other things that could indicate that there's infection or inflammation going on. Now, even if that semen analysis is, quote-unquote,"normal," we oftentimes will take it a step farther, especially when people have been trying to conceive and have been unsuccessful. We oftentimes will consider looking at a hormone panel to address testosterone issues, thyroid problems, prolactin issues, insulin resistance, other vitamin deficiencies, and we also discuss DNA fragmentation. This is completely separate from looking at the actual sperm counts, but it tends to look more for where we have damage to the DNA, which can be a significant driver of impaired sperm quality. And finally, with men, we are always looking at a lifestyle review, looking for any heat exposure to the testes. What is their overall alcohol or tobacco intake? Are you taking any medications that might be impacting the quality or the quantity of sperm production? And again, if semen analysis is normal, not stopping there, realizing that just because it's normal may not mean that it's optimal. This concept of sperm DNA fragmentation was elevated in infertility with a study done in 2021 showing that increased fragmentation was associated with increased problems with recurrent pregnancy loss and infertility independent of other standardized parameters Now, depending upon your results from lab testing, from semen analysis testing, what your age is, what your cycles are showing, there are lots of different things that we may recommend depending upon your unique situation. Sometimes antioxidants are recommended. Again, we want to be careful not to overdo it on antioxidants, but certainly if your unique situation supports the need for antioxidants, we'll talk about what that means for you, how long you should be on them, and what the appropriate dosage is. We also always talk about sleep. Again, you hear me talk about this all the time in that sleep is really the master driver of so many of our hormones, especially that cortisol balance. And chronic sleep deprivation actually undermines the hormones of both partners. We also make a special note to pay attention to alcohol because this impacts sperm morphology, ovarian reserve, and egg quality. So both partners benefit from reduction of alcohol intake. And finally, trying to minimize endocrine disruptors. Now, we haven't talked about this a whole lot on the show yet, but I'm going to do a whole episode about it in a couple of weeks. So make sure you stay tuned for that. But we also will talk about how you can work on minimizing your exposure to different endocrine disruptors like BPA, phthalates, PFAS, artificial fragrances, because all of these do have the possibility of impacting both egg and sperm quality. So again, I can't give specific generic advice for everybody, but really focus on individualizing those targeted recommendations based on each partner's specific testing. And this can make all the difference in the world. And finally, we always will talk about the emotional dimension. Infertility stress is comparable to a cancer diagnosis in the psychological impact, but it's rarely addressed clinically. Chronic stress of infertility increases cortisol levels, which oftentimes further suppresses gonadotropin-releasing hormone, which can have a significant impact on ovulation. For men, that chronic stress with cortisol elevations can decrease testosterone and sperm quality. So we always want to make sure we're including both partners in our evaluation to share what's going on, how are we going to work through this together, and keep everybody on the same page as far as treatment strategies moving forward. Having a real diagnosis rather than just unexplained infertility and having a real plan that is specific to you helps to significantly reduce your anxiety, even before treatment begins or even before you finally get pregnant. Conventional care is largely technical in that it is very structured and very cookbook, whereas the care we provide recognizes that emotional and physiological health are inseparable. So let's address a few of the common questions we get when people ask us about preconception testing. Sometimes we get asked,"Well, we've only been trying for a few months. Is it too early to do any assessment?" We typically say,"Not at all." Preconception care is proactive, not reactive. If we can find something now that is addressable, it can save months or even years of uncertainty, and has the potential to improve the overall health of that upcoming pregnancy. Again, as we addressed at the beginning, we oftentimes get told,"Well, his semen analysis was normal. We were told he doesn't need more evaluation." And we would politely say,"No, that's not true." Standard analysis does not assess the quality of the DNA. It doesn't assess metabolic factors. It doesn't assess hormone imbalance. And so normal by conventional standards of a semen analysis does not mean that semen is optimized, nor is health. So sorry, guys, you don't get off the hook quite so easily. Okay. Well, what about if I'm taking a prenatal vitamin? Is there anything more I should do? While a prenatal vitamin is foundational, it is not a complete plan. We oftentimes focus on that targeted testing to show exactly what your body needs, what do you need in therapeutic dosages, not just baseline coverage. Another question we oftentimes get is,"How long should we try and prepare before we actually try to conceive?" And again, ideally, at least three, if not six months, if you know that you're planning for the future. Because if we find something, it can take a while to correct that underlying dysfunction and help the interventions to meaningfully impact both egg and sperm quality. Regardless, we start where you're at and work efficiently. So sometimes people come and see us and they end up conceiving a month later. We'll do the best we can to help improve the quality of your health all along, but again, ideal situation, three to six months ahead of time gives us the most lead time we need to make sure that everything is optimized prior to going into conception. And finally, I would just like to add a note about unexplained infertility. Almost always, unexplained infertility diagnosis typically means the evaluation wasn't complete enough. It is incredibly rare that there's not an answer at all. That's our entire focus when it comes to infertility at Radiant Clinic. We find the diagnoses that most standard cursory workups miss because we are digging deeper. We are looking more deeply into male factor. We are looking at optimizing your hormones rather than just checking a box that says,"Yep, looks like she ovulated" Imagine if the conversation about fertility started with both partners in the room, not just as a formality, but because their shared improved health outcomes genuinely changed what happened. Imagine if the months before conception were used with intention to find out what's actually present, to nourish your body with what it needs, and to remove what's quietly getting in the way. Imagine if couples arrived at conception prepared rather than depleted, having done the foundational work that gives a pregnancy its best possible start. This is what preconception care done well can do, and this is what it looks like to improve health and promote fertility.

Speaker 2 19:23

If you're ready to work with our elite team of healthcare professionals, go to our website, radiantclinic.com, to schedule a free discovery call and learn more about our package-based pricing for comprehensive care. We are currently able to see people for in-person appointments in our Cedar Rapids, Iowa clinic or can arrange for a telehealth visit if you live in many different states across the US. Check out our website for current states that we can serve medical clients and let us know if your state is not listed to see if we can still cover you there as we are constantly expanding our reach. Please note that our fertility educators are able to take care of clients no matter where they live. Thank you so much for listening to this episode. Please share this podcast with someone in your life who would benefit from our services. Remember to subscribe to this podcast for more empowering content that I look forward to sharing with you on our next episode of Cycle Wisdom