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Fertility: hormones, cycle and the wish for a baby

Fertility rests on a finely tuned hormone system: oestrogen, progesterone and the pituitary hormones FSH (follicle-stimulating hormone) and LH (luteinizing hormone) control ovulation and the menstrual cycle, while testosterone drives libido in men and women. An irregular cycle and low libido are typical signs of an imbalance, as the guide on balancing hormone levels naturally explains. In polycystic ovary syndrome (PCOS), an excess of male hormones (androgens) can lead to infertility; in a meta-analysis of nine randomised trials with 591 women with PCOS, omega-3 fatty acids improved insulin resistance. Endometriosis, in which tissue similar to the lining of the womb grows outside the uterus, affects around 6 to 10 percent of women, and a laparoscopy (a keyhole examination of the abdomen) finds it in 44 percent of women with unexplained infertility.

Folate before conception and in early pregnancy

The neural tube of the unborn child, from which brain and spinal cord develop, closes about 28 days after conception, often before a pregnancy is noticed. European recommendations therefore name 400 µg of folic acid a day, or an equivalent amount of active folate such as 5-methyltetrahydrofolate (5-MTHF), from at least four weeks before conception until the end of the first trimester. In a Cochrane review of five trials with 7,391 women, folic acid taken around conception lowered the risk of neural tube defects by 69 percent. Folate is the natural form of vitamin B9, folic acid the synthetic one; the guide folic acid or folate when planning a baby covers requirements, foods and deficiency signs. 5-MTHF is already active and works regardless of the common MTHFR gene variant, as set out in why active folate.

Nutrition in pregnancy: calories, key nutrients and foods to avoid

Eating for two needs only slightly more energy: about 70 extra calories a day in the first trimester, 260 in the second and 300 to 400 in the third. Folate, iron, calcium, vitamin D, choline and the omega-3 fatty acid DHA deserve special attention. In large Cochrane reviews, daily iron reduced anaemia at term by 70 percent (44 trials, 43,274 women), and omega-3 fatty acids lowered early preterm births before week 34 from 4.6 to 2.7 percent (70 trials, 19,927 women). Raw meat, raw eggs, raw or smoked seafood, fish high in mercury and alcohol are best avoided; the full overview is in the guide on nutrition during pregnancy. Magnesium matters for mother and baby; the European Food Safety Authority recommends 300 mg a day for women, during pregnancy as well.

Gestational diabetes, birth and birth preparation

Gestational diabetes is high blood sugar that develops during pregnancy, usually in its second half, and affects between two and five percent of pregnant women. It rarely causes symptoms, which is why a glucose test between weeks 24 and 28 is used to find it. Most women keep their blood sugar in balance with the right diet and regular exercise, and about 15 percent need insulin; in randomised trials, exercise programmes during pregnancy lowered the odds of gestational diabetes by 38 percent. The birth method shapes which bacteria colonise a baby first: babies born by caesarean section pick up fewer of their mother's gut bacteria, and skin-to-skin contact and breastfeeding help after every type of birth. Hypnobirthing prepares for labour with slow breathing, deep relaxation and visualisation; in a Cochrane review of nine trials with 2,954 women, women prepared with hypnosis used medical pain relief less often.

Breastfeeding and milk production

The World Health Organization recommends exclusive breastfeeding for the first six months. Breastfeeding protects babies against infections, and breastfeeding for at least two months was linked to half the risk of sudden infant death syndrome (SIDS), even when it was not exclusive. Mothers benefit too: every 12 months of breastfeeding lowered the relative risk of breast cancer by 4.3 percent. Worry about having too little milk is common, and around 35 percent of women who stop breastfeeding early name it as their main reason. What drives milk production most is frequent feeding or pumping, ideally combined with hand expression.

Guides on fertility, pregnancy and breastfeeding

• 8 natural ways to balance hormone levels: sleep, exercise, healthy fats, adaptogenic herbs and nutrients for a stable cycle and hormone system.
• Bringing the hormone balance into equilibrium: typical signs of a hormonal imbalance, PCOS and the best-studied plants such as monk's pepper.
• What is endometriosis?: symptoms, warning signs, diagnosis and treatment options, including when a pregnancy is wanted.
• Folic acid or folate when planning a baby: daily requirement, deficiency signs, folate-rich foods and the active form 5-MTHF.
• Folate or folic acid: the difference between the forms of vitamin B9 and the current recommendations before conception.
• Nutrition during pregnancy: extra calories, healthy weight gain, the best foods and supplements and what to avoid.
• Magnesium in pregnancy: what the studies show for leg cramps, sleep, nausea, blood pressure and pre-eclampsia.
• Gestational diabetes: causes, screening, blood sugar targets, diet, exercise and life after the pregnancy.
• Birth method and health: vaginal birth, caesarean section, water birth and their effect on the baby's microbiome.
• Hypnobirthing: how self-hypnosis works as birth preparation, what the research says and how to practise.
• What to expect when breastfeeding: benefits for baby and mother, storing breast milk and frequently asked questions.
• Stimulating milk production: what lies behind too little milk and what really increases supply.

Frequently asked questions

How to increase fertility in women naturally?

Fertility depends on hormones that control ovulation and the cycle, so the natural levers are the ones that keep this system in balance: 7 to 8 hours of sleep, regular exercise, healthy fats instead of sugar and simple carbohydrates, and enough omega-3 fatty acids and zinc. Women who could become pregnant are advised to take 400 µg of folic acid or active folate a day from at least four weeks before conception. More in the guide to hormone balance.

What causes infertility in women?

Hormonal disorders play a major role. Polycystic ovary syndrome (PCOS), with an excess of male hormones, can lead to infertility, an irregular cycle, acne and weight gain. Endometriosis, in which tissue similar to the lining of the womb grows outside the uterus, causes inflammation, adhesions and cysts; in women with unexplained infertility, a laparoscopy finds it in 44 percent of cases. More in the endometriosis guide.

What causes infertility in men?

The Herbano guides look at two factors: testosterone, which drives libido, and sperm quality. Zinc plays a central role in both, because it naturally increases testosterone levels and sperm quality; men need at least 9.4 to 16.3 mg a day from food. In a placebo-controlled study with 57 overweight men aged 40 to 70, an ashwagandha extract taken for eight weeks went along with a 14.7 percent greater rise in testosterone than placebo. More in the zinc guide.

When should we see a doctor for infertility?

Trying for a baby for more than a year without success is a reason for a check-up with a gynaecologist. Period pain that does not get better with common painkillers, pain during sex, bowel movements or urination and heavy or irregular bleeding should also be checked, because they can point to endometriosis. Diagnosis starts with a conversation about the symptoms, a gynaecological examination and an ultrasound scan. More on the warning signs.

What can I drink to get pregnant faster naturally?

No single drink balances the hormones on its own. Water and unsweetened herbal tea are good everyday choices, while sugary drinks make blood sugar and insulin rise sharply. For women with polycystic ovary syndrome (PCOS), a hormonal disorder linked to infertility, spearmint tea is interesting: in a randomised trial with 42 women, spearmint tea twice a day for 30 days lowered free and total testosterone levels. More on hormone balance.