Be Fruitful INTRODUCTION
With excitement, joy, and perhaps a bit of trepidation, you’re considering having a baby. This primal urge is an intrinsic part of being human. What could be more natural or straightforward? Every day, women become pregnant, sometimes unintentionally. On the other hand, many women have difficulty conceiving, which can be emotionally traumatic, exhausting, or frustrating. My opinion is that pregnancy is well worth preparing for. Whether it’s ensuring that you are immune to chicken pox, taking a multivitamin with folic acid to reduce neural tube defects, or approaching your ideal weight to avoid gestational diabetes, we know that there are things you can do to prepare your body for conception and to up the odds of bearing a healthy child. Those activities, and much more, are the subject of this book.

Conception, happily, is a dream that most couples achieve. Yet we’ve all heard anxiety-fueling stories of frustration and heartbreak, even for people in their twenties. This anecdotal evidence has many women asking whether there’s some kind of fertility crisis today. Is it now harder to get pregnant for some reason?

The answer is “maybe.” The U.S. birth rate is about the same as it was in the mid-1980s (down from a high point in 1990). But the current statistics may be bolstered by the success of assisted-reproduction technologies that didn’t exist in the past. Certainly there are challenges to fertility today that our mothers and grandmothers never faced: new birth control methods; unprecedented cultural pressure to be thin—and, on the flip side, epidemic obesity—both of which take a toll; high rates of hormone-disrupting stress; a fast-food diet that leads many to consume the exact opposite foods from those that bolster fertility; and environmental toxins permeating everything from our water bottles to our lip gloss to the food we eat and the air we breathe. In this book, I use the principles of integrative medicine to provide you with up-to-date information on nutrition, the mind-body connection, the vitamins you should be taking, and the environmental chemicals that you will want to avoid, with the goal of helping you prepare your body, mind, and spirit for easy conception and a healthy pregnancy.

Integrative medicine addresses the challenges to our health and fertility by synthesizing advances in medical science and the wisdom of healing traditions. In today’s high-stress, chemical-laden, frequently unhealthy environment, integrative medicine is the most effective way to prepare for pregnancy, guiding you to create an oasis of health. Within these pages, you will find answers to your questions on topics ranging from the physical (what to eat, what supplements to take) to the environmental (toxins to be wary of), from the mind-body (breath work, meditation) to the spiritual (ceremony and prayer). You will also find a complete discussion of the most recent scientific findings from conventional medicine, as well as wisdom from traditional Chinese medicine and Ayurveda. This approach is proven to not only make it easier to get pregnant, but also reduce the risk of miscarriage, preterm birth, and birth defects, and, through epigenetic influences, it can alter gene expression, thereby enhancing the health of your child.

Let me offer another argument for well-informed preparation. In 2011, the New England Journal of Medicine reported a study of women who took antidepressant medication of the SSRI (selective serotonin reuptake inhibitor) class three months prior to conceiving or during their pregnancy. They found a two to three times higher rate of autism in children of mothers who took these medications. Now, this is preliminary research that needs further study before we advise all women planning pregnancies to stop taking antidepressants. But if you were no longer depressed, or had only mild depression to begin with, wouldn’t you wish to be informed of the potential risk so that you could make your own decision about whether or not to continue the drug while you planned to conceive? At present, 50 percent of Americans are taking at least one prescription medication; the use of many of these drugs should be reexamined vis-à-vis conception. And it is not only about avoidance: two additional studies published in 2011 revealed that women who took multivitamins one to three months before becoming pregnant reduced their chances of having a child with autism or severe language delay.

I advocate for thoughtful preparation to make your body as welcoming as possible for a baby. Fertility requires health and vitality; ideally, you would not seek to create another life when your body is depleted. In this book, I focus on the integrative medicine approach, which can enhance your innate ability to conceive and bear a child. Integrative medicine is the thoughtful synthesis of conventional and alternative medicines; in keeping with this philosophy, I not only present the scientific evidence from research trials on nutrition, mind-body, and environmental factors, but also synthesize the wisdom that emerges from healing systems such as traditional Chinese medicine, Ayurveda, ceremony, rituals, and intuition. While I am a doctor trained in Western medicine, I value the experience of these traditions and the practitioners who have honed their skills through years of study and clinical practice. Within these pages, you will find the voices of acupuncturists, Ayurvedic practitioners, mind-body therapists, nutritionists, and a wide range of physicians. Integrative medicine honors working as a team, and acknowledges that no one person can know everything.

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Often I am asked, “Is there an ideal age to have a baby?” Biologically, the answer is clear. Peak fertility occurs in a woman’s midtwenties. For most of us, however, other factors weigh in. There are social considerations: Do I have the right partner? Is he ready? Financial constraints also influence us; having a baby and raising a child are expensive! And educational and career aspirations can be all-consuming early in adult life. In these pages, I tackle difficult realities straight on. The media has portrayed advances in reproductive technology as a panacea. We are regaled with celebrities who conceive and bear children in midlife, leaving many women to believe they can have children easily, with a bit of help from modern medicine, at age forty or even fifty. This has obscured the fact that as women age, fertility declines and miscarriage rates increase. So I ask younger women to think carefully about whether it might be best if they were to have children earlier, and I help women of all ages to maximize their fertility with the full range of integrative approaches.

In a certain respect, the challenge that we face today is an unintended consequence of the miraculous invention of the birth control pill. Introduced in 1965, it allowed women, for the first time in history, to be sexually active and to control whether or not they bore children. This freedom helped women avoid unplanned pregnancies, and drove up the average age of first childbirth from twenty-one in 1968 to twenty-five in 2002. As we swallow these pills from our teenage years on, we can lose touch with our underlying cycles, and with the fact that time is slipping by. I advocate that women become reacquainted with their cycles, as this will make it easier to conceive. It also provides warnings of potential fertility problems (polycystic ovarian syndrome, short luteal phase, and more) that are better addressed at earlier stages and younger ages when they will be easier to reverse.

Soon after the pill was introduced, women successfully fought for and won equal rights to jobs, housing, and financial and public services. We have access to unprecedented work opportunities, and building a career often overlaps with our years of maximal fertility. While social programs in Canada and Europe legislate a paid year off after childbirth with guaranteed job preservation, in the United States, we have not made this commitment to families.

The philosophy and practices presented in this book emerge from my work as executive director at the Arizona Center for Integrative Medicine. I have spent fourteen years at the center founded by my mentor, Dr. Andrew Weil, caring for patients and designing educational programs for health professionals. Our center developed the curriculum for integrative medicine and offers the most extensive range of integrative medical training programs in the world. I interviewed many of our fellowship graduates for this book, and I include their wisdom and clinical experience on these pages.

I grew up in the shadow of infertility. As a child, I wondered about my grandmother’s older sister, and why she couldn’t have children. My mother’s younger sister, who lived just a few blocks away, struggled unsuccessfully to become pregnant. Diagnostic tests and interventions were talked about in hushed whispers; a cloud hung over the topic. As an adult, when I queried my aunt, she described herself as being “just too late.” When she was forty, IVF was brought into widespread practice—but at that time, she was considered too old. Observing her sadness over not being able to have a child inspired me to focus on a career in women’s health.

For more than twenty-five years, I have had the honor and privilege of working with women on health issues that matter to them. From everyday maladies to their struggles with breast cancer, transition through menopause, and desire to become pregnant, I have walked the path with them as physician and partner. I have been deeply touched by the longing to have a child, and the incredible joy that pregnancy and birth bring.

As an integrative physician, I am passionate about health and wellness. My days (and sometimes my nights) are devoted to preventing disease, maintaining health, and restoring good health in those who have become ill. I fervently believe that the greatest opportunity we have to impact health is when helping a couple prepare for pregnancy. This is the fundamental reason I am writing this book: to help you become pregnant with greater ease and to bear the healthiest child possible.

I hope you will find the information you need in this book in order to more easily achieve a pregnancy and to birth a healthy child. I encourage you to set an intention to do all you can to make yourself a welcoming host for a new life. I am honored to serve as your advisor to help you prepare physically, emotionally, mentally, and spiritually for the exciting events to come.