Tips for Conceiving
You’ve made the big decision that you’re ready to start trying, so what now? You’ve probably spent your whole post-pubescent life worrying about how to avoid getting pregnant, and suddenly you’re faced with the opposite goal - and turns out, getting pregnant may be harder than your younger self believed!
Getting off Birth Control
If on birth control pills, may take 1-3 months for your cycle to return to normal (in some cases, up to 9 months); but of course, you have to be prepared that you could indeed get pregnant immediately
If you have an IUD, ovulation usually restarts 1-3 months after its removal - it may be sooner for a copper IUD compared to hormonal IUD, but in both cases it may take more time for periods to become regular (source)
In order to get a really accurate sense of the length of your cycles for timing pregnancy attempts, it may take a few months of tracking if periods are initially irregular
I would recommend getting off birth control 3 months before your ideal start date. If you really want to avoid getting pregnant before the start date, either use a condom or don’t have sex anywhere close to when you think you might be ovulating.
Existing Medications
A few months before you start trying, talk to your doctor about any medications you are currently taking and whether 1) they may have an impact on fertility and 2) they will be safe for pregnancy
Some medications will be clearly fine to continue while trying to conceive and once you’re pregnant
Others you’ll clearly need to stop, so you may require a few months to slowly taper off (e.g. anti-depressant or anti-anxiety meds), and ideally find a pregnancy-safer alternative
But many will fall into a grey area where you’ll have to weigh the pros and cons with your provider - unfortunately, we don’t have the best research with human subjects for many of these medications because of the ethical concerns of testing with pregnant women
In some cases, supplements can work as an alternative to medication. Some examples below that you could discuss with your provider:
L-Theanine: helps w anxiety/agitation
Magneisum Glycinate: helps with anxiety, depression, sleep
Inositol: helps with sleep
Other Medical Appointments
Have your regular dental cleaning before starting to try, since they likely wouldn’t want to do x-rays once you’re pregnant
If you get regular mammograms, knock this appointment off beforehand too, since it involves some radiation, plus your breast tissue changes in pregnancy as you approach lactation (and later it’s also trickier to assess if you’re breastfeeding)
Carrier Screening
Before you start trying to conceive naturally, it may be worthwhile to get a carrier screening test, which uses blood or saliva to determine if you are a carrier for any genetic conditions (e.g. Tay-Sachs, cystic fibrosis, spinal muscular atrophy, fragile X syndrome)
For most of these diseases, it is only a risk for the baby if both parents are carriers (i.e. it is a recessive disorder), so your partner may want to get be tested as well
If it turns out there is a worrisome risk of a genetic issue, you may want to consider going the IVF route so that you can test and select for healthy embryos
Prepping Your & Partner’s Bodies
Prenatals
I recommend beginning to take prenatal vitamins at least three months before you start trying to get pregnant
Male fertility can also benefit from vitamins, especially if there are any nutritional gaps: Vitamin E and C specifically have been found to help with sperm count and motility (Vitamin D, Zinc, Selenium, L-Carnitine are also important)
While not as essential as female prenatals, there’s little downside apart from cost - and unlike female prenatals, he won’t need to continue taking them once you’re pregnant so it won’t end up costing as much
Sperm take 2-3 months to mature, so just like female prenatals, it’s best to start taking them before you start trying
You can always start trying without it and if you end up having trouble conceiving, it’s an easy thing to add to your regime to boost your chances
Cheaper: Bird and Bee, Naturemade Gummies
Smoking/Vaping
Nicotine can negatively impact both male and female fertility (review of studies)
For women, smoking or vaping during pregnancy is also dangerous so you’ll need to quit anyway, and it’s best to do it before trying to conceive
For men, nicotine can affect sperm quality/quantity and sperm take 2-3 months to mature, so it’s best to quit (or at least cut back) 2-3 months before trying to conceive. And obviously once pregnant, it doesn’t matter if male partner returns to vaping again (but smoking around the future baby is def not good)
Marijuana
Survey data suggests that marijuana use (by both male and female) has no impact on how long it took couples to conceive
That said, there is some research showing that frequent (more than once per week) smoking of marijuana resulted in lower sperm count, so it’s something to consider cutting if you find yourself having trouble conceiving
Alcohol
While there isn’t great scientific consensus on the question of alcohol use preconception, studies generally find that light to moderate drinking doesn’t affect female fertility, but binge drinking (4 or more drinks in a sitting) or 10+ drinks per week does lower chances of conception (summary of studies)
Similarly, light to moderate drinking doesn’t seem to affect male fertility, but heavy drinking may (summary of studies)
However, if you’ve been trying for a few months without success, cutting back on even moderate drinking could be something to try, for both partners
Hot Tubs & Saunas for Him
Sperm needs to be kept at a certain temperature to remain healthy (that’s why the scrotum holds it away from the rest of the body to keep it a few degrees cooler)
Frequent (e.g. weekly) or prolonged (e.g. over 30 mins) heating in a hot tub or sauna can impact sperm count/motility for up to 3 months (source). An occasional or short hot tub sesh is unlikely to make a huge difference.
If your partner is frustrated about cutting hot tub sessions short (I’m speaking from experience here!), gently remind him that you’ll be sacrificing your ability to enjoy these things for 9 whole months!
Weight
Obese women have a harder time conceiving and also have more pregnancy compilations (higher risk of preeclampsia, gestational diabetes, C-sections, etc) (source)
So if you currently fall into this category, it may be worth it to attempt to lose some weight before trying to conceive. But if you are only somewhat overweight, a few pounds here and there doesn’t make a real difference.
On the other end of the spectrum, being significantly underweight can also affect your fertility and cause irregular menstrual cycles
Stress
Research finds that higher stress among women is associated with a harder time getting pregnant (male stress doesn’t appear to impact fertility)
While lots of stress factors are outside our control, if there is something you can do to lower your stress levels once you’re starting to try to conceive, it may be helpful. For instance, deciding not to take on an additional home renovation or work project right now, or other ways of saying “no” to things or people that cause you added stress.
The whole project of getting pregnant can itself be a stressor for many women, so try your best to not put too much pressure on it, or on a particular timeline
If you find yourself getting obsessive with ovulation tracking and timing sex, for example, maybe see if your partner will take over this responsibility (and sex may be even more relaxed if you’re not aware when it’s for baby-making purposes vs. not)
Exercise
You can maintain your normal workouts - there’s no particular exercises you need to avoid when trying to conceive
The only exception is if you are underweight due to exercising too much or too intensely and it’s affecting the regularity of your menstrual cycle. That would be reason to lower the level of your physical activity (and also make sure you’re getting enough calories).
Notes:
There is a separate page of Behavioral Dos, Don’ts and Grey Areas for once you are pregnant - the above guidance is specifically for the preconception phase
If you want to go even deeper on this topic, check out Doveras and their 3 month “Pre-Pregnancy Clean Up” program, which provides holistic and personalized recommendations for men and women to boost their fertility
Conception 101
For a normal 28 day cycle, day 1 is first day of your period and day 14 is when you ovulate
For fertilization to occur, the sperm needs to meet the egg after it’s been released and is moving down the fallopian tubes to the uterus
There is a “fertile window” of a handful of days when this is possible: 4-5 days before you ovulate (sperm can live in the fallopian tubes for a few days), the day of ovulation, and (less likely) the day after ovulation
The highest chances of conception (~30% chance) are the day before you ovulate and the day you ovulate, so the crucial thing is to try to hit one of those two days
Determining Ovulation & Timing Sex
The tricky part of this is determining exactly when you are ovulating, so that you can ensure you have sex at the right time
You have a few options for this:
Cycle tracking: apps like Flo or Ovia can help you track your cycle based on your period, and thus predict when your conception window should be. This is the easiest/cheapest/most common method, but you could combine this with one or both of the below options too.
Ovulation test sticks: these work like pregnancy tests - you pee on the stick and a few minutes later get a result. I like Clearblue because it’s digital and very easy to interpret. These can be helpful if you have some irregularity in your cycle length or want to know with more precision, as they actually measure your hormone levels to identify peak fertility days. However, they aren’t cheap, especially if you end up needing to try for many months.
Temperature charting: after you ovulate, your temperature rises by a half degree or more, and stays elevated for the rest of the menstrual cycle. So if you take your temperature at the same time every morning, you can use this to determine when you likely ovulated. This is useful for figuring out or validating your cycle pattern, but not for determining when to have sex during that particular cycle, since it’s only after the fact. If you’re already using a wearable device, like the Oura ring, it’s not too much effort to starting tracking temp.
Change in mucus: a telltale sign that you’re about to ovulate is your cervical mucus gets more stretchy and egg whitey. I think it’s hard to use this as a primary tracking mechanism since it’s a little subjective, but it could be an additional data point. Just make sure you don’t confuse the mucus with semen, which can look similar (i.e. check your undies before you’ve had sex!)
Once you have a good idea about your fertile window and peak days, you can figure out your sex strategy: some people do it every day during the window to cover their bases, others do it every-other day (which can help preserve energy/excitement for sex!).
Research on this shows that it doesn't really matter which approach you take, as long as you hit one or the other peak day (day before ovulation, day of ovulation).
One thing to avoid: some people think it’s better to “save up sperm” and not have sex or masturbate in the weeks leading up to the peak days, but actually this can lead to sperm that is older and less healthy
There are lots of old wives tales around conception sex that have no real evidence behind them - different positions that are recommended, ways to try to get a boy vs girl, etc. The one thing that may have some scientific backing is continuing to lie on your back for ~15 mins after sex, rather than getting up, to give the sperm a better chance at swimming to the egg!
Did it work!?
The Two-Week Wait:
After your attempts in the fertile window, you begin the “two-week wait” until you can test to see if you successfully got pregnant (remember - even if you time it perfectly, it’s still only a ~30% chance a given month). The suspense of this time can feel agonizing!
During this time, many people avoid alcohol in case they are pregnant. Might not be a big deal to abstain during the “two-week wait” for the first month or two, but will feel like a bummer the longer you keep trying
The research suggests that excessive drinking during this period can indeed prevent implantation, so if you are trying to maximize your chances of conceiving, I’d limit your drinking. But if you do drink a little (e.g. just one glass a couple nights during the period), it is unlikely to affect your chances, and there isn’t a risk of birth defects at that early stage (research summary)
Pregnancy Tests
Historically, a missed period was the first sign that you might be pregnant, and then with the invention of pregnancy tests, women could confirm their suspicion with the pee stick test that measures the uptick in the pregnancy hormone HCG
Today, there are early detection tests that allow you to test up to 6 days before your missed period with relatively high accuracy. A few things to note here:
The accuracy 5 days before the missed period is only 76%, and then it goes up to 96% 4 days before, and then 99% for the remaining days as you get closer to your period
So it’s possible to have false negatives if you’re testing too early, especially if you are off even by a day or two in your estimate of when you’d expect your period
False positives, on the other hand, are exceedingly rare - if you see even a faint line, you are almost certainly pregnant
Early detection tests are expensive; like ovulation tests, it’s not a big deal for the first month or two, but will add up after many months
One downside of the availability of these pregnancy tests is that more women find out they are pregnant, only to soon after lose their pregnancy in an early miscarriage called a “chemical pregnancy” (in the past, these women may have thought it just a slightly late period, since it can look similar to the early miscarriage).
This type of early miscarriage is extremely common, so just know that there is still this delicate window for a few weeks even after you’re testing positive
Confusing symptoms
There is a lot of overlap of symptoms related to pregnancy and those that accompany a regular period. Ugh.
An especially confusing one is implantation bleeding - a light amount of spotting that occurs 10-14 days after conception when the egg attaches to the uterine lining. A few key differences to distinguish this from a period:
Implantation bleeding is lighter in color - more like pink or rust, rather than the red of period blood
Implantation bleeding doesn’t last more than a day or two, and isn’t as heavy a flow as period bleeding
Seeking Fertility Support
The typical guidance for when to get referred for fertility testing (for both you and your partner) is after 12 months of trying if you are under 35, and after 6 months of trying if you are over 35
Initial fertility testing for women usually involves a pelvic exam, ultrasound, and blood/urine test to look at hormone levels. For men, it involves a semen analysis and blood/urine tests.
KindBody has locations in most big cities - they are recommended for fertility analysis (e.g. semen analysis), not necessarily the IVF/IUI treatment itself
In the Bay Area, RMA (Dr. Morin is particularly well regarded) and Spring Fertility are excellent options
Look into whether you or your partner’s company offers fertility benefits (such as Carrot)
Check out the IVF & IUI Readiness Program at Doveras, which can help prepare you for treatment with customized lifestyle and supplement recs that promote egg and sperm health
The experience of struggling with fertility can be extremely emotional, frustrating, and overwhelming. Know that you are not alone and there are many online support groups and therapists who specialize in this area.
When you’re going through a difficult time, comparison can make it even harder - it might seem like everyone else is getting pregnant left and right. Perhaps temporarily delete any apps or unfollow accounts that are causing you this additional suffering.
