An OBGYN’s guide to getting pregnant

Whether you’re just starting to try to get pregnant, or you’ve been at it for a few months and want some guidance, here are tips to help.

By Dr. Nazaneen Homaifar, Chief Medical Advisor, Natalist

Getting pregnant may seem straightforward in theory, but when you’re actually trying, it can feel a little like a black box. Luckily, science and medicine have a lot to say about the best ways to get started and how to troubleshoot if things aren’t going as expected.

The Preconception Visit

Before you’ve even started trying to conceive on your own, experts recommend checking in with an OB/GYN or your primary care provider a couple of months prior, just to get the lay of the land. They’ll be able to compassionately help you make a game plan that keeps several factors in mind, like any potential health risks, and any lifestyle changes you (and/or a partner, if applicable) may need to begin making.

For women, your doctor will likely also run through any medications you take to see whether or not any drugs in your regimen could impact embryo development or cause birth defects further down the line. They’ll want to know about prescription medication and birth control, of course, but herbal supplements and vitamins count, too! So come prepared to talk about it all.

During this conversation, it’s also especially important to make sure your doctor knows if you have conditions that can directly impact fertility, like polycystic ovary syndrome (PCOS) or endometriosis, but it’s equally as important to discuss other chronic conditions like diabetes or thyroid disease. While these issues may come less immediately to mind when considering reproductive health, many health conditions can have far-reaching effects. Management of these chronic conditions has implications for the pregnancy and outcomes that may affect delivery planning.

Putting TLC into TTC

There’s no need to sacrifice all of your guilty pleasures in order to conceive, but, in general, maintaining a balanced and conscientious diet can make all the difference in how long it takes to get pregnant.

Given the glut of nutritional advice online, it can be tough to tell fact from fiction when it comes to what it means to eat a “healthy fertility diet,” and ultimately it’s best to discuss this with your doctor or a nutritionist for a more personalized plan. It’s also not just on women to take their diets into consideration when trying to conceive. Men’s diets can impact their side of the fertility bargain too. Research suggests a possible link between healthy diet and higher semen quality.

Here are some broad guidelines to be mindful of:

  1. Getting a daily dose of iron (found in healthy foods like spinach, lentils, and chicken) is a must. Iron helps your body make a protein called hemoglobin, which carries oxygen from your lungs to other parts of your body, boosting your energy levels.
  2. Make sure to get enough fiber, which you can do by eating beans, oatmeal, and a range of vegetables, including artichokes and broccoli.
  3. Women should start taking a prenatal vitamin when they’re trying to conceive. Among other things, these vitamins contain folic acid, which helps prevent birth defects of the brain and spine, and promotes the general growth of the fetus.
  4. Minimizing your sugar intake is also suggested. But don’t beat yourself up over the occasional scoop of ice cream — diet is all about moderation.

Lifestyle plays a significant role in fertility. In the same vein as diet is, of course, weight. If women are overweight or underweight while they’re trying to conceive, they may encounter some difficulty. Body Mass Index (BMI) is a tool often used to determine healthy weight (between 18.5 and 24.9), though it does have its limits and we don’t all conform to tidy boxes on a chart. Checking in with a physician can help you set realistic, attainable goals around how your weight may impact how long it takes you, and whether you’re able, to conceive.

And of course exercise plays a role here. Physical activity not only increases mental and physical health but it can also help you conceive more efficiently and successfully. Granted, this doesn’t mean you have to start training for a triathlon (though by all means, go for it if you want to!). Experts recommend something more moderate and achievable for the average person: at least a half-hour of exercise, three days a week.

Know Your Fertile Window

Now that we’ve talked about various ways you can prepare to get pregnant, let’s talk about what’s actually going on inside a woman’s body that can help you seal the deal when you’re trying to conceive.

For women, keeping up with your ovulation cycle can help you identify the exact time of the month when you’re likeliest to conceive. According to the American Society for Reproductive Medicine, a woman’s “fertile window” is the six-day period that includes the five days before ovulation and the day of ovulation. Having sex daily or every other day within this window increases your chances of getting pregnant.

A woman’s “fertile window” is the six-day period that includes the five days before ovulation and the day of ovulation. Having sex daily or every other day within this window increases your chances of getting pregnant.

But how do you figure out when this period of time is? If you have an extremely regular, textbook menstrual cycle that lasts 28 days, the fertile window will usually be from day nine to day 14 of your cycle. But sometimes it can be tough to tell, especially if you have an irregular period. Fortunately there are two fast and easy tests to help you figure it out:

  1. Cervical Mucus Test

Checking cervical mucus is an easy and inexpensive way for a woman to keep track of ovulation using just her fingers and her powers of observation. Cervical mucus is a fluid secreted by your cervix; it provides natural lubrication during sex, protects against infections, and helps sperm reach the egg.

The amount and type of cervical mucus that a woman’s body produces fluctuates throughout the month. During ovulation, it will have a slippery and clear consistency, which is often comparable to egg whites. If you see this, get to it! This means you’re ovulating and it’s the ideal time to have sex if you’re trying to conceive.

2. Ovulation Predictor Kits

If you don’t so much trust your own senses, or just want to be a bit more scientific about tracking ovulation, ovulation predictor kits (OPKs) are another option. These kits monitor levels of luteinizing hormone (LH) in urine. Although LH is always present in your body, it spikes significantly 24–48 hours before ovulation. This big increase in LH signals that it’s time for a woman’s ovary to release an egg.

OPKs are generally straightforward to use. Some contain a test strip for dipping into a urine sample, while others are digital and require you to pee on them.

Of course, OPKs will never be 100% accurate — false positives occur in about 7% of cycles. Sometimes women can experience what’s called an anovulatory cycle, when an egg is not released and a woman doesn’t go through a luteal phase. Anovulatory cycles can also happen as a result of a few different conditions, including PCOS or obesity, to name a few.

The main takeaway is, you’ll want to start having sex during the couple of days leading up to the LH surge, the day of the surge, and the day or two after.

What About Infertility?

Even if you’re doing everything by the book, listening to all the health advice, and sticking to having sex on an ovulation-based schedule, you may still find that you’re not conceiving. This is common, and not always cause for immediate concern. Sometimes it just takes time.

According to research by the American College of Obstetricians and Gynecologists, you should consider a work up for infertility if you’ve been trying consistently for year with no results. That’s for women under 35. For women over 35, experts recommend meeting with a reproductive specialist if you’re still not pregnant after six months of trying.

There are lots of potential causes for infertility, and we’ll get into some of them below, but many of them come with treatments and solutions — some are even pretty low-hanging fruit like changing your diet or exercise.

First Line Troubleshooting

Abstaining from smoking and cutting back on alcohol should both be your first stop for lifestyle changes that can positively impact fertility, for both men and women. Cutting back on caffeine may also help — consuming five or more cups of coffee has been associated with decreased fertility.

There is also some evidence that using vaginal lubricants during sex may make it harder for sperm to complete its course through the cervix and fallopian tubes, on its way to fertilizing an egg. So if you’re having trouble conceiving, before jumping to a medical conclusion, you might try having sex without lube first just to see if it helps.

If you’re someone who relies on lube to have comfortable sex, though, please don’t force yourself into painful sex just to try to conceive. Try finding a sperm-friendly lube (one without spermicide that is pH-balanced and isotonic).

Age Is Unfortunately Still a Factor

Many people are now postponing having children into their late 30s and early 40s. Waiting to become a parent until that age has its benefits — you’re usually more financially secure, more sure of yourself, and have a more stable support network — but it’s also important to know the potential impacts of age on conception.

All women are born with their lifetime supplies of eggs. Not all of them will ever be considered viable, but the pool of eggs that stand a chance (about 300–500 eggs) steadily declines in quality and quantity over time. This decrease in quality means an increased risk of miscarriage and aneuploidy (abnormal numbers of chromosomes in cells). This can really lower a woman’s odds of conceiving, though there are still options for becoming a parent, like IVF, surrogacy or adoption, if you find yourself in this position.

Although men don’t see quite the same precipitous drop in fertility with age, and can theoretically pull their end of the conception bargain until the end of their life, this doesn’t mean that they, too, don’t experience some age-related changes. As a man grows older, his testosterone levels decrease and he will produce less sperm, which can make it trickier to conceive.

Reproductive Health Roadblocks

If you feel like age and lifestyle factors aren’t an issue, but conception still isn’t happening, know that there are some health conditions associated with reduced fertility. For women, those include endometriosis and polycystic ovarian syndrome (PCOS), two of the most common endocrine disorders. Pregnancy is also difficult if the fallopian tubes are blocked from scarring. In addition, male factor is a cause of infertility in about 40–50% of couples.

For women, endometriosis and PCOS are often under-diagnosed, so it’s entirely possible that you’ve been living with one, or (rarely) both of them, and flying under the radar.

Endometriosis is a condition where the endometrium (or inner lining of the uterus) grows or implants in other areas like the fallopian tubes, ovaries, or on the bowels or bladder. The primary symptom is pelvic pain, and sometimes pain with bowel movements or peeing. People can also experience painful sex. Endometriosis can cause scarring of the tubes, which can affect fertility.

PCOS can complicate a woman’s journey to pregnancy because, among other symptoms, it’s often characterized by hormone imbalances that can lead to irregular bleeding in which ovulation doesn’t occur monthly.

Women with endometriosis and PCOS do get pregnant all the time, but it’s worth discussing with your doctor if you think you have one of these conditions before you get pregnant for awareness. Your doctor may want to assess your fertility sooner.

Turning to Reproductive Technology

Assisted reproductive technologies (ART) are available if you find yourself needing help.

Some women can take drugs like Clomid or Letrozole to induce ovulation — this can help if your menstrual cycle is really irregular and it’s hard to pinpoint your fertile window

There are many reasons why people may turn to intrauterine insemination (IUI), in which sperm is placed inside the uterus as part of a medical procedure rather than during sex. It is a great option for single parents by choice, LGBTQ couples, couples who may not be able to have sex or couples who have tried for a while with no success. The sperm used could be from a partner or a donor.

Then there is in vitro fertilization (IVF), which involves fertilizing an egg with sperm outside of the body, in a lab, and then putting the newly fertilized egg (the embryo) back into a woman’s uterus with the hope that it will implant and become a fetus. There are so many permutations of this, or reasons why hopeful parents rely on IVF: sometimes it’s used by couples in which both or one partner is infertile, but it’s also used by single people, and LGBTQ couples. The egg and sperm that are used could be from both partners in a couple or donated by other people to a couple or a single person; a woman could be using eggs that she had previously removed and frozen, or she could be embarking on this journey from scratch. And more!

Having to use ART does come with additional costs, and it can be financially limiting for many. Talk to your insurance provider or see if you have access to benefits with your employer to see if you qualify to have some of your treatment covered.

In Conclusion

Remember to always include a physician in any big conception decisions you’re considering, like treatment for endometriosis, navigating male infertility, changing your diet, or trying IVF. While the internet is a great place to start gathering information, or getting some basic questions answered, it’s best to turn to someone who knows your body and is licensed to help you make the most informed choices.

There are many possible paths to conception, no matter who you are, what health issues you’re navigating, or what kinds of expectations you have. This is just an overview, but we hope that you feel more informed and empowered to make whatever choices are ultimately right for you.

Learn more at Natalist.

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