Trying to conceive can be one of the most exciting—and most nerve-wracking—times of your life. In this article, I’ll share six things to consider when you’re trying to conceive (TTC).
The internet is rife with advice and “tricks” (many of which are unproven) to speed the process up, give you choice over choosing the sex of your baby, or even increasing your chances of conceiving twins.
There is no evidence that you can do the last two, but you certainly can optimize your body for fertility and prepare it in the best possible way to achieve a healthy pregnancy. For women, this involves understanding your menstrual cycle, optimizing genetic health, and making sure your body is primed with the nutrients it needs. The same is true for men: his genes and nutritional needs should be considered, too. After all, he’s providing half of what you need to make that healthy baby!
Sometimes things don’t go as planned and it takes longer to get pregnant. In this article, we’ll also help you understand what it looks like to seek fertility treatment. Conventional advice says that if you’re under age 35 and having unprotected intercourse, you should seek treatment if you’re not pregnant within a year. For women over 35, seek fertility treatment if you’re not pregnant within six months. However, if you have had one or more miscarriages or have a family history of hormone or fertility problems, it never hurts to seek a professional opinion sooner.
Here are six important steps to take when you’re trying to conceive (TTC).
1. Track Your Ovulation & Natural Fertility Signs
The generic rule is that women ovulate halfway through their 28-day menstrual cycle on day 14. But you need to throw this rule out in order to get pregnant as quickly as possible. Why? Because every woman’s cycle can vary by up to 7 to 10 days and still be considered normal. You can ovulate as early as cycle day 9 or much later than day 14… and still be normal. But if you assume that your ovulation is on day 14, and you are actually ovulating sooner or later, you could be missing your fertile window. The only way to achieve pregnancy is to time intercourse around the time that your ovaries are actually releasing an egg.
While this subject has had entire books written about it, here are the basic facts that you need to know:
- Use a fertility tracking app.
- Don’t assume anything—watch for signs.
- Be intentional about the timing of intercourse.
- Track your whole cycle, not just ovulation.
- Use ovulation testing as a support, not the solution.
Let’s dive into each of these a bit more.
Fertility Tracking or Charting
The most common way to understand your body’s fertility cues is to take your basal body temperature every morning at the same time. You can do this with a basal body thermometer, or there are some wearable devices that will do it for you (like the Ava, TempDrop, and others). The important thing is to be consistent with your method.
Results can be charted on paper or in an app. Fertility Friend is the gold standard for fertility app charting in the infertility community, but you can also use the apps associated with Ava or TempDrop, as well as many others that are available for smartphones. Again, consistency is key.
The reason why you chart your body temperature is because of something known as the thermal shift. After you ovulate, your baseline body temperature increases enough to be visibly seen on a chart if you’re tracking your temperature. You need 3 days of elevated temperatures to confirm ovulation, so your cycle is best understood by tracking for many months and noticing patterns. Most women tend to ovulate within the same window of time each month, give or take a few days. But tracking has allowed some women to understand that they consistently ovulate well before or after the assumed cycle day 14.
Fertility Signs
Along with charting your temperature, there are other fertility indicators. Cervical mucus tends to appear a few days to a week before ovulation, increasing in quantity and changing in texture. As you near ovulation, your cervical mucus will be close to the consistency of egg whites—kind of stretchy and clear. Cervical fluid exists to provide a pH balanced and optimal environment for sperm to travel the vaginal canal and survive to meet the egg.
If you do not have apparent or obvious cervical fluid, that does not mean you are not ovulating. Some women produce more than others. You can use a fertility-friendly lubricant if you want to promote an optimal environment for sperm and conception, such as PreSeed, which is often recommended by fertility clinics.
Intercourse Timing
You need to have unprotected sex around the time of ovulation if you want to conceive. If you are tracking your cycle, then you should be able to identify the time leading up to ovulation and then confirm, after the fact, that you did. There are many old wives tales and unproven recommendations for how and when you should have sex to get pregnant, but science knows best here:
-
Sperm can live for up to 6 days in the vaginal canal.
-
Your egg is viable for up to 24 hours after ovulation.
- Your chances of getting pregnant are 25-30 percent on any given cycle (if you are under age 35) where you have unprotected intercourse.
Myths that abound in the infertility community are that you need to have sex every single day, which is not true. In fact, if your partner has a reduced sperm count, this could actually be detrimental to chances of conception. Having sex every day does not increase your chances of conception to 100% for the cycle. You will still have, at most, a 25-30 percent chance of getting pregnant, whether you have sex once the day before ovulation, or every day for the week leading up to ovulation. Experts recommend having sex every other day or every 2 days in your fertile window (while you see cervical fluid or the week before you typically ovulate) and, if possible, the day before you ovulate for optimal chances. Now, don’t stress if you can’t plan for the day before you ovulate exactly. That is why it’s called a fertile window. You have a range of time. Stressing over the exact moment that you have intercourse to try to conceive is the opposite of what you should be doing.
Cycle Tracking
Cycle tracking can help you to identify your fertile days. But the important thing to note is that when you have confirmed ovulation with 3 elevated temperatures, you should not stop paying attention to your cycle. The luteal phase is the time in your cycle after ovulation. It is expected to last for 14 days, but can be normal at just 12 days. If your luteal phase is consistently shorter than 12 days, your hormones may not be optimal for conception. After ovulation, the egg that gets released helps your body produce progesterone. If you have a fertilized egg that implants in your uterine wall, this will increase and help your body to sustain the pregnancy. But some women’s bodies don’t effectively produce progesterone which is sometimes implicated in cases of early miscarriage or recurrent pregnancy loss. By tracking your cycle before you’ve conceived, you’ll be able to understand if your luteal phase is typically long enough, or whether you should speak to your doctor about potential hormone support.
Ovulation Tests
Some women want to short-cut having to track cycles by using ovulation tests. Depending on the brand and type you’re using, it may help you to clearly identify your ovulation within a 12-48 hour window. However, ovulation tests can never confirm ovulation. Sometimes your body will gear up to ovulate with a hormone surge of LH (luteinizing hormone) that will not actually result in ovulation. You can have more than one LH surge per cycle, and sometimes, you can have anovulatory cycles. If you are tracking your temperature, you will be able to know that you did ovulate and when. Ovulation tests can help to confirm what your tracking is telling you, but are not a replacement for the vital information that charting your cycle can provide.
Birth Control
If you have been taking hormonal birth control, it is important to understand that it may take your hormones some time to return to normal. In most cases, you can’t stop birth control and expect to immediately conceive. Birth control can also deplete nutrient stores, particularly B vitamins (including the ultra-crucial fertility nutrient folate), zinc, magnesium, vitamin E, vitamin C, and selenium. (1) If you are planning to get pregnant, give your body 3 to 6 months to be primed for pregnancy after the fact. Of course, you don’t have to wait that long, but you should be prepared that it may take a little longer to conceive, especially if you have been on oral contraceptives for a long time.
2. Clean Your Genes & Manage Stress
There are a lot of myths about things that you “need” to do to be able to get pregnant. Forget all of those. The best way to prepare for pregnancy is to be healthy. This means doing common sense things like eating a balanced, nutrient-dense diet and staying hydrated. It also means getting good amounts of sleep, managing stress as well as you can, and being physically active. Everyone has individual genetic factors that can influence their health. Your methylation and how your other genes are behaving can play a big role in how your body is primed for pregnancy, although to be sure, there are many times when “unhealthy” people conceive. Health is a spectrum and we are always somewhere on it. Erase the notion that you must be perfectly healthy, fit, or unstressed to get pregnant. Just do the best that you can. By following a protocol like the one outlined in Dirty Genes, you will be prepared for your best health. This extends well beyond getting pregnant and is important for the father-to-be, too. In the infertility community, there are entire message boards devoted to the fear or belief that if you are stressed, you will be unable to get pregnant. Everyone has some level of stress—even if not cognitively aware of it. Being alive is stress. Not all stress is “bad.” It is how you manage your stress that counts. I went through three high-risk pregnancies, after many miscarriages, so I can say with certainty that I was always pretty stressed. But that did not stop me from carrying three healthy babies to term. The important thing to note is that research can’t agree on whether or not stress actually impacts fertility. However, it is proven that infertility leads to higher levels of stress and that stress more negatively impacts male fertility. So, both partners should manage their stress as well as they can both from diet and lifestyle, as well as from psychological counseling when available. (2, 3)
3. Prep Your Body with Prenatal Nutrients
Your body needs optimal prenatal nutrition before you’re actually pregnant. So does your male partner. Both the egg and the sperm undergo cycles of development that make the 90 days prior to conception a time of increased nutritional need. There is no one-size-fits-all fertility diet, as much as the internet would have you believe. Eating for fertility means nourishing your body to be in its best possible health. This means:
- Whole, unprocessed foods
- Plenty of vitamins and minerals
- Healthy fats, protein, and carbs
The specifics of these can vary widely depending on your personal circumstances and health conditions, food allergies, and more. Eat plenty of vegetables, because they’re rich in folate and other important fertility nutrients. Healthy fats should be consumed, not feared, because they support balanced hormone levels and support normal inflammation levels. Protein provides amino acids, the literal building blocks of life, so you should get enough every day. If you really want to follow a fertility diet, try one of two things:
- Find a nutrition professional who will create a targeted program for you
-
Follow the principles found in Dirty Genes to support your epigenetic needs
But don’t feel like you need to spend lots of money signing up for fertility diet programs or coaching. Either target something for your genes or find a professional who will take a look at your entire lifestyle and create an optimal plan for your total health, including fertility. Another important note: conventional advice says that folic acid is essential for preconception health. But folic acid is a synthetic nutrient, and some who have MTHFR or other methylation SNPs may struggle to use the folate from folic acid. Be sure to choose a prenatal vitamin that contains folinic acid or L-5-MTHF, the bioavailable forms of this vital fertility nutrient.*
4. Don’t Forget About Male Fertility
As we’ve touched on, the male partner’s health is every bit as vital as the female’s! Too many fertility programs only consider the woman, but it takes two to create an embryo. Research shows that problems in the sperm can be every bit as problematic for miscarriage and infertility. (4) Between 40 and 50 percent of infertility is attributable to male factors. (5) Sperm relies on antioxidants to protect it from damage, and as such, can be prone to problems depending on lifestyle factors. Smoking, alcohol intake, lack of exercise, excess intake of omega-6 fats, and even gut-related disorders could all decrease antioxidants which can directly or indirectly affect sperm quality. Some men will also have genetic or physical factors that lead to reduced sperm count, low motility, or defects in sperm formation. Like females, males can respond to certain amounts of dietary and lifestyle intervention, but if there are genetic or other factors in play, fertility treatment may be needed.
5. Seek Fertility Treatment When Needed
Fertility treatment can involve a wide array of help. Some women will need it if they have conditions that lead to infertility or increase the time to pregnancy. These can include endometriosis, PCOS, fibroids, thyroid disorders, or other hormone-related health problems. Most commonly, IVF
(in vitro fertilization) is discussed, but fertility treatments can also include IUI
(intrauterine insemination), hormone replacement
, or close monitoring of follicles for timed intercourse
. Some fertility treatments will address physical barriers to conception in either the man or the woman. Ultimately, fertility treatment involves thoroughly assessing all of the factors that may be preventing conception between male and female partners and creating a customized treatment plan based on those needs. Fertility specialists can be OBGYNs (obstetrician-gynecologist doctors), MFMs (Maternal Fetal Medicine doctors), or REs (Reproductive Endocrinologists) and may be found in obstetrical clinics or fertility clinics. When seeking fertility treatment, ask questions about who the practitioners are and what they are skilled at treating. In many cases, after you receive your fertility treatment recommendations, it can be beneficial to seek a second opinion, especially since most forms of fertility treatment could cost thousands of dollars and may not be covered by insurance. If it takes longer than 6 to 12 months to get pregnant, or you have back-to-back miscarriages, it is worth consulting with a fertility specialist.
6. Take Pregnancy Tests the Right Way
It is devastating to get a negative test when you’ve tried so hard to conceive. That’s why it is important to make sure that you are taking pregnancy tests the right way.
How To Test
Following the instructions on the specific brand and type of test you’ve chosen is important. Some want you to dip the test into a cup of urine for 3 seconds, others want 5 or even up to 15 seconds. Not following the instructions for your specific test could invalidate your results—meaning a false positive result or a false negative.
When To Test
It’s important not to test too early. The temptation is strong to test as early as possible, especially if you have symptoms! But seeing early negative tests, especially when you could be pregnant, is deflating and can lead to unnecessary stress. While some women can get consistent positive results as early as 9 days after ovulation, and some early result pregnancy tests are designed to work up to 6 days before a missed period, it is still best to test at the time your period would be due
. At most, test a day or two before that. If you are working with a fertility specialist, they may offer you the choice to skip urine tests altogether and just go into the office for a blood test for HCG, the pregnancy hormone. Many women in the infertility community prefer this, because they can get a black-and-white answer instead of having to worry about whether they will or won’t see a line on a test. Taking pregnancy tests can be stressful. You know yourself best, so if you think it would be helpful to get a blood test and not try urine tests, let your doctor know when your ovulation is confirmed (if that’s not already done with fertility treatment) and plan to get a blood test around 13 or 14 days after. Your doctor’s office may also have specific rules around the timing of testing, so it’s always best to check with them directly before you set your own plan. Keep in mind that if you use HCG injections as part of your fertility treatment, you are at a higher risk of a false positive test result, so be sure to follow your doctor’s instructions.
Choosing a Pregnancy Test
When it comes to selecting which type of pregnancy test that you want to use, there is a long-standing belief in the infertility community that tests with pink dye produce earlier results than tests with blue dye. There is no scientific evidence to back this up. What matters when it comes to early results is to read the test to understand what level of HCG it can detect. HCG stands for human chorionic gonadotropin and is the hormone that is produced when a pregnancy develops. Levels increase rapidly in the first days and weeks, typically being detectable by pregnancy tests around 9-14 days after ovulation. They typically double every 48 hours in the first 2-3 weeks of pregnancy. Some pregnancy tests only find 25 mIU/ml and higher, while others can detect HCG levels as low as 10 mIU/ml. If you want to get a positive result as early as possible, you’ll want to find a test that can detect the lowest number possible. When you do decide it’s time to take your pregnancy test, you should use your first morning urine. It should be as strong as possible, so hold off drinking fluids an hour or two before bed, and then try to have at least six or eight hours between your test and the time that you last urinated. It always feels exciting and a little terrifying to take a pregnancy test, but if you do it the right way, you set yourself up for the best chance of accurate results.
The Bottom Line
“Baby-making” is an exciting time of life… unless it takes too long. Then, the process of TTC can feel stressful, exhausting, frustrating, and even depressing. Before you get bogged down in internet discussion forums or paying for expensive fertility products, consider the basic aspects of health, like nutrition and optimizing how both partner’s genes (male and female) are working. If you’re not getting pregnant in a timely manner, or you need help with understanding your cycle, seek help from a fertility specialist. You don’t have to feel alone in the journey of trying to conceive. Even if you feel isolated from others who are having babies, there is no shortage of medical professionals and healthcare specialists to assist you on your journey. You can also find plenty of support online from TTC communities on social media, blogs, and elsewhere. (Just remember that they’re all going through this journey with you, and don’t replace evidence-based medical advice.) 
References:
- https://pubmed.ncbi.nlm.nih.gov/23852908/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6016043/
- https://pubmed.ncbi.nlm.nih.gov/30474562/
- https://doi.org/10.1016/j.beem.2020.101477
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4691969/
† This information is for educational purposes only. No product results are implied.
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