When my husband and I decided we were ready to try for a baby, I made one discovery: I knew virtually nothing about how to increase my chances of getting pregnant. I mean, I knew how to get pregnant, of course, but that was it. I had some vague inklings about ovulation, but in truth, I had basically no idea that most of the month there was little chance of me getting pregnant. I was 34 years old, and up to that point, all I’d been taught was how not to get pregnant. Many women are in the same boat—and whether you’re ready to try for a baby or just want to understand your body better, read on!
How do I get pregnant?
We’ve all been taught about the birds and the bees, but that knowledge turns out to be largely insufficient when you’re actually trying to get pregnant. When it comes to making a baby, timing is everything. Women are born with anywhere between 1 and 2 million eggs (!), but only release 300 to 400 over the course of our lives, typically releasing just one each month starting when we have our first period. This is why it’s absolutely key to time intercourse if you’re trying to get pregnant. “Eggs only live for 12 to 24 hours,” explains Steven Brenner, MD, a reproductive endocrinologist at Long Island In Vitro Fertilization. He goes on to share that sperm live for two to three days. If you time intercourse correctly, sperm may fertilize an egg on its way to the uterus. If the egg isn’t fertilized within 24 hours, though, it will simply dissolve, which renders your chances of getting pregnant very, very low. The most important factor if you want to up your odds of conceiving? Getting to know your cycle. The average woman’s cycle is 28 days, but that’s an average. Cycles range from 28 to 32 days, but longer and shorter cycles are possible, too. (Some women go up to 35 or 40 days.) There are four main phases of your cycle:
The Follicular Stage, aka Your Period
This starts with the first day of bleeding. The body releases hormones like follicle stimulating hormone (FSH) that make the eggs in your ovaries mature. Between days two and 14 (on average), those hormones are thickening the inside of your uterus so it can make a cozy home for a fertilized egg. You have little chance of getting pregnant during this time.
Around day seven, you’ll see some signs that ovulation is on its way as your discharge becomes increasingly white and creamy. Since sperm can stay trapped in fertile vaginal mucus for two to three days (some even say up to five days), fertilization is possible, though not terribly likely. You should have sex now since you might ovulate early. It’s good to cast a wide net if you’re aiming to make a baby.
Sometime between day 11 and day 21—or approximately 14 days after the first day of bleeding—you are ovulating, which means that the egg that’s most ripe is released. For many women, this phase is easy to identify on a purely physiological level—the vaginal mucus becomes thin and stretchy (like egg whites). Some women even experience ovulation pain. The thick mucus helps the sperm make it to (and adhere to) the egg. This is when you should be having sex, at least once every two days for a week. According to Kelly Smith, licensed acupuncturist, “This is when ovulation predictor kits can be helpful because you can have intercourse until that OPK is positive. …Once it is, you can basically do it once more that very moment and then give up because the ship has sailed.”
Post-Ovulation or Luteal Phase
This is when conception happens—or doesn’t. Your ovaries stop releasing eggs and your cervical mucus dries up. It can take up to six days for fertilized eggs to travel to the uterus. If the embryo implants in the uterus, progesterone levels will stay high and human chorionic gonadotropin (hCG) levels will rise. If it doesn’t, the egg disintegrates. If you aren’t pregnant, this phase lasts 14 to 16 days until your period starts up again. There’s little chance of getting pregnant.
How do I keep track of all this?
There are now a wide variety of convenient ways to track your fertility and get to know your ovulation cycle. You can go with a simple chart, websites, or apps. There are many factors to track—temperature, cervical mucus, even your cravings and moods!—but this depends entirely on how far down the rabbit hole you want to go. Brenner believes that if you’re under 30 and having regular periods, there is no need to get an app or an ovulation kit (he doesn’t think store-bought kits are particularly accurate or effective). The most bare bones approach to upping your chances of getting pregnant is to simply follow the schedule stated above and time sex accordingly. There are additional systems to employ, but none of these are particularly foolproof, and some—like regularly checking your basal body temperature—have been proven largely ineffective. The one advantage to charting your temperature, however, is that it might help you discover that you’re not ovulating. Smith shares that ovulation predictor kits, on the other hand, are useful only if you keep in mind that they typically tell you when you’ve already ovulated, not when you’re going to ovulate.
How can I increase my chances of getting pregnant?
“Figure out when ovulation is taking place,” says Brenner. That’s the most important thing. You can have sex all you want, but if you’re not doing it when you’re ovulating, pregnancy is extremely unlikely to occur. How do you do this? Get to know your cycle. Is it regular? Are the days of bleeding uniform from month to month? Most women know this. (And if you don’t, start tracking it.) If it’s uniform, there’s a good chance you’re ovulating, says Brenner. If it’s inconsistent, you might not be ovulating in each cycle, which is worth discussing with your doctor. Two great resources are Taking Charge of Your Fertility and Cycle Savvy, both by Toni Wechsler, MPH, a women’s health educator and public speaker. But remember: Just because you don’t have a 28-day cycle doesn’t mean your cycle is inconsistent, it only means that you won’t bleed on the exact same day of every month. Once you know your cycle, make sure you’re having sex at the right time. This can’t be overstated. Although you will probably ovulate between days 14 and 16, you want to have sex “at least every two days from day 11 and 12 on, for a week, because you might ovulate a little earlier or later,” according to Brenner, and it’s best to cast a wide net.
Be mindful of your weight.
This means in both directions—being either underweight or overweight can diminish your chances of conceiving.
According to a landmark Nurses’ Health Study, diet does contribute to a woman’s chances of getting pregnant. The primary directive is to eat a balanced, healthy, nourishing diet, but a few key takeaways include:
- Avoiding trans fats and using more unsaturated vegetable oils in your diet
- Drinking whole milk (skim can actually contribute to infertility!)
- Taking a multi-vitamin that includes folic acid
- Eating carbs that are rich in fiber (whole grains, vegetables, fruit, beans)
- Eating plant proteins (tofu, nuts, beans)
That said: Don’t go crazy. “I treat people who are trying to get pregnant and cut out coffee, alcohol, sugar, and gluten,” Smith says. “But is that stressing you out? If you’re depleting yourself because of this, don’t do it.”
Get enough sleep.
This is vital for all women at any stage of their reproductive journey, but Smith always reminds her acupuncture patients who are trying to conceive how fundamental sleep is to so many basic biological functions. Adults should aim to get seven to nine hours of sleep each night.
“Fertility is really affected by stress, whether you’re having sex or being inseminated,” says Smith. “Acupuncture can lower stress levels, help with general wellness, boost immune function, and regulate cycles.” It can also help mitigate some of the side effects of fertility treatments—migraines, major bloating, irritability. Although acupuncture might not up your odds of getting pregnant per se—it can’t increase your number of viable eggs, or make you magically fertile at 45—Smith explains that it can “bring blood and chi to the right place—the uterus—and increase endorphin levels for a while.” In some ways, the most vital role acupuncture can play in a woman’s life is to make her slow down and take care of herself. “When people are trying to get pregnant and they’re also busy, busy, busy, this is just another thing they’ve added to their packed schedule. Simply lying down for an hour forces them to take the time to slow down a bit, which is good for the body.”
How soon should I start trying to conceive after stopping birth control?
There’s no reason to wait. But after you come off any kind of hormonal birth control, it takes two to three months before your periods are regular again, explains Brenner. So the real problem with trying to get pregnant right after calling it quits with your hormonal birth control is that you won’t have a clear sense of when your period is coming, meaning you can’t calculate when ovulation will occur. This only means that your chances of actually hitting the mark will be a little lower to begin with. If your periods still aren’t regular after two to three months, there may be a problem. “Sometimes when you’ve been on the pill a long time, it masks a change that’s happened,” Brenner says. “The assumption is that it’s the pill, but it might have happened in conjunction with being on pill and isn’t related.” For example, hormonal birth control can mask the release of too much prolactin, or you could have developed polycystic ovary syndrome (PCOS) that went undetected while you were taking hormonal birth control.
Speaking of PCOS…
PCOS is a hormonal disorder that affects between 4 and 20 percent of women of reproductive age. It impacts the length and frequency of a woman’s period, her hormone levels, and the ability of her ovaries to release eggs. Although it is only one possible side effect of many, PCOS can (Can! Not will!) lead to infertility. Although there’s no one test to confirm that a woman has PCOS, a doctor will do a thorough exam and take a comprehensive history—sometimes talking about issues and symptoms that date back to the beginning of puberty. Basically, PCOS is a problem with the follicles, that is, the egg sac, not the eggs themselves, and the body’s ability to regulate the hormones that enable pregnancy to happen. In terms of fertility-forward treatments for PCOS, if your doctor detects a problem, she may prescribe Clomid or Letrozole to boost your follicle-stimulating hormones. In other words: Yes, you can get pregnant with PCOS, it just might take some additional help and time.
How do I know if there’s a problem?
“If you’re at or below 28 to 30 years old, most pregnancies occur within three to four cycles,” explains Brenner. “In a textbook you’ll read that ‘infertility’ is when you’ve been trying for a year with regular periods and there’s still no pregnancy. That doesn’t apply for a younger person because it should have happened before then.” Someone over the age of 39, however, should not wait a year before seeing a doctor, he advises. If you have regular periods and have been trying to conceive for six months, it’s time for an evaluation. This doesn’t mean something is necessarily wrong, but time is not on your side and it’s best not to wait. When a patient comes in for an evaluation, Brenner begins with non-invasive testing: He draws blood, performs a sonogram, and does a semen analysis if a male partner is part of the equation. If all of that looks normal, he makes sure a woman’s fallopian tubes are open. Brenner also checks the quality of male partners’ sperm—is it absent or are there only a few sperm? If no sperm are coming out, are any being produced? (Sometimes sperm sits in the testes, not coming out in the ejaculate.) Smith concurs with Brenner when it comes to the importance of male testing—often all the stress and blame that piles up when a couple isn’t conceiving is put on the woman when it turns out to be a problem with their male partner’s reproductive health.
Is my age really an issue when it comes to my odds of conceiving?
Yes, yes, yes. “Many women are not aware of the influence of age on fertility,” says Brenner. “It’s surprising how often I see somebody whose OB has said that if you’re having regular periods, everything is fine, but in fact things can change even if you’re having regular periods.” In other words, it’s impossible to circumnavigate biology and genetics. Women are most fertile before age 25, but stay pretty fertile up to age 34 according to a Parents article featuring contributions from Alan Copperman, MD, the director of Reproductive Medicine Associates of New York. If you conceive after that, you’re considered to have what the medical community refers to a geriatric pregnancy. After 35, female fertility declines, with your chances of conceiving decreasing significantly every year and dwindling in your forties. The reason for this is that egg quantity and quality goes down as women age—so while someone might still have a lot of eggs, up to 90 percent of them are chromosomally abnormal in their forties according to Copperman. “As an acupuncturist, the lion’s share of my patients were women who’d never had children and were in their forties and wanted to conceive,” Smith explains. “They’d been chasing their careers, and were now literally putting all their eggs in one basket and trying everything at the same time. That’s super stressful.” Smith saw much of her job as educational. “I used to call it sex camp,” she jokes. She’d hand out charts and explain about timing intercourse, which alarmingly few women she worked with knew how to do. And as for a second pregnancy in your forties? “Somebody who has had no problem getting pregnant in the past has a better chance of having no problem in future,” says Brenner, “but that’s all, of course, related to age.”