With all the effort you may have put into preventing pregnancy over the years, it probably feels like conceiving should be the easy part. That’s not always the case. Many couples find that getting pregnant is a lot more complicated than they anticipated, which can raise a lot of questions. If you’re wondering why you haven’t gotten pregnant yet (and what you can do about it), you’re in the right place. Below, we answer frequently asked questions about getting and staying pregnant.
When you’re trying to get pregnant, you’ll have the best chance of success if you have sex when you’re most fertile. The first step to figuring out when you’re fertile? Pinpointing when you ovulate (1). To do this, you’ll need to familiarize yourself with the following 3 key signs of fertility:
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Cervical mucus (CM) is a fluid that’s produced by your cervix. Throughout your menstrual cycle, CM changes in color, consistency, and quantity. Right after your period, CM is usually dry or sticky. As you approach ovulation, it becomes more clear, watery, and slippery (2, 3). After ovulation, CM dries up again and stays that way until the end of your cycle (4).
To track your CM, you can use toilet paper or a clean finger to wipe across your vagina from front to back. Observe the color, consistency, and quantity. Try rubbing the CM between your thumb and forefinger, noticing what the sensation feels like. Record your observations every day, using words like dry, sticky, stretchy, and watery to describe what you see (3). CM phases look different for everyone, and it may take you a few cycles to recognize what your peak CM days look like.
There are 2 types of temperature tracking that may help you determine when you ovulate: basal body temperature (BBT) and continuous core body temperature (CCBT). BBT is your temperature when your body is fully at rest. It can be used to confirm ovulation after it’s happened. CCBT, on the other hand, is your body’s internal temperature. Since it is a more sensitive measurement, CCBT can be used to both predict and confirm ovulation (5, 6).
If you’re ovulating, your temperature will go through 2 phases each menstrual cycle. Before ovulation, in the follicular phase, your temperature will be lower. After ovulation, temperatures rise by about 0.5–1 degrees Fahrenheit and stay elevated until the end of your cycle (5). This is called a biphasic pattern and you might be able to see this distinct temperature difference when looking at your temperature chart. If you’re measuring CCBT, you may notice a slight dip in your temperature about 2 days before you ovulate — which also happens to be when you have the highest chances of getting pregnant (1, 6).
To track your BBT, you’ll need a thermometer that measures your temperature to at least a tenth (that’s two decimal places) of a degree. Use it to take your temperature every morning immediately after you wake up — before you get up, take a drink of water, talk to your significant other, or do anything else. Record your temperature each day (5). Apps like Kindara can graph your BBT data for you and make it easier to recognize the 2 phases of your cycle.
To track CCBT, you’ll need an internal temperature sensor, such as the Priya intravaginal sensor. You’ll insert the sensor in the comfort of your own home, pair it with the mobile app, and then let the technology do all the work for you. The Priya Fertility System will give you continuous measurements of your core body temperature, and its proprietary algorithm will interpret the data to pinpoint your fertile window.
Your pituitary gland produces a surge of luteinizing hormone (LH) about 12–24 hours before you ovulate. This rise in LH is what tells your ovary to release a mature egg (7, 8). At-home ovulation predictor kits (OPKs) can help detect the LH surge that precedes ovulation (7).
Start using OPKs a few days before you expect to ovulate. The more days in a row you take the test, the more likely you are to detect your LH surge. However, LH is released in short bursts, so it’s possible to miss it if you’re only testing once a day. If you don’t get a positive test result for 2 or more cycles in a row, try testing more than once per day, but it may be a sign that you’re not ovulating and you should talk to your doctor (7).
Once you start recognizing the fertility signs we discussed in Question 1 —cervical mucus (CM), basal body temperature (BBT) or continuous core body temperature (CCBT), and luteinizing hormone (LH) — you can use them to figure out when you’re fertile. Your fertile window is defined as the 6 days each cycle that unprotected sex could lead to a pregnancy, and it’s determined by a few factors, including the lifespan of the egg and sperm, your CM, and the day you ovulate. If you don’t have unprotected sex during this 6-day period, your chances of getting pregnant are virtually zero (10).
For you to get pregnant, a healthy sperm must fertilize the egg within 12–24 hours after you ovulate. Thanks to fertile CM, sperm can survive for up to 5 days in the female reproductive tract (11, 12). For the best chances of conceiving, aim to have unprotected intercourse everyday or every other day during your fertile window. It is especially important to have intercourse around 2 days prior to ovulation (1). This helps ensure that sperm are ready and waiting in the fallopian tube when the egg is released (13).
It may take a few cycles to learn to recognize your fertile window, but it’s well worth the effort to increase your chances of getting pregnant. Fertility tracking apps like Kindara can help you record your observations about the changes in your fertility signs (including BBT and CM) throughout your menstrual cycle. Once you know when you’re about to ovulate, you can plan to have sex during your fertile window to give yourself the best chance of conceiving.
Charting your fertility signs (think: cervical mucus, luteinizing hormone, and waking temperature or continuous core body temperature) to pinpoint your fertile window is one of the best things you can do to increase your chances of getting pregnant (14, 15). However, it’s not the only thing that can help you give yourself a better chance of conceiving. Factors like weight, exercise, nutrition, stress, and lifestyle may all impact your chances of getting pregnant.
Being overweight or underweight may affect reproductive function and reduce fertility in females and males (16). Fortunately, even small steps towards a healthy weight can improve your overall health and help prepare you for a healthy pregnancy (17).
A regular exercise routine can help your body get stronger, healthier, and more ready to take on the physical demands of pregnancy. Moreover, moderate exercise has been shown to improve fertility in all women, even those already in the “healthy” weight range (18).
There’s a lot of recommendations out there on which foods to eat and avoid while trying to conceive, but the most important advice is also the simplest: eat a nutritious, balanced diet to improve your fertility and overall health (19). Not sure what that means? Check out this post on the backed-by-science diet to increase fertility. It’s also a good idea to avoid refined sugar and processed foods whenever possible (20, 21).
It may sound like a tall order, but managing your stress levels should be a priority when you’re trying to conceive. Stress has been shown to negatively affect fertility in both women and men (22, 23). Exploring relaxation techniques, such as meditating, taking daily walks, and deep breathing, may help lower stress levels and promote calmness (24, 25).
Other lifestyle factors that may be negatively affecting your fertility include (26):
According to the American College of Obstetricians and Gynecologists (ACOG), if you’re under 35, plan on getting an infertility evaluation if you’re unable to get pregnant after 1 year of trying. If you’re 35 and older, only try for 6 months before seeing a fertility specialist, and if you’re 40 and older, see a doctor even sooner (27).
You may want to see a fertility specialist sooner if you or your partner have (or think you may have) any of the following conditions (27):
During your fertility evaluation, your doctor will look at your comprehensive medical history, give you a physical exam, and suggest tests to assess your reproductive health. For women, these tests will mainly focus on ovarian reserve, ovulatory function, and structural abnormalities in the uterus or fallopian tubes. Men can typically expect to undergo a complete semen analysis to give the doctor a picture of their sperm health (27).
This appointment is also your chance to get answers to all of the questions you have about trying to conceive. Don’t be shy! Ask your fertility specialist about anything that’s been on your mind during this journey. Whether or not your doctor finds a definitive cause of your infertility, they’ll be able to advise you on your options and the different paths you may take to conceive.
When you’re having sex based on the timing of your fertile window instead of your sex drive, it’s perfectly normal to lose a little heat in the bedroom. Fortunately, there’s some leeway in the timing of intercourse when you’re trying to conceive. While there’s a small drop (2%) in your chances of getting pregnant when you go from having sex every day to every two days, there’s there’s no reason not to give yourselves a day off when you need it (10). If having sex every other day matches up better with your sex drives, then do it!
Some research suggests that it’s actually better to have sex every other day during your fertile window if your partner’s sperm count is low. The idea is that the days off will give their sperm count time to replenish between ejaculations. However, in some men with low sperm count, having sex every day may be the key to peak sperm quality (28).
If your partner has a low sperm count, there’s no benefit to abstaining from ejaculation for more than a day. There’s no such thing as “saving up” sperm (28). In fact, abstaining for 2 or more days may cause sperm to have poorer health and move less effectively. For the best sperm quality and motility (and highest chances of conception), your partner should ejaculate at least 3 or 4 times a week (10, 28).
There’s also some research to suggest that having sex outside of your fertile window may improve your chances of conceiving. Sexually active women may see an increase in humoral immunity, which may help cause changes in your body to prepare it for pregnancy (29). Plus, sex outside of the fertile window gives you and your partner a chance to connect and get intimate without the pressure of trying to get pregnant. Trying to conceive can be stressful, but you and your partner deserve to enjoy the journey!
Once you and your partner start seeing a fertility specialist (for when to do this, see Question 4), they may recommend different medications to increase your chances of conceiving. One of the most common fertility drugs prescribed in the U.S. is clomiphene citrate (Clomid®). Clomid works by causing the pituitary gland to secrete more follicle-stimulating hormone (FSH), which stimulates the growth of eggs in the ovaries (30).
For those who aren’t ovulating regularly, Clomid can help induce ovulation. For those who are already ovulating regularly, Clomid may increase the number of eggs released each cycle and increase the chances of conception. Clomid is often combined with intrauterine insemination to increase the procedure’s chances of success (30).
Other fertility medications include:
Letrozole: Like clomiphene, letrozole increases the odds of ovulation by telling your body to produce less estrogen and more FSH. It can also be used to increase the number of eggs released each cycle. Letrozole may work better for women who aren’t ovulating regularly — often a symptom of polycystic ovary syndrome (PCOS) — and it’s mostly used for in vitro fertilization (30, 31).
Gonadotropins: Given by injection, gonadotropins contain FSH and are used to directly stimulate the ovary to induce ovulation. This medication may come with a higher risk of multiple births than other fertility drugs (31).
Metformin: If your doctor suspects that insulin resistance is contributing to your infertility, they may suggest Metformin to help control your blood sugar (31). However, there are other, more natural ways to improve insulin sensitivity, such as dietary changes, exercise, and inositol supplements (32).
Before you start taking fertility drugs or supplements, talk to your doctor about potential side effects and risks, such as pregnancy with multiples and ovarian hyperstimulation syndrome (31).
If you’re trying to increase your fertility, the lifestyle changes discussed in Question 3 are a great place to start. Beyond that, you may also want to consider increasing your daily intake of vitamins and minerals. Just make sure that you talk to your doctor before taking any new supplements. Some supplements that may boost your fertility include:
Folate: This type of B vitamin may help you get pregnant and stay pregnant. Research has found that taking a multivitamin with folate may lower your risk of ovulatory infertility, increase your chances of ovulating regularly, and help you get pregnant faster (33, 34). For the best chance of absorbing the folate in your supplement, look for a multivitamin with folate or methyl-folate, and avoid folic acid (35).
Vitamin C: If you have a short luteal phase (the time between ovulation and the start of your next period), taking vitamin C supplements may increase your likelihood of conceiving, according to a study in Fertility and Sterility (36).
Vitamin D: Women with polycystic ovary syndrome (PCOS) may benefit from taking vitamin D supplements, according to a paper in Clinical Endocrinology. In this paper, researchers suggest that vitamin D may help reduce PCOS symptoms and increase a woman’s chances of a successful pregnancy (37).
Coenzyme Q10 (CoQ10): CoQ10 is an antioxidant produced naturally by the body that helps with cell growth and maintenance (38). Recent research has found that this supplement may improve ovarian response in women with decreased ovarian reserve undergoing in vitro fertilization (IVF) or intrauterine insemination (IUI) (39, 40). More research is needed to determine how CoQ10 affects women with average ovarian reserve and those trying to conceive naturally.
Acetyl L-carnitine (ALC) and L-carnitine (LC): Acetyl L-carnitine (ALC) and L-carnitine (LC) are antioxidants that may improve female fertility, especially in women with conditions such as PCOS, endometriosis, and amenorrhea (skipped or absent periods) (41).
Your body absorbs nutrients best when they’re delivered through the food you eat. However, dietary supplements can help you fill in any gaps between the nutrients you need and the nutrients you get from your diet (42). Work with your doctor to choose which dietary supplements to take for a boost your fertility and a healthy pregnancy.
Women tend to be the most fertile in their late teens and 20s, according to the American College of Obstetricians and Gynecologists (ACOG) (43). Female fertility starts declining gradually around the age of 32 and more rapidly around age 37 (44). This decline in fertility is perfectly natural and is caused by age-related declines in the quality and quantity of the eggs. As you get older, your ovarian reserve gets smaller, meaning that you have fewer eggs available for ovulation (45).
Your chances of ovulating a healthy egg also decrease as you age. In your early 30s, about 40% of your eggs may have chromosomal abnormalities (up from 25% in your 20s). In your early 40s, as many as 75% of your eggs may have chromosomal abnormalities. Most women have ovulated their last viable egg by age 45 and are essentially infertile, even if they’re still having periods (46, 47).
Male fertility may also decline with age, though it’s not talked about as often as age-related declines in female fertility. As men get older, their testes become smaller and softer, which may cause them to produce less healthy sperm (45). According to a meta-analysis that looked at research data from 93,839 men, age may decrease semen volume and sperm movement and negatively affect sperm shape and size (48).
However, it’s worth noting that age isn’t the only factor that determines your fertility. Many women are able to conceive naturally in their 30s. Caring for your overall health and learning to pinpoint your fertile window (see Question 2) can help you increase your chances of getting and staying pregnant.
At-home fertility tests can measure your levels of different hormones and give you insight into your reproductive health. They may help you learn about your ovarian reserve and alert you to any conditions, such as thyroid disorders or PCOS, that could make getting pregnant more difficult.
Typically, these fertility tests measure one or more hormones in a sample of your urine or blood. Hormones that are commonly measured in at-home tests include:
These hormones all have the power to impact your fertility in one way or another. The company that makes your at-home test should give you information on interpreting your results and understanding what they may have to say about your fertility.
With prices ranging from $40 to $200, at-home fertility tests may be cheaper than a visit to the doctor (depending on your insurance). However, they do have their limitations, and they aren’t a substitute for getting healthcare from a medical professional. Once you get results, you’ll still need help — from your physician or someone who works for the testing company — to understand what your hormone levels mean for your fertility. These tests can’t provide diagnoses or help you figure out the next steps to increase your chances of conceiving.
Note: At-home fertility tests are different from fertility sensors (such as Priya) and ovulation predictor kits (OPKs). They help you get a snapshot of different factors that may affect your overall fertility, while sensors and OPKs are designed to help you find your fertile window by figuring out when you ovulate each cycle.
When you’re trying to get pregnant, timing is everything. Your fertile window — the day of ovulation and the 5 days preceding it — is the only time you can conceive during each cycle (49). Figuring out when it happens is one of the most important things you can do to increase your chances of getting pregnant.
You’re most fertile in the 2–3 days before you ovulate (1). If you’re charting your fertility signs each cycle, cervical mucus (CM) observations, ovulation predictor kits (OPKs), and continuous core body temperature (CCBT) measurements can be used to estimate when you’re close to ovulating (2, 6, 7). Basal body temperature (BBT) and CCBT measurements can also confirm ovulation after it happens (5, 6). However, there are drawbacks to some of these techniques:
While CM charting is free and a powerful way to understand your fertility, changes in CM can be difficult to interpret. Sometimes, you may not realize you’ve reached peak fertile CM until after you’ve ovulated and you see it start to dry up again (4). Your body may also produce fertile CM in an attempt to ovulate, but not actually ovulate. To confirm ovulation occurred, and therefore pregnancy is possible, temperature or ultrasound are the two current options (4, 50).
OPKs work by detecting the LH surge that happens only 12–24 hours before ovulation (7). By this point, you’ve missed the most fertile days of your cycle (1). Plus, since LH surges can be extremely variable (aka when the surge occurs can vary a lot), it’s possible to miss your LH surge completely if you don’t test often enough or at the right time (7).
BBT is typically an inexpensive method of ovulation confirmation, but that information isn’t very helpful for planning to have sex during your fertile window. Charting your BBT requires a commitment that just isn’t feasible for some people — taking your temperature at the same time every morning immediately after you wake up. BBT data can also be influenced by external factors such as medication, irregular sleep schedules, and alcohol consumption (51).
CCBT is one of the most advanced measurements of the fertile window to both predict and confirm ovulation. CCBT, however, does require inserting a vaginal sensor, which may not work for those who are not comfortable with vaignal product, such as tampons or menstrual cups.
If you need additional help pinpointing your fertile window, the Priya Fertility System may be able to help. By monitoring your continuous core body temperature (CCBT) instead of BBT, Priya identifies subtle temperature patterns that occur before ovulation. This allows you to plan to have sex on the days when you’re most fertile (1, 6).
The key to figuring out when you're fertile is to study your fertility charts over time. The longer you observe your fertility patterns, the easier you’ll be able to recognize what your chart looks like when you’re approaching ovulation.
Going from trying to avoid pregnancy to trying to conceive (TTC) can be an exciting and scary decision. The first step to preparing to get pregnant is to stop using birth control. If you used hormonal birth control, such as the pill, it might take a few months for your cycles to settle into your normal. However, this doesn’t mean that you can’t (or shouldn’t) get pregnant during this time (52, 53).
Before you start TTC, you may want to talk to your doctor about any lifestyle or medication changes you should make before you get pregnant. (See Question 3 for lifestyle factors that can affect your chances of conceiving.) They may also give you a preconception checkup to look for health conditions that may affect your fertility or your chances of having a healthy pregnancy (54). It’s a good idea to check with your health insurance before this visit to see what (if any) preconception care is covered.
When you’re ready to start trying to get pregnant, you can increase your chances of success by learning to pinpoint your fertile window (see Questions 2 and 10). By charting your fertility signs to estimate when you ovulate, you can plan to have sex in the days when you’re most fertile – the 2–3 days before ovulation (1).
Knowledge fuels the empowered. Read more about trying to conceive in our blog posts below. We do the research so you don't have to.
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