Fertility 101: What’s the Big Deal Behind Fertility

Reviewed by Dr. Lisa Czanko MD, MPH

It’s been about 20 years since that classic Friends episode in which Monica was told she has an “inhospitable environment” and Chandler joked about his sperm getting “off of their BarcaLoungers.” But the reality is that giving yourself the best chance to get pregnant and the problems that some people face are much more nuanced than can be addressed in a 22 minute sitcom.

With about 65% of people of reproductive age using some form of birth control, much of the focus of health education is rightly on preventing pregnancy. But when that desire shifts to wondering how to increase your chances of pregnancy, many people may feel unsure of where to begin. Whether a person is considering pregnancy down the road, actively trying to conceive, or currently exploring assisted reproductive technologies, let’s dive into three important concepts to consider on the fertility journey. 

Your Health

To give yourself the best chance to get pregnant, an important first step is to get as healthy as possible. For people with chronic conditions, this means making sure those conditions are under good control. While many conditions have important implications in pregnancy, two of the most common are diabetes and high blood pressure. People with chronic conditions should speak to a healthcare provider prior to getting pregnant, to ensure they are in the best health possible and to check whether any medications they are taking are safe during pregnancy. 

Another important step in promoting good health is to ensure that general health screenings are up to date. When ready to start trying to conceive, it is a good time to schedule a preconception counseling visit with a gynecologist or primary care provider. Some conditions they may look for include diabetes, high blood pressure, thyroid disease, HIV and other STDs, and a history of blood clots. Knowing any health issues upfront is key to learning how to increase your chances of pregnancy. 

Besides optimizing physical health, it is also important to focus on good mental health prior to embarking on the fertility journey. Pregnancy and the postpartum period are times when conditions such as depression and anxiety may worsen. Having a good treatment plan before getting pregnant will go a long way in helping to ensure symptoms remain well controlled. Treatments may include therapy, meditation, journaling, and/or medications. There are medications that may be taken during pregnancy and while breastfeeding. It is important to speak to a healthcare provider about what is best for your individual situation. 

Your Lifestyle

Optimizing health for the best chance to get pregnant extends beyond medical conditions to day-to-day life. Avoiding substances that are known to do harm during pregnancy is important not just while pregnant, but prior to getting pregnant  too. 

Smoking cigarettes is known to be associated with increased risk of miscarriage, preterm labor, and low birth weight, in addition to the numerous problems smoking can cause outside of pregnancy. Although overall the percentage of people who smoke is decreasing over the past decade, about 20% of people of reproductive age still smoke cigarettes. Speak to a health care provider for help quitting smoking before getting pregnant.

Regarding that nightly cocktail, there is no safe level of alcohol use during pregnancy, and alcohol use while pregnant is associated with abnormal brain development, growth defects, and mental impairment that can have a lifelong effect. For people who are struggling with cutting down or quitting, it’s important to speak to a healthcare provider for help prior to getting pregnant.

About 2-5% of people use marijuana during their pregnancies. While the long term effects are still unclear, smoking marijuana during pregnancy may be associated with low birth weight and impaired mental development. As a result, it is recommended to avoid marijuana during pregnancy and when trying to conceive. Other recreational drugs should be avoided as well.

The benefits of a well-balanced diet and active lifestyle are important in pregnancy and beyond. The American College of Obstetricians and Gynecologists recommends 30 minutes of moderate activity per day three to four times a week when trying to conceive and during pregnancy.

Dietary changes such as avoiding trans fats and reducing complex carbohydrate intake may help with fertility problems caused by underlying conditions such as polycystic ovarian syndrome. Starting a prenatal multivitamin with at least 400 ug of folic acid daily prior to getting pregnant is important for early fetal development, but no other “fertility” supplements have been shown to be helpful across the board.

Your Body

When trying to conceive, this is a great time to get familiar with your normal menstrual cycle and learn about your body. Many people choose to track their periods; there are apps and calendars for this purpose. Knowing more about your cycle will empower you with the best chance to get pregnant.

Ovulation typically occurs about 2 weeks before the period starts. Once the egg comes out of the ovary, it lives for less than 24 hours. As a result, the best time to have intercourse to get pregnant starts about five days prior to ovulation and ends on the day of ovulation. This is because sperm can live inside of the reproductive tract for up to five days. During this “fertile window” having intercourse every one to two days is ideal.

Some people choose to get ovulation tests over the counter to help determine when they produce an egg and learn how to increase their chances of pregnancy. These tests detect a surge in luteinizing hormone, which spikes just before ovulation. When this test is positive, that is an indicator to have intercourse as this is the most fertile time in the cycle. 

For anyone considering embarking on a fertility journey, it is a great time to see a health care provider to make sure health screenings are up to date, medical conditions are controlled, and to address any questions or concerns you have about conceiving and pregnancy.

Citations

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Centers for Disease Control and Prevention. National Diabetes Statistics Report 2020. US Department of Health and Human Services. Updated 2020. Accessed January 23, 2022. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf

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