When making a concerted effort to get pregnant, an understanding of basic reproduction can help couples have more success.  In order for pregnancy to occur, there must be an egg from the mom and sperm from the dad in the fallopian tube of the uterus at the same time.  Once the egg and the sperm combine, that newly formed zygote has to be able to get into the womb in the interior of the uterus and implant into the wall of the uterus.

Sounds simple enough, but the synchronized hormonal signals necessary to stimulate the production of an egg, release of that egg, and to prepare the uterus to receive a pregnancy can be a disrupted in some women.  In other women, there may be a blockage in the passage from the fallopian tube to the interior compartment of the uterus which may prevent sperm from getting to the egg or the zygote from getting into the uterus to implant and grow.  There is a high attrition rate for sperm as they navigate through the vagina, cervix, uterus, and finally the fallopian tube to meet the egg.  While only one sperm is necessary to impregnate an egg, about 20 million are needed to have decent odds of getting one survivor to the finish line.  In some men, the quantity of sperm may be low or the sperm might not be hearty enough to survive the journey to the egg in the fallopian tube and be able to penetrate its shell.  In some couples, there may be more than one impediment to the usual mechanism of making a baby and in other couples, the cause of infertility is not easily identifiable and getting pregnant may be difficult even when everything appears normal with ovulation, passageways, and the sperm.

The Basics of Baby-making

All women not using birth control and having sexual intercourse should be regularly taking a prenatal vitamin with 400 mcg of folic acid.  It does not have to be a fancy or expensive kind.  In the event of an unanticipated pregnancy, appropriate folic acid stores are crucial to the development of the brain and spinal cord of the baby in the first three weeks after conception.  Most women do not know they are pregnant yet at this time.

Women wanting to conceive should stop smoking, be eating a healthy diet, and should be regularly exercising.  While it is not necessary to be at your ideal weight or peak level of fitness, carrying extra weight can have negative effects on ovulation and being overweight and out of shape makes pregnancy more difficult and sometimes more complicated.  Work on getting any chronic medical conditions like hypertension, thyroid dysfunction, or diabetes under optimal control.  Discuss your intention to get pregnant with your doctors and make sure any prescription medications are appropriate for use in early pregnancy.  Sufficient sleep and strategies to manage and decrease stress are also important.  Ideally, sex should not become a chore or part of a to-do list.  Sometimes, that is unavoidable when schedules are tight, but be mindful that no partner wants to feel like he/she is being used for their reproductive contribution.

Women should begin tracking their menstrual cycles.  There are plenty of calendars and apps to discretely document this.  The first day of menstruation is called day 1 and counting proceeds until the first day of menstruation of the following cycle, which resets the clock.  Women with irregular bleeding or bleeding between their periods should document amount of flow and associated premenstrual symptoms.  In women with regular, predictable menstrual cycles between 22-35 days, it is pretty safe to assume you are ovulating (releasing an egg) regularly. Ovulation typically occurs about 14 days prior to the onset of the menses.  You can see that sometimes using the menstrual cycle to predict ovulation can be challenging because we only know exactly when ovulation occurred by looking back once the menses starts.  The egg only lives for 24 hours after it is released whereas sperm can survive for about 72 hours after ejaculation.  This means the five days preceding release of the egg and the day of ovulation are the couple’s greatest opportunity for getting pregnant if they have intercourse within this “fertile window”.

Couples can have sex every other day the week before expected ovulation.  For more certainty about ovulation, a woman can check her temperature every morning before getting up and active.  There is a 0.4-0.8 degree Fahrenheit increase in basal temperature when ovulation occurs.  With this method, you identify the last day of the fertile window, so make a date for sexual intercourse that day.  There are also a variety of over-the-counter ovulation predictor kits that help predict ovulation by detecting a rise in a hormone called luteinizing hormone in the urine.  Ovulation usually occurs within 14-26 hours of detecting this surge but definitely within 48 hours.  Couples should have intercourse on the day of the surge and the 2 days after to maximize the fertility window.

Of course, without doing any elaborate planning about 85% of couples who are regularly having sex without birth control will get pregnant within a year. However, if you have your partner have not been using contraception for awhile and hoping to get pregnant and it’s not happening easily on its own, it may be time to see your ob/gyn for an evaluation.  We can guide you through the work-up, offer advice to maximize your success on your own, and can add treatment for infertility as needed.

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