What you need to know about fertility, infertility, and trying to get pregnant

Written by Bryonna Mathews, MS, CNM, WHNP-BC, RN

The truth about trying to get pregnant is that it may not happen immediately for most people — and many people in the U.S. experience trouble conceiving and staying pregnant. While conception will likely happen within a year of trying for the majority of people, for many others, the path to parenthood may involve fertility treatments, gestational carriers, or adoption. That’s a really important reality to know and normalize, but it’s also important to know there are things you can do to have the best chances of conceiving.

Here is what I, a Certified Nurse-Midwife at Millie, tell my patients about the preconception phase and the process of trying to get pregnant.

What’s important to know about fertility

Fertility refers to the ability to conceive and have offspring. There’s an expected decline in fertility as people get older because of drops in egg quantity (ovarian reserve) and egg quality. The American Society for Reproductive Medicine (ASRM) estimates that people in their 30s have about a 20% chance of getting pregnant each cycle, and that people in their 40s have about a 5% chance per cycle — but that is based on averages, not what can happen for the individual. 

(Because fertility declines over time, some people may choose to freeze their eggs to preserve the quantity and quality they’re able to retrieve at a younger age for more options in the future.) 

What’s important to know about infertility

Infertility refers to a state in which the capacity for fertility is diminished, but not necessarily absent. Some studies suggest that approximately 1 in 8 couples experience infertility, which is clinically diagnosed if someone under 35 doesn’t get pregnant after 12 months of trying or someone over 35 doesn’t after six.

So, what can cause infertility? Here are some of the more common factors that can get in the way of conception:

‍1. Issues with ovulation: An egg needs to be released before it can be fertilized by sperm. When there are challenges with ovulation, that can make it harder to get pregnant. These challenges may include irregular menstrual cycles in general, no periods or ovulation at all, or conditions that can disrupt ovulation like polycystic ovary syndrome (PCOS), thyroid disorders, or hyperprolactinemia.

‍2. Issues with ovarian reserve: Ovarian reserve is egg quantity. Having an issue with ovarian reserve doesn’t mean you can’t get pregnant without fertility treatment (you only need one egg!), but it might make it a little harder. These issues can be because of conditions like diminished ovarian reserve or primary ovarian insufficiency.

‍3. Blocked fallopian tubes: Traveling through the fallopian tubes is an important step in fertilization and conception without fertility treatment. Sometimes, though, there’s blockage in one or both of the tubes. A common cause of this is pelvic inflammatory disease (PID), which untreated sexually transmitted infections (STIs) can result in.

‍4. Uterine malformations: This refers to abnormalities in the uterus (where a fertilized egg implants to start a pregnancy) that can be associated with infertility, like polyps, fibroids, adhesions, or endometriosis.

‍5. Male-factor infertility: The sperm side of the equation contributes to 30-40% of infertility cases. This primarily has to do with “abnormal” semen parameters (e.g., low sperm count, low motility, abnormal shape, etc.) as detected semen analysis.

Infertility can also be “unexplained,” which means infertility evaluation hasn’t identified a direct cause.

Getting pregnant when you’re experiencing infertility

People who are dealing with infertility, or those who want to get pregnant on their own or with a partner who doesn’t produce sperm, have options for having biological children:

• Using medications to induce ovulation
• Doing the assisted reproductive technology (ART) procedure intrauterine insemination (IUI), with or without donor sperm
• Doing the ART procedure in vitro fertilization (IVF), with or without donor sperm or donor eggs

Figuring out when to start trying to get pregnant

It takes an estimated 90 days for the developing ovarian follicles (where eggs mature and are released) to become ready for ovulation, so the health of eggs can be greatly influenced by the last three months. I like to encourage my patients to start getting ready for trying to conceive at least three months out so their eggs can potentially benefit from any steps they’re taking to prepare. And one month prior to conception is when the American College of Obstetricians and Gynecologists recommends starting prenatal vitamins with folic acid.

There are some reasons people may want to start preparing earlier than three months in advance of when you ideally want to get pregnant: 

• Menstrual health disorders like irregular periods, heavy periods, painful periods, long/short periods
• Conditions like endometriosis, fibroids, PCOS, thyroid disorders, and autoimmune disorders
• History of pregnancy loss or infertility

If any of the above situations apply for you, it’s a good idea to meet with a fertility specialist before you’re ready to start trying to get pregnant. They can help you understand your options (including the treatments we outlined a little earlier) so you can figure out the best path forward for you.

What you need to know about trying to get pregnant

The most important thing to pay attention to before you start trying to get pregnant is your health and lifestyle. When you’re making the healthiest choices you can, you’re setting yourself for the best odds at conceiving.

I encourage my patients to think about envisioning their potential pregnancy and some of the things they would do for that pregnancy — whether that’s nourishing their bodies with nutrient-dense foods or doing lots of relaxing activities throughout the day.

8 evidence-based ways to optimize your fertility

‍1. If you’re trying to get pregnant through sex, time it around your ovulation window. Appropriately timing intercourse may improve your chances of conceiving. They’re highest during the five days before plus the day of ovulation. You can get a good sense of when ovulation may come next by tracking it through urine tests or fertility awareness methods (like tracking cervical mucus or basal body temperature). Ovulation tracking also allows you to understand your body on a deeper level.

‍2. Stretch, move, walk, do restorative exercises. Movement and exercise are good for you no matter what the reason — and good habits may be associated with a lower risk of irregular ovulation. When choosing the best way to move for you, ask yourself: Am I moving in a way that respects my body and doing things that I enjoy? Find what you love to do to get your blood flowing, like dancing, walking, hiking, biking, lifting, or yoga.

‍3. Adopt well-balanced, nutrient-rich eating. I am a huge proponent of nourishing ourselves through nutrition to optimize our fertility — but diet culture is real, and there's often pressure to lose weight before trying to get pregnant. This is an especially not-good time for dieting; you need to be eating and feel nourished. I recommend making sure you’re having well-balanced meals, breakfast, lunch, and dinner, and snacks in between those. For our fertility and health across the board, eating well-balanced, nutrient-rich meals is really good for us.

‍4. If you smoke, try to quit. Smoking harms fertility, but quitting may reverse some of the damage within a year.

‍5. Get some sun. Vitamin D has been associated with gut health, thyroid health, the immune system, and even improved fertility.

‍6. Reduce your exposure to endocrine disruptors. Endocrine disruptors are toxins commonly found in everything from personal care products to cleaning products to food packaging. Although more research is needed, BPA, phthalates, parabens, and other endocrine disruptors have been linked to many reproductive health issues. 

‍7. Incorporate meaningful practices that help to reduce stress. When your body is in a chronically stressed state, increased cortisol levels can shut down “nonessential” systems like the reproductive system. Getting pregnant can also feel really stressful on its own. I recommend experimenting with mindfulness exercises and seeking out emotional or psychosocial support if you need it to help you keep stress levels as low as possible.

‍8. Get a good night’s sleep. If we aren't getting enough quality sleep, that can affect hormones like estrogen, testosterone, and progesterone — which are all important for fertility — and increase stress hormones like cortisol and adrenaline. Also, in one systematic review that examined the association between sleep and fertility, researchers found that fertility may be affected by short sleep duration or shift/night work schedules. It’s for all of these reasons that I recommend a goal of at least 7-8 hours of sleep per night. 

Above all else, be sure to check in with yourself daily on your journey to conceiving to make sure you're feeling healthy, well, nourished, and supported. Take charge of your fertility and be your own preconception health investigator.

Schedule a preconception counseling appointment

Not everyone knows about the preconception counseling appointment, but it can be incredibly helpful. The goal of the appointment is to meet with a healthcare provider who can help you connect and tune in to what you and your body need as you begin trying to get pregnant.

If you schedule a preconception appointment, here’s what you can expect:

• You’ll discuss your health history, current reproductive health, and learn about the factors that can impact fertility.
• You’ll talk about your reproductive plans and figure out when it is right for you to start trying to get pregnant.
• You’ll get assistance with what’s called “natural” family planning, including menstrual cycle tracking and charting ovulation.
• You’ll learn about nutrition, prenatal vitamins, movement, and other lifestyle recommendations to support fertility.

Book a virtual preconception session with one of Millie’s Certified Nurse-Midwives and take the first step toward building your family!