When you decide you are ready to start a family, it can be an exciting but also an overwhelming time. For some, the decision to conceive is followed swiftly by a pregnancy, for others, it can be a long struggle with infertility. Whether you are just starting to plan for conception or you have been trying for a long time, there are some important things to consider. This is not an exhaustive or personalized list, but here are 5 important things to consider for anyone who is trying to conceive.
- Timing of intercourse
- Timing of ovulation
Timing of Intercourse
From early on in our lives, the focus of education of the reproductive systems for women is around menstrual pads and birth control. Women and men are led to believe that a woman can conceive throughout her whole cycle. There is little discussion on how the reproduction cycle works and many of the women I see do not have a great understanding of their cycles. It is important to understand when in her cycle a woman is most fertile, as correctly timing intercourse is integral for pregnancy to occur. Timing is based on the female cycle because fertile men have a consistent sperm production all month long. Women, however, only release an oocyte (egg) once per cycle. In a normal menstrual cycle, lasting 28 days, ovulation is assumed to occur on day 14.* This textbook cycle timing, however, does not always occur, but more on that below! For simplicity though, let’s start there. So, based on a 28-day cycle with ovulation (egg release) on day 14, here are three important facts to understand:
- the oocyte is only viable for 24-48 hrs after ovulation
- sperm can live in the female reproductive tract for 3-5 days
- the closer to ovulation intercourse occurs the greater the chance of conception
Therefore, there is a 7-day fertile window per cycle and that window precedes ovulation. In this textbook cycle that would be cycle days 9-16. Now there are many apps that can help you track this, but the most important thing to note here is that there is the greatest chance of conceiving if intercourse occurs on ovulation day. As such, the general recommendation is to have intercourse every other day during the fertile window and always ensure intercourse on the day of suspected ovulation.
*when dating a menstrual cycle day 1 is always the first day of bright red blood.
Timing of ovulation
Many women choose to track their menstrual cycles using an app. These apps often offer predictions of menses and ovulation. In many cases, for women with regular cycles, the algorithms used are correct in their predictions. However, there are occasions where the day you started and ended your period is not enough to accurately predict ovulation timing. We know intercourse on the day ovulation occurs has the greatest chances of conception, thus we want to be as accurate as possible in calculating ovulation date. In order to accurately predict ovulation there are several tools I recommend. First and foremost, you must be tracking your cycles. If your cycles are regular, then predicting ovulation become much easier. Second, I recommend patients use Ovulation Predictor Kits. Ovulation predictor kits test the LH hormone in urine. This hormone spikes prior to ovulation occurring. Once you get a positive test on an Ovulation Predictor Kit, you will most likely ovulate within 12-36hrs. This is important to track as it may or may not match up with your period app. Finally, using ovulation predictor signs like cervical mucus changes, cervix position, and basal body temperature help to identify more accurately your ovulation day. For more information on these fertility signs, I recommend the book “Taking Charge of your Fertility” by Toni Weschler.
Healthy thyroid function is integral to part of fertility in men and women. In men, an underactive thyroid may cause low libido and low sperm count. In women, hypothyroidism can affect ovulation and therefore reduce chances of conceiving significantly. In addition, women with hypothyroidism have an increased risk of miscarriage and pregnancy complications. The ideal thyroid-stimulating hormone (TSH) range for women attempting conception has not been determined however the current recommendations include optimizing the preconception TSH value to ≤2.5 mIU/L, which is the established goal for pregnant women.(1) In my practice, I recommend thyroid investigations be run on both partners who are trying to conceive or considering trying to conceive to ensure not only satisfactory but optimal thyroid levels for conception and healthy pregnancy.
Alcohol consumption is a common habit among men and women. Many studies evaluating the effects of alcohol in men have shown a negative impact on the sperm parameters and a reduction in testosterone. However, other studies have shown no correlation between male alcohol consumption, sperm health and pregnancy outcomes.(2) As the jury is still out for men, I think it is prudent to keep to a low to moderate alcohol consumption for male partners with no known sperm parameter concerns. For women, avoiding alcohol while trying to conceive may improve outcomes. It has been demonstrated that for women, even moderate alcohol use (approximately 1 drink per day) can negatively impact fertility.(3)Another study showed that there was greater than a 50% reduction in the probability of conception during a menstrual cycle during which participants consumed alcohol.(4)Once pregnancy is achieved there is no safe limit determined for alcohol consumption and as such the recommendation is to abstain for all alcohol.
In recent years, sleep is being implicated in idiopathic (undiagnosed) infertility. Sleep is a critical component to health and well-being, and as such likely has a significant impact on fertility. It has been shown that, overall, female and male fertility, as well as in vitro fertilization (IVF) outcomes may be affected by short sleep duration, evening chronotype (those who have a propensity to stay up late), or shift/night work schedules.(5) Further research has determined that undisrupted sleep and circadian rhythmicity appear to optimize fertility and early pregnancy outcomes and may play an important role in the success of fertility treatment.(6) Optimal sleep times are person dependant, but the average person requires 7-8 hrs of sleep per night and benefits from maintaining a consistent sleep and wake rhythm. There are a variety of health reasons beyond fertility to ensure you are getting sufficient sleep so go and catch some Zs..
- Green, K. A., Werner, M. D., Franasiak, J. M., Juneau, C. R., Hong, K. H., & Scott, R. T., Jr (2015). Investigating the optimal preconception TSH range for patients undergoing IVF when controlling for embryo quality. Journal of assisted reproduction and genetics, 32(10), 1469–1476. https://doi.org/10.1007/s10815-015-0549-4
- de Jong, A. M., Menkveld, R., Lens, J. W., Nienhuis, S. E., & Rhemrev, J. P. (2014). Effect of alcohol intake and cigarette smoking on sperm parameters and pregnancy. Andrologia, 46(2), 112–117. https://doi.org/10.1111/and.12054
- Grodstein, F., Goldman, M. B., & Cramer, D. W. (1994). Infertility in women and moderate alcohol use. American journal of public health, 84(9), 1429–1432. https://doi.org/10.2105/ajph.84.9.1429
- Hakim, R. B., Gray, R. H., & Zacur, H. (1998). Alcohol and caffeine consumption and decreased fertility. Fertility and sterility, 70(4), 632–637. https://doi.org/10.1016/s0015-0282(98)00257-x
- Caetano, G., Bozinovic, I., Dupont, C., Léger, D., Lévy, R., & Sermondade, N. (2021). Impact of sleep on female and male reproductive functions: a systematic review. Fertility and sterility, 115(3), 715–731. https://doi.org/10.1016/j.fertnstert.2020.08.1429
- Mills, J., & Kuohung, W. (2019). Impact of circadian rhythms on female reproduction and infertility treatment success. Current opinion in endocrinology, diabetes, and obesity, 26(6), 317–321. https://doi.org/10.1097/MED.0000000000000511