When we first learn about conception in sex ed, the process often seems deceptively simple: A person with ovaries and a person with sperm have unprotected sex, then voila: a baby is born. But getting pregnant is a lot more complicated than that. For starters, having unprotected sex does not guarantee that a sperm cell and egg cell will meet. And what if your partner doesn’t produce sperm — or you're planning to conceive on your own?
Below, we're diving into what you need to know about trying to conceive — from ovulation-tracking methods to acquiring donor sperm. But before we get into it, here's an overview of what you'll learn:
- If you're thinking about trying to conceive in the near future, you can schedule a preconception appointment with your OB-GYN or a visit at a fertility clinic (if your path to pregnancy could involve one) for all the info you need to get started.
- OB-GYNs recommend that all people who are hoping to carry a pregnancy should start taking a prenatal vitamin with folate (aka methylfolate or folic acid) at least one month before conception.
- Whether you're trying to conceive through sex, with a partner who has ovaries, or on your own, ovulation tracking will likely be part of the process. Measuring luteinizing hormone (LH) in your urine with ovulation predictor kits (OPKs) is one of the most accurate ways you can do that.
- How long you try before seeking out another path to pregnancy depends on your circumstances. If you're trying to get pregnant through sex, the rec is to visit your healthcare provider after 12 months if you're under 35 and six months if you're over 35. If you're working with a fertility clinic, they can help you determine if or when other treatments may give you better chances.
All of this said, adds OB-GYN and Modern Fertility medical advisor Dr. Eva Luo, MD, MBA, "There is only so much you can control. We OB-GYNs are here to answer any questions along the way."
First things first: What's the process of conception?
Here's why conception is a little more complex than sperm meeting up with egg:
- We're born with all the eggs we'll ever have (over one million!) and have approximately 400,000 eggs left by the time we hit puberty. But eggs will only develop enough to be fertilized in the few months before they're released during ovulation. This means that not all eggs are available for ovulation and fertilization every cycle.
- Around ovulation, typically one egg is released from the ovarian follicle it grew and developed in. The egg only has about a 24-hour shelf life by the time it makes its way to the end of the fallopian tube for fertilization.
- If any sperm were waiting around in the reproductive tract before ovulation occurred (they can survive in the female reproductive tract for up to ~5 days) or if they make it all the way to the egg when it's released, fertilization can occur.
- It takes about six days for a fertilized egg to travel down into the uterus where it then implants into the uterine lining — on average, fertilized eggs implant 1-2 weeks after fertilization in the fallopian tube. The implanted embryo can then begin developing and receiving the nutrients it needs to result in a pregnancy.
- Only about 40% of fertilized eggs will implant — though because this data is hard to come by, estimates widely vary.
How can you start trying to conceive (TTC)?
A vital first step is understanding ovulation and why conception can't happen without it. Ovulation is a stage of your menstrual cycle where your hormones relay chemical signals between your brain and your ovaries so one of your ovaries releases an egg each month. Anticipating ovulation is important for anyone who's trying to conceive with their own eggs because your chances of conception get higher the closer you are to that egg's release. (More on this later.)
Here's a quick refresher on what actually happens during ovulation:
- During the follicular phase of the menstrual cycle (which comes before ovulation), the brain releases follicle-stimulating hormone (FSH) — causing multiple follicles in your ovaries (which house and develop eggs) to mature.
- Only one follicle matures an egg enough for it to be released into the fallopian tube. That follicle produces estradiol, which is an estrogen.
- The estradiol in this mature follicle cues the brain to increase production of luteinizing hormone (LH).
- LH cues the follicle to grow bigger in size until it eventually ruptures, releasing the egg. (Ovulation is that egg's release.)
- The fallopian tube then catches the egg — and it's within that fallopian tube that the egg can be fertilized by sperm.
Now that we've covered some of the most important high-level info for all people with ovaries, we'll get into more of the specifics below.
How can you start TTC with a partner who produces sperm?
There's no exact TTC process that works for all people. If you're TTC with a person who produces sperm and you want to take a very active approach, "sex every other day, cycle tracking, ovulation predictor kits (OPKs) — the whole shebang — would be recommended," explains Dr. Luo. "If you are more of the let's see how it goes type of person, just general awareness of the fertile window can be helpful."
Here are some general recs for those who are TTC with a partner who produces sperm.
1. Schedule a preconception appointment with your healthcare provider.
If you're planning on trying to get pregnant by having sex with a partner who produces sperm, one of the first steps you can take is to schedule a preconception appointment with your healthcare provider. At this visit, your provider will answer questions about fertility, going off birth control, getting pregnant, the early parts of pregnancy, and anything you need to know about how your known family or medical history might play into your plans for kids.
"Preconception appointments can be very helpful," says Dr. Luo — and "absolutely crucial if you're managing any other medical condition (asthma, hypertension, diabetes, lupus, etc.)." If you don't have any medical conditions, Dr. Luo explains that preconception topics can typically be covered in your annual OB-GYN appointment.
2. Go off birth control if you're on it.
Trying to conceive includes stopping birth control use (this process would be one of the topics covered in your preconception appointment). Going off and on birth control is not likely to have any impact on your fertility, but different birth control options may have different effects on your cycle and fertility when it comes to time to pregnancy after stopping it.
According to research with ex-contraceptive users ranging in age from late teens to early 40s, this is the percentage of people who got pregnant 12 months after stopping their specified birth control method:
- 74.7% of ex-implant users
- 77.74% of ex-injection users
- 87.04% of ex-oral contraceptive users
- 84.75% of ex-IUD users (no difference based on type of IUD)
"General rule of thumb is that for implants and IUDs, once removed, fertility theoretically returns immediately," says Dr. Luo. But if you're going off the pill, the patch, or the ring, your "normal" menstrual cycles might take three months to return — "so plan accordingly!" she adds. This means making sure you're incorporating how long it might take for "normal" cycles to come back into your timeline.
The one big exception is Depo-Provera (the birth control shot). If you're using this form of birth control, your healthcare provider may recommend you stop the shots earlier than you would other types of birth control — that’s because Depo can affect ovulation for up to 18 months after stopping.
If you’re on hormonal birth control to manage the symptoms of health conditions like polycystic ovary syndrome (PCOS), endometriosis, or uterine fibroids, you can talk with your doctor about alternative medications that won't interfere with conception.
3. Start taking a prenatal vitamin with folate.
The American College of Obstetricians and Gynecologists (ACOG) recommends 600 micrograms (mcg) of folate per day during pregnancy — with at least 400 mcg DFE (dietary folate equivalent) of that coming from supplemental folate (i.e., methylfolate or folic acid) starting at least one month preconception through at least the first 12 weeks of pregnancy. (The Modern Fertility Prenatal Multivitamin includes methylfolate, an easy-to-absorb form of folate.)
4. Track ovulation.
Tracking ovulation so you can time sex around your 6-day fertile window (the five days leading up to and the day of ovulation) makes it more likely that some sperm will be in the reproductive tract around the egg's release.
- Using ovulation predictor kits (OPKs): An ovulation test, aka an ovulation predictor kit (OPK), is a urine test that measures the levels of LH in your body to predict an egg's release. While standard ovulation tests only give you a "yes" or "no" result based on "average" LH levels, the Modern Fertility Ovulation Test detects your LH at low, high, and peak levels for more insight into your unique LH and ovulation patterns. (This is especially helpful for people who don't have "normal" cycles or hormone levels.)
- Using tracking apps: Period and ovulation-tracking apps are a convenient way to track your cycle throughout the month. Apps count the number of days between the last day you reported being on your period and the first day you report being on your next period. Using that info, they can make a prediction of how long your cycle is and when your next period will come. Apps that allow you to track LH levels — like the Modern Fertility App — take these predictions to another level.
- Monitoring cervical mucus: The type of cervical mucus you produce changes depending on where you are in your cycle. Tracking your cervical mucus to help you time sex requires paying attention to the mucus produced by your cervix throughout the month. Right before you ovulate, you’ll see more mucus than usual — specifically thin, slippery mucus, as explained by ACOG. Once you’re done ovulating, you'll see less mucus, and any that you do see will be of a thicker consistency.
- Charting basal body temperature (BBT): Basal body temperature (BBT) is your body’s temperature when you’re at rest. This temperature rises during the second half of your menstrual cycle, after ovulation occurs. To measure your BBT, you'll take your temperature every morning before you get out of bed or engage in any activity (that includes eating or drinking), and record it each time.
Tracking LH with OPKs is the most accurate way to predict ovulation (aside from having an actual ultrasound machine at your disposal). Monitoring changes in cervical mucus or BBT can be complex to interpret — and since BBT rises after ovulation, it's a better predictor of whether or not you’ve already ovulated.
5. Time sex around your most fertile days.
As we mentioned earlier, timing sex as close to ovulation as possible is key to ensure you’re giving sperm the best possible chance to meet an egg in your reproductive tract. What do those chances look like exactly? In a cycle where ovulation occurs, recent estimates suggest the chances of conception are between 3% seven days before ovulation and 42% the day before ovulation.
Doctors recommend having sex every other day during your 6-day fertile window. According to a 2017 committee opinion from the American Society for Reproductive Medicine, the chances of getting pregnant through sex every day are 37% — while sex every other day only decreases chances to 33% — but trying to have sex every day might be stressful for some people. "Since there isn't much of a difference between 33% and 37%, go with the less stressful option," says Dr. Luo.
How can you start TTC if you're using donor sperm?
If your plan involves using donor sperm, some of the same steps we mentioned in the last section still apply — like taking prenatal vitamins and tracking ovulation. That said, there are several important differences in the process. We'll outline all of the above below.
1. Nail down your plan for conception.
If you're planning to try to get pregnant with a partner who has ovaries, on your own, or you're using donor sperm for any other reason, your first step will be choosing how you'd like to conceive. This means deciding whether or not you want to work with a fertility specialist at a clinic and how you'd like to acquire sperm (either from a sperm bank or a known donor).
You can schedule a preconception appointment to discuss your options, or if you're definitely going to go the route of treatment at a fertility clinic, they'll walk you through your options there. These appointments can also get you answers about anything you want to know about conceiving, as well as how your known family and health history could factor in.
Some of the fertility treatments and assisted reproductive technology (ART) you can pursue include:
- Intrauterine insemination (IUI): This is a procedure where sperm is directly put into the uterus just before ovulation. IUI can be done at a clinic or with your OB-GYN, and may cost around $1,000 per cycle without medication. (We break down the steps here.)
- In vitro fertilization (IVF): This is a treatment in which a previously retrieved egg (the same process that kicks off egg freezing) is fertilized in a lab and transferred into the uterus. IVF can only be done at a clinic and can cost $11,000-$15,000 per cycle without medication. (We explain the process here.)
Don’t plan on working with a fertility clinic? Intracervical insemination (ICI) is a way to inseminate at home using a kit and donor sperm — but know that this is not typically recommended by doctors (since there's no medical supervision).
2. Start taking a prenatal vitamin with folate.
Like we mentioned earlier, ACOG recommends taking prenatal vitamins with 400 mcg DFE starting at least one month before conception through at least the first 12 weeks of pregnancy.
3. Acquire your donor sperm.
You can acquire donor sperm from a sperm bank or a known donor (like a friend), depending on what makes you (and your partner if you have one) the most comfortable. Here are some of the main differences between your options:
- Non-directed (anonymous) donor sperm: The sperm is purchased through a sperm bank, where the donor undergoes lots of tests (genetic testing, sexually transmitted infections, overall health, semen analysis, and more) — meaning you don’t have to deal with that aspect of the process. Anonymous donor sperm is typically frozen. Donor sperm can range from $500-$1,000 per vial.
- Directed (known) donor sperm: When using a friend or family member’s sperm without the assistance of a sperm bank, you and the donor will have to undergo testing on your own. It’s also worth noting that using the sperm of someone you know can sometimes add personal or legal complexity to the process. Known donor sperm can be freshly retrieved or frozen, depending on the situation.
- For either option, clinics may recommend psychological counseling for all involved people.
5. Time the insemination as close to ovulation as possible.
Like timed intercourse, timing insemination as close to ovulation as possible makes it more likely that sperm and egg will meet. That's why, whatever your conception plan is, tracking ovulation will play an important role in timing insemination. If you're inseminating at home, you'll track ovulation on your own. If you're working with a fertility clinic, they'll likely do much of the tracking for you.
For those who are inseminating at home, tracking LH with OPKs is the most accurate way to predict ovulation.
How can you increase your chances of getting pregnant?
Your healthcare provider may cover all of this in your preconception appointment or your first visit at a fertility clinic, but there are a few things you can do to boost the odds that you'll conceive — before turning to medications or fertility treatments (if those aren't already a part of your plan):
- Get in 30 minutes of movement, five days a week: Regular exercise is good for everyone — but we all have an amount that’s right for us. For some people, more vigorous-intensity exercise (like running or swimming) per week may cause an energy deficiency and negatively impact ovulation. That said, moderate-intensity exercise (think workouts you can talk through) of any amount is beneficial.
- Eat balanced meals: There’s no such thing as “hacking” your fertility with food — especially not with overly restrictive, extreme diets. That said, in terms of overall health, balanced eating (think mostly Mediterranean style) is recommended.
- Stop smoking: On top of the long-term health effects of smoking (like cardiovascular disease, lung cancer, and stroke), it also speeds up the rate of egg loss and reduces the chances of conception each cycle. (Sustained secondhand exposure has similar risks.) Quitting smoking improves fertility outcomes — though it’s important to understand it can’t reverse egg loss.
- Get off birth control a few months early: While birth control use has no long-term impact on fertility, some methods are associated with a slightly longer return to ovulation than others (like the implant and injectable). Because it may take a few months to get back to your pre-birth control cycles after stopping, it may be helpful to quit using birth control a little earlier than immediately before you want to start trying to conceive.
- Know about underlying conditions: Common conditions (that aren’t always commonly talked about!) like PCOS and hyper/hypothyroidism are characterized by changes in reproductive hormones that in turn affect cycle regularity and ovulation. Fertility hormone testing is one way to check in with your levels and get insight into these conditions. If you have any of these conditions, it's important to talk to your healthcare provider before trying to conceive so they can help you improve the likelihood that you'll get pregnant.
How soon can you tell if a TTC method "worked"?
A TTC method "working" means a positive pregnancy test. The recommendation is to take a home pregnancy test two weeks/14 days post-ovulation (aka DPO) — that's when, if you've conceived, an embryo will have attached to your uterus and begun developing. If you haven't conceived, that's around when you'd get your period. If you worked with a fertility clinic to conceive, they'll give you a pregnancy test there.
Since the Modern Fertility Pregnancy Test is an early pregnancy test, you can start testing as early as six days before your missed period (which would be roughly eight days DPO, based on a "textbook" 28-day cycle).
When is it time to see a doctor?
The answer to this question depends on your unique circumstances. It's a good time to reach out to your healthcare provider in the following situations:
- If you've been trying to conceive through sex and haven't gotten pregnant for 12 months if you're under 35 and six months if you're over 35.
- If you want to start trying to conceive through sex but you have irregular cycles or your partner has known issues with their sperm.
- If you're planning on conceiving with a partner who also has ovaries or on your own.
- If you’ve experienced two or more miscarriages (what's called recurrent miscarriage).
Exactly how your healthcare provider may help you also depends on your circumstances:
- Some healthcare providers may prescribe ovulation-inducing medications (like Clomid or Femara) or other fertility drugs to improve your chances of conception with or without fertility treatment.
- Some healthcare providers may recommend pursuing fertility treatment if you haven't already — or other infertility treatment options if you've tried one already. (For example, IVF is often recommended after 3-4 cycles of IUI.)
You can also always bring up your plans for kids with your healthcare provider. Modern Fertility Hormone Test results can help you kick off that conversation with clinically sound data about your hormone levels.
The bottom line on TTC methods
When you’re trying to conceive, the planning options available to you can be overwhelming. From ovulation-tracking methods to fertility treatment, Modern Fertility is here to guide you through each step of your journey — and you can always rely on your OB-GYN. "It breaks my heart when I hear that patients were told to just call with a positive pregnancy test," says Dr. Luo. "We are here for you to answer your questions along the journey — whether it's about cycle tracking, timed intercourse, or when further evaluation may be needed."
The conception process looks different for everyone, so products like the Modern Fertility Hormone Test and Ovulation Test can help you understand how to navigate your road to parenthood, whether you’re currently trying to get pregnant or just being proactive about your health. And you can always find support, empathy, and camaraderie along your journey in our Modern Community.
This article was medically reviewed by Dr. Eva Marie Luo, MD, MBA, OB-GYN at Beth Israel Deaconess Medical Center and Clinical Lead for Value at the Center for Healthcare Delivery Science at Beth Israel Deaconess Medical Center.