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What to know when trying to get pregnant: Q&A with Dr. Nataki Douglas

What to know when trying to get pregnant: Q&A with Dr. Nataki Douglas

9 min read

This article was last updated on April 12, 2021.

Once you decide you're ready to start trying to get pregnant, you might find yourself googling “how to get pregnant fast.” "Anecdotally, we've all heard stories of women who conceive in the first month they start trying, but that doesn't happen to most women," says Dr. Nataki Douglas, MD, PhD, a reproductive endocrinologist and the chair of the Modern Fertility Medical Advisory Board.

Unfortunately, there's no surefire recipe for lightning-fast conception, but there is a lot of information about how you can optimize your fertility when family planning — so when you’re planning for a pregnancy you'll know how to proceed with confidence.

In our live Q&A, "Goodbye Dr. Google: Real Talk on Getting Pregnant With a Fertility Doctor," Dr. Douglas jumps into the nitty-gritty of trying to conceive and answers all your questions. We've rounded them up here, so read on to find out:

  • When will your period come back after stopping birth control?
  • Which tests and doctors should you get and see before trying to get pregnant?
  • What lifestyle changes should you make when you’re planning a pregnancy
  • What prenatal vitamins should you be taking?
  • Is there anything you can do to increase your chances of getting pregnant?

Your pre-pregnancy checklist

Before we get into the specifics about all of Dr. Douglas’ recommendations, let’s run through a quick list of what you can do to prepare for a potential pregnancy:

  1. Schedule your doctor appointments, including a dental X-ray, a routine checkup with your gynecologist, a visit with your primary health care provider to discuss any vaccinations you should get before pregnancy, and a general preconception visit.
  2. Monitor your fertility through ovulation tracking and fertility hormone testing. This will give you insight into your ovulation patterns and the big picture of your reproductive health.
  3. Transition off of birth control if you’re currently taking it. Heads up that depending on your method of birth control, how long it takes for ovulation to resume may vary. (More on this later.)
  4. Start taking prenatal vitamins with 400 micrograms (mcg) of folate (aka methylfolate or folic acid). Doing this (at least one month) before getting pregnant supports healthy fetal neural tube (brain and spine) development.*
  5. Stay on top of regular physical exercise and nutrition, stop smoking if you currently smoke, and limit alcohol and caffeine intake. These lifestyle factors can all impact conception.

Now, we'll dive deeper into the above steps (including common questions about them) and explain what they have to do with your chances of conception.

Which types of appointments and tests are helpful before trying to conceive?

Here's what you need to know, per Dr. Douglas' recommendations, about important appointments with your doctor and useful tests you can take at home before you start trying to get pregnant.

Doctor's appointments

Dr. Douglas recommends scheduling a number of appointments in advance:

  • A dental appointment: "Getting exposed to X-rays can be harmful," says Dr. Douglas, "so you should really consider having your routine dental check-up a little earlier — certainly if you know you're scheduled for X-rays."
  • A routine OB-GYN checkup: This visit will take care of your Pap test and breast/chest exam. Plus, since untreated sexually transmitted infections (STIs) can interfere with fertility and also increase risks during labor and delivery, this visit can also help you identify and treat any possible STIs.
  • The preconception visit: "It's a great opportunity to ask questions, find out how the practice works in terms of appointments, labor and delivery, and to discuss any health concerns you might have," explains Dr. Douglas.

Ovulation tests and tracking

If you're not already tracking your ovulation, practicing before you go to the OB-GYN in anticipation of trying to get pregnant is a good idea. And Modern Fertility has got you covered with our own Ovulation Test and ovulation-tracking app.

  • Ovulation predictor kits (OPKs) measure your luteinizing hormone (LH) levels to help indicate when you’re going to ovulate so you can schedule unprotected sex during your fertile window — and get a better understanding of your hormonal patterns (which could also be useful for your doctor).
  • Cervical mucus monitoring is a super easy way to check in with your cycle and get important knowledge about your menstrual cycle. (And it doesn’t require anything but your clean fingers and a glass of water!)
  • Basal body temperature tracking (or tracking your temperature when your body's at rest) is another way to track ovulation, but because so many factors can influence your body's temperature, it's an unreliable way to get a read on your ovulation patterns.

Fertility hormone testing

Checking in with your hormones helps you gain insight into your ovarian reserve (how many eggs you have), as well as your thyroid hormone levels, which are major when it comes to achieving a healthy pregnancy.

  • A baseline on your fertility: "Although knowing your hormones is not predictive of how successful you'll be at getting pregnant in the time frame that you want," says Dr. Douglas, "knowing what's happening with them can give you a baseline sense of what's going on in your body."
  • Your ovarian reserve: "We're specifically looking at hormones related to ovarian reserve, like AMH." says Dr. Douglas. "It's a way for us to know what's going on with your egg supply, as well as any red flags or health conditions (like polycystic ovary syndrome, or PCOS)."
  • Your thyroid health: "Thyroid hormones are important for your general health, but we also know that pregnancy can be impacted by thyroid problems if those problems aren't addressed first," explains Dr. Douglas. "Really low thyroid levels or high thyroid levels have been associated with adverse outcomes … in terms of during pregnancy and getting pregnant."

You don't have to wait until you've stopped hormonal birth control to test your hormones — there are some fertility hormones, such as anti-Mullerian hormone (AMH) and thyroid hormones (both of which Modern Fertility can test for!) that can be evaluated while you're on BC. (Other fertility hormones are typically tested on day 3 of your cycle, so if you aren't getting periods, testing those hormones wouldn't get you an accurate read.)

Fertility doctors

An appointment with a fertility doctor will be helpful if you're planning to conceive on your own or with a partner who has ovaries. They can also help you manage any medical conditions that could affect your fertility, including PCOS, endometriosis, and uterine fibroids.

If you're looking for a fertility specialist, Dr. Douglas advises talking with your OB-GYN first about potential providers. If you don't have an OB-GYN (for example, if you see a primary health care physician instead), do your research — look into specialties and practices before calling for an appointment.

Genetic carrier screening

The American College of Obstetricians and Gynecologists (ACOG) recommends screening before conceiving, when possible. Dr. Douglas says that insurance often covers it when it’s in the context of treating fertility problems, but plans may differ in terms of coverage. If you have a family history that suggests increased risk of recessive genetic disorders, the American Society for Reproductive Medicine (ASRM) also recommends looking into genetic testing — especially if you’re planning for IVF treatments.

When will your period come back after stopping birth control?

If you had a regular menstrual cycle before starting hormonal birth control, you might see your menstrual period return about 28-30 days after you stop taking hormonal birth control. Sometimes, though, that return can be delayed. The reason, says Dr. Douglas, is that the hormone needs to clear your body, and that happens at different times for different people. Here’s what you should know about going off your form of contraception:

  • There's no evidence that being on birth control for a long time results in an impact on your fertility (though it’s worth noting that taking Depo-Provera can delay periods for up to 22 months after stopping).
  • If your period doesn't make an appearance within 90 days of stopping birth control, Dr. Douglas does recommend seeing a doctor. But, she says, "It's not always indicative of a problem.”
  • She also recommends testing your hormones to get a better idea of why you haven’t had a period yet.
  • So how long should you wait between that last pill/implant/shot/ring and trying to conceive? "I recommend that people wait until they get a period," says Dr. Douglas, "so we have an idea of when you got pregnant. But, besides that, there's no real timing."  

An important reminder: Your age is one of the biggest factors when it comes to your chances of conceiving. "We really should be considering age in our expectations," urges Dr. Douglas. To put this into perspective, the ASRM states that a healthy 30-year-old has a 20% chance of getting pregnant in one month, while a healthy 40-year-old has a 5% chance. (And you can read more about conceiving over age 35 here.)

What prenatal vitamins should you be taking?

Daily prenatal vitamins are a must when you're pregnant and trying to get pregnant since they support healthy fetal development.* Starting prenatals with folate at least one month before conception (the clinical recommendation) will help you build up optimum levels of nutrients before pregnancy. (But don't panic if you miss a couple of days!)

The American College of Obstetricians and Gynecologists (ACOG) recommends the following nutrients before and during pregnancy:

  • Folate (aka folic acid or methylfolate) to support fetal neural tube development*
  • Iron to form red blood cells and hemoglobin — the protein in your blood that transports oxygen from your lungs throughout the body*
  • Choline to support fetal neurodevelopment*
  • Omega-3 fatty acids (DHA and EPA) to help develop the fetal brain and retina*
  • Vitamin C to promote the growth of all connective tissue (skin, joints, etc.) and a healthy immune system*
  • Vitamin A to support fetal eye development and good vision, as well as a healthy immune system*
  • Vitamin B-6 to boost your energy while you're pregnant*
  • Vitamin B-12 to help keep the central nervous system on track*
  • Iodine to help with developing a healthy fetal brain and maintaining thyroid health*
  • Calcium to strengthen fetal teeth and bones*
  • Vitamin D3 to promote bone health and improve immune function for you and and the fetus*

The Modern Fertility Prenatal Multivitamin includes all of ACOG's recommended nutrients except for calcium. Many prenatals don't include calcium because it can block the absorption of iron and supplementation maxes out at ~500 mg. Both of these factors can make it difficult to put calcium alongside other nutrients in a prenatal. Instead, the Prenatal Multi has a calcium booster: vitamin D.*

On top of 10 ACOG-recommended nutrients, the Prenatal Multi also has zinc and biotin. Zinc is essential for healthy fetal growth, and can be up to 50% deficient in vegetarians.* Biotin aids in converting food into energy, and a third of pregnant people are deficient.

What lifestyle factors can impact chances of getting pregnant?

According to Dr. Douglas, these are the main lifestyle factors to look into when thinking about trying to get pregnant:

  1. Exercise: Staying physically active while trying to conceive and in pregnancy is beneficial. Dr. Douglas recommends finding and maintaining a routine that works for you.
  2. Body weight: Your body weight can impact your hormones, which then can affect your fertility.
    • A higher body-fat percentage can interfere with ovulation, causing irregular periods and complications in pregnancy such as gestational diabetes.
    • However, "restricting yourself and eating only a few foods can impact your overall health and your fertility" too, says Dr. Douglas.
    • In general, Dr. Douglas advises eating regular balanced meals, as well as limiting your exposure to processed foods and pesticides.
  3. Endocrine-disrupting chemicals (EDCs): You should also be aware of what you're eating and drinking on and out of. There's evidence that a class of chemicals known as endocrine-disrupting chemicals (EDCs), such as BPA, can cause fertility issues, so using stainless steel and glass instead of plastic is a good idea before trying to conceive.
  4. Smoking: Deciding to stop smoking is another big step you can take toward improving your fertility — and quitting at any point will have a positive impact. (FYI: Sustained exposure to secondhand smoke carries similar risks to smoking, so keep that in mind as well.)
  5. Alcohol: Can you drink alcohol when you’re trying to get pregnant? "Getting exact information on how alcohol impacts fertility is hard," says Dr. Douglas. "There are many studies that show that having one or two drinks a day won't impact fertility, but there are others that show that moderate drinking can be harmful.” Ultimately, Dr. Douglas explains, it's up to you to decide whether or not you want to stop drinking alcohol when you’re trying to conceive.
  6. Caffeine: "Most of the time, one cup of coffee per day is fine during pregnancy and when you're trying to conceive," clarifies Dr. Douglas. "If you're drinking more than that, the sooner you start cutting back on those larger amounts, the better, so your body can get over those symptoms of caffeine withdrawal."
  7. Certain beauty products and procedures: "When you're actively trying to conceive, we're concerned about the chemicals that are in hair coloring entering your system," says Dr. Douglas. Also, consumers of Botox should know that while there aren't necessarily clear associations between the treatment and infertility, Dr. Douglas says it does depend on how much you're using, where you’re using it, and how much you’re using.

Is there anything that can increase your chances of conception?

There are a lot of ideas out there about what affects your fertility and can make you more or less likely to conceive (check out this piece about sex positions, orgasms, and getting pregnant). While you might have been told that lying down for 15 minutes after sex or using a Diva Cup will improve your chances of getting pregnant, Dr. Douglas says there's no research that supports this.

You might also think that having intercourse (with a partner who has a penis) as often as you possibly will help you get pregnant quickly, but Dr. Douglas debunks this. "While looking at sperm during fertility treatment, we've found that multiple ejaculations in one day aren't all of the same good quality." What’s most optimal? Having sex the day before and of ovulation. While we're on the subject of sperm health, it can be negatively impacted by some lubricants — but there is sperm- or "baby"-friendly lube on the market.

Watch the full convo below for even more pregnancy knowledge — and stay tuned for even more live Q&As with fertility experts.

*This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.

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Chanel Dubofsky

Chanel's writing has appeared in Cosmo, Rewire, Lilith, HelloFlo, & Extra Crispy. She has an MFA in Fiction from Vermont College of Fine Arts & lives in New York. Follow her @chaneldubofsky.

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