Pregnancy

Understanding How to Get Pregnant

An Overview of Getting Pregnant

It is likely that when you think about getting pregnant, you imagine that you and your partner have decided that the time is right for a baby. Then, you stop using your current method of birth control, engage in some delightfully fun nights of passion, and a few weeks later roll out of bed for a romantic pregnancy test. Certainly, this does happen for some folks, but it can be a bit more than that for others.

One thing that is important to remember is that you should plan that it will take you about one year of well-timed sex to get pregnant. Some couples will get pregnant right away. Some couples will try the entire year and get pregnant the very last month of that year. The vast majority of people will get pregnant within this year. Not getting pregnant in the first three months does not mean that you have fertility issues at all.

We will talk about how to tell if you need to see a specialist in a minute.

Back to the baby making! Having a healthy pregnancy should start months before you are actually ready to have a baby. Here’s a look at how the journey might go instead.

Have a Physical Exam

Nothing says sexy like a healthy person. Both you and your partner should plan to have a regular physical exam before you get pregnant. In years past, most of the attention has been on the female body, but now we know that your partner’s health is also relevant both in terms of fertility, but also in terms of the health of the pregnancy and the resulting child.

A good physical exam should consist of a variety of things to get a general view of your health. It will look at:

  • your height and weight
  • your blood pressure
  • any medications you are currently taking
  • a family health history
  • current illnesses or diseases (e.g., high blood pressure, thyroid issues, diabetes, etc.)
  • specialty tests as determined by your practitioner
  • screening for sexually transmitted infections
  • physical exam to include your reproductive organs

The thought process behind a physical prior to pregnancy is that you can get many of your chronic conditions under control or find out if you have chronic conditions and get them treated. It’s also a chance to ask questions specific to the process of conceiving or of discontinuing birth control.

You may also talk about your weight or blood pressure, even if it is not causing you to experience problems at this point. In the intervening time between when you see your doctor and when you get pregnant, you will also have a chance to bring your weight closer to a goal weight for you and your partner.

Pregnancy is not the ideal time to lose weight. Doing it before you conceive can have benefits in terms of making it easier to get pregnant.

Live a Healthy Lifestyle

One thing that is a must for a healthy pregnancy is a healthy lifestyle. This includes things like:

  • watching your diet
  • eliminating social or recreational drugs (including alcohol and cigarettes)
  • maintaining exercise habits
  • improving sleep habits

Each of these will play a part in your health. It might be pretty obvious to say that eating more fruits and vegetables will make you healthier, but it will also ensure that your body is functioning optimally. A simple but effective example is that if you’re eating fruits and vegetables, you’re probably getting the fiber you need to avoid constipation. Constipation can be something that is problematic both when taking some prenatal vitamins but also simply because of pregnancy hormones. They may cause your intestines to be a bit more sluggish. With the rapidly changing guidelines, checking in with your provider can be helpful at getting great advice on how to have a healthier diet.

Your practitioner may only have the most basic of information on nutrition. There are some areas that offer a cooking class geared towards conception and/or a healthy pregnancy. Ask around at local hospitals or pregnancy centers for more information in your area. There are also a number of books on the subject. This may be more important if you have a strict diet that is vegetarian or vegan, though it is absolutely possible to have a healthy vegetarian or vegan pregnancy.

Social and recreational drugs can be problematic because they may actually lower your chances of getting pregnant. Sometimes it’s something mechanical like alcohol causing temporary impotence—though there can also be some chromosomal damage from smoking, drinking, or drug use. It’s ideal for both partners to quit prior to pregnancy to give your pregnancy the best chance of succeeding. Most of the social and recreational drugs can cause an increased risk of genetic problems or the risk of pregnancy loss like miscarriage or stillbirth.

Talking to your provider openly and honestly will be the best way to get accurate information to help you.

Sleep and exercise are also two facets of a healthy lifestyle that are key to a healthy pregnancy. Not only will this help you be strong and healthy for a pregnancy, but it will also help you have an easier pregnancy. Exercising while pregnant has been shown to increase the sense of well-being and decrease the aches and pains of pregnancy. Some studies also show shorter labor when the mom exercises in pregnancy. Don’t panic if you aren’t big into exercising. Walking and swimming are great ways to get out and move – that movement also helps you. Your partner participating makes it more likely that you’ll go to the gym or for that walk as well.

Start Taking Prenatal Vitamins Before Pregnancy

Prenatal vitamins are your insurance policy. They won’t fix a horrible diet or prevent bad outcomes, but they will decrease the chances. Folic acid, for example, can help prevent neural tube defects when taken prior to and during very early pregnancy. It's during these beginning stages when it's most important to protect the neural tube, the structure from which the spinal cord and brain form. If you start taking them before you’re pregnant, not only does it ensure that you’re covered in early pregnancy, but it also helps you form the habit of taking them.

There are a lot of prenatal vitamins available. The truth is, you don’t need anything fancy, a standard multi-vitamin with the right amount of folic acid might be just right for you. So, if you have a vitamin that you know you tolerate well—because not everyone will tolerate every vitamin—bring it in and ask your provider if that will serve the same purpose. It may also cost less.

Get Your Insurance and Finances in Order

Talking about money and insurance now can save you big headaches in the future. If you are near open enrollment and think that next year might be the year for you to get pregnant, look at the coverage that is offered. Does it cover all of the birth options you may be interested in? Specifically ask about fertility coverage—this has a very wide range of what is covered, when, and where. You should also ask about coverage for both really low risk births and providers like doulas and midwives, to really high risk coverage like maternal fetal medicine specialists (MFM) and neonatal intensive care units (NICU).

If you are paying out of pocket, learn what that cost might be and plan how you will cover it. Will you be able to use a flexible spending account (FSA) or health care savings account (HSA)? Asking now will allow you a chance to prepare financially for the impact of a pregnancy.

Talk About Parenting Topics

While it might seem premature to talk about parenting before you’re a parent, this is something that many couples haven’t given much thought to before the baby arrives. They both assume that they love each other and the rest will sort itself out. Talk about how you were raised. What did you love? What would you like to avoid? Where does that conflict? Other specific topics to talk about can include:

You can see there are some hot button topics on this list. It is not a one night conversation, but rather an ongoing discussion. Parenting will change along the way as well. However, having a background in the discussion will at least give you a starting point.

Discuss Birth Control

Finally, it is time to talk about birth control. You may have been using oral contraceptives, the pill, for a while. Your provider will talk to you about when and how to stop. Sometimes it’s easiest to give yourself a cycle or two to get pregnant. If you want that time, be sure to use another method of contraception like condoms or a diaphragm. This gives you a bit of a break and allows you to start charting your cycles, if you are interested, prior to conceiving.

You may just decide that a specific date in the future is the big day to quit using birth control and circle that date and never look back. Or you might just decide to discuss it in the future and decide what works closer to that time. Some of this might depend on if you have preferred timing for your pregnancy.

Have Baby-Making Sex

Woo-hoo! Have sex—you’ll get pregnant! Well... when done correctly. There are some specific things we mean when we say "have sex." For starters, you should have vaginal intercourse without birth control, preferably when you think ovulation may be near.

You don’t need to do it twice a day, though if you do occasionally, that’s fine. You don’t even have to do it every day, but that's OK, too. However, oral sex, anal sex, sex with condoms, and sex on your period are all bad ways to get pregnant.

Predicting Ovulation

Predicting ovulation can be done in a variety of formats. Some are more intense than others. Which you chose may depend on your personality, your cycles, your tolerance, and your need to predict the date of birth. You do not need to try to predict your ovulation in order to get pregnant, though it may shorten your time to conceiving or help you identify if you have a fertility issue.

Sometimes you simply use an app that charts when you had your period, how long your cycles are, and it tries to guess an average for when you're ovulating. The easy way to do this without an app is to take your cycle length (start counting on the first day of menstruation and end counting on the first day you begin the next cycle). Count backwards 14 days from the end.

So, if you started your period on Dec. 1 and started menstruating again on Dec. 29, 14 days back would estimate that you ovulate around Dec. 15. You then predict, or guess, for the months ahead, still charting the basic numbers.

Some people don’t want to count but want to be a bit more precise at the same time. They would start counting at the beginning of their cycle, and when they hit day nine, would use urine test strips daily until the test strip indicated that ovulation was soon. This can be costly, but you can buy these ovulation prediction kits (OPK) anywhere from about a $1 per test strip or $30+ per cycle.

Other families chose to use basal body temperature (BBT) methods. Here you chart your daily temperature from the moment you wake up. Using a calculation by hand or a program or app, you look for the temperature shift prior to ovulation. This is aided by watching for specific symptoms of ovulation. This can also help you figure out when you have gotten pregnant, because of changes in the body temperature.

Decide How Serious You Are About the Timing of Your Pregnancy

There are some professions that have specific times that are easier than others to have specifically timed births. An example might be a teacher who prefers to have her baby born at the very end of the school year or beginning of the summer, or a clergy member who needs to avoid giving birth during a high holiday season. Sometimes you just know that you want to have a baby born in October. Whatever the reason, you can try to plan the conception of your baby to coincide with a specific timing.

That said, remember, it’s a guess. You might completely miss and not get pregnant and wind up doing just the opposite of what your intentions were for that pregnancy. If you absolutely can’t have a baby born in a specific month, use a back-up method of birth control in the corresponding nine months prior to that date.

This may prolong how long it takes you to get pregnant simply because you aren’t trying for 12 months out of the year. It may also mean that you should work on predicting ovulation to help you get a specific date, rather than simply abandoning birth control.

Adjusting to the 'Getting Pregnant' Lifestyle

It may seem like it’s a no-brainer—you’re just living your life without birth control. If that’s how it works for you and your partner, that’s great! Other couples wind up having lots of issues around thinking about timing sex. That’s why you shouldn’t worry too much about it, particularly in the beginning. Remember, most couples will conceive within the first year. This is normal, and you should not be surprised if you are not pregnant as soon as you stop birth control. (Nor should you be surprised if you are.)

There is an uncertainty about trying to conceive. It can be a bit unnerving for some families. Try to be open to that possibility of not being able to control all the factors except the ones that you can control.

Know When to Take a Pregnancy Test

The big reveal in the whole journey to conception is the pregnancy test. When you are trying to get pregnant, it can be tempting to assume that every single thing you feel is an indication of pregnancy. It is also normal to be keenly aware of how your body feels in the days leading up to your anticipated period.

This can be extra confusing when so many pregnancy tests advertise themselves as being valid before you even miss your period. While a positive test prior to your missed period should be considered a positive pregnancy test, a negative test should not be considered anything. You would want to wait until your period was due and retest.

Since a home pregnancy test is relatively inexpensive, accurate, and easy to do, it makes it more likely that you will decide to simply take a pregnancy test or three in the days leading up to your period. Some people want to know what the harm is in doing this, and while there is not a true physical harm, the emotional toll of the big fat negative pregnancy test can really start to weigh on you emotionally.

The best advice is to wait until the day your period is due until testing—sometimes even the day after that. A test done then is more likely to be positive if you are pregnant, simply because the extra day or two would give your body a chance to register a higher amount of the human chorionic gonadotropin (hCG), the pregnancy hormone a pregnancy test detects.

Know When to Ask for Help

One of the most frequently asked questions we hear is that families are unsure of whether or not they are having problems and should seek help. The best guidelines to use are some of the guidelines for conception in general. If you are under 35 and you’ve had well-timed, unprotected sex for a year, it is time to get a second opinion from your obstetrician or midwife. If you are 35 or older, only wait six months.

You should also at least call your practitioner if you have anything that seems odd about your cycle. This might be bleeding that lasts shorter than three days or longer than seven days. It may be that your cycle is shorter than 22 days or longer than 42 days. Sometimes this is just a remnant of birth control and a bit of kick starting is helpful. Sometimes it’s an early indicator of another issue, which needs further exploration.

You should begin the process of charting your cycles while you wait to see the specialist, if you have not already done so. This may give them some data to help you pinpoint any issues and save you time.

Sources:

American College of Obstetricians and Gynecologists. ACOG: The importance of preconception care in the continuum of women's health care. ACOG Committee Opinion No. 313. American College of Obstetricians and Gynecologists. Obstet Gynecol 2005;106:665–6.

American College of Obstetricians and Gynecologists. ACOG Committee opinion no. 549: obesity in pregnancy. Obstet Gynecol. 2013 Jan;121(1):213-7. doi: http://10.1097/01.AOG.0000425667.10377.60.

Braspenningx S, Haagdorens M, Blaumeiser B, Jacquemyn Y, Mortier G. Preconceptional care: a systematic review of the current situation and recommendations for the future. Facts Views Vis Obgyn. 2013;5(1):13-25.

Hussein N, Kai J, Qureshi N. Eur J Gen Pract. 2015 Nov 26:1-11. [Epub ahead of print] The effects of preconception interventions on improving reproductive health and pregnancy outcomes in primary care: A systematic review.

Salihu HM, Salinas A, Mogos M. The missing link in preconceptional care: the role of comparative effectiveness research. Matern Child Health J. 2013 Jul;17(5):776-82. doi: 10.1007/s10995-012-1056-1.

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