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Many people get pregnant with little to no effort or planning, and that’s great! But if you’re like me, you like to prepare as much as possible. This is the information I share with my friends who are preparing to start this journey. While I hope this is a helpful starting point, I highly recommend getting an appointment with a naturally-minded doctor, such as a functional medicine doctor who specializes in reproductive health or a supportive and educated OBGYN, prior to trying to conceive. They’ll be able to make recommendations on lifestyle changes, labwork, and cycle tracking that are specific to you. Also, if you haven’t yet read my blog on birth control and cycle-tracking, that is a great place to start!

Diet and lifestyle:

• Both sperm and eggs mature for about three months, so while all these changes are good to make any time, the critical window is three months prior to trying.

• Diet and lifestyle have a big impact on both egg and sperm quality, and thus your ability to get pregnant (and then carry the baby to term). You will want to ensure you’re eating nourishing food and reducing toxins in your home. My favorite resources list includes some books with a lot more details on changes to make. There is a LOT of information available out there, but my approach has been to make the changes that are practical for our family, and not worry about the rest. For example, we don’t burn candles any more (although I mourn this in the fall), but we do still use aluminum foil.

• It appears that moderate caffeine consumption actually has more of a negative effect on egg health than moderate alcohol consumption does. Obviously most women continue drinking both while trying to conceive and are totally fine, but it’s something to keep in mind.

• It is now estimated that a large number of the population has the MTHFR genetic mutation—I’ve seen estimates up to 50%. The significance of this mutation in regards to fertility is widely disputed, but I think it is at least valuable to be aware of and ask your medical team about. Thankfully, the effects of the mutation are typically easily managed by making healthy choices such as choosing the methylated form of vitamins and eating a healthy diet. If you’re making healthy lifestyle choices, you’re likely doing all you need to do.

Supplements:
I’m not going to go into actual recommendations here because, as I’ve said many times before, I am not a medical professional! My three favorite resources for supplements both pre-conception and during pregnancy are It Starts With the Egg, Brain Health from Birth, and Real Food for Pregnancy, all of which can be found on my favorite resources list. These books do an excellent job sharing what to look for in various supplements (and why), optimal amounts of critical vitamins and minerals, and which popular supplements can actually harm your chances of pregnancy.

Assuming you don’t have any underlying medical conditions, most medical professionals will recommend starting a prenatal vitamin (I take Thorne) and DHA (I like Nordic Naturals Prenatal DHA) for at least three months prior to conception, and then continue throughout pregnancy. I personally also take several other vitamins and supplements based on my labwork, but those will vary from person to person. It is also important that your husband takes a good-quality multivitamin (my husband takes Naturelo); DHA is also often beneficial (he takes Nordic Naturals DHA Xtra). All the books I mentioned have good guidelines for supplements, and discuss several additional ones, but It Starts With the Egg goes into the most detail.

Labwork:
This is the labwork I discussed with my doctor and is intended just as an example of what you might want to consider; remember I am not a medical professional, so your medical team may have different recommendations. The books I mentioned, particularly It Starts With the Egg, provide optimal ranges of many of these. Note that optimal ranges for fertility are often different than what the medical community considers “normal” ranges.

• Full thyroid panel (TSH, free T3, free T4, reverse T3, thyroid peroxidase antibody, and thyroglobulin antibody).

• Hemoglobin A1C (the most accurate indication of insulin resistance, as it gives a picture of glucose levels over the past three months; it is highly predictive of gestational diabetes so that can be managed earlier if necessary)

• Vitamin D (the best test is 25-hydroxy vitamin D)

• Iron panel (at least hemoglobin, hematocrit, and serum ferritin; others could include MCV and sTfr)

• A comprehensive nutritional analysis could be helpful to highlight any vitamin or mineral deficiencies

• Other panels, such as liver and blood panels, could be helpful as well

Cycle and ovulation tracking and timing sex:
In the birth control and cycle-tracking, I covered the basics of what you need to know regarding timing sex to get pregnant. If you’re tracking your BBT and cervical mucus, you should have a good idea of when you ovulate. If you’re type-A like me, you might like using ovulation test strips too, just to make sure you time everything well.

There are a number of ovulation tests on the market. I primarily use two different types:

1. Easy@Home test strips
   These are inexpensive and, similar to pregnancy tests, have a test and control line. The test line tracks luteinizing hormone (LH), which is what your body secretes to trigger the release of an egg during ovulation. For most women, ovulation usually happens 24-36 hours after their peak LH; thus as soon as the test line peaks, ovulation is imminent.

2. Clearblue digital tests
   Using these is definitely overkill (but if you haven’t figured this out yet, I like to have alllll the information). They are expensive, so I have only used these during cycles when we are actively trying to conceive. They track both estrogen and LH; estrogen surges prior to LH (causing more fertile-quality, egg white cervical mucus). Thus, these tests will indicate “high fertility” days when estrogen is increasing and your “peak fertility” day, which LH surges. Note though that these tests will show peak fertility as soon as your LH starts to increase, not necessarily at its actual peak, which is why I like using them in conjunction with the Easy@Home tests where I can watch the test line get progressively darker.

The next logical question is when to actually have sex in order to optimize your chances of getting pregnant. One of my favorite books, Expecting Better, shares that people are statistically equally fertile the day before ovulation and the day of ovulation, so mathematically it makes the most sense to have sex every-other day once you're in your fertile window. This ensures you'll have sex on one of those days, and that you're giving your partner enough time to "recharge". Ultimately though, the right timing will vary widely between couples and is influence by factors such the man’s sperm quality and the woman’s fertile window length, as discussed in Taking Charge of Your Fertility. My advice is to not stress too much about it, try what seems best to you for a few months, and if it isn’t working, then switch it up.

One small but important fact to know is that nearly all kinds of lube, even natural types like coconut oil or spit, can make the vaginal canal more hostile to sperm. If you want or need to use lube, I recommend looking into types that mimic the makeup of cervical mucus. I have heard Pre-Seed recommended but have not personally tried it.

What if it’s not working?
Common medical advice today is that you should not seek out fertility testing unless you have tried to conceive for a year with no luck. However, if you’re tracking your cycles carefully, and especially if you are using ovulation test strips, I encourage you to meet with a doctor if you are not pregnant within 4-6 months. If sex is timed well within the fertile window, most couples should be pregnant within this timeframe. Of course there are cases where there is nothing wrong and conception just takes longer, but my personal opinion is that it is better to not waste time and catch (and treat) potential problems early.

One final note—the journey of trying to conceive can be filled with a lot of excitement, but it also can easily become stressful. Stress (cortisol levels) has one of the greatest impacts on fertility, so the more you can do to reduce your stress, the better. I know it’s easier said than done, but try to relax and don’t expect there to be any problems. I have personally experienced that knowledge isn’t always power—that sometimes more knowledge can cause more stress. So if this blog has just added stress to the process, forget you read it and just have fun!