Thinking about starting a family? You may have some questions about your fertility, or the ability to conceive. You can talk with your primary care provider, certified nurse-midwife, or OBGYN to answer any specific questions or create a detailed plan, but if you're not there yet, here are some frequently asked questions and answers about fertility and getting pregnant. 

What are some factors that can affect fertility? 

Fertility can be influenced by a number of factors and both men and women may experience challenges in conceiving. Some key factors include: 

  • Age - fertility for women begins to decline in their late 20s and more significantly after age 35. For men, sperm quality declines gradually with age, and significant changes often occur later than in women. 
  • Health conditions - chronic conditions such as diabetes, thyroid disorders, and autoimmune diseases can affect fertility in both men and women. Polycystic ovary syndrome (PCOS) and endometriosis are common conditions in women that can impact fertility. Careful management of chronic conditions will help create an internal environment that can best promote fertility. 
  • Sexual health - sexually transmitted infections (STI) can lead to fertility issues if left untreated. Infections such as chlamydia and gonorrhea can cause damage to the reproductive organs. Discuss STI screenings with your health care provider, including certified nurse-midwives and OBGYNs, if you have any concerns about exposure. 
  • Lifestyle factors - smoking, excessive alcohol consumption, and recreational drug use can negatively impact fertility in both men and women. High levels of stress can affect reproductive hormones and disrupt menstrual cycles in women. Stress can also lead to erectile dysfunction and lower sperm quality in men. 
  • Weight - poor nutrition and being underweight or overweight can affect fertility. Obesity can contribute to shared factors that affect fertility in men and women, such as insulin resistance and inflammation. Underweight women may also experience irregular menstrual cycles or lack of menstruation (amenorrhea) due to hormonal imbalances. 
  • Environmental factors - while less common, exposure to environmental toxins, such as certain chemicals and pollutants, can have adverse effects on fertility. 

What can I do to improve fertility before trying to get pregnant?

If you know you want to try to conceive, there are some simple things you can do to help improve your chances. 

First, schedule an appointment with your health care provider to discuss preconception health and any specific concerns you may have. 

Overall, it's important to focus on a well-balanced diet rich in fruits, vegetables, whole grains, lean proteins, and dairy products. Limit caffeine intake, as excessive caffeine consumption has been associated with a higher risk of fertility issues. Additionally, it's advisable to minimize alcohol intake, as excessive alcohol consumption can negatively impact fertility and increase the risk of birth defects. Smoking is also associated with a higher likelihood of infertility in both men and women and can increase the chance of pregnancy complications. 

Ideally, women should start taking prenatal vitamins before conception. Prenatal vitamins contain folic acid, which is crucial for preventing neural tube defects. It's recommended to take 400 to 800 micrograms (mcg) of folic acid daily before conception and during pregnancy. Prenatal vitamins also include other essential nutrients like iron, calcium, vitamin D, and omega-3 fatty acids, which are important for the health of both the mother and the developing baby. 

How can I track my menstrual cycle to determine the most fertile days? 

You are most likely to get pregnant if you have sexual intercourse or insemination within the fertile window of your menstrual cycle. This period is typically four days prior to ovulation (which happens roughly halfway through your menstrual cycle) and one day after ovulation. There are a variety of methods you can use to track your menstrual cycle and determine your window of fertility. 

Using a calendar or fertility app to track your menstrual cycle 

Track your cycle with a menstrual calendar or mobile app by marking the start and end dates of each menstrual cycle. Over time, patterns may emerge that can help anticipate ovulation. For example, in a 28-day menstrual cycle (your menstrual cycle will be unique to you, but a normal cycle can be 23 to 35 days), ovulation would likely happen 14 to 15 days after the first day of your period. 

Fertility apps allow users to input menstrual cycle to predict fertile days based on cycle length, cervical mucus changes, and trends in basal body temperature. 

Charting your basal body temperature 

A basal body temperature (BBT) is the lowest body temperature attained during rest. Basal body temperature typically rises less than half a degree Fahrenheit after ovulation as your body responds to increased levels of progesterone. 

To measure your BBT, use a highly accurate thermometer (which reads to the 100th decimal point, not just the 10th) and take your temperature first thing in the morning, before getting out of bed. Start with the first day of your cycle and chart the findings each morning, or record in your tracking app. 

Using an ovulation predictor kit 

These kits detect the surge in luteinizing hormone (LH) that precedes ovulation. A positive result indicates that ovulation is likely to occur in the next 24 to 36 hours. Since the egg only survives for approximately 24 hours, ovulation predictors can help determine the fertile window. 

Tracking other changes in the body 

The body undergoes many changes to prepare for the possibility of carrying a pregnancy, and if you are able to track them as part of your menstrual cycle tracking, they may help you better predict your fertility window. Monitor any changes in cervical mucus throughout your cycle—around ovulation, cervical mucus becomes clear, slippery, and stretchy, resembling raw egg whites. The cervix itself changes position and becomes softer, higher, and more open during ovulation, though being aware of these changes may require practice and familiarity with one's body. 

Some women experience mild pelvic pain or twinges (called mittelschmerz) on one side of the body during ovulation. Other physical symptoms women may experience around ovulation include breast tenderness or sensitivity, an increase in sexual desire, mood changes, or increased energy. 

How often should we have intercourse to maximize chances of conception? 

Couples are often advised to have intercourse every one to two days during the fertile window to maximize the chances of sperm encountering the egg. While some couples may choose to have intercourse every day during this time, others may find every other day to be sufficient. Sperm can live up to five days inside the female body, meaning intercourse prior to ovulation or during ovulation increases the chance of having the sperm ready to meet the egg as it arrives and accomplishing pregnancy. 

When is it time to consider fertility testing? 

Infertility is defined as the inability to conceive after a year of regular unprotected intercourse. If a woman is under 35 and has been trying to conceive for a year without success, she could schedule an appointment with an OBGYN or certified nurse-midwife for an evaluation or counseling. If a woman is 35 or older, she could consider seeking help after six months of unsuccessful attempts. 

It is essential for both partners to undergo fertility evaluations, as infertility can be due to factors affecting men or women, or a combination. Seeking help earlier may be advisable if there are known fertility risk factors, such as irregular menstrual cycles, a history of reproductive health issues, or other medical conditions that could impact fertility. 

What are some reproductive technology options for extending fertility? 

For those who know they want to try to conceive later in life but are not ready at the moment, there are some options to help extend the chances of pregnancy. Women can opt for egg freezing (oocyte cryopreservation) to preserve their eggs for future use. This is often recommended for women who want to delay childbearing due to career or personal reasons. Men can preserve their fertility by freezing sperm, which can later be used for assisted reproduction. 

For couples undergoing in-vitro fertilization (IVF), surplus embryos can be cryopreserved for future use. 

How successful are assisted reproductive technologies? 

Success rates of assisted reproductive technologies (ART), including IVF, vary based on several factors, such as the woman's age, the cause of infertility, and the specific ART procedure used. Generally, younger women tend to have higher success rates with ART compared to older women. Success rates are typically reported as the percentage of cycles resulting in a live birth. These success rates can range from around 20 to 30 percent or higher per cycle for women under 35, but they decrease with advancing maternal age. 

What are some potential risks of assisted reproductive technologies? 

ART increases the risk of multiple pregnancies (twins, triplets, etc.), which can have higher rates of complications for both the mother and babies. Excessive stimulation of the ovaries can lead to Ovarian Hyperstimulation Syndrome, characterized by abdominal pain, bloating, and in severe cases, fluid accumulation in the abdomen and chest. While rare, the risk of ectopic pregnancy (in which a fertilized embryo implants outside the uterus) may be slightly higher with ART. Finally, the emotional and financial stress associated with fertility treatments can be significant and should be considered. 

Are there support groups or resources available for individuals or couples struggling with fertility? 

Joining a fertility support group, either in-person or online, can provide a sense of community and shared experiences. Connecting with others facing similar challenges can be comforting. 

The National Infertility Association provides excellent supportive resources for individuals or couples facing infertility. In New England, Resolve New England offers more than 20 virtual peer support groups on different fertility and family building topics. For more one-on-one support, you can visit the Psychology Today website and search for therapists who specialize in helping people working through infertility issues. If you're on a journey to becoming a parent, the team at Newport Women's Health Center can help. Visit us online to learn more or call 401-848-5556 to schedule an appointment.

Sara Bates King, NP, CNM

Sara Bates King, CNM, FNP

Sara Bates King is a certified nurse midwife and family nurse practitioner with Newport Women's Health, a Lifespan Physician Group Practice.