Trying to Get Pregnant? Timing is Everything

Most of us spend the first 15 to 20 years of our reproductive lives trying not to get pregnant.  For many of us, there is a point at which it feels as though a switch is flipped.  We not only want to be pregnant, we want to be pregnant yesterday. An entire industry of apps, tools and websites have flourished promising women to help them get pregnant quickly.   How can women use all this information effectively and when should they pass on the home chemistry experiments and seek professional help?

Are your periods regular?

So, you’ve ditched contraceptives including pills and rings or you’ve seen the gynecologist and had your IUD removed.  The first step in getting pregnant is to track your period.  There are myriad apps for this.  They all function on the same principles–you tell the app when you start a period and it uses this data over time to estimate the timing of various parts of your cycle.  

A normal cycle length is anything from 21 to 35 days counting from the first day of bleeding of one period to the first day of bleeding of the next.  Your period is regular if the cycle length is the same from cycle to cycle (i.e. always 28 days give or take a day or two).  Regular periods with a typical cycle length typically indicate regular ovulation.  

Many women will have an irregular cycle here or there, but if your cycle is 21 days and then 47 days and then 32 days, etc. you may not be ovulating regularly or at all.   There are many reasons women do not ovulate regularly including recent use of hormonal contraception (like birth control pills). An evaluation with your physician can help pinpoint causes and plan next steps.

When are you ovulating?

If your periods are regular the next step is to figure out when you are ovulating.  Ovulation is almost always 14 days prior to the first day of your period (give or take a day).  So, if you have a 28-day cycle you will ovulate on day 14, but if you have a 32-day cycle ovulation will be on day 18 and if you have a 21-day cycle ovulation will be on day 7.

Many of the tools available help to pinpoint ovulation.  Basal Body Temperature uses normal and predictable changes in body temperature to tell you when you have ovulated.  To use this method you must use a basal body temperature thermometer (they are more accurate).  You need to take your temperature daily at the same time BEFORE you get out of bed.  You will see a rise of ½ to 1 degree the day after you ovulate.

Ovulation predictor kits (OPKs) detect the hormone that triggers ovulation in your urine.  This hormone rises significantly in the 24-48 hours prior to ovulation. The trick to using OPKs is to know when to start using them.  Start too late and you will miss ovulation, start too early and you will spend days peeing on sticks that cost upwards of $1.50 a piece.  

How should you time intercourse?

To become pregnant sperm has to meet egg in the fallopian tube.  Sperm can hang out in the uterus and fallopian tubes for a few days so the key is to time intercourse for before ovulation occurs–but not too far before.  To maximize sperm quality and quantity it is better to target having intercourse every other day.  

The chart below outlines the timing of basal body temperature changes, suggested use of OPKs and optimal timing of intercourse for a few different cycle lengths:

Key: Start OPKs = begin checking OPK once daily, Intercourse = suggested days for timing intercourse, +OPK = days when OPKs should be positive–once you have a positive OPK you can stop checking them, ↑ BBT = the day basal body temperature should rise, +pregnancy test = the day a home pregnancy test should be positive if you have conceived

What if my periods are regular, I know when I am ovulating and I am timing intercourse, but I am still not getting pregnant?

Most women under the age of 35 will conceive with timed intercourse in 12 months or less.  If you are under age 35 and have been tracking periods and timing intercourse for 12 months, you should see your gynecologist for further evaluation.  Women over the age of 35 should seek evaluation after 6 months of trying to conceive and women over 40 may want to seek evaluation as soon as they are considering pregnancy to optimize their chances of conceiving.  

There are many ways gynecologists, reproductive specialists and endocrinologists can help women to become pregnant.  An evaluation for common causes of infertility is the first step.

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