1. Get pre-conception counseling. About 60 to 90 days before you're ready to start trying, make an appointment with your ob-gyn. "He or she will discuss your reproductive goals, screen you for conditions such as anemia that might need treatment, and consider less toxic alternatives to any prescription or over-the-counter medications you take," says Kelly Pagidas, M.D., a fertility specialist with Women & Infants Center for Reproduction and Infertility in Providence, and an associate professor at Brown University Medical School. Clearing up any issues upfront can prevent delays down the road when your fertility is declining due to diminished quality and quantity of eggs.
2. Update your annual exams. In addition to your Pap, mammogram (if it applies), and regular physical, be sure to visit the dentist regularly for cleanings. Certain infections may not be treatable while you're pregnant and could result in reproductive delays. "Some people believe that gum disease may cause more complications later in pregnancy," Dr. Pagidas says.
3. Talk to your family. Find out how easily your female relatives got pregnant and if there's a family history of hereditary medical conditions. "If you or your partner have Jewish, French Canadian, or Hispanic ancestry, for example, or a family history of Down syndrome, you may want to seek genetic counseling before trying," says Steven R. Bayer, M.D., reproductive endocrinologist at Boston IVF fertility clinic in Boston. "It's much better to find out if you're both carriers of complications like cystic fibrosis before you conceive."
4. Get vaccinated. Make sure all your shots are updated, particularly those for German measles, chicken pox, and flu, before you try to get pregnant. "You're at higher risk of complications if you get sick during pregnancy, and some vaccines are not safe during pregnancy," Dr. Bayer says.
5. Check your thyroid levels. "We're seeing increasing numbers of women whose thyroid is very subtly under-functioning," says Jani Jensen, M.D., a reproductive endocrinologist and assistant professor at the Mayo Clinic in Rochester, Minnesota. "A slight dysfunction could lead to difficulty becoming pregnant or miscarriage." But many doctors don't test your levels because the accepted normal range applies to 28-year-old women and 80-year-old men alike. You and your doc may need to be extra vigilant.
6. Have your guy checked out too. "It makes sense to do a basic semen analysis on men when you start trying," says Alan Copperman, M.D., director of Reproductive Medicine Associates of New York and codirector of the Division of Reproductive Endocrinology and Infertility at The Mount Sinai Hospital in New York City. "Many guys have low sperm counts or they take some supplement at the gym that interferes with the motility of their sperm." Early testing can also give you a heads-up if your guy is experiencing andropause, a permanent reduction in sex hormones.
7. Don't wait to have sex after getting off the Pill. "There's a myth that after you stop using hormonal birth control it takes a long time to get fertility back," Dr. Jensen explains. "Most women will have regular periods and the ability to be pregnant within three months of stopping use."
8. Time your baby-making just right. "Once an egg is released it can only be fertilized for somewhere between 12 and 24 hours," says Angela Chaudhari, M.D., a gynecologic surgeon and assistant professor in the Department of Obstetrics and Gynecology at Northwestern University Feinberg School of Medicine in Chicago. That's why it's best to start having sex well before you ovulate. One study showed that the day with the highest chance of success after intercourse was the one right before ovulation.
9. Don't feel you have to abstain from sex. You may have been advised to wait a few days between sexy times with your guy because men need time to build up enough sperm. "That's not true," says David Ryley, M.D., a reproductive endocrinologist at Boston IVF fertility clinic and clinical instructor at Harvard Medical School. "Ejaculation effects seminal volume, not the concentration of sperm. The concentration is more important and not influenced by the frequency of sex."
10. Switch up your coital positions. Some research suggests that missionary is best for being impregnated, but the data is not conclusive. "There's no doubt that some [positions] are more comfortable," Dr. Pagidas notes. "Just do what feels right for you so you're more likely to keep up a consistent routine." Oh, and you don't need to elevate your legs afterward. Says Dr. Jensen: "It does not make one bit of difference in conception."
11. Take care with vaginal lubricants. Many commonly used water-based lubricants can inhibit sperm movement by 60 percent. "Good old-fashioned mineral oil is a natural option that seems to work well," Dr. Pagidas says.
12. Consider using an ovulation predictor kit. Doctors used to rely on basal body temperature to predict ovulation. "It only tells you once you've already ovulated, which is too late, plus taking your temperature daily often adds stress," Dr. Bayer explains. An ovulation predictor kit is now the recommended method. It monitors the levels of luteinizing hormone (LH) and helps couples with busy schedules stay on top of their fertility. "Once it turns positive, you want to have sex in the next 24 to 36 hours," Dr. Bayer says.
13. Watch your caffeine intake. Limit it to 200 milligrams per day, which is equivalent to two 6-oz cups of coffee -- we're not talking Venti size here! Soda, tea, and energy drinks count, too. "Half the time I see patients totally forgetting about the monster power energy drinks they're consuming," Dr. Pagidas says.
14. Reduce exposure to cigarette and marijuana smoke. "We already know that smoking clearly impacts blood supply to ovaries and results in a more exponential loss of eggs," Dr. Ryley says. But passive smoke has been linked to increased pregnancy complications as well. There's really no safe level of exposure, so limit your time around family members, friends, or coworkers who won't kick butts.
15. Stop binge drinking. Cutting back alcohol in general is recommended; eliminating booze fests is essential. "Nobody knows exactly what happens with prolonged heavy drinking before you conceive, but there are likely structural changes in the eggs that affect the quality," Dr. Pagidas says. "It's hard to know how long it takes for them to recover, if at all, so stop as soon as possible when you are ready to start trying."
16. Keep an eye on your weight. Being too far on either side of a healthy body mass index can affect the health of your eggs and result in pregnancy complications. "Women with excess weight are particularly challenged because they don't ovulate as regularly, which can render a woman more infertile," Dr. Ryley says. Aim to be within 15 percent of your target body weight when you start trying.
17. Make sure his bad habits under are control. "A lot of men continue to smoke cigarettes or marijuana, and that can seriously affect motility of sperm," Dr. Ryley notes, so your guy should stop smoking as well as drinking in excess. It may also be time for him to hit the gym. Says Dr. Ryley: "The more overweight a man is, the lower [his] testosterone and sperm function." Obesity can also do a number on sperm production and ejaculatory function.
18. Get your blood pumping. "The rule is 30 minutes of cardiovascular exercise five to six days per week, both before and during pregnancy," Dr. Chaudhari says. Some doctors suspect that super high-impact workouts might hinder conception, as very athletic people tend to have irregular periods. But if you're of a healthy weight and have regular cycles, don't feel you need to give up that intense Spin class you love.
19. Limit your exposure to radiation. There's not a lot of data about what happens when people go through newer TSA scanners at the airport, but the scanners do emit a small amount of radiation. "Because we don't know what the cumulative effects are of repeated exposure, I recommend frequent flyers do a security pat-down instead to minimize any radiation that could affect reproduction," Dr. Chaudhari says.
20. Combine Eastern and Western medicine with caution. "There may be benefits to doing acupuncture while trying to get pregnant, particularly in stress reduction," Dr. Jensen says. "What makes me a little wary is when Chinese herbs are added to the mix. We're not certain exactly what they are and how they're formulated." Some studies show that herbs may interact negatively with conventional medicines, so use them only under a doctor's care.
21. Don't douche. "We discourage it not because you're flushing out the sperm but because it makes the environment in your vagina less hospitable to them," Dr. Pagidas says. The same caution goes for the use of scented tampons and vaginal sprays. You're best off limiting their use during your cycle.
22. Do certain beauty treatments sparingly. Some research has shown that women who work in nail and hair salons and were exposed to chemical fumes such as acetone had a lower chance of achieving pregnancy and higher chance of miscarriage. A mani-pedi or highlights here and there shouldn't be harmful for the average woman. "Just make sure the salon is well-ventilated and wear a respirator mask if you're really concerned," Dr. Chaudhari says.
23. Go at your own pace after a miscarriage. "I've had patients hear they need to wait three months or a specified amount of time, but really that isn't true," Dr. Jensen says. As long as you're emotionally ready and feeling up to it physically, there's absolutely no reason to delay trying again.
24. Be realistic about your own chances of conceiving past 40. "We all see celebrities getting pregnant with twins when they're in their 40s and think it can happen to anyone that age," Dr. Ryley says. "But the vast majority of those are donor eggs because women that age don't have enough healthy eggs of their own." Even if you look like a movie star on the outside, it's important to manage your expectations and be open to various options for motherhood.
25. Stop stressing about being stressed. "The theory that you should just relax and go on vacation to magically get pregnant is an old wives' tale," Dr. Copperman says. Worse yet, it makes women feel guilty if they can't Zen themselves to motherhood. Anxiety over fertility is totally normal and it's not likely to be harmful in the long run. Says Dr. Copperman, "The stress that comes along with fertility challenges has not been shown to affect whether a woman makes a good egg or not."
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