Reading online advice about what to do in advance of a pregnancy, one might think that the human race was an endangered species. Or, that breeding among humans was a complicated, perilous process, only to be attempted by the young and fit. Given the right medical supervision under strictly controlled circumstances, you might have half a chance. Think giant pandas in the in the Beijing Zoo.
Let’s get real.
Of course I’m exaggerating. If getting pregnant, for you, is like falling off a bicycle, chances are you’re not trolling the web for advice on how to get knocked up and what to do to prepare yourself for a pregnancy. That being said, we’re a culture of planners, cling tight to the illusion that we’re the dominatrices of destiny. And, of course, if you’re one of the millions who struggle with the heartbreak of infertility, chances are you’d try having sex standing on your head while O Come O Come Emmanuel played in the background if someone with “MD” behind their name recommended it before taking out a second mortgage to pay for medical treatment.
For most of the world, getting pregnant is not difficult. Chances that the “average” hetero couple will conceive over the course of a year are about 80%; given two years, that number goes up to about 90%. Fertility problems are far from uncommon, but in the world online, telling people “don’t sweat it, you’re fine” doesn’t sell advertising.
But that’s what I’m here to tell you: don’t sweat it, you’re fine. Unless you’ve tried and failed, are over 40, or have some significant health issue, the most likely outcome of unprotected sex for you and your male partner is a healthy pregnancy. Of course, the chances of infertility, miscarriage, or other less-than-optimal pregnancy complication increase as we age. Of course you’re most biologically “fit” in your 20s. But what the internet doesn’t tell you is that most pregnancies are easily achieved and result in healthy babies born to healthy moms. It’s a matter of perspective: your glass isn’t 20% empty, it’s 80% full.
There’s a lot of information, good, bad, and ugly, available online for those who are struggling to conceive. But if you’re young and otherwise healthy, here is the GynoGirlfriend version of what to do before jumping on the mommy train.
- Recognize you’re not in control of the universe. This is a harder one for some than others, but entering into the pregnancy and parenting club is likely the biggest crap shoot you’ll ever take. From the timing of your conception to the sex of your baby to how many fingers and toes he has to whether she’ll go to college: it’s not up to you. Get used to it. Learn to accept “what is” and let go of your ideas of “what should be.” You’ll be a happier person in general and a better parent in particular. Do control what you can (that’s what the rest of this list is about!)
- Be a well woman. Get a health maintenance exam from your practitioner of choice. This is a great opportunity to discuss your personal “to do list” in advance of a pregnancy. While there are very few medical conditions that are incompatible with a healthy pregnancy, some common ones, like high blood pressure, can significantly impact your chances of a good outcome. Also, you and your doc will want make sure you’re caught up on your immunizations, review any medications you’re on and make sure you’re caught up on your recommended health screenings. Also, you’ll want to discuss you and your partner’s genetic history and see what pre-conception testing may be recommended for you.
- Try to act like you’re pregnant. By this, I mean no booze, no smoke, no recreational drugs. Yes, I really mean it. If you’re serious about a healthy pregnancy, you will forgo all of the aforementioned for the duration of your pregnancy at the very least (I don’t want to get too far off topic about how these may impact your parenting). Some online advice givers would have you play the game of “only drink before ovulation…” etc. There’s no good reason not to stop now, other than you just can’t. If you have trouble giving up your bad habits on your own, let’s find this out now and get some help.
- Clean up your diet and start exercising. I cringe when I read these online lists that instruct you to achieve an ideal body weight. Gosh, that’s a good idea, but hardly a pre-requisite for a healthy pregnancy. Absolutely, women who are fit have higher pregnancy rates and fewer complications. But again, even for those who are underweight or overweight, the most likely outcome of pregnancy is a healthy mom and a healthy baby. Insisting that only those with a body mass index between 19 and 24 can join the parenting club is discouraging at best, outright discrimination at worst. Don’t get me wrong: small changes can reap big rewards. If you are overweight, even a loss of 5-10% of your body weight can improve your fertility, blood pressure, and blood sugar metabolism. Can’t find time to exercise now? You won’t find it after you have a baby either. 30 minutes of walking, most days of the week, will improve your fitness and increase the odds of a healthy pregnancy independent of its effect on weight.
- Consider your contraceptive method. What method you’re using can affect how long it takes you to conceive. One oft-repeated piece of online advice I find particularly bewildering is to stop birth control pills 3 months in advance of attempting to conceive. While it’s true that your cycle may be different than when you started taking the pill at age 16, the pill does not, I repeat, NOT take time to ‘get out of your system’. It only takes a day. How many stories have you heard of women who’ve conceived while on the pill? Merely one well-timed oops with the pill may be enough to allow ovulation to occur. If your cycles aren’t back on track within two to three months of stopping the pill, it’s not the pill, it’s you. You may have an underlying hormonal imbalance that deserves attention. Similarly, if you’re using the an IUD, the contraceptive ring or patch, or the etonogestrel rod (aka Nexplanon), consider yourself fertile the moment you stop these methods. On the other hand, if you’ve been on Depo Provera, you may want to switch to a different method earlier, as this may interfere with ovulation for up to a year after your last injection.
- Don’t overthink it. Did I mention that, for most women, getting pregnant is kind of like falling off a bicycle? Again, more than likely, this means you. For most women, ovulation predictor kits are a waste of money. That being said, do be familiar with your cycle. If your cycles consistent in their timing from month to month (there’s a wide range of what’s normal, but for each woman, cycles shouldn’t vary a whole lot), chances are excellent that you ovulate. Pay attention to signs of ovulation, such as mid-cycle pelvic pain, changes in cervical mucous, breast tenderness, and cravings for salted caramel chocolate ice cream. Do understand when your most fertile periods are, but don’t just have sex when you think you’re ovulating. You’re outsmarting yourself and killing all the fun in it. We don’t understand fully the role that stress hormones like cortisol play in fertility. I firmly believe that “trying” per se is stressful and counterproductive. Have. Sex.
- Give up the water-based lubricant. In my book, this is a definite maybe. However, the advice to throw away the KY jelly is repeated so often, I thought I should weigh in. Turns out that certain types of lubricant can interfere with sperm motility. While this has only been studied in the laboratory, this finding has been consistent enough that most fertility experts recommend staying away from water-based lubricants containing glycerine (like KY, astroglide, etc). Likewise, saliva and olive oil have also found to interfere with little swimmers, at least in the petri dish. If you need lubricant, mineral oil or other vegetable oils are usually considered better choices from a fertility standpoint. However, if KY jelly or spit or whatever else you’ve been using is your preferred lubricant, it’s not critical to abandon these at the outset. The most important thing is to have sex, right? After a few months, if you’ve not conceived, it may be worth revisiting this issue.
- Take a prenatal vitamin. Unless you’ve been living under a rock, I probably don’t need to tell you that folic acid is important for a healthy pregnancy. It reduces the odds of having a baby with what’s termed, in medical speak, a neural tube defect, such as spina bifida. While folic acid deficiency is relatively rare in the industrialized world, a multivitamin formulated for pregnancy is generally considered a good idea. You don’t need a prescription, there are plenty of good prenatal vitamins available over-the-counter, all of which contain the recommended daily allowance of folic acid. What is not universal among prenatal vitamins is extra iodide, the nutrient which is added to most table salts, otherwise known as “iodized salt.” Iodine is an important nutrient for fetal growth and development, and deficiency is becoming more common. Also, you may want to consider supplementation with DHA. DHA, one of the omega 3 fatty acids, is an important nutrient for brain development. Found most abundantly in seafood, supplementation is usually advised during pregnancy and breastfeeding.
- See your dentist. What’s your mouth got to do with your baby-making plans? A whole lot, it seems. Gingivitis and cavities have been linked to a whole host of less-than-ideal pregnancy outcomes, including pre-eclampsia and preterm birth. Plus, you don’t want to be getting major dental work and having x-rays in your first trimester.
- Have lots of sex. See #6. If you’re in a relationship with a man you’d like to have a baby with, this is usually a good starting point. Besides its reproductive function though, sex is good for you and it’s good for relationships. Make sure your partnership is on a solid foundation and you’ll have a big head start on a healthy pregnancy and a healthy family. So get after it, doctor’s orders.
For most women under 35, experts typically recommend one year of unprotected, regular intercourse before seeking medical attention for fertility issues; if you’re over 35, it’s 6 months. Again, do consult with a health professional sooner rather than later if you have a history of fertility issues, your cycles are irregular, or if you have any ongoing medical concerns. But for the rest of you: be not afraid, tune out the noise, and have fun.
Resources
American Society for Reproductive Medicine. http://www.reproductivefacts.org
Center for Disease Control and Prevention. http://www.cdc.gov/reproductivehealth/Infertility