Maximising the chance of Natural Conception
Conceiving naturally is, of course, the goal for most couples. Around 80% will conceive within the first six months of trying, with the highest chance being in the first three months.
Conceiving naturally is, of course, the goal for most couples. Around 80% will conceive within the first six months of trying, with the highest chance being in the first three months. In order to conceive naturally in the shortest possible time, it’s important to have an understanding of the fertile window. This is the time in a woman’s menstrual cycle in which the receiving of sperm can result in a fertilized egg, which can then implant in the uterus. This window of time will differ depending on the length of each menstrual cycle; being the time from the first day of one period to the first day of the next. For example, a woman with a 28-day cycle can expect to ovulate around day 14 as the luteal phase (the time after ovulation and before the next bleed) is 14 days. If the cycle were 32 days, the likely day of ovulation would be day 18. The fertile window is the day of ovulation and the 5 days preceding it, with the most fertile thought to be two days prior to ovulation.
Predicting the time of peak fertility and ovulation can be done in a number of ways. Cycle tracking is the most simple; this is where you record the days of your period and work out your fertile window from this. Many people now utilize phone apps for this, which has been shown to decrease the time to conceive in some studies, but it has also been shown to actually predict the correct day of ovulation only 21% of the time.
Ovulation detection methods such as urine LH (luteinizing hormone) testing can also decrease time to pregnancy. Ovulation can occur any time in the two days after the surge is predicted. Some kits also measure estrone glucuronide (a byproduct of estradiol, the potent estrogen measured in the bloodstream of women). This will also help to predict when there is a “high” chance of fertility as well as when “peak” fertility is reached that cycle.
Cervical mucus monitoring is another option. This mucus is seen as vaginal discharge; over time, it is possible to compare the changes and work out what this means. When it is clear and slippery and at its highest amount, this predicts the best time for intercourse as it is an indirect measure of the rising estradiol levels seen when the ovarian follicle (housing the egg) is large and close to ovulating.
The frequency of intercourse recommended is a common question. Before focusing on exactly how many times per week is recommended, it must be recognized that this can be a very stressful time for couples who have been trying for some time without success, and the added pressure of the expectation of having to have intercourse frequently can be overwhelming for some. It is important not to focus too much on counting the exact number of times and to know that any frequency between every 1-3 days in the fertile window will be beneficial. Long periods of abstinence for the male can result in poorer sperm parameters, with 5-10 days without ejaculation likely to negatively affect sperm counts. There does not seem to be a problem with frequent, i.e., daily ejaculation, and for some men, this can actually be beneficial.
After sperm has reached the vagina, it takes around 15 minutes to reach the fallopian tube (but can be as fast as two minutes!). Different sexual or postcoital positions do not affect the chance of pregnancy.
Lifestyle modification is always recommended but not necessarily taken seriously by many. We have evidence to show that poor lifestyle habits do negatively affect the chance of conception as well as pregnancy outcomes; this can be a simple way to set yourself up for improved long-term health.
Folic acid supplementation and vitamin D and B12 (if low levels) should be optimized. Avoiding processed foods and focusing on fruit and vegetables, plant proteins, and other whole foods is recommended. Various diets have been specifically studied and some, such as the Mediterranean diet, have been shown to improve outcomes for those who are undergoing fertility treatment. There are, however, some studies that don’t agree with these findings, and more rigorous research is needed before being completely sure. Making healthy changes prior to pregnancy is beneficial for pregnancy and also the long-term health of the parents and children, and so there is, of course, good reason to recommend this nonetheless.
Smoking is clearly harmful in pregnancy and also implicated in infertility. Women who smoke are also more likely to have an earlier menopause, supporting the idea that it does harm reproductive potential. It also causes an increase in miscarriage and pregnancy complications as well as childhood illness. Overall, it is best to stop smoking before pregnancy, and support is available as it is known to be exceptionally difficult for many people.
The evidence around alcohol is somewhat mixed depending on which country the study is from. A large Swedish study showed a significant increase in the chance of infertility when two standard drinks were consumed per day. Chronic alcohol use is also known to decrease sperm count and motility. Sexual dysfunction is also more common among those who drink alcohol. And of course, it is not safe in pregnancy. Having a few drinks per week is unlikely to cause a problem in the pre-pregnancy period, but excessive alcohol should be avoided.
High levels of caffeine ingestion, e.g., 5 cups of coffee per day, have been linked to a decrease in fertility. It is also associated with an increase in miscarriage. One to two coffees per day is thought to be safe both pre-pregnancy and in pregnancy. The effect doesn’t seem as significant for men.
The use of cannabis has a dose-dependent effect on sperm, meaning the more that is used, the worse the sperm parameters. It may also affect the fertility of women. This and other illicit drugs should be avoided altogether.
Environmental exposures to chemicals have become an increasing concern globally, with emerging evidence of harm in both increased infertility and also increased miscarriage rates. People who live in areas of high pollution are known to have a longer time to conceive on average. It is impossible in modern life to avoid all of these toxins, but where possible, small changes can help. For example, avoid non-stick cookware, limit cosmetics containing these compounds, eat whole and unpackaged foods, wash fruit and vegetables, and store leftovers in glass, not plastic.
Deciding to try and conceive can be an exciting but also daunting time. Knowing your own body and optimizing your health at the start can help decrease the stress of a prolonged time to conception. If you are a woman and have been trying for a year without pregnancy or are aged 35 or more, or have other risk factors such as polycystic ovarian syndrome, endometriosis, and have been trying for six months, it is important to be assessed for barriers to conception. Men who have had previous testicular surgery or infections, or work in areas of high use of chemicals should also seek assessment early.
Written by Dr Sylvia Ross
Dr Sylvia Ross is a dedicated medical professional with over a decade of experience in the field of women's health. She is a specialist in Obstetrics and Gynaecology (FRANZCOG) and currently in the final stage of completing her Certificate of Reproductive Endocrinology and Infertility (CREI), a highly competitive program producing board certified subspecialists in infertility.
Specialising in infertility treatment, Sylvia offers a range of services to support individuals and couples facing fertility issues. Her expertise includes management of polycystic ovarian syndrome, ovulation induction, in vitro fertilisation (IVF), and various surgical interventions tailored to meet the unique needs of her patients.