Written by Dr. Filza Swalah, ND

First, congratulations on deciding that it’s time to start or continue to grow your family. Now, take a deep breath! In my practice I see many women trying to conceive, so I understand the emotions involved and the questions being asked. Most of the conversations I have in my office range from discussing the menstrual cycle and fertility window to the best sex positions for conception (plot twist – there is no such thing as the best sex position for conception)

It can be overwhelming, I get it. That’s why I’ve created this blog/guide to ease your mind and answer some of your questions. Here are top 3 factors to consider when trying to conceive:

1. You don’t know your fertility window

Get intimate with your partner….and your cycle! I started cycle tracking when I was 18 (and no, I was not trying to conceive at that time). Cycle tracking is important – not just for trying to conceive – and it’s something I recommend all menstruating women to do. It not only helps you track the frequency and duration of your menstrual cycle but helps identify patterns (like PMS symptoms) and can help you track subtle changes that may go unnoticed (i.e., changes in your cycle length). By understanding your cycle length, we can understand your fertility window.

Did you know that women are only fertile for about 6 days?¹ This is why I spend so much time educating my patients about subtle cues to help identify ovulation – the moment a mature egg leaves the ovaries and makes it way to the uterus. In general, you want the sperm and egg to meet and highest chance of this happening is about 5 days before ovulation and the 24 hours after ovulation! When you track your cycle and ovulation, you get a general sense of when you are ovulating so you can start having sex to conceive accordingly.

Here are subtle cues to understand ovulation has occurred:²

1. Changes in temperature:Start tracking your basal body temperature first thing in the morning before any activity. After ovulation, temperature increases slightly by 0.5 – 1.0°F.
2. LH surge:Luteinizing hormone (LH) is released from the brain and tells the ovaries to release a mature egg! LH hormone can be measured through urine strips. In order to understand your fertility window, track your LH peak for about 6 cycles before trying to conceive and while trying to conceive. Start from Day 10 until you have a peak. After LH peaks, ovulation happens about 24-48 hours later so it’s recommended to have sex within that time so sperm is there when the egg arrives!
3. Changes in cervical mucous:Cervical mucous changes according to where you are in your menstrual cycle. Cervical mucous is influenced by estrogen and as estrogen increases, cervical mucous changes to support sperm reaching the egg! During ovulation, cervical mucous will be watery and a raw egg white like consistency.

2. You have an underlying condition

Cycle tracking and ovulation timing can help you understand if there are any underlying conditions that can impact fertility. Here are some scenarios that can help you understand if there are underlying conditions:

1. Long period cycles i.e., >35 days + no signs of ovulation could point towards Polycystic Ovarian Syndrome (PCOS). Women with PCOS don’t ovulate as frequently as women without it, hence why, making trying to conceive more difficult.
2. 28 days – 35 days cycles + signs of ovulation BUT painful menstruation, intercourse and or bowel movements could point towards endometriosis. Endometriosis is a condition where the endometrial lining grows outside of the uterus and in areas like the ovaries, fallopian tubes, or pelvic tissue.³One third to one half of women with endometriosis have trouble conceiving and that’s because the endometrial tissue can obstruct the egg from meeting the sperm.

If you suspect that you have these conditions, talk to your health care professional for a proper diagnosis.

3. Male fertility matters too!

If I had a dollar for every time I recommended assessment for male fertility, I’d be rich! Making a baby is half a healthy egg and half a healthy sperm, so don’t forget your partner! His sperm matters as much as your egg. Of all infertility cases, 40-50% are due to factors related to men!⁴When thinking about men’s fertility, we are interested in taking a microscopic look at their sperm and assessing the amount of sperm, how it moves, and how it looks. If there isn’t enough sperm, then that’s obviously going impact whether or not it meets the egg BUT how it moves (does it go backwards, does it stay still) and the way it looks (does it have 2 tails, no tails) can also determine conception.

With this being said, it’s also important to know when to see a doctor for a full fertility work up:⁵

• For women 35 or younger and not pregnant after a year of trying
• For women 30 or older and not pregnant after 6 months of trying
• If you experience symptoms of endometriosis or PCOS, missed periods, history of abdomen or uterus surgery, previous STI’s, cancer treats or family history of early menopause, you should consider seeking medical advice sooner.
• For men, seek medical advice if you’ve had surgery or injury to testicles in the past, have premature ejaculations, have history of STI’s and/or cancer treatment in the past.

Now that you know the basics of cycle tracking, understanding when ovulation occurs and other conditions that can impact fertility, I hope this blog empowers you to understand you and your partner’s body! Trying to conceive can be a stressful time but it can also be an amazing opportunity to learn more about your hormones.

Good luck on your journey!

References:

1. Najmabadi S, Schliep KC, Simonsen SE, Porucznik CA, Egger MJ, Stanford JB. Cervical mucus patterns and the fertile window in women without known subfertility: a pooled analysis of three cohorts. Hum Reprod. 2021 Jun 18;36(7):1784-1795. doi: 10.1093/humrep/deab049. PMID: 33990841; PMCID: PMC8487651.
2. Su, H. W., Yi, Y. C., Wei, T. Y., Chang, T. C., & Cheng, C. M. (2017). Detection of ovulation, a review of currently available methods. Bioengineering & translational medicine, 2(3), 238–246. https://doi.org/10.1002/btm2.10058
3. Mayo Foundation for Medical Education and Research. (2018, July 24). Endometriosis. Mayo Clinic. Retrieved April 27, 2022, from https://www.mayoclinic.org/diseases-conditions/endometriosis/symptoms-causes/syc-20354656#:~:text=Endometriosis%20(en%2Ddoe%2Dme,the%20tissue%20lining%20your%20pelvis.
4. Kumar, N., & Singh, A. K. (2015). Trends of male factor infertility, an important cause of infertility: A review of literature. Journal of human reproductive sciences, 8(4), 191–196. https://doi.org/10.4103/0974-1208.170370
5. Canada, P. H. A. of. (2019, May 28). Fertility. Government of Canada. Retrieved April 27, 2022, from https://www.canada.ca/en/public-health/services/fertility/fertility.html