Deciding to have a baby is an incredibly exciting moment in life’s journey. Like researching your destination before a big trip, preparation can help smooth the way. Consider this your baby-making checklist: we detail every step you need to take (well, almost every step). Not planning to conceive any time soon? You may still want to read on; 45 percent of pregnancies in America are unintended.
Step #1: Check on your health
A basic health checkup is a great place to start your journey toward childbirth. Your family doctor can review your vaccine status with you, check your iron levels, update your Pap test and run a sexually transmitted infection panel. In addition to those pretty standard checks, there are some emerging factors to consider and discuss with your doctor too.
Body mass index (BMI)
Both high and low BMI numbers are associated with negative outcomes for pregnancy, delivery and infant health. Lower risks are associated with a normal BMI: between 18.5 and 24.9.
Adequate vitamin D levels may play a role in improving the chance of fertilization. Should you become pregnant, having a healthy vitamin D status may help protect against miscarriage, gestational diabetes and the need for Caesarean delivery. A simple blood test can tell you if your levels are adequate.
Blood lipids are used to assess risk for heart disease, but they can tell us something about pregnancy outcomes too. Having levels of HDL (good) cholesterol less than or equal to 50 mg/dL and levels of triglycerides greater than or equal to 150 mg/dL is associated with an increased risk of preeclampsia (a potentially serious complication of pregnancy characterized by higher-than-normal blood pressure).
What you eat is essential for your health and for a healthy pregnancy. Research has found that a higher intake of veggies and whole grains helps lower the risk of pregnancy loss, as does high folate consumption and minimal alcohol intake prior to conception.
Step #2: Supplement before pregnancy
Before conception, the egg and sperm cells mature. This process takes about 100 days, so it’s best to take prenatal supplements at least three months before you start trying to conceive. Check with your health care practitioner for advice about which supplements best suit your individual needs.
Beginning appropriate multivitamin supplementation increases the odds of becoming pregnant and reduces your risk of pregnancy loss. Your multi should include iron, calcium, folic acid (the bioavailable form is called methylfolate) and potassium iodide.*
Omega-3 supplementation may help reduce the risk of preterm delivery and increase infant weight, height and head circumference. Algae-derived supplements are available, and certain vegetable oils (like flaxseed) can also boost omega-3 intake.
Step #3: Help sperm meet egg
Once you’re ready to start trying to conceive, it helps to understand fertility and timing. After ovulation, the egg cell lasts about 24 hours. If you combine the lifespan of the egg with the lifespan of sperm (five days), you get a fertile window of about six days.
There are many different ways to identify when to time sex within the six-day window: monitoring cervical mucus, tracking temperature and using ovulation predictor kits, for example. The definitive guidebook on the subject is Toni Weschler’s Taking Charge of Your Fertility.
You can, of course, choose not to track any fertility signs. Assuming there’s no reason to question potential fertility, if you have sex every one to two days, you’ll definitely improve your likelihood of conceiving. Here are a couple of common factors that can affect your chances of conceiving.
Once birth control is discontinued, the number of menstrual cycles it’ll take to conceive is highly variable. Most couples will become pregnant within three months of trying. But even if you haven’t conceived one year after discontinuing birth control, your odds of conceiving within the next year, without any assessment or treatment, are high.
Celebrity pregnancies late in life paint a rosy picture of delaying the decision to have kids (who isn’t wowed by supermoms like Halle Berry and Gwen Stefani?).
Here’s the thing, though: in population studies, the age at last birth for people not using assisted reproduction technologies is consistently eight to 10 years before menopause. The average age of menopause in America is 51.
Pregnancies later in life are often achieved with IVF using a younger woman’s egg cells. Success of IVF with donated eggs is higher under age 40, but few births occur even with donated eggs in women older than 45. These figures are averages, so you could have a very different experience.
One of the theories explaining why age can determine fertility is that oxidative stress affects the quality of egg cells. Supplementing with different antioxidants may help offset the damage. Some research shows that coenzyme Q10 and melatonin may improve egg cell quality and ovarian function. Taking melatonin could also improve the number of good quality embryos in IVF.
Whether pregnancy is a planned destination or a surprise detour, a little bit of knowledge helps you know which way to turn.
We’ve been trying and I’m still not pregnant!
Should you seek help?
If you’re 35 years old or younger, seek help if you haven’t conceived after 12 months of unprotected sex.
If you’re older than 35, seek help if you haven’t conceived after six months of unprotected sex.
Seek help sooner if you have infrequent periods; have very long or irregular cycles; have (or suspect you have) endometriosis or have (or suspect you have) a disease affecting the uterus, Fallopian tubes or abdominal cavity.
*For more advice on picking a prenatal multi (from a superstar mama and holistic nutritionist), see p. 70.