The Impatient Woman's Guide to Getting Pregnant

date Jan 4, 2019
authors Jean M. Twenge
reading time 28 mins

Todo before trying to conceive

Why prepare even before getting pregnant?

The brain and nervous system start developing incredibly early, around two weeks after conception. When you’ve prepared to get pregnant, you’re more likely to give your baby the best start in life.

For potential fathers

That means no smoking, no recreational drugs, and no heavy drinking or caffeine use. It’s probably also a good idea for him to take a multivitamin. Make sure it includes vitamin E and zinc, both of which are important for sperm production.

Getting immunized before getting pregnant

Childhood shots sometimes wear off, and diseases like rubella (sometimes called German measles) can cause birth defects if you have the bad luck to contract them when you’re pregnant. It’s not a good idea to get most immunizations when you’re pregnant, so planning ahead is important.

Flu shot

Having immunity to these diseases is important because many are becoming widespread again, probably due to decreased immunization rates. And get a flu shot every year (it’s safe even if you are pregnant, and much better than getting the flu, which can be dangerous during pregnancy).


Some medications shouldn’t be taken when you’re pregnant or even trying to get pregnant, so you might need to find alternatives. And definitely schedule a dentist appointment. Gum infections and other dental problems are a potential cause of premature labor (weird but true), so it’s good to be up-to-date on your dental care.

(Optional) Taking DHEA with professional guidance

Among several hundred women, DHEA increased the number of embryos produced in IVF cycles, improved pregnancy rates, and decreased the number of abnormal embryos. Best of all, it cut the miscarriage rate in half among women over 35. Only 7 percent of women 35 to 37 years old who took DHEA miscarried, compared with the usual rate of 16 percent. Women who took DHEA also produced 38 percent fewer abnormal embryos. And that’s from taking a nonprescription supplement that costs about $10 for a month’s supply.


Avoid Melatonin

Melatonin, which some people take to sleep better, is also a powerful antioxidant that led to higher pregnancy rates among IVF patients. However, the usual dose of melatonin (3 milligrams) is high enough to disrupt natural cycles. So for trying naturally it’s best to either avoid melatonin or take a smaller dose (1 milligram) and not every night.


Other good things to do

Natural sunlight

Another alternative is to make sure you get some natural light first thing in the morning. That produces melatonin and sets your sleep cycle—so it might help you get some z’s as well as possibly improving your fertility.

Difference between sad, stressed and depression

you’re worried, or obsessed, or keyed up, that’s stress. If you’re sad, crying all the time, or lethargic for more than two weeks, that’s depression. (Feeling sad for a few days after getting your period doesn’t count—it has to go on longer than that.) If you are depressed or think you might be, consider starting therapy—for your own mental health, not just for fertility.


You’ll probably end up telling your closest girlfriends, especially if they’ve already tried to conceive. Even if they haven’t, you should be able to count on them for emotional support. Girlfriends are also partners in crime for obsessing over your fertility signs

First trimester

Also consider your commitments and plans during the months right after you start trying, when you might be in your first trimester and feeling really awful. The symptoms are likely to kick in when you’re about six weeks pregnant. You’ve probably heard about the nausea that characterizes early pregnancy. Most women are also very tired and unenergetic. Unfortunately the fatigue doesn’t go away even if you sleep for nine or ten hours a night (which you will).

Eating food and medicines

It’s safe to travel in your first trimester, but you will need to eat very frequently (that helps with the nausea) and sleep just as much or more as you do at home. You won’t be able to take most medications such as sleeping pills.

Healthy baby more than when!

If I could have pinpointed when I’d be pregnant, that wouldn’t have been my choice, but after a few months of trying and an early miscarriage, I decided I didn’t care anymore and that a healthy baby was more important. And she was.

18 months spacing

A few studies have shown it’s healthier to space pregnancies at least eighteen months apart (so at least eighteen months between delivering one child and getting pregnant with the next, which would put the children at least two years and three months apart). This results in fewer complications such as low birth weight, probably because the woman’s body has had enough time to recover and build up her nutritional stores.

Good fats

The fat doesn’t have to come from ice cream or chips. Try relatively healthy weight boosters such as fruit, sweet potatoes, and brown rice. If you don’t gain weight fast enough on those foods, some studies suggest that whole milk has fertility benefits.

Prenatal vitamins

Most important: Start taking a prenatal vitamin about two months before you start trying to get pregnant so that the nutrients have enough time to build up in your body before the crucial first trimester. Most prenatal vitamins don’t include enough calcium, so take a separate calcium supplement with vitamin D, ideally after a low-calcium meal.


Several studies have found that women taking prenatal vitamins, especially folate and vitamin B6, are more likely to get pregnant quickly. New research also suggests that taking prenatal vitamins before conception can lower the risk of autism.


Just make sure the vitamin has enough folic acid (sometimes called folate; at least 800 micrograms), enough iron (about 25 milligrams), and enough vitamin B6 (about 10 milligrams). Folic acid, especially when taken before conception and early in pregnancy, greatly reduces the chance of having a baby with a neural tube defect (like anencephaly, when the baby is born with a tiny brain and lives only a few hours, or spina bifida, an exposed spine).

Fish oil

Also consider taking an omega-3 supplement of fish oil (sometimes labeled DHA or EPA). One study of women undergoing IVF found that those with higher omega-3 levels produced better embryos.

Pre-pregnant health

So it’s up to your prepregnant self to eat healthy, because your postpregnant self probably won’t, at least not in the first three months. It takes time for nutrients to build up in your body—you are what you ate two or three months ago. So when you get pregnant, your baby will be snacking off everything you ate before you got pregnant.

Food to eat

Overall, these findings bring to mind the succinct advice of author Michael Pollan: “Eat food. Not too much. Mostly plants.” That means fruits, vegetables, lentils, nuts, fish, chicken, beans, and soy.

Natural whole foods

Mostly, I try to eat unprocessed, whole foods, and when I can’t, I read labels. When I have microwave dinners for lunch, I try to find the few out there without too many white carbs (the Atkins frozen meals are good for this). Especially between meals, I drink water instead of soda or juice.

Olive oil

The second part of the SOS plan is olive oil, which is a memory cue for a Mediterranean diet with foods such as olive oil, fish, vegetables, and legumes (like beans, peas, or peanuts).


Only some fish have high levels of mercury, and only some have high levels of omega-3s. Fortunately, one common fish has the right combination of low mercury and high omega-3s: salmon. So the last S in SOS is salmon. Trout, arctic char, herring, whitefish, and oysters are also low in mercury and high in omega-3s, but salmon often is the easiest to find.

Full fat milk and yoghurt

What about dairy? A lot of fertility books advise against eating dairy, but The Fertility Diet research studies found that full-fat dairy (such as whole milk and ice cream) actually improved fertility, lowering the risk of ovulation problems. The researchers aren’t sure exactly why. They speculate that the skimming process for making low-fat and fat-free milk might also remove other beneficial substances. Another good dairy choice is yogurt. Even people who have trouble with other dairy foods can often eat yogurt, and it has important probiotics.

Avoid food

Two food types increase the risk of ovulatory infertility: sweetened carbonated beverages (like soda, which you already know is bad for you) and trans fat (also known as partially hydrogenated oils, or, as I like to call them, partially hydrogenated evil).

Painkillers not allowed

One more thing to be cautious about putting in your mouth: ibuprofen painkillers such as Advil or Motrin, which many of us take without even thinking about it. Ibuprofen is an anti-inflammatory, and ovulation is an inflammatory process. So it’s not a good idea to take ibuprofen in the days before ovulation.

Need to know the ovulation

If you don’t have sex on the days right before you ovulate (release an egg), you’re very unlikely to get pregnant. Sperm live for 2 to 5 days, the little rascals — but the egg only lives about 12 hours on average. So we Impatient Women need to know when we ovulate, and we need to know in advance.

When to try to conceive

Let’s > say your cycles are normally between 26 and 32 days long. You’ll want to have sex every other day between days 7 and 21 of your cycle. That makes it very likely that you will have sex on one of the most fertile days.

Cervical mucus

Have you ever gone to the bathroom and seen some stretchy clear stuff coming out of you? More than likely, that was cervical mucus flowing out of your vagina, and it’s perfectly normal. In fact, it’s the best natural sign of fertility. A few days before ovulation, women’s bodies make mucus that resembles the clear part of raw eggs in consistency and stretchiness. Egg-white mucus is like a little highway for sperm — they get in it and happily zip along, probably well above the speed limit.

Before ovulation

Then you might see white, creamy mucus, and finally, somewhere between 2 and 6 days before you’re going to ovulate (often around day 10 if you have an average-length cycle), you’ll see clear-to-whitish watery stuff that will stretch between your fingers and will look like raw egg whites. This is your body’s signal that it’s time to get it on. You’ll see this type of mucus for several days—the average is about five—and then it will disappear, either on the day of ovulation or the day afterward.

BBT and ovulation link

Most women who chart also take their temperature every morning before they get out of bed (called basal body temperature or BBT). That’s because a woman’s temperature rises after she ovulates: After ovulation, the body produces more progesterone, which increases body temperature. Most women use a digital thermometer, often a special ovulation thermometer that reads to the hundredths of a degree.

Lower temperature

The last day of lower temperatures is usually the day of ovulation, and the first day of higher temperatures is the day after. Your temperature will probably stay high until the first day of your period.

Miscalculation on the due date

Most “overdue” babies aren’t overdue at all, just the product of late ovulations, and that can lead to needless interventions. Doctors these days rarely let you go much beyond 41 weeks (one week beyond the due date), and many start talking about induction at 40 weeks or even earlier.

Ovulating again after giving birth

If you’re breastfeeding a baby who’s less than six months old and not supplementing with formula, you probably haven’t ovulated yet and thus are very unlikely to get pregnant. You’ll start ovulating and then get a period once your baby starts solid food or formula and is nursing less.

How long to breastfeed?

You probably already know all of the reasons to keep breastfeeding until at least a year, but if you’ve made it to six months, that’s really great, too.

Chance is higher before ovulation than on the exact day

For young women, the chance of getting pregnant on the day of ovulation is less than 1 in 10, but two days before ovulation it’s 1 in 3—three times higher! You can up those chances even more if you have sex more than once during your fertile time.

Lower risk of early miscarriage

when the researchers looked at which pregnancies survived past six weeks, they found that a large percentage of conceptions from sex on the day of ovulation led to early miscarriages. So having sex on the days before ovulation and not just on the day of ovulation is an effective way to lower your risk of an early miscarriage.

No lubricants

Don’t use lubricants like K-Y Jelly, Astroglide, scented oils, spit, or even water. All of them can kill sperm. If you can go natural, that’s best—foreplay helps.

(not proven, but still!) Stay lying down

Some studies show that you’re more likely to get pregnant if you stay lying down after sex for at least 15 minutes — that was among women who had intrauterine insemination instead of the fun way, but it still makes sense not to jump up right away.

Older than 35

The bottom line: Most 35- to 39-year-old women will be able to get pregnant naturally, but it might take a few months longer than for younger women. These studies are clearly better than 500-year-old birth records, but they are not as precise as most of us would like. It’s tough to know if these averages apply to all women trying to get pregnant—maybe the people who participate in such studies are less (or more) fertile than the average couple.

Approximate chances

Nevertheless, these numbers are remarkably similar to the studies on natural fertility, where 33 percent of women in their early 30s and 27 percent of women in their late 30s got pregnant in the first cycle. The IVF numbers are slightly lower than that—30 percent for the early 30s and 24 percent for the late 30s. That might be due to the population of women undergoing IVF,

Late 30s

Overall, this new, cutting-edge IVF research confirms the older, less precise studies on natural cycles. Both lead to the same conclusion: Fertility in a woman’s late 30s is still very high, with a normal embryo showing up within 3 months for the majority of women. The idea that fertility drops off a cliff after age 35 is clearly wrong based on these data.

Availability bias?

So, why are fertility doctors still so negative about fertility in women’s late 30s? Probably because so many infertility patients are in this age range. Social psychologists call this the availability heuristic—people believe what’s right in front of them, and fertility doctors see infertile women in their late 30s every day. However, these are the couples who can’t get pregnant on their own—often for reasons that have nothing to do with their age, such as low sperm count or blocked tubes.


One caution: I am not saying that every woman in her late 30s will become pregnant quickly. Even women with no fertility issues can take longer through bad luck, bad timing, and many other factors, and of course if you have fertility issues it can take longer and might not happen at all without help.

Most common cause of miscarriage

Most of the time, miscarriages are caused by chromosomal mistakes in the embryo… Among 35-year-old women, 99.5 percent of babies will be chromosomally normal at delivery, and 0.5 percent, or 1 in 204, will not be. Among 40-year-old women, 98.5 percent of babies will be chromosomally normal, and 1.5 percent, or 1 in 65, will not be.

Down syndrome?

Interestingly, the majority of Down syndrome babies are born to women younger than 35. (Their risk is lower, but more have babies.)

Prenatal screening

If even these small risks seem daunting, several prenatal screening tests are available. A special ultrasound (called nuchal translucency) can detect about 80 percent of cases of Down’s in the first trimester, and there’s no risk of miscarriage from the procedure.

Older advantage

Age is a frustrating aspect of fertility because you can’t change it, and it just keeps getting worse as the days go by. Women are already sensitive about age in our youth-centered, Botoxed society. Worries about fertility just add another layer of anxiety to something we can’t do anything about. The good news is you are probably better prepared for pregnancy and parenthood now than when you were younger. You’re also more likely to have the financial resources to eat better, exercise, and take care of yourself.


Whatever you do, don’t blame yourself. What’s past is past, and you have to accept the age you are. It’s very easy to get panicked about things you read about age and fertility, and so much of what’s out there is slanted in one way or another because that makes a better headline. For some reason, everyone loves to begin their article with the scary line, “Women are born with all the eggs they will ever have.”

2% babies born !== 2% chance

I read a Newsweek cover article that began by noting that only 2 percent of babies are born to mothers 40 or over. That makes it sound as if a 40-year-old woman has only a 2 percent chance of having a baby, which isn’t even close to true. The reason so few babies are born to mothers over 40 is that most 40-year-old women aren’t trying to get pregnant—usually because they’ve had their children already. So that’s a very misleading statistic.

Young advantage

It’s true that having your children when you are younger has numerous benefits. You’re likely to get pregnant faster and will be less likely to miscarry, and you’ll have more energy for chasing young kids around. But the chances are still very good that you will have no problem getting pregnant and carrying a baby up until your late 30s and even very early 40s.

Balance it all out

Take action. Read books like this one, gather information, buy a fertility monitor, and have sex. The key is finding a balance. Try not to obsess so much that you drive yourself (or your husband) crazy.

Some takeaways to prepare

1. Avoid rumination 1. Get out in natural sunlight 1. Take an omega-3 supplement 1. Exercise regularly 1. Get enough sleep 1. Spend time with friends and family

When to get help

But if you’ve been trying for more than six months (the point at which many women get frustrated), or had an early loss or a miscarriage, my advice is to talk to someone who has been through these experiences.

Defensive pessimism

If you are less optimistic, even a little pessimistic, you tell yourself it’s unlikely that you’ll get pregnant on the first try and that it will probably take about six months. Then if you get pregnant on your first try, you’re pleasantly surprised. If you don’t, it’s what you expected. This viewpoint is called defensive pessimism.

Dealing with partners

And because pregnancy doesn’t happen inside them like it does for you, they feel more disconnected from the process. Although there are certainly exceptions, with most guys it’s best to just realize they aren’t as into it as you are, and accept that.

Feeling of unfairness

One of the most common feelings is the unfairness of it all. Women—even teenage girls—who have no business raising a child get pregnant accidentally. Freaking crack addicts get pregnant! Yet when a married woman with a good job who makes responsible decisions wants a baby, the universe says, “Nah, I don’t think so.” It’s enough to make you crazy.

When to use the pregnancy test kits?

So to balance the use of expensive pregnancy tests with your own impatience, my advice is to start testing 10 days after you ovulate or 11 if you want to be more certain, preferably using first morning pee.

Testing too early?

There is one big downside to testing early: You might be aware of an early miscarriage that otherwise would have seemed like a late period. A lot of pregnancies—one study found about 25 percent—are lost very early, within the first four weeks after conception, and the risk is highest right after implantation.

Early miscarriage

you might find out you are pregnant only to have your period come a few days later. This is not a false positive; it’s an early loss. This happened to me. I got a positive pregnancy test and excitedly showed the test to my husband and even my parents. Four days later I started to bleed, and then a test was negative later that day. I sometimes wish I hadn’t known I was “almost” pregnant.

Positive result

When you test early—and any time prior to 14 days after ovulation is early—even a sensitive pregnancy test will likely give you only a faint line for a positive. But if you see a colored line, even a faint one—congratulations, you’re pregnant!

Sign of miscarriage

If you start to see red blood that’s more than just spotting, it’s more likely to be a sign of miscarriage (though not always). Other signs include moderate to strong cramping, backache, or the sudden loss of pregnancy symptoms.

Saving the tissue for analysis

If you miscarry at home, you should also ask your doctor if you should save the tissue for analysis. It’s a gruesome question and probably not something you want to think about, much less do, but many doctors recommend it so that the cause of the miscarriage might be determined.

After a miscarriage

And if it happens to you, remember, commit to memory, and all but tattoo on your hand: It was not your fault. It’s rare for a miscarriage to be caused by anything you did. And tattoo this right underneath: The chances that you will have a normal pregnancy next time are very high.

Factors that do not cause a miscarriage

If you have a miscarriage, you will undoubtedly wonder why it happened. Most of the time, miscarriages are abnormal embryos that just couldn’t survive. It is extremely unlikely that your miscarriage was caused by having sex, picking up your toddler, worrying too much, or exercising in moderation.

How soon after miscarriage?

If you were further along when you miscarried but still in the first trimester, you will want to wait one cycle, though not necessarily more, to try again. Doctors used to advise waiting three or even six months, but now they say you can try whenever you feel ready. One study found more successful pregnancies among women who tried sooner after a miscarriage.

Defensive pessimism

If you get pregnant again, the sad thing is that miscarriage ruins the joy of a positive pregnancy test. After our early loss, I was fortunate to get pregnant again the very next cycle. The first time, I took a digital test and was all excited to show my husband. The second time, I used a cheap line test and told my husband, “I got a positive pregnancy test this morning.” He replied, “Okay.” And that’s exactly how I felt: Okay, let’s see if this one sticks or not. As

How long to try?

Fortunately, the medical community is starting to come around to the idea that a year is too long to wait, particularly if a couple has been timing sex around ovulation. … It took me five cycles to get pregnant the first time even though I had charted for two years, had no known fertility issues, and was under 35.

Causes of infertility

Sometimes there are relatively simple solutions, such as antibiotics to clear up an infection, or an oral medication such as Clomid to induce ovulation. Other women get pregnant using IUI, which is fairly inexpensive (a few hundred dollars a try) and usually doesn’t involve the extensive hormone injections that IVF does.

How long to try?

So when should you seek help? The general rule of thumb is to try for a year if you’re 34 or younger, six months if you’re 35 to 39, and three months if you’re 40 or older.

Get the numbers for blood test

Always get the exact numbers for blood test results from the nurse; don’t just accept it when they say the numbers are “normal.” Follow up with, “Great! Can I get the number for my records?” Then (in the words of one blogger) “run to Google.” Labs have different definitions of normal, and numbers at the high or low end of the range can still indicate problems.

Costs of IVF

And IVF, though it boasts success rates near 50 percent a cycle for women under 35, is very expensive, about $15,000 or more a cycle — $11,000 for doctors’ fees and $2,000 to $5,000 for medications.

Psychological effects of IVF

As Dr. Alice Domar’s research shows, fertility treatment in itself can lead women to become depressed, which further hampers their fertility. (Remember that it’s depression, not anxiety, that is linked to fertility problems.)

False stats from IVF clinics

Another way clinics cheat is by listing their success rates per embryo transfer. Women who don’t make enough eggs usually don’t have an egg retrieval (where they extract the eggs from the ovaries), and not everyone has embryos that make it far enough to transfer.

Emotional aspect of infertility

Doctors sometimes speak dispassionately and even coldly about fertility problems, seemingly oblivious to just how emotional these issues are for the couples involved.

A lot of work, learning, but worth it

After I had kids, I learned two important things. First, a lot of the complaints were exaggerations. Yes, having kids is a lot of work and there are downsides, but there are ways to manage them. Second, to my surprise, it really was worth it.

Read about babies and children after reading about birth

But don’t spend so much time reading about birth that you neglect reading and learning about babies and children. Birth lasts at most a day, but parenting lasts for the rest of your life!

Healthiest birth (when possible)

But birth is usually healthiest for mother and baby when it is not planned. Inductions don’t always work (which usually means a C-section), and a C-section, planned or not, is major abdominal surgery.

Vaginal birth recovery is faster

With my second daughter, though, I had a quick labor and a vaginal birth. I can’t even describe how much better the vaginal birth and recovery was compared with the C-section. I was walking normally within hours; after the C-section, I shuffled for days and had to move very slowly when doing the simplest things like getting into bed or going to the bathroom.


  • AF = Aunt Flo = your period
  • BBT = basal body temperature (your temp right when you wake up)
  • BD = baby dancing (otherwise known as sex)
  • BFN = big fat negative
  • BFP = big fat positive usually on a pregnancy test
  • BMI = body mass index
  • CD = cycle day
  • CM = cervical mucus
  • DH = dear husband
  • DHEA = dehydroepiandrosterone
  • DPO = days past ovulation
  • DS or DD = dear son or dear daughter
  • EDD = estimated date of delivery
  • EWCM = egg-white cervical mucus (the fertile stuff)
  • FSH = follicle-stimulating hormone
  • HCG = human chorionic gonadotropin (what a pregnancy test detects; can also be a shot used in fertility treatment)
  • HSG = hysterosalpingogram (to see if your fallopian tubes are open)
  • HPT = home pregnancy test
  • IUD = intrauterine device
  • IUI = intrauterine insemination
  • IVF = in vitro fertilization
  • IW = Impatient Woman
  • LH = luteinizing hormone (detected by OPKs and fertility monitors)
  • LOL = laughing out loud
  • LP = luteal phase (the time between ovulation and your period)
  • MC or m/c = miscarriage
  • MIL or FIL = mother-in-law or father-in-law
  • O = ovulation (not orgasm, sadly)
  • OB = obstetrician
  • OPK = ovulation predictor kit
  • PCOS = polycystic ovary syndrome
  • PG = pregnant
  • POAS = pee on a stick
  • RE = reproductive endocrinologist (a doctor specializing in fertility issues)
  • TTC = trying to conceive
  • TWW or 2WW = two-week wait (the time between ovulation and your period when you are waiting to find out if you are pregnant)

Some foods

  • Healthy yogurt
  • Easy veggies
  • Easy rice
  • Sweet potatoes
  • bok choy
  • Grilled fish
  • Grilled or baked chicken
  • Turkey
  • Spinach instead of iceberg lettuce


Uterine fibroids Fibroids usually don’t prevent women from getting pregnant. If you know you have fibroids and have tried for six months or more, see your doctor.

Choosing gender

The more I read, the more it seemed that Shettles’s theory was not just wrong but the opposite timing (far away from ovulation for a boy, close for a girl) actually worked better.

Trusting source

Journal articles are read by other scientists and an editor (in a process called peer review). These experts try to make sure the studies are done correctly, with unbiased samples and proper methods. Publishing results in a book isn’t the same, as it hasn’t been peer-reviewed by other scientists and thus isn’t held to the high scientific standards of a journal article.