Real talk with Dr. Nataki Douglas, MD, PhD on trying to get pregnant

Real talk with Dr. Nataki Douglas, MD, PhD on trying to get pregnant

Once you decide you’re ready to start trying to get pregnant, you might find yourself googling “how to get pregnant fast.” “Anecdotally, we’ve all heard stories of women who conceive in the first month they start trying, but that doesn’t happen to most women,” says Dr. Nataki Douglas, MD, PhD, a reproductive endocrinologist and the chair of the Modern Fertility Medical Advisory Board.

Unfortunately, there’s no surefire recipe for lightning-fast conception, but there is a lot of information about how you can optimize your fertility when family planning — so when you’re ready to get pregnant, you’ll know how to proceed with confidence.

In our live Q&A, “Goodbye Dr. Google: Real Talk on Getting Pregnant With a Fertility Doctor,” Dr. Douglas jumps into the nitty gritty of trying to conceive and answers all your questions. We’ve rounded them up here, so read on to find out:

  • When will your period come back after stopping birth control?
  • Which tests and doctors should you get and see before trying to get pregnant?
  • What lifestyle changes should you make when you’re trying to conceive?
  • What prenatal vitamins should you be taking?
  • Is there anything you can do to increase your chances of getting pregnant?

When will your period come back after stopping birth control?

If you had a regular menstrual cycle before starting hormonal birth control, you might see your menstrual period return about 28-30 days after you stop taking hormonal birth control. Sometimes, though, that return can be delayed. The reason, says Dr. Douglas, is that the hormone needs to clear your body, and that happens at different times for different people.

There’s no evidence that being on birth control for a long time results in an impact on your fertility (though it’s worth noting that taking Depo-Provera can delay periods for up to 22 months after stopping). If your period doesn’t make an appearance within 90 days of stopping birth control, Dr. Douglas does recommend seeing a doctor. But, she says, “It’s not always indicative of a problem.” She also recommends testing your hormones to get a better idea of why you haven’t had a period yet.

So how long should you wait between that last pill/implant/shot/ring and trying to conceive? “I recommend that people wait until they get a period,” says Dr. Douglas, “so we have an idea of when you got pregnant. But, besides that, there’s no real timing.”  

An important reminder: Your age is one of the biggest factors when it comes to how long it takes to conceive. “We really should be considering age in our expectations,” urges Dr. Douglas.

Which types of tests and doctors are important before trying to conceive?

Dr. Douglas recommends scheduling a number of appointments in advance, such as a dental X-ray, a routine OB-GYN checkup (so that any sexually transmitted infections can be identified and treated, since untreated STIs can interfere with fertility and also increase risks during labor and delivery), as well as a general preconception visit. “It’s a great opportunity to ask questions, find out how the practice works in terms of appointments, labor and delivery, and to discuss any health concerns you might have.”

Ovulation tests

If you’re not already tracking your ovulation, practicing before you go to the OB-GYN in anticipation of trying to get pregnant is a good idea. Ovulation predictor kits (OPKs) not only indicate time of ovulation and when it’s time to have unprotected sex — the test will tell you when your luteinizing hormone (LH) level suggests ovulation and help you find your two most fertile days — but they can help you and your doctor get an understanding of the hormonal patterns of your cycle.

Also, monitoring your cervical mucus is a super easy way to check in with your cycle and get important knowledge about your menstrual cycle. (And it doesn’t require anything but your fingers and a glass of water!)

Hormone tests

Checking in with your hormones helps you gain insight into your ovarian reserve (how many eggs you have), as well as your thyroid hormone levels, which are major when it comes to achieving a healthy pregnancy. “Although knowing your hormones is not predictive of how successful you’ll be at getting pregnant in the time frame that you want,” says Dr. Douglas, “knowing what’s happening with them can give you a baseline sense of what’s going on in your body.”  

You don’t have to wait until you’ve stopped hormonal birth control to test your hormones — there are some fertility hormones, such as anti-Mullerian hormone (AMH) and thyroid hormones, like TSH and free T4 (all of which Modern Fertility can test for) that can be evaluated while you’re on BC.

You also don’t have to have regular periods in order for your doctor to get a look at what your hormones are up to. Random-cycle hormone testing allows you to get tested for a full panel of hormones any day (instead of only on day three of your period). “We’re specifically looking at hormones related to ovarian reserve, like AMH.” says Dr. Douglas. “It’s a way for us to know what’s going on with your egg supply, as well as any red flags or health conditions (like polycystic ovary syndrome, or PCOS).”

Fertility doctors

If you’re looking for a fertility specialist, Dr. Douglas advises talking with your OB-GYN first about potential providers. If you don’t have an OB-GYN (for example, if you see a primary care physician instead), do your research — look into specialties and practices before calling for an appointment.

As for genetic testing? Dr. Douglas says that insurance often covers it when it’s in the context of treating fertility problems, but plans may differ in terms of coverage. If you have a family history suggesting increased risk of recessive genetic disorders, she recommends looking into genetic testing.

What lifestyle changes can improve chances of conception?

According to Dr. Douglas, these are the main lifestyle factors to look into when thinking about trying to get pregnant:

1. Exercise: Exercise while trying to conceive and in pregnancy is beneficial. Dr. Douglas recommends finding and maintaining a routine that works for you.

2. Body weight: Your body weight can impact your hormones and cause fertility challenges.

  • A higher body-fat percentage can interfere with ovulation, causing irregular periods and complications in pregnancy such as gestational diabetes.
  • On the other hand, “Restricting yourself and eating only a few foods can also impact your overall health and your fertility,” says Dr. Douglas. She advises eating regular balanced meals, as well as limiting your exposure to processed foods and pesticides.

3.  Endocrine disruptors: You should also be aware of what you’re eating and drinking on and out of. There’s evidence that a class of chemicals known as endocrine disruptors, such as BPA, can cause fertility issues, so using stainless steel and glass instead of plastic is a good idea before trying to conceive.

4. Smoking: Deciding to stop smoking is another big step you can take toward improving your fertility — and quitting at any point will have a positive impact.

5. Alcohol: “Getting exact information on how alcohol impacts fertility is hard,” says Dr. Douglas. “There are many studies that show that having one or two drinks a day won’t impact fertility, but there are others that show that moderate drinking can be harmful. So, ultimately, it’s up to you to decide.”

6. Caffeine: “Most of the time, one cup of coffee per day is fine during pregnancy and when you’re trying to conceive,” clarifies Dr. Douglas. “If you’re drinking more than that, the sooner you start cutting back on those larger amounts, the better, so your body can get over those symptoms of caffeine withdrawal.”

7. Beauty products and procedures: “When you’re actively trying to conceive, we’re concerned about the chemicals that are in hair coloring entering your system,” says Dr. Douglas. Also, consumers of Botox should know that while there aren’t necessarily clear associations between the treatment and infertility, Dr. Douglas says it does depend on how much you’re using, where you’re using it, and how much you’re using.

What prenatal vitamins should you be taking?

Daily prenatal vitamins are a must when you’re pregnant and trying to get pregnant since they reduce the chances of early miscarriage, as well as neural tube birth defects. (But don’t panic if you miss a couple of days!) Starting prenatals up to a year before conception will ensure that you have the optimum levels of vitamins in your body.

While there’s no particular brand that she’d suggest — generic or over-the-counter is fine — Dr. Douglas says the key is making sure the one you take has the recommended daily dose of folic acid (.4 milligrams), calcium (1000 milligrams), vitamin D (600 international units), and iron (27 milligrams). While some opt to take a prenatal containing DHA, an omega-3 fatty acid, which can help with inflammation and brain health, Dr. Douglas says that’s not necessary. Similarly, while there are reasons to choose folate versus folic acid and vice versa, it’s a conversation to be had with your doctor.

For folks who can’t tolerate prenatal vitamins due to the size of the pill, acid reflux, morning sickness, or any other reason, Dr. Douglas recommends taking vitamins such as vitamin C separately, and making sure you’re eating well-balanced meals and taking folic acid. Iron supplements are also important — all pregnant people, regardless of blood count status before pregnancy, are at risk for developing anemia.

Is there anything that can increase your chances of getting pregnant?

There are a lot of ideas out there about what can make you more or less likely to conceive (check out this piece about sex positions, orgasms, and getting pregnant). While you might have been told that lying down for 15 minutes after sex or using a Diva Cup will improve your chances of getting pregnant, Dr. Douglas says there’s no research that supports this.

You might also think that having intercourse (with a partner who has a penis) as often as you possibly can will help you get pregnant quickly, but Dr. Douglas debunks this. “While looking at sperm during fertility treatment, we’ve found that multiple ejaculations in one day aren’t all of the same good quality.” What’s most optimal? Having sex the day before and of ovulation. While we’re on the subject of sperm health, it can be negatively impacted by some lubricants — but there is sperm- or “baby”-friendly lube on the market.

Watch the full convo below and stay tuned for even more live Q&As with fertility experts.

Raghav

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