People ask me all the time… every day, actually….almost every hour “What more can I do?”  They are referring to getting pregnant – trying to conceive – what else can be done to increase their chances of having a baby.  I get this question from both men and women but mostly from women.  So if you are trying to conceive, or thinking about trying to conceive, or not at all thinking about this now but might want to conceive in the future, this article is for you.

Most of the people who ask me for advice have already been trying to conceive for a year or more and are at the point when they feel they need medical help.  However, everyone can benefit from this advice.

The high tech option of fertility preservation – freezing your eggs is becoming more and more popular.  Egg freezing is a great option for some people but does require that you see a fertility specialist who has experience in IVF (in vitro fertilization or test tube babies) and egg freezing and thawing.  It involves taking injectable fertility medications and having your eggs removed from the body via a needle while you are asleep.  It is a relatively safe procedure (much less risky than pregnancy itself) but is still somewhat invasive, and expensive as these procedures are not covered by insurance.

There are many other, simpler, easier things you can do yourself to optimize your fertility.

One thing to note is that more sex does not always increase your chances of conceiving.  Sex is good, but more is not always better.  Many couples that do not conceive right away drive themselves batty with having lots of timed sex.  Dr Google and others are propagate the myth that sex precisely timed around ovulation improves the chances of conceiving.  This is one of the most common misconceptions about conception.  While you need to have intercourse in order to conceive, the sperm can survive for days, even more than a week in the female reproductive tract so that for a woman with a typical 28 day cycle, having intercourse 2 or 3 times between days 10 to 16 should be all that is required for conception.  Most couples that do not obsess about timing will naturally have sex around the right times – your libido apparently increases during your more fertile times.  If you have not used any form of contraception for a year without conception (or 6 months if you are 35 years old or older) then it is time to speak with your doctor and have an evaluation.  It is not time to “try harder” by having sex more often or buying home ovulation kits or phone apps designed to pinpoint the moment of egg release.  You will only drive yourself and your partner crazy and make sex a lot less fun.  As a fertility doctor, I see a lot of couples who have significant issues as a result of this type of stress – marital relationship issues, anxiety and mood disorders, even sexual dysfunction.  Some guys get so anxious around their wife’s ovulation time that they actually cannot get an erection!  No one needs these kinds of problems.  Please get help and information sooner rather than later.  Fertility treatments these days can be very successful and tend to have higher success rates the earlier you get evaluation and treatment.

Take a folic acid supplement.  Folic acid or folate is a type of B vitamin.  Most over the counter multivitamins have 100% of the RDA (recommended daily allowance) of folic acid – 400 micrograms a day or 0.4 milligrams a day.  Folic acid does not improve fertility but taking it for at least 4 weeks prior to conception and then throughout pregnancy will help fetal brain/neural development and lower the risk for neural tube defects.  Women who are significantly overweight – BMI of 35 and above should consider taking much higher doses of folic acid and should discuss this with their doctor.

Quit smoking – now.  Don’t even hang out with other people who smoke.  First and second hand smoke exposure for either partner is associated with higher rates of infertility, miscarriages and birth defects.  Third hand smoke is associated with higher rates of asthma in children.  Also, by the way, there is the increased risk of heart attacks, cancer, stroke and death – just saying.  Smoking kills your eggs.  People who smoke go through menopause earlier.  And unlike freezing your eggs, quitting smoking will save you money instead of costing you money.

Try to get to and maintain a healthy weight and eat a healthy low glycemic index diet.  Half of Americans are overweight, and one third are obese.  Excess weight and fat have a big impact upon fertility and increase rates of infertility, miscarriages and birth defects – including possibly autism.  This is actually one of the most common fertility problems we see today.

Be proactive about stress management – whether it is exercise, meditation, yoga, seeing the therapist once a week, stress management is good for your mental and physical health.  People who actively pursue stress management during fertility therapy have higher success rates.  This is not the same as saying that stress causes infertility.  That misconception just puts the blame of infertility upon the victim.  It’s not helpful to tell people “just relax and it will happen”.  Infertility is a real medical problem and deserves information and treatment, not guilt.

Get at least 7 hours of sleep at night.  More and more research demonstrates the importance of adequate sleep for health and well-being.

Talk with your doctor.  Ask questions.  Get information.  Your particular situation may require a different approach, further testing, other things that you may not be aware of if you do not speak up.  If you have any chronic medical conditions like a thyroid problem, diabetes, high blood pressure, irregular periods, previous treatment for serious illnesses like cancer, or previous pelvic or abdominal surgery, or even just a family history of conditions like PCOS, endometriosis, premature ovarian failure, large fibroids, your risks for infertility are increased compared to people who do not have these conditions or risk factors.  Talk with your doctor or a reproductive endocrinologist about your own health history.

So fertility preservation is about a lot more than just thinking about freezing your eggs.  There are things you can do today to improve your fertility and your chances of conceiving, but remember that you should have an evaluation and a conversation after 6 to 12 months of unprotected intercourse and maybe earlier if you have any concerns or risk factors for infertility.

Copyright Serena H. Chen, MD 2013