So now you’ve decided you want to have a baby. What do you do next and what are your chances of getting pregnant?

If you are in your 20’s there usually isn’t much to worry about, women are fertile at this age.  Women in their 20’s usually get pregnant in the first few months of trying and they are less likely to have a baby with birth defects. 

Many women wait until they are in their 30’s to have a baby.   Many women have spent their 20’s focusing on their careers, traveling and having fun.  Fertility rates drop in the early 30’s and drop even more after age 35.  From age 30-34 the infertility rate is 15%, after age 35 it goes up to 22% and after age 40 to 29%. 

Don’t let these numbers scare you!  You can get pregnant in your 30’s and 40’s. 

There are many things you can do to help yourself. 

1.  Make a preconception visit with your Ob/Gyn.   Your doctor will ask about your past medical history and any medical problems in your family.  Talk with your doctor about any medications you are taking including over the counter medicines.  Some medicines are harmful to a growing baby so you want to make sure you aren’t taking something that may be harmful.  At this visit make sure your immunizations are up to date.  Here’s a good article on what to expect during your preconception visit:

http://www.babycenter.com/0_preconception-checkup-why-you-need-one-and-what-to-expect_730.bc

1.  Start taking prenatal vitamins, Calcium and DHA BEFORE you get pregnant.    Let’s face it, our diets aren’t perfect and prenatal vitamins are an easy way for you to make sure you have the nutrients you need for a growing baby.  Prenatal vitamins are different from regular vitamins in that they have extra folic acid (should have at least 600mcg) which is important for preventing neural tube defects in the baby.   You can’t wait until you are pregnant to start taking these important vitamins, especially folic acid because birth defects of the brain and spine happen in the first few weeks of pregnancy.  Most likely at this point you won’t even know you are pregnant.  Folic acid helps prevent at least two very important neural tube birth defects, spina bifida and anencephaly.  Anencephaly occurs when the neural tube fails to close and parts of the brain and head fail to develop.   Spina bifida is an incomplete closure of parts of the spinal cord.  (More complete information about spina bifida and anencephaly can be found in the pregnancy section on this website.)   Prenatal vitamins also have iron which is important to build your growing blood supply during pregnancy.  DHA is important to take during pregnancy and isn’t in most prenatal vitamins.  It is an omega-3 fatty acid that is essential for the development of the baby’s brain, nerves and eye tissue.  300mg of DHA daily pregnancy is recommended.    It is also a good idea to take a Calcium supplement since the amount in most prenatal vitamins is too low for what your body and baby needs.  Your baby will need calcium for its bone development.  When you don’t have enough calcium your body takes it from your bones (breaks them down) leading to osteoporosis.  You should take about 1200mg of Calcium a day and try to get it in your diet as much as possible.  You can get calcium from yogurt, cheese and milk.  Other foods containing calcium include salmon, sardines, mustard and collard greens, spinach, broccoli, Brussels sprouts and peas. 
2. Stop birth control.  If you have been on the pill for a long time it may take awhile for your hormones to balance and for you to begin ovulating.  If you were using Depo-Provera injections for birth control it may take a year until you start having regular cycles and ovulating.  (See number 7 on restoring ovulation)   Start a menstrual calendar to track your periods.  It’s easy to do:  The day you start your period is Day 1, mark this on your calendar.  Track how many days you have any sort of bleeding whether it is heavy, light or even spotting.  Most women have menstrual cycles that are 21-35 days in length.  Once you start tracking your periods you can see if you are regular or not.  What is regular for your best friend may not be regular for you.  If you have periods that come every 25 days or even every 29 days then that what is regular for you.  Causes of irregular periods include illness, drug use, stress, excessive weight gain or loss, stress, smoking, over exercising, hormone imbalance, uterine abnormalities and medications.
3. Figure out when you ovulate.  American pregnancy website has an easy ovulation predictor, you just type in the info it asks for and it gives you the days you are most likely to be fertile:  http://www.americanpregnancy.org/gettingpregnant/ovulationcalendar.html

Steps to calculate your fertility window:  Subtract 18 from the number of days in your shortest cycle, i.e. if your shortest cycle was 27 days -18 = 9

Then subtract 11 from the number of days in your longest cycle, i.e. if your longest cycle was 31 days then subtract 31-11 =20.  Now you know that your fertility window is from days 9 to 20 in your cycle.  This is when you are most likely to get pregnant.  Other methods of determining ovulation include checking basal body temperature, cervical mucus changes. 

You can find more information about this at

 http://www.babyhopes.com/articles/ovulation-symptoms.html

1.  Quit smoking and cut down on alcohol.  Here’s an interesting article of about how smoking affects fertility:  http://wish2conceive.com/smoking-fertility.htm
2. Get to a healthy weight with proper diet and exercise.  A healthy weight makes it easier to conceive. 
3. Check with your health insurance company on the cost of having a baby; make sure you have maternity coverage.
4. Consider how long you will take maternity leave.  Does your employer have paid maternity leave?  Probably not.  You can usually use any sick days and vacation days you have accrued or you go on unpaid maternity leave.  The Family and Medical Leave Act of 1993 allows workers to take up to 12 weeks of unpaid leave.  You need to decide how much time you can afford to take off.
5.  Consider bioidentical progesterone.  Some early miscarriages occur due to something called a corpus luteum defect.  The corpus luteum produces progesterone which helps sustain the pregnancy until the placenta can produce enough progesterone after about 8-10 weeks.   If the corpus luteum doesn’t produce enough progesterone or if the level of progesterone drops then menstrual bleeding will occur and possibly an early miscarriage. 
6. Take Vitex.  Vitex agnus-castus (chaste tree berry) is a well-known herb that has been used for centuries in Europe and Asia for hormonal imbalances in women.  You can buy it online or at many organic food stores.  Vitex somehow makes the pituitary gland in the brain release Luteinizing hormone (LH); LH in turn helps regulate ovulation.  It is used frequently for people who are either not ovulating or have irregular ovulation cycles thereby increasing fertility.   Dose?
7. Use a home ovulation predictor.  You can buy this at your drugstore or buy online.    When used correctly, the major-brand ovulation prediction kits are more than 97 percent effective in detecting an LH surge.  These ovulation tests work by detecting luteinizing hormone (LH).  Just preceding ovulation, women experience and “LH surge” which is a sudden, brief rise in the luteinizing hormone.   Ovulation tests detect this surge, allowing you to accurately predict when you will ovulate.  A positive result on an ovulation test means that you will most likely become fertile over the next 3 days with peak fertility at 36 hours following the LH surge.