Trying to Conceive

Trying to Conceive: evidence-based guidance for trying to conceive.

Cycle basics

  • The menstrual cycle is typically 21 to 35 days long for most adults (in teens it can range 21-45 days); the average cycle length is around 28 days, and it is normal for cycle length to vary somewhat from month to month.Source: NICHD (NIH)
  • The same NICHD overview also confirms the general 21-35 day range using the phrase 'for most women, it is 21 to 35 days,' matching NHS guidance that regular cycles anywhere from 21 to 35 days are considered normal.Source: NHS
  • Ovulation is triggered by a surge in luteinizing hormone (LH), and release of the egg typically occurs about 36 hours after the start of that LH surge.Source: ASRM
  • The luteal phase is the second half of the cycle, running from ovulation until the next period starts; NHS guidance describes this post-ovulation window as typically 10 to 16 days before the next period begins.Source: NHS

Ovulation signs

  • Around the time of ovulation, vaginal/cervical secretions typically become thinner, clearer and more stretchy — often described as similar to raw egg white — and this is generally the most fertile-feeling type of mucus.Source: NHS
  • In a large study cited by ASRM, pregnancy rates were highest (around 38%) when intercourse occurred on the day of peak (egg-white type) cervical mucus, compared with 15-20% on other fertile-window days, and cervical mucus changes predicted the day-specific chance of conception as well as or better than basal body temperature or urinary LH monitoring.Source: ASRM
  • ASRM notes that ovulation predictor kits/devices that detect the urinary luteinizing hormone (LH) surge have real limitations: in one comparison study, LH-based and app-based predictors reached a maximum accuracy of only about 21% in predicting the exact day of ovulation, false-positive LH results occur in roughly 7% of cycles, and ovulation itself can occur any time within about 2 days after a positive LH test.Source: ASRM
  • ASRM defines the fertile window as the 6-day interval ending on the day of ovulation (i.e., ovulation day plus the 5 days before it), with peak fertility in the 2 days before ovulation and the highest per-cycle pregnancy probability when intercourse occurs the day before ovulation.Source: ASRM
  • It is common to feel mild one-sided lower-abdominal pain around ovulation, roughly 14 days before a period, often described as a dull ache or sharp sudden twinge; this ovulation pain (mittelschmerz) usually lasts from a few minutes up to 1-2 days and is generally not a cause for concern unless it is severe or persistent.Source: NHS
  • In an average 28-day menstrual cycle, ovulation typically occurs about 14 days before the next period starts, but cycle length and the timing of ovulation can vary considerably between individuals and from month to month.Source: Mayo Clinic
  • Having sex regularly from about 3 to 4 days before ovulation until roughly one day after ovulation improves the odds of conception, because sperm can survive in the female reproductive tract for about 3 to 5 days while the released egg itself can only be fertilized for about 12 to 24 hours.Source: Mayo Clinic

Timing & tips

  • For couples trying to conceive, having sex every day or every other day during the 6-day fertile window gives the best chance of pregnancy, though daily sex is not required — sperm can live in the body for up to 5 days.Source: ACOG
  • Sperm can live inside the female reproductive tract for about 3 to 5 days after sex; because of this, having sex regularly from 3-4 days before ovulation until one day after ovulation improves the odds of getting pregnant. Couples who can't manage daily sex are advised to aim for every 2 to 3 days a week starting soon after the end of the period.Source: Mayo Clinic
  • ASRM's committee opinion states that intercourse every 1 to 2 days during the fertile window yields the highest pregnancy rates, though intercourse every 3 days produces nearly equivalent results; couples should not deliberately limit frequency.Source: ASRM
  • The fertile window is best defined as the 6-day interval ending on the day of ovulation, with the highest chance of pregnancy when intercourse occurs within the 2 days before ovulation.Source: ASRM
  • There is no evidence that coital position, female orgasm, or remaining horizontal (lying down) after intercourse improves conception chances — ASRM's patient fact sheet states research does not support these common beliefs.Source: ASRM
  • Some common lubricants (including certain brands like Astroglide and KY Jelly, as well as saliva and olive oil) may impair sperm movement and viability, while alternatives such as Pre-Seed, mineral oil, or canola oil do not show this negative effect.Source: ASRM
  • An NIH-funded study of 274 women trying to conceive found that women with the highest levels of alpha-amylase (a marker of the stress hormone system) had about a 12% lower chance of conceiving each cycle compared to those with the lowest levels, though a related stress hormone, cortisol, was not linked to reduced conception in the same study.Source: NICHD (NIH)
  • ACOG notes that using fertility trackers and apps to time intercourse can create a sense of urgency around getting pregnant, and that many people find this information overwhelming and become fixated on doing everything 'just right,' which can add unnecessary stress to sex.Source: ACOG
  • ASRM's committee opinion acknowledges that stress associated with trying to conceive can reduce sexual esteem and satisfaction and the frequency of intercourse, particularly when couples follow rigid ovulation-prediction schedules, and recommends that fertility-awareness methods be used to guide frequent intercourse rather than replace it.Source: ASRM

The two-week wait

  • In an average 28-day menstrual cycle, ovulation occurs about 14 days before the start of the next period, and the number of days between ovulation and the next period is the most consistent part of the cycle.Source: ACOG
  • The normal luteal phase (from ovulation to the next period) ranges from about 11 to 17 days, with most luteal phases lasting 12 to 14 days (mean 14.2 days).Source: NIH (PMC)
  • During the luteal phase, the corpus luteum produces progesterone (necessary to prepare the endometrium and maintain early pregnancy); this happens every ovulatory cycle, and the corpus luteum regresses (into the corpus albicans) if not rescued by hCG from pregnancy.Source: NIH (PMC)
  • ACOG lists breast tenderness, bloating and weight gain, fatigue, and abdominal pain/aches among common physical symptoms of PMS.Source: ACOG
  • For PMS to be diagnosed, symptoms must be present in the 5 days before a period for at least three menstrual cycles in a row and end within 4 days after a period starts.Source: ACOG
  • If someone has a regular monthly cycle, the earliest and most reliable sign of pregnancy is a missed period; other early symptoms like fatigue and breast tenderness/enlargement are described as similar to what a person might feel before a period.Source: NHS
  • In the first few weeks of pregnancy some people notice a bleed similar to a very light period, with some spotting or only losing a little blood, called implantation bleeding -- but not everyone experiences it.Source: NHS
  • hCG can appear in blood and urine as early as about 10 days after conception, but most over-the-counter home pregnancy tests will not reliably show a positive result until the expected menstrual cycle is late; testing before that point often gives an inaccurate result.Source: MedlinePlus (NIH)
  • A positive home pregnancy test result is almost certainly correct if instructions were followed properly, but a negative result is less reliable early on; if a negative test is obtained but pregnancy is still suspected, it's recommended to wait about a week and retest.Source: NHS

Nutrition & supplements

  • ACOG advises taking a prenatal vitamin with at least 400 micrograms of folic acid daily starting at least 1 month before pregnancy and continuing through the first 12 weeks of pregnancy, to help prevent neural tube defects.Source: ACOG
  • ACOG notes that women with a previous pregnancy affected by a neural tube defect (or certain other risk factors) may be advised to take a much higher dose — 4 milligrams (4,000 mcg) of folic acid daily, as a separate supplement — starting at least 3 months before pregnancy, in consultation with their obstetric care provider.Source: ACOG
  • ACOG states iron needs rise from 18 mg/day for non-pregnant women to 27 mg/day once pregnant, an amount most prenatal vitamins already provide; it also recommends iron-rich foods (beans, lentils, enriched cereals, beef, turkey, liver, shrimp) plus vitamin-C foods that aid iron absorption.Source: ACOG
  • ACOG advises against taking high levels of vitamin A, capping intake at no more than 10,000 international units a day, because very high vitamin A intake has been linked to severe birth defects.Source: ACOG
  • ACOG recommends limiting mercury exposure by avoiding bigeye tuna, king mackerel, marlin, orange roughy, shark, swordfish, and tilefish, and limiting white (albacore) tuna to 6 ounces a week — while still eating 8-12 ounces of low-mercury fish and shellfish weekly for their nutrients.Source: ACOG
  • ACOG advises stopping use of alcohol, tobacco, marijuana, illegal drugs, and non-medically-indicated prescription drug use before pregnancy, since these substances can harm a pregnancy.Source: ACOG
  • NHS recommends taking a 400 microgram folic acid supplement daily, ideally starting up to 3 months before conception, and continuing until the 12th week of pregnancy; those with a family history of neural tube defects, diabetes, or certain blood conditions may be prescribed a higher 5mg daily dose.Source: NHS
  • NHS recommends a vitamin D supplement of 10 micrograms daily during pregnancy (and advises this year-round for people with limited sun exposure or darker skin), and separately advises NOT to take cod liver oil or any supplement containing vitamin A/retinol, since too much vitamin A can harm the baby's development.Source: NHS
  • NHS advises against liver and liver products in pregnancy due to their high vitamin A content, recommends complete avoidance of alcohol, and limits tuna to no more than 4 cans or 2 tuna steaks a week and oily fish to no more than 2 portions a week because of pollutant/mercury buildup.Source: NHS

Lifestyle changes

  • ACOG recommends moderate exercise for at least 30 minutes a day, 5 days a week (a minimum of 150 minutes/week), and says this level is recommended in the prepregnancy period as well as during pregnancy and postpartum.Source: ACOG
  • Mayo Clinic notes that for people at a healthy weight, very hard or prolonged exercise (such as running or fast cycling) can affect ovulation and lower progesterone, so if trying to conceive soon it suggests considering limiting hard exercise to under 5 hours a week and under 60 minutes a day.Source: Mayo Clinic
  • CDC states there is no known safe amount of alcohol during pregnancy or when trying to get pregnant, and no safe time to drink during pregnancy.Source: CDC
  • Mayo Clinic advises limiting or avoiding alcohol when trying to conceive, noting heavy drinking is linked with a higher risk of ovulation problems, and that not drinking at all is the best choice once conception is the goal.Source: Mayo Clinic
  • Mayo Clinic states that drinking less than 200 milligrams of caffeine a day (about one to two 6-8 oz cups of coffee) doesn't seem to affect the ability to conceive.Source: Mayo Clinic
  • ASRM's patient fact sheet reports that infertility rates in both male and female smokers are about twice the rate found in nonsmokers, and that quitting smoking improves fertility prospects, though egg loss already caused by smoking cannot be reversed.Source: ASRM
  • ACOG recommends achieving a BMI in the normal range before attempting pregnancy, noting that both abnormally high and low BMI are associated with infertility and with maternal/fetal pregnancy complications.Source: ACOG
  • ASRM's fact sheet explains that a BMI of 18.5 or below (underweight) often causes irregular cycles and may stop ovulation, while obesity-range BMI can also cause irregular cycles/ovulation problems, and that even obese people with normal ovulation have lower pregnancy rates than normal-weight people — framed as a fertility factor, not a moral judgment.Source: ASRM
  • ASRM is explicit that it is not clear how stress impacts fertility and it is not known whether high stress levels can prevent pregnancy or affect a person's chance of conceiving; stress-reduction techniques are recommended for wellbeing and coping, not as a proven way to improve conception odds. Mayo Clinic similarly states stress isn't likely to keep someone from getting pregnant, while still suggesting stress-lowering activities for general health.Source: ASRM
  • Mayo Clinic advises trying not to work permanent night shifts when possible, since consistent night-shift work may affect hormone levels and raise the risk of reduced fertility; it suggests getting adequate sleep on days off if night shifts are unavoidable.Source: Mayo Clinic

When to see a doctor

  • ASRM's committee opinion states that for couples with regular, unprotected intercourse and no known cause of impaired fertility, evaluation should be initiated at 12 months when the female partner is under 35 years of age, and at 6 months when the female partner is 35 years of age or older.Source: ASRM
  • ACOG's patient FAQ states that experts recommend an infertility evaluation if pregnancy has not occurred after 1 year of regular intercourse without birth control; if a woman is older than 35, evaluation is recommended after 6 months of trying; and if she is older than 40, ACOG advises talking with an ob-gyn now about an evaluation, rather than waiting.Source: ACOG
  • ASRM's 2021 committee opinion on fertility evaluation of infertile women notes that in women over 40, more immediate evaluation and treatment may be warranted, rather than waiting the standard 6-month threshold used for women 35 and older.Source: ASRM
  • ASRM's 2021 committee opinion states that diagnostic testing for infertility should be initiated without delay, regardless of how long a couple has been trying, when a person presents with a condition already known to cause infertility - including irregular menstrual cycles, cycle length under 25 days, intermenstrual bleeding, oligomenorrhea, or amenorrhea; known or suspected uterine, tubal, or peritoneal disease including endometriosis; or known or suspected male subfertility.Source: ASRM
  • ASRM's 2021 committee opinion notes that a fertility evaluation may also be appropriate for some women who do not otherwise meet the definition of infertility, for example to inform care around recurrent pregnancy loss or to plan assisted reproductive technology treatment.Source: ASRM
  • The NHS advises seeing a GP if you haven't conceived after a year of regular unprotected sex, but recommends seeing a GP sooner - women aged 36 and over, or anyone already aware they may have a fertility problem, should not wait the full year before seeking advice.Source: NHS

Emotional wellness

  • The World Health Organization notes that infertility carries significant negative social and psychological consequences, particularly for women, who frequently experience stigma, emotional stress, depression, anxiety, and low self-esteem as a result.Source: WHO
  • ASRM's patient fact sheet on stress and infertility describes two common but unhelpful extremes in how people cope: some patients respond by aggressively pursuing every possible treatment and procedure, while others withdraw and isolate themselves from family, friends, and community.Source: ASRM
  • ASRM recommends stress-reduction approaches for people undergoing fertility treatment, including mindfulness/meditation, yoga, psychotherapy and cognitive behavioral therapy, support groups, and exercise, while noting that reducing stress is primarily about improving quality of life during a difficult time rather than a guaranteed way to improve pregnancy chances.Source: ASRM
  • ASRM's patient fact sheet on infertility counseling advises considering professional support if someone experiences persistent feelings of sadness, guilt, or worthlessness, social isolation, depression, anxiety, mood swings, marital strain, or difficulty concentrating during fertility treatment.Source: ASRM
  • ASRM identifies several sources of support for the emotional side of fertility treatment: mental health professionals experienced with infertility (psychiatrists, psychologists, social workers, psychiatric nurses, or marriage/family therapists), peer support groups, individual or couple counseling, and trusted family and friends.Source: ASRM
  • MedlinePlus (NIH) states that a diagnosis of depression generally requires that symptoms such as a depressed mood or loss of interest in most activities occur most of the day, nearly every day, for at least two weeks, and that people who think they may have depression should talk to a health care provider or mental health provider.Source: MedlinePlus (NIH)
  • MedlinePlus (NIH) advises that if someone or someone they know has thoughts of self-harm or suicide, they should get help right away, including calling 911 in an emergency.Source: MedlinePlus (NIH)

IVF & IUI overview

  • In IUI, sperm is 'washed' in the lab to concentrate it and remove seminal fluid, then a thin catheter is passed through the cervix to slowly inject the prepared sperm directly into the uterus around the time of ovulation, bypassing the cervix.Source: ASRM
  • IUI is a brief, usually painless in-office procedure (some mild cramping possible) and is commonly used for unexplained infertility, cervical scarring that blocks sperm passage, certain male-factor issues, or alongside ovulation-inducing medication.Source: ASRM
  • IVF involves several stages: ovarian stimulation with fertility medication over roughly 8-14 days (monitored by ultrasound and blood tests), egg retrieval via a needle about 36 hours after a trigger injection, fertilization of eggs with sperm in a lab dish (sometimes using ICSI), embryo culture for a few days, and embryo transfer into the uterus via catheter; extra embryos can be frozen.Source: ASRM
  • IVF is used for a wide range of situations, including blocked or damaged fallopian tubes, male-factor infertility, endometriosis, unexplained infertility, use of donor eggs or a gestational carrier, and family-building for LGBTQIA+ or single people.Source: ASRM
  • According to ASRM's clinical guideline, IUI is generally considered first-line treatment for unexplained or mild male-factor infertility because it is less invasive and less costly than IVF, while IVF is 'the most effective form of treatment for nearly all causes of infertility, but is substantially more invasive and more costly than other methods of treatment.'Source: ASRM
  • For couples with unexplained infertility, ASRM's guideline notes that in women under about 35-38, studies found no significant difference in pregnancy rates between ovulation stimulation with IUI and IVF, but for women 38 and older, immediate treatment with IVF produced higher live-birth rates than IUI-based approaches.Source: ASRM
  • A typical treatment strategy in this guideline is to first try about 3-4 cycles of ovulation stimulation combined with IUI using oral fertility medication, and to move to IVF if that is unsuccessful, rather than escalating to IUI with injectable gonadotropins.Source: ASRM
  • The most invasive step of IVF is egg retrieval, done with a thin needle guided by transvaginal ultrasound; documented risks include mild medication side effects (nausea, breast tenderness), ovarian hyperstimulation syndrome (OHSS) in under 1% of cases, and rare procedural complications such as infection or organ injury.Source: ASRM
  • In the NHS's description of the IVF process, a full IVF cycle typically takes about 3 to 6 weeks: ovulation suppression (2-3 weeks), egg stimulation (2 weeks), egg collection (about 20 minutes under sedation), lab fertilization, and embryo transfer, with a pregnancy test roughly 16 days after transfer.Source: NHS

Secondary infertility

  • Secondary infertility is defined as having had one or more pregnancies in the past, but now having difficulty conceiving again.Source: NHS
  • ASRM's clinical glossary formally defines secondary female infertility as "a condition in which a woman is diagnosed as infertile following a previously confirmed clinical pregnancy" (distinguished from primary infertility, where no prior pregnancy has occurred).Source: ASRM
  • ASRM's patient fact sheet on defining infertility states that a fertility evaluation should generally begin after 12 months of trying to conceive for those under 35, or after 6 months for those 35 or older — the same timelines used for a first pregnancy, with no separate rule for those trying again after a prior pregnancy.Source: ASRM
  • NHS guidance similarly advises seeing a doctor after a year of trying without success, but sooner — for those 36 or older, or anyone already aware of a possible fertility problem — which applies equally to people who have conceived before.Source: NHS
  • NHS lists declining fertility with age as a general risk factor for infertility, which is relevant to secondary infertility since time has passed since a prior pregnancy even when no problems existed before.Source: NHS
  • MedlinePlus defines infertility broadly as not being able to become pregnant after a year of trying (or repeated pregnancy loss), a definition that does not depend on whether a person has previously carried a pregnancy.Source: MedlinePlus (NIH)
  • ASRM's patient fact sheet on infertility counseling notes that infertility "touches all aspects of your life" and can bring persistent sadness, guilt, anxiety, mood swings, and social withdrawal, and recommends that people experiencing these reactions seek support from family, friends, or a mental health professional.Source: ASRM

Third-party reproduction & donor conception

  • Third-party reproduction is a general term for any process that involves someone other than the intended parent(s) in conceiving and having a child, and it encompasses gestational carriers (surrogacy), egg donation, sperm donation, and embryo donation.Source: ASRM
  • A gestational carrier is a woman who agrees to have a couple's fertilized egg (embryo) implanted in her uterus and carries the pregnancy for the intended parent(s); because she does not provide the egg, she is not biologically (genetically) related to the child.Source: ASRM
  • Egg donation is a form of third-party reproduction in which a woman (the donor) provides her eggs to another woman (the recipient) so the recipient can become pregnant and have a baby, typically after the donor takes medications to stimulate development of multiple eggs in a single cycle.Source: ASRM
  • Embryo donation allows intended parents to use embryos that were created by another couple during in vitro fertilization (IVF) but were not used and were instead frozen (cryopreserved) for possible future use, offering another path to parenthood through third-party reproduction.Source: ASRM
  • Under FDA regulations, establishments that recover reproductive cells or tissue (such as donor eggs, sperm, or embryos) must test a specimen from the donor to reduce the risk that relevant communicable disease agents of the genitourinary tract will be transmitted to the recipient, with required testing covering specific listed disease agents unless the tissue is recovered by a method that ensures freedom from such contamination.Source: FDA (21 CFR 1271.85)

Building your family, inclusively

  • The ASRM Ethics Committee holds that access to fertility treatment should not be restricted based on a person's marital status, sexual orientation, or gender identity — individuals and couples are entitled to fertility services on the same basis regardless of these factors.Source: ASRM
  • Reviewing the available research, the ASRM Ethics Committee found that children's development, adjustment, and overall well-being are not meaningfully affected by whether their parents are married, their parents' sexual orientation, or their parents' gender identity.Source: ASRM

Adoption as a path to parenthood

  • Adoption as a path to parenthood is not just a legal procedure — it is also a social and emotional process that can bring joy alongside challenges like loss, grief, and identity issues for everyone involved.Source: Child Welfare Information Gateway
  • When a child's home environment is unsafe, placing them with relatives (kinship care) is generally the preferred option because it helps preserve family connections and cultural traditions while reducing the trauma of separation.Source: Child Welfare Information Gateway

Educational reference only — not medical advice. Every fertility journey differs. Always consult your doctor or midwife.