Pod Insights Life Kit Plus Want to get pregnant? There’s more to it than you think About this episode Whether you’re ready to become pregnant today or thinking about the future, there’s a lot to learn about your fertility. In this episode, a reproductive endocrinologist and a reproductive psychiatrist walk through the basic factors that contribute to your ability to get pregnant — and explain the best ways to get your timing right.
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Transcript Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.
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0:16 Marielle Segarra? It's so interesting to me how we think about pregnancy and sex. Like, if you don't want to get pregnant, it feels like it could happen so easily. Basically, if you let your guard down at all.
0:27 Speaker 02 Yeah. As a woman, especially, like, my whole life, you know, I'm thinking about that very first sex ed class that I think was, like, in seventh grade. The messaging was like, it is so easy to get pregnant, no matter how careful you are, no matter how much protection you use, you know, if someone just looks at you a little too long, or whatever.
0:47 Marielle Segarra? Yeah, or you're, like, in a hot tub with a boy.
0:50 Speaker 02 Yeah.
0:52 Marielle Segarra? But yeah, then, for a lot of women, when the switch flips and they're actually ready to get pregnant, it doesn't happen right away. And they're like, what's going on? Which is why we're doing this whole episode about what it actually takes to get pregnant through sex. By the way, you're listening to Life Kit. I'm Mary El Segarra, and I'm talking to Life Kit reporter Andy Tagle.
1:13 Speaker 02 That's right. And there's more to getting pregnant than you think. For some people, it can be that simple, but everyone's going to have a different experience based on a lot of different factors. To give you an idea, from a statistical standpoint, at what's considered peak fertility, we're talking about people in their early 20s to early 30s, having regular unprotected sex to try and conceive, you only have around a 25 to 30% chance of getting pregnant in any given month.
1:42 Marielle Segarra? Wow, I've been lied to.
1:43 Speaker 02 I know, isn't that? I was shocked by this. But as the experts I talked to told me, that huge gap between what you're taught in high school or middle school, and what you actually experience when you're trying to conceive, can be really jarring for a lot of people. Here's reproductive endocrinologist Dr. Lucky Secon.
2:01 Speaker 03 A lot of people feel like their bodies are broken or that they've done something wrong. I've had patients even say, is it because I drank too much in college? And I think it is a very natural, human nature tendency, especially for women, I might add, to kind of internalize things and blame themselves and take on more responsibility for things, when in reality, so much of our fertility is not in our control.
2:27 Marielle Segarra? That's actually really helpful to know because I can hard relate to that saying, is it because I drank too much in college? You know, did I cause this problem?
2:36 Speaker 02 Right. Is it me? But you know, Marielle, one antidote to feeling disempowered is information. And this episode is absolutely fertile with know-how.
2:46 Marielle Segarra? Ha!
2:47 Speaker 02 That can help if you're thinking about getting pregnant.
2:49 Marielle Segarra? All right, what are some of the topics you're going to get into?
2:52 Speaker 02 We'll do a little conception science crash course. We're going to cover the basic factors that can and cannot affect your ability to get pregnant. We're going to help you think about your timing, lots, lots more. That's coming up after the break.
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4:11 Marielle Segarra? A lot of us have basically a mini beauty product store in our bathrooms. And it's easy to feel like if you don't use the right serums, creams, acids and toners, you're somehow doomed to having bad skin. But do you really need all those products? Life Kit made a special newsletter series to help you figure out your skincare goals and what you actually need. Sign up at npr.org/skincare or find the link in the description for this episode.
4:43 Speaker 02 One thing I do want to quickly note upfront for listeners. This episode is going to focus on the so-called "traditional" way to make a baby, meaning through heterosexual intercourse. We want to acknowledge, of course, there are lots of ways to make a baby and endless ways to make a family. And we plan to give that non-traditional baby-making its own spotlight with a companion episode to this one in the near future. So keep an ear out. All right, I'm pretty sure I know why a lot of you are listening right now, so let's cut to the chase. You want to know when you should start trying, right? You want to know if you need to worry? Like, if you were to walk into your doctor's office, you might say, "I'm not ready yet."
5:25 Speaker 03 "But I want you to do whatever testing you can, and I want you to tell me if I'm good and how long I'll be good for, and I just want to make sure I'm not going to have any issues."
5:37 Speaker 02 That was Dr. Lucky Secon again. She's a New York City-based infertility expert and author of the aptly named new book, The Lucky Egg, which is a fertility guidebook of sorts. Lucky says she gets this request from patients all the time. And it's great to plan ahead, but the problem is, there's no such thing as an all-encompassing female fertility test. Sorry to break it to you. No nasal swab, no blood draw.
6:05 Speaker 03 The best test for fertility is to try, which is the most annoying, unhelpful answer, right? But it's kind of this confluence of factors and you have to actually try and see how those factors come together.
6:17 Speaker 02 The first of those factors you need to understand is the process of reproduction itself, because it can be tricky.
6:25 Speaker 03 Each egg that you ovulate each month is kind of like a long shot. So I feel like I need to get that put on T-shirts because it's like one of my slogans at this point.
6:34 Speaker 02 And that leads us to our bit of a downer, but crucial to know upfront takeaway one. Human reproduction is inefficient and not totally in your hands.
6:46 Speaker 03 I talk about it in my book as being a sort of reproductive slot machine where pulling the lever is timing when to try, but whether everything after that lines up is so out of our control.
6:56 Speaker 02 This part, ovulation, I'm assuming you already know about. Every cycle, a single egg cell, chosen at random, travels down the fallopian tube where it can live for 12 to 24 hours. Around that time, or a little before, you want to shoot some millions of sperm cells up the vagina through the cervix to meet it. Those guys can live in the reproductive tract for about three to five days.
7:21 Speaker 03 So there's this very narrow fertile window, this narrow window of opportunity each cycle.
7:27 Speaker 02 But get this, just getting the egg and sperm in the right place at the right time doesn't guarantee a connection will take place.
7:35 Speaker 03 It's like saying going on a date guarantees you're going to find your life partner. That's not true. And the same is true of the chemistry between the egg and the sperm. And it's like maybe 70, 80% of the time, the timing is right, an egg might fertilize successfully. This is extrapolation from what we see in an IVF lab where we really try to orchestrate that meeting happening.
7:55 Speaker 02 If sperm and egg do hit it off, there's still a few more hurdles before you've made it to the finish line. Only about half of the time, a fertilized egg will continue to grow and make it to the next step, which is called the blastocyst stage. It takes about a week. That blastocyst then also has to find its way to the uterus. Sometimes it gets lost along the way. And once it arrives at the uterus, it has to implant and keep growing there.
8:21 Speaker 03 And so it takes a lot of energy and a lot of them just don't make it to that stage.
8:25 Speaker 02 So suffice it to say, there's a lot that has to go right in order to get pregnant. It is no exaggeration to call it the miracle of life. And I know that all might feel a bit discouraging or intimidating, but it might help you set more realistic expectations, minimize any shame and blame if you understand upfront what the odds are. According to the American Society for Reproductive Medicine, approximately 80% of healthy heterosexual couples will conceive in the first six months of attempting pregnancy. From there, stats vary a bit, but some recent cumulative conception research has shown some 85 to 90% will conceive within a year
9:07 Speaker 02 and 95% will get pregnant within two years. So your next question, of course, what do you need to get pregnant when you want to? Like, should you be running straight to your OB-GYN's office right this very minute?
9:22 Speaker 03 You know what I like? I like before even going to a doctor. It's like, learn about your cycle.
9:30 Speaker 03 I want you to know how long your menstrual cycle is.
9:33 Speaker 02 Dr. Sarah Orick is a mother of three and a reproductive psychiatrist.
9:38 Speaker 03 Which means that I specialize in how female reproductive hormones impact mental health throughout the life cycle.
9:45 Speaker 02 She brings us to a quick takeaway, too. To track a true period, get off of hormonal birth control. Now, tracking your cycle isn't hard to do. You start by just marking the first day of your period on a calendar. But this might be a bigger ask for some than others because in order to track your period, you have to have one and a true period at that. Not just the light or complete lack of a period you might enjoy if you have an IUD, the irregular spotting you might get with a depot shot or what's called withdrawal bleeding, which is actually just a reaction to a drop in hormones, not a result of ovulation. If you're using the pill, the patch, or a vaginal ring. So if you're using a hormonal birth control method, like other millions of American women,
10:31 Speaker 02 this first, so-called, simple step might be less so.
10:36 Speaker 03 You may find that the hormonal birth control was sometimes helping your mood if you potentially had more premenstrual
10:43 Speaker 04 Symptoms, some of those might come back. Oh, this was helping my skin a lot and I hadn't realized.
10:50 Speaker 02 It might not be super fun to remove the barrier to a lot of pain, discomfort, or oily skin, but it can be extremely useful, even critical to your future reproductive health, to get an idea of your sensitivity to hormones. Maybe, for example, you find you have really significant mood symptoms in the two weeks before your period.
11:09 Speaker 04 There's a chance you have PMS. There's a chance you have premenstrual dysphoric disorder, which is like really escalated mood symptoms during that time. And having all that information is actually important because sometimes that PMDD can kind of have you in a risk bucket for maybe increased risk of pregnancy or postpartum depression or anxiety.
11:28 Speaker 02 Another thing about getting off of birth control, with the exception of the Depo-Provera shot, you're going to want to consult your doctor if this is your chosen method, you don't have to plan for any ramp up time when getting off of it.
11:40 Speaker 03 Most people getting off of the pill will get their period, you know, pretty much within a month or so.
11:46 Speaker 02 Now, I should say, this isn't a hard and fast rule. Like, if you've been on birth control for decades, Lucky says there is a minority of people that might need somewhere between three to six months to get their pituitaries to fully wake up and get back to work, so to speak.
12:01 Speaker 03 Having said that, there are many people whose bodies will just snap back into their normal routine. And so unless you're prepared to get pregnant or you're prepared to use a backup method, right? Like condoms, don't get off the pill, you know, if you're using it for contraception.
12:16 Speaker 02 Copy that. All right, now that you've brought back amp flow, let's learn what she has to share. Takeaway three: Track your menstrual cycle for clues about your reproductive health. Sarah says there are a few good reasons why anyone with a uterus should track their menstruation. For one, if you do want to start trying for a baby soon, once you have a general sense of the length of your menstrual cycle, it should be easier to pinpoint when you're ovulating, which generally happens around two weeks before the start of your next period.
12:44 Speaker 04 Start to learn, do I have a 26 day cycle? Do I have a 29? Is mine pretty regular? I say like even buy ovulation test kits and see if you ovulate.
12:53 Speaker 02 Check in with your body for signs and then track them. One way you might have heard of is through your basal body temperature, which is just the temperature of your body when it's fully at rest. You want to take it every day as soon as you wake up and then monitor for changes. Because when you ovulate, your basal body temp will increase slightly. And we're talking super slight here, like from 98 degrees to 98.5 degrees. And ovulation is likely over when that high temperature has stuck around for three days or more. Another way to tell.
13:22 Speaker 04 Learning what your cervical mucus changes. I mean, I think many of us are saying, oh, something's kind of different. But if you have that sort of egg white textured, your cervical mucosa, it's likely that you're ovulating.
13:33 Speaker 02 Another important reason to track is to spot and get ahead of any potential problem areas. For example, if you always get terrible cramps or your period never arrives on time, that could be signaling something about your ability to get pregnant in the future.
13:49 Speaker 03 If they start to note early on that these patterns are thrown off and there really isn't a pattern, this tells us that it could be more challenging. And it makes sense to get to the bottom of what's going on now so that you have a plan to hit the ground running with once you are in a position to start trying.
14:04 Speaker 02 Heavy, irregular, or painful periods could point to potential threats to fertility, like endometriosis, or polyps, or PMOS, formerly known as PCOS. Or these symptoms could be no problem at all. But you can't know until you start tracking. So do you have that first day of your period marked? Good, now just do it again.
14:26 Speaker 03 Give yourself at least three months, four months of tracking your cycle and collecting data to really be able to understand your reproductive rhythm reliably.
14:37 Speaker 02 A dot and red pen on your calendar and some notes in your planner are a fine way to start. But there are lots of online tools that can help you too, of course. If you go this route, be sure to note upfront how any interface will use and share your personal medical data. There are apps that can log symptoms, predict fertility, help you spot patterns, even share your cycle tracking with a partner. Which reminds me, thus far, we've really only been talking about the person who carries the baby. But as we know, they're only half of this equation.
15:05 Speaker 04 I think boys should be educated around all of these issues as well. And then when it comes to fertility, it's really important to note that about 50% is male factor in fertility.
15:17 Speaker 02 Male reproductive health. We'll jump into that after the break.
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16:22 Speaker 02 You're listening to Life Kit, and it's time for Takeaway Four. Fertility is 50/50. Both sides can make lifestyle choices to boost their odds. So let's talk sperm, shall we? Where female fertility remains at least somewhat of a question mark until go time, I'll expand on that in a bit. Male fertility is extremely testable, largely noninvasive. And the big one here is that a lot of the things that we see are reversible. Maybe you go in to get tested, and your doctor says you have low motility, or tells you that your sperm count is lower than the minimum threshold of 15 million sperm per milliliter.
17:01 Speaker 03 I've had couples where the husband was like a professional biker and that repetitive stress in that area, we think led to lower sperm quality. And they'll say, okay, I'm going to stop doing this.
17:12 Speaker 02 Then Lucky will retest two or three months later and see a big turnaround in the quality of the sample. Some other potentially reversible lifestyle factors for men: testicular trauma, overly tight underwear, or other similar chronic scrotal exposure to heat. And yes, the rumors are true: cannabis. Research shows cannabis is strongly linked to reduce sperm count and concentration. But the effects aren't permanent. The same goes for excessive alcohol consumption and nicotine in all forms. Top of the list for women who want to get pregnant in the near future is taking a daily prenatal vitamin, starting at least one to three months before trying to conceive. Ingredients to look for include folic acid, iron, and DHA.
17:55 Speaker 02 All right, so now, let's jump into lifestyle factors for both men and women. To start, a general rule of thumb.
18:02 Speaker 03 Whatever is better for heart health is typically going to be better and protective when it comes to your fertility, and also optimal in terms of setting you up for the healthiest pregnancy possible.
18:14 Speaker 02 You want to try to get in that recommended 150 minutes of exercise a week, keep stress levels low, and follow a heart-healthy diet as best you can. You know, eat the rainbow, Afro-Mediterranean-style, high protein, low carb, lots of leafy green vegetables.
18:29 Speaker 03 Treating food as medicine is a real thing. And I think, you know, making sure that you are getting enough protein, enough fiber, because that actually helps stabilize your blood sugar.
18:40 Speaker 02 Lucky says this bit in particular can be impactful to fertility if you have a uterus. Because if you're churning out too much insulin, it can act like a growth factor on the ovaries.
18:50 Speaker 03 And can cause your ovaries to overproduce testosterone. And when an egg is going through an ovulation cycle, and again when it gets fertilized, it's actually undergoing a massive amount of genetic reorganization, and that's where those errors happen.
19:02 Speaker 02 This is important advice for men, too. Maybe you've heard that Mountain Dew or other sodas can shrink your sperm count. That's a myth. No research shows direct links to caffeine intake and fertility. But consuming lots of sugary drinks? Not a good idea for that blood sugar. Lastly, what about environmental factors? BPAs, pesticides, heavy metals, and air pollution have all been shown to disrupt hormonal balances, which can in turn affect fertility overall. So do what you can. But also know, you can only do what you can. Because at the end of the day, as Lucky says, fertility isn't logical.
19:43 Speaker 03 There's no single lifestyle factor or something that they did which we can say this is the cause of that. At the end of the day, it's never someone's fault and it's very, very unfair.
19:53 Speaker 02 And the thing is, you just don't know where you fall until you know. Takeaway five. Timing conception is an educated guess at best. The only true way to test female fertility is to try to have a baby.
20:08 Speaker 03 A lot of it is age, timing, and our genetic makeup.
20:12 Speaker 02 Let's take those in reverse. Fertility red flag number one: genetic makeup. So if you have irregular, heavy, or painful cycles, hopefully you have a good idea of that one now or a strong family history of any other major gynecological issues.
20:27 Speaker 03 Whether that be endometriosis, fibroids, PCOS, there's a major heritability factor there. If you have a first degree relative with some of these issues, it increases your personal risk by several fold.
20:39 Speaker 02 Next, timing. If you're healthy and under 35, it's recommended you try to get pregnant on your own for at least one full year before seeking out any infertility treatments.
20:50 Speaker 03 If you're 35 and older, you shouldn't wait longer than six months. And if you're in your 40s, you shouldn't wait longer than the three-month mark.
20:57 Speaker 02 Which brings us to our last factor and the tick-tock, tick-tock of that pesky biological clock.
21:03 Speaker 03 A lot of people think of turning 35 like being Cinderella at the ball. And it's like, poof, now your carriage turns into a pumpkin. And that's just not what it is.
21:13 Speaker 02 Why age 35 matters, according to Lucky, is that it's considered a turning point. So if you were to map out on a chart the health of your egg cells through your lifespan, age 35 is when you start to see a downward slope. And what's happening is the proteins that keep the chromosomes in your egg cells lined up correctly slowly break down with age.
21:34 Speaker 03 But I want to say that nobody has perfect eggs. And even in our 20s, 20 to 25% of embryos will have missing or extra DNA. And that increases to about maybe a third of them at 35?
21:48 Speaker 02 By 37 or 38, your odds are more like a coin flip, 50/50.
21:53 Speaker 03 Now, at 40, this is where the coin flip, it's like a weighted coin, and it's flipping in the negative direction.
21:59 Speaker 02 At this point, the split is 70/30, meaning up to 70% of the time, an egg cell will have missing or extra DNA. So it's going to be harder to have a viable pregnancy naturally. The other age component you might have heard about is the number of eggs you have available. Egg count is always decreasing, and it tends to decrease more rapidly around 35. And by the way, sperm ages too, a little differently. But motility can start to decrease after 30, for example. And this is likely an important consideration if you're planning on assisted reproduction of some kind, egg or embryo freezing, or IVF, where egg harvesting is necessary.
22:38 Speaker 03 Because the more eggs I have to work with, the better the chance of getting what I need out of a given treatment cycle.
22:44 Speaker 02 We actually have a whole episode on egg freezing that can give you a lot more on that process, if you're interested. And if you just want to arm yourself with as much information as humanly possible, there is one thing you can test that can provide some insight on the state of your egg reserve. It's called AMH, or anti-malarian hormone. It's a hormone produced by the small, developing egg volicles in your ovaries. But if you do get it tested.
23:06 Speaker 04 Be careful with some of those numbers because it's a full clinical picture that's really important.
23:11 Speaker 02 Sarah says it can be tempting to put all your eggs in one basket, so to speak. To think of, say, egg or even embryo freezing as an insurance policy, or maybe a low egg reserve as a sign that you have no chance of conceiving. But.
23:26 Speaker 04 You can't just use one outcome or one data point to kind of influence your, all of your decision making.
23:33 Speaker 02 Sarah took the test and found she had low AMH, for example. Those test results helped her and her partner make the calculation to start trying sooner rather than later.
23:42 Speaker 04 If I didn't have a partner, for example, maybe I would have frozen my eggs. And that would have made sense to me and felt like, okay, this is right.
23:49 Speaker 02 Lucky had her first child the traditional way, then decided to freeze embryos at age 34. When she struggled to get pregnant again in her late 30s, she used those embryos to have her second child. Which is all just to say, there's no one size fits all here. And unfortunately, no magic calculator to tell you the perfect time to start trying. But hopefully, you now have a starting point or two for making this decision yourself. So you've tracked your cycle, you've cultivated your ideal baby-making environment, you've figured out exactly when you want to start trying. What's left on the checklist? Well, nothing to it but to do it. Takeaway six: don't beat around the baby-making bush.
24:34 Speaker 02 Before we leave you to go forth and multiply, a few last tips for some successful sexy time. First up, don't do what I just did and lead with innuendo. Be direct about the change to your sex life. That doesn't mean it has to be a chore.
24:53 Speaker 04 Just setting expectations can be so important. I think we should, you know, have sex during these days of my ovulation window. Maybe we can plan some dates.
25:05 Speaker 02 Now, how often should you be trying? Every day of the month? First thing in the morning? Under the light of the full moon. Lucky says, "Your most fertile window is the five days leading up to ovulation and the day of ovulation itself." So you could have sex every day of the month, but...
25:23 Speaker 03 Rather than burning yourself out, unless, I mean, there are obviously some people out there that like, this is what they would be doing anyway. I don't know those people.
25:31 Speaker 02 So your best bet, sex on a daily basis, the five days leading up to and including the day of ovulation. Another thing you might have heard is that you should save up all those swimmers until that window. You know, hold out so that your sperm is extra strong. Nope.
25:47 Speaker 03 If you are abstinent for too long, over a week, you can actually build up dead, old sperm cells. They need to get out, right? And so, we actually recommend that they ejaculate at least within a week.
26:00 Speaker 02 That simple schedule should put you in a good position to make a baby. And hey, now that we're on the topic, doc, is there a best baby-making position? Like, before, during, after?
26:11 Speaker 03 There are no sexual positions that are more effective at helping you get pregnant than others. You don't have to have an orgasm. You do not need bedrest. You don't need to be in a certain position.
26:23 Speaker 02 So that covers the mechanics. A final tip. If you dare, try to enjoy the process together.
26:29 Speaker 04 I think it's also a nice time to reevaluate. And people, I don't think, do this enough of like, what turns you on? Is that intimacy, meaning chores done at home? Does that mean a date? Really assessing that for yourselves and being able to come together? And how can we make this still meet some of the criteria, even though there's some goal-directed aspect?
26:54 Speaker 02 OK, team, let's recap. Takeaway one, human reproduction is inefficient. And some of it just comes down to luck. Takeaway two, to track your period, you'll need to get off of hormonal birth control. Brace yourself. Takeaway three, get to know your cycle. It's important information whether or not you're ready to start trying. Takeaway four, fertility is 50/50. Both sides can make lifestyle choices to boost your odds. Takeaway five, there's no way to fully test female fertility, but factors like age, timing, and genetics can guide you to an educated decision about when to start trying. And finally, takeaway six, trying to make a baby is probably going to change your sex life. Why not have some fun along the way?
27:36 Marielle Segarra? That was Life Kit reporter Andy Tagle. Before we go, would you take a moment to rate and review us? Tell us a favorite tip that you've learned or tell us what kind of episodes you like best. We love hearing from you. And when you leave a review, it helps the show grow. This episode of Life Kit was produced by Sylvie Douglas. Our digital editor is Malika Gharib, and our visuals editor is CJ Rieke-Lan. Megan Cain is our senior supervising editor, and Lauren Gonzalez is our executive producer. Our production team also includes Claire Marie Schneider and Margaret Serino. Engineering support comes from Sina Lefredo. Fact checking by Tyler Jones. Special thanks to Maria Goodman. I'm Maria El Segarra. Thanks for listening.
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