There are several ways to have kids, and the right path depends on your body, your partner (if you have one), and your circumstances. Most people conceive through sex during a fertile window each month, but others need medical help like fertility treatments, and some build their families through surrogacy or adoption. Here’s how each option works.
Conceiving Through Sex
For most couples, having kids starts with timing sex around ovulation. Each menstrual cycle has a fertile window of about six days: the five days before ovulation and the day of ovulation itself. Ovulation typically happens about 14 days before your period starts, so the exact day shifts depending on cycle length. If your cycle is 28 days, you likely ovulate around day 14. A shorter 21-day cycle means ovulation around day 7, while a 35-day cycle pushes it closer to day 21.
You don’t need to pinpoint the exact moment of ovulation. Having sex every one to two days during that roughly six-day window gives sperm the best chance of meeting an egg. Ovulation predictor kits, which detect a hormone surge in your urine, can help narrow the timing. Tracking basal body temperature and changes in cervical mucus are lower-tech options that work for many people as well.
Preparing Your Body First
If you’re planning to conceive, start taking 400 micrograms of folic acid daily before you get pregnant. The CDC recommends this for all women who could become pregnant because folic acid dramatically reduces the risk of neural tube defects in the baby’s brain and spine. Ideally, you’d start at least one month before trying to conceive and continue through the first three months of pregnancy. If you’ve previously had a pregnancy affected by a neural tube defect, the recommended dose jumps to 4,000 micrograms daily.
When Conception Doesn’t Happen Easily
About one in eight couples has trouble conceiving. If you’ve been having regular unprotected sex for 12 months without a pregnancy (or 6 months if you’re over 35), fertility testing can help identify what’s going on.
For women, standard testing includes bloodwork measuring hormone levels that reflect how many eggs remain in the ovaries. One key marker, AMH, gives a snapshot of your egg reserve. For women under 35, a normal AMH level falls between 1.5 and 4.0 ng/ml. Levels below 1.0 are considered low. This test can be done at any point during your cycle, which makes it convenient. An ultrasound to count developing follicles in the ovaries rounds out the picture.
For men, a semen analysis checks sperm count, movement, and shape. Healthy baselines include at least 15 million sperm per milliliter, with 40% or more showing some movement and at least 4% having a normal shape. Falling below these thresholds doesn’t mean conception is impossible, but it does help guide the next steps.
Intrauterine Insemination (IUI)
IUI is often the first fertility treatment doctors recommend because it’s less invasive and less expensive than IVF. During the procedure, specially prepared sperm is placed directly into the uterus through a thin catheter, cutting down the distance sperm has to travel to reach an egg. In natural conception, sperm must swim from the vagina through the cervix, into the uterus, and all the way to the fallopian tubes. IUI skips the first part of that journey.
IUI is a good option for couples dealing with low sperm count, thick cervical mucus that blocks sperm, unexplained infertility, or a semen allergy. It’s also the standard method when using donor sperm, whether for single parents, same-sex couples, or anyone using a sperm donor.
In Vitro Fertilization (IVF)
IVF is a more involved process where eggs and sperm are combined in a lab, and the resulting embryo is placed back into the uterus. A single cycle in the United States costs between $12,000 and $18,000, with medications adding another $3,000 to $5,000 on top of that. Many people need more than one cycle.
The process starts with about 10 to 14 days of hormone injections to stimulate the ovaries into producing multiple eggs at once instead of the usual one. During this phase, you’ll have regular ultrasounds and blood draws to monitor how the eggs are developing. When the eggs reach the right size, a trigger injection prompts final maturation, and egg retrieval is scheduled 34 to 36 hours later.
Egg retrieval is done under sedation and takes about 15 to 30 minutes. A needle guided by ultrasound collects fluid from each follicle in the ovaries, and an embryologist identifies the eggs. Those eggs are then fertilized with sperm in the lab. If sperm quality is an issue, a single sperm can be injected directly into each egg to improve the odds.
Fertilized eggs develop in the lab for five to seven days until they reach the blastocyst stage. The embryologist grades each embryo based on how well its cells are dividing and developing. One embryo (sometimes two) is then transferred into the uterus using a soft catheter. This part is quick and painless, with no anesthesia needed. A pregnancy test about two weeks later confirms whether the embryo implanted.
Surrogacy
Surrogacy involves another person carrying and delivering a baby for you. There are two types, and they differ in a significant way.
In gestational surrogacy, the surrogate has no genetic connection to the baby. An embryo created through IVF, using the intended parents’ eggs and sperm (or donor eggs and sperm), is transferred into the surrogate’s uterus. This is the more common form of surrogacy today.
In traditional surrogacy, the surrogate provides her own egg and is the biological mother of the child. Conception happens through IUI rather than IVF, which is a simpler and less expensive medical process. The intended mother does not need to take fertility medications or go through egg retrieval. However, traditional surrogacy raises more complex legal and emotional considerations because of the genetic connection between the surrogate and the baby.
Surrogacy laws vary widely by state and country. Some states have clear legal frameworks that protect all parties, while others restrict or prohibit surrogacy arrangements entirely.
Adoption
Adoption is a path to parenthood that doesn’t involve pregnancy at all. In the U.S., you can adopt domestically (a newborn or a child from foster care) or internationally.
The domestic adoption process follows a fairly standard sequence: submitting an application, completing required training, going through a home study, being matched with a child, receiving the placement, and then legally finalizing the adoption. The home study involves interviews, background checks, home inspections, and documentation of your finances and health. On average, completing all the steps needed to be licensed to adopt or foster takes six to twelve months.
Adopting from foster care is typically much less expensive than private infant adoption, which can cost $20,000 to $50,000 or more. International adoption timelines and costs vary dramatically depending on the country. Each path has its own waiting periods, legal requirements, and emotional challenges, but all of them end the same way: with a child who is legally and fully yours.
Choosing Your Path
How you have kids depends on factors that are deeply personal: your biology, your relationships, your finances, and your preferences. Some people conceive easily on their first try. Others spend years navigating fertility treatments. Some always planned to adopt. Many end up combining approaches, trying naturally before moving to IUI or IVF.
There’s no single “right” way. The options above aren’t a hierarchy. They’re different doors to the same destination, and the best one is whichever fits your life.