What to Do If You Want to Get Pregnant

Starting folic acid supplements, tracking your fertile window, and scheduling a preconception checkup are the three highest-impact steps you can take when you decide you want to get pregnant. Beyond those basics, the list of things that actually move the needle is shorter than the internet makes it seem, and some widely repeated advice turns out to matter less than you’d think. What follows is a practical walkthrough of what the evidence says helps, what probably doesn’t, and where the science gets murky.

Start Folic Acid Well Before Conception

If you take away one thing from this article, make it this: begin a folic acid supplement before you stop using contraception. Neural tube defects, the group of serious birth defects that affect the brain and spinal cord, develop in the first few weeks of pregnancy, often before you even know you’re pregnant. An umbrella review pulling together multiple systematic reviews and meta-analyses found that prenatal folic acid supplementation was linked to a 77% reduction in neural tube defects.¹ Multivitamins containing folic acid also helped but to a lesser degree.

Timing matters. Research examining optimal start dates suggests beginning supplementation roughly one to two months before pregnancy, with a total duration of about four months, to get the lowest risk of congenital malformations overall.² A large population-based study in China reinforced this, finding that women who supplemented for more than three months before pregnancy saw significantly lower odds of neural tube defects and cleft palate compared with those who started later.³ The standard recommendation in most countries is 400 micrograms daily, though your doctor may suggest a higher dose if you have specific risk factors.

Track Your Fertile Window

You can only conceive during a narrow window each cycle, roughly the five days before ovulation and the day of ovulation itself. That sounds simple, but pinpointing when ovulation actually happens is the part that trips people up. Several methods exist, and each has trade-offs. Cervical mucus monitoring, urinary hormone test strips, and basal body temperature tracking are the most common home approaches.⁴

Urinary hormone strips detect the surge in luteinizing hormone that precedes ovulation by about 24 to 36 hours. They’re straightforward and widely available. Basal body temperature charting confirms that ovulation has already happened rather than predicting it in advance, which makes it more useful over several cycles to learn your pattern than as a real-time signal for any single cycle. Cervical mucus changes, specifically the shift to a clear, stretchy consistency, are a free and surprisingly reliable indicator once you learn what to look for. Many people combine two methods for more confidence.

The practical upshot: you don’t need to have sex every single day. Having intercourse every one to two days in the days leading up to expected ovulation is generally sufficient. Obsessively scheduling it can backfire by adding stress, so the broad approach of regular sex throughout the mid-cycle window works well for most couples.

Body Weight and Conception

Weight affects fertility in both directions. Being significantly underweight and being significantly overweight both make it harder to conceive, though the mechanisms differ. A U.S. study using national survey data found a non-linear relationship: below a BMI of about 19.5, each unit increase in BMI actually reduced the risk of infertility by roughly a third, while above that threshold each unit increase predicted a small but steady rise in infertility risk.⁵

The effect grows more pronounced at higher weights. A preconception cohort study found that compared with women at a normal BMI, those with a BMI of 40 to 44 had about 40% lower fecundability (the per-cycle probability of conceiving), and those above 45 had nearly 60% lower fecundability. Interestingly, central body fat measured by waist-to-hip ratio and waist circumference also mattered independently.⁶ A Chinese cohort study similarly found that pre-pregnancy overweight and obesity lengthened time to pregnancy, though male BMI did not show a significant association in that study.⁷

None of this means you need to reach an “ideal” weight before trying. Modest shifts in the right direction can help, and extreme dieting creates its own fertility problems. The practical message is that if your weight is very high or very low and you have some time before you want to conceive, working toward a healthier range can meaningfully improve your chances.

Exercise Helps, Until It Doesn’t

The relationship between exercise and fertility is one of those areas where the research gives a frustratingly “it depends” answer. A review of 25 studies on physical activity and female fertility found that the majority showed either mixed results or no clear association.⁸ That doesn’t mean exercise is irrelevant. It means the dose matters a lot.

Light to moderate activity appears to support fertility by improving metabolic health, lowering stress hormones, and helping regulate the menstrual cycle. For women who are overweight or obese, even vigorous exercise can improve ovulation and conception rates. The problem emerges when prolonged intense training is combined with inadequate calorie intake, which can disrupt the hormonal signals that drive ovulation, leading to irregular periods or loss of periods entirely.⁹ The issue is energy availability, not exercise per se. If you’re eating enough to fuel your activity, staying active is a net positive.

Smoking, Alcohol, and Caffeine

Smoking is the clearest villain here. Across numerous studies and several meta-analyses, women who currently smoke have consistently worse fertility outcomes, including reduced live birth rates in both natural conception and assisted reproduction.¹⁰ Quitting before you start trying is one of the most impactful changes you can make.

Alcohol is more nuanced. Drinking at least one alcoholic drink per day has been associated with reduced fecundability in some populations.¹¹ Among women undergoing fertility treatment, current alcohol consumption showed negative effects on fertilization, embryo quality, and implantation in some studies, though drinking in the year before treatment did not show the same association.¹⁰ The safest approach is to cut back or stop when you’re actively trying, though the evidence for harm from an occasional glass of wine is thin.

Caffeine gets the most relaxed verdict. Among studies examining moderate caffeine intake and fertility outcomes, the evidence of a significant harmful effect is weak.¹⁰ One study found no effect of caffeine on fecundability at all.¹¹ You don’t need to give up your morning coffee, though most guidelines suggest keeping it under about 200 milligrams a day (roughly one to two standard cups) as a reasonable precaution.

Sleep and Shift Work

This is an underappreciated factor. Systematic review evidence indicates that short sleep duration, evening chronotype (being a natural “night owl”), and shift or night work schedules can all affect fertility.¹² The mechanism likely involves disruption of circadian rhythms, which are tightly linked to the hormones that regulate your menstrual cycle.

Night shift work appears to carry specific risks. Among women who underwent fertility treatment, night shift workers were about 40% more likely to have menstrual irregularity and about 30% more likely to be diagnosed with endometriosis compared with day workers.¹³ A broader review confirmed that while the overall picture is complex, evidence points toward shift work adversely affecting reproductive health.¹⁴

Obviously, not everyone can change their work schedule. But if you have flexibility, prioritizing consistent sleep timing and aiming for seven to nine hours is a low-cost step that supports overall reproductive health. For shift workers, talking to your doctor about strategies to minimize circadian disruption is worth doing.

How Much Does Stress Really Matter

Everyone has heard “just relax and it’ll happen,” which is both unhelpful and not entirely wrong. The LIFE study, a well-designed prospective cohort study following couples trying to conceive naturally, measured stress using salivary biomarkers. Women with the highest levels of alpha-amylase, a marker of sympathetic nervous system activation, had a 29% reduction in fecundability and more than double the risk of meeting the clinical definition of infertility compared to women with the lowest levels.¹⁵

What makes this finding interesting is that salivary cortisol, the hormone most people associate with stress, did not show the same relationship in that study. A systematic review looking specifically at cortisol and infertility found mixed and inconsistent results across multiple studies.¹⁶ So the stress-fertility connection is real but more complicated than a simple “cortisol suppresses ovulation” story. The type of stress and how your body responds to it may matter more than whether you feel stressed in general.

The takeaway isn’t to add “stop being stressed” to your to-do list, which is its own source of anxiety. It’s that the things commonly recommended to manage stress, such as regular moderate exercise, adequate sleep, and doing activities you enjoy, also happen to support fertility through other pathways. They’re worth doing for multiple reasons.

Environmental Chemicals Worth Avoiding

Research over the past several years has increasingly connected common environmental chemicals to fertility problems. Plasticizers like BPA and phthalates, organochlorine compounds, and certain pesticides are among the most studied offenders. These endocrine-disrupting chemicals interfere with ovarian function, including the processes by which follicles develop and produce hormones.¹⁷

The documented effects span a wide range. Exposure to various endocrine disruptors has been linked to decreased estradiol levels, lower egg quality, reduced fertilization and implantation rates, and lower rates of clinical pregnancy and live births.¹⁸ These are not obscure industrial chemicals; they show up in food packaging, personal care products, cleaning supplies, and plastics you handle every day.

You can’t eliminate exposure entirely, but practical steps that reduce your load include:

Food storage: Use glass or stainless steel containers instead of plastic, especially for heating food.
Personal care products: Choose fragrance-free options and check labels for parabens and phthalates.
Receipts: Thermal paper receipts are a significant source of BPA; decline them when you can or wash your hands after handling them.
Pesticides: Wash produce thoroughly and consider choosing organic for the items you eat most often.

The Male Partner’s Health Matters Too

Fertility conversations tend to focus on the person who will carry the pregnancy, but roughly half the equation depends on the sperm. Lifestyle factors including diet, exercise, smoking, alcohol use, and body weight can all affect sperm count, motility, morphology, and DNA integrity.¹⁹ The same general advice applies: don’t smoke, moderate alcohol, keep weight in a healthy range, and avoid overheating the testicles (which means skipping hot tubs and not keeping a laptop on your lap for extended periods).

The evidence on some male lifestyle factors and fertility outcomes in studies of assisted reproduction is sparser and less consistent than the female data.¹⁰ But sperm quality improvements from lifestyle changes can show up relatively quickly since the sperm production cycle takes about two to three months. Starting healthy changes a few months before you plan to try gives those changes time to have an effect.

Conditions That Are Worth Knowing About in Advance

Some medical conditions can quietly affect your ability to conceive or carry a healthy pregnancy. Two of the most common are polycystic ovary syndrome (PCOS) and endometriosis, both of which are associated with reduced rates of natural conception.²⁰ If you have irregular periods, very painful periods, or have been on hormonal birth control for years and aren’t sure what your natural cycle looks like, a preconception visit with your doctor can help uncover issues early.

A preconception appointment is also the time to review your medications (some are unsafe in pregnancy), update vaccinations (rubella and varicella immunity should be confirmed before conceiving), check your thyroid function, and discuss carrier screening. The American College of Medical Genetics and Genomics recommends a tiered approach to screening for genetic conditions that could be passed to your child, with the number of conditions screened based on their frequency in the general population.²¹ If both partners carry a gene for the same recessive condition, that information opens up options like preimplantation genetic testing that are harder to pursue once a pregnancy is already underway.

Lubricants and Other Common Worries

One question that comes up surprisingly often is whether lubricant use during sex can hurt your chances. The concern stems from older lab studies showing that some lubricants can impair sperm motility in a test tube. But human studies tell a different story. A prospective cohort study found that lubricant use during the fertile window had no effect on time to pregnancy across all types tested, including water-based, silicone-based, and oil-based varieties.²² A separate study confirmed this, showing similar fecundability between lubricant users and non-users after adjusting for intercourse frequency.²³ If lubricant makes sex more comfortable and enjoyable, use it without worry.

Other common worries that turn out to be overblown: you don’t need to lie still with your hips elevated after sex (there’s no good evidence this helps), you don’t need to orgasm for conception to occur (though it doesn’t hurt), and specific sexual positions don’t meaningfully affect your odds. The things that actually matter are having sex during your fertile window and maintaining the health factors discussed above.

When Your Path to Pregnancy Isn’t Standard

Everything described so far assumes a scenario where a male and female partner are trying to conceive through intercourse. But many people who want to get pregnant don’t fit that mold. Same-sex female couples, single people planning to use donor sperm, and those who already know they’ll need medical assistance face a different set of first steps.

For same-sex female couples, the medical and legal systems still largely revolve around heterosexual reproduction, which creates practical barriers. Research has documented that despite efforts by fertility clinics to become more inclusive, same-sex couples continue to face disproportionate obstacles in accessing services.²⁴ Finding an LGBTQ-friendly reproductive endocrinologist, understanding insurance coverage for donor sperm and insemination, and clarifying legal parentage in your state or country are all steps that belong on the preconception checklist for these families.

Regardless of your path to pregnancy, the biological preparation is the same. Folic acid, healthy weight, sleep, reduced chemical exposures, and managing any underlying conditions all apply whether you’re conceiving with a partner at home or through intrauterine insemination in a clinic. The medical groundwork doesn’t change; only the logistics around it do.

When to Seek Help

Most couples under 35 who are having regular unprotected sex will conceive within a year. The general guideline is to see a fertility specialist if you haven’t conceived after 12 months of trying if you’re under 35, or after six months if you’re 35 or older. But there are reasons to seek evaluation sooner: irregular or absent periods, a known history of PCOS or endometriosis, prior pelvic surgery, a history of sexually transmitted infections, or a male partner with known testicular issues.

Age is the single biggest factor that no lifestyle change can fully compensate for. Egg quality and quantity decline with age, and the decline accelerates after 35. This doesn’t mean you can’t conceive after that age, just that the odds per cycle are lower and the time to seek help is shorter. If you’re in your late 30s or early 40s, being proactive about evaluation is worthwhile even if nothing seems wrong. A basic fertility workup, which typically includes bloodwork, an ultrasound, and a semen analysis for the male partner, can catch problems that have straightforward solutions and save months of frustration.

1
PubMed. Preconception Folic Acid and Multivitamin Supplementation for the Prevention of Neural Tube Defect: An Umbrella Review of Systematic Review and Meta-analysis
2
PubMed Central. Initiation and duration of folic acid supplementation in preventing congenital malformations
3
PubMed Central. Preconception folic acid supplementation for the prevention of birth defects: a prospective, population-based cohort study in mainland China
4
PubMed Central. Current Ovulation and Luteal Phase Tracking Methods and Technologies for Fertility and Family Planning: A Review
5
PubMed Central. Association Between Body Mass Index and Female Infertility in the United States: Data from National Health and Nutrition Examination Survey 2013–2018
6
PubMed. Body mass index, physical activity and fecundability in a North American preconception cohort study
7
PubMed Central. Pre-pregnancy body mass index and time to pregnancy among couples pregnant within a year: A China cohort study
8
PubMed Central. Physical activity and fertility
9
International Journal of Innovative Technologies in Social Science. THE IMPACT OF PHYSICAL ACTIVITY ON FEMALE FERTILITY- A REVIEW OF CURRENT LITERATURE
10
PubMed Central. Caffeine, alcohol, smoking, and reproductive outcomes among couples undergoing assisted reproductive technology treatments
11
PubMed Central. Alcohol, smoking, and caffeine in relation to fecundability, with effect modification by NAT2
12
PubMed. Impact of sleep on female and male reproductive functions: a systematic review
13
PubMed Central. Night Shift Among Women: Is It Associated With Difficulty Conceiving a First Birth?
14
PubMed Central. Impact of night shift work on women’s fertility, pregnancy and menopause
15
PubMed Central. Preconception stress increases the risk of infertility: results from a couple-based prospective cohort study–the LIFE study
16
PubMed Central. Infertility and cortisol: a systematic review
17
PubMed Central. The role of endocrine disruptors in female infertility
18
PubMed. Exposure to modern, widespread environmental endocrine disrupting chemicals and their effect on the reproductive potential of women: an overview of current epidemiological evidence
19
PubMed Central. Implications of lifestyle factors on male reproductive health
20
Brazilian Journal of Implantology and Health Sciences. POLYCYSTIC OVARY SYNDROME AND ENDOMETRIOSIS: IMPACT ON FERTILITY AND QUALITY OF LIFE AND SURGICAL OPTIONS
21
PubMed Central. Laboratory testing for preconception/prenatal carrier screening: A technical standard of the American College of Medical Genetics and Genomics (ACMG)
22
PubMed Central. Lubricant use during intercourse and time-to-pregnancy: A prospective cohort study
23
PubMed Central. Effect of Vaginal Lubricants on Natural Fertility
24
PubMed Central. Laboring to Conceive: Reducing Barriers to Fertility Care for Same-Sex Mothers Pursuing Parenthood