The Playbook of Trying to Conceive
There are a ton of acronyms and "iykyk"s in this space so decided to put into a simple post on the topic.
This guide is written for anyone trying to understand the “trying to conceive” or TTC journey be it someone planning this exciting new phase in life or a healthcare provider. As a healthcare provider, it’s useful to know the journeys and effort patients have taken to learn about their fertility. As people, it may be useful to learn what goes into conceiving.
While this Substack generally focuses on genetics - it’s still about our modern reproduction which in the last few years means increased data, knowledge, tracking, community, and so much more. For some, conceiving is way less complicated than this post. For others, it won’t cover nearly as much as they’ve experienced.
Let’s dive into the playbook.
To Prepare:
Healthy diet and lifestyle
Removal of toxins: drugs, alcohol, exposures (i.e. plastic containers)
Carrier screening, if desired
Daily prenatal vitamin **best to start folic acid supplementation 3 months before conception. Folic acid is often included in prenatal vitamins
Preconception doctor’s appointment
Resources: ACOG, Canada.Ca, Tommy’s
How It Starts:
There’s an evolution for how in depth people will go when it comes to planning and tracking, often dictated by how long it takes to conceive and costs. People may start with the “not trying to prevent” approach, where they are no longer using birth control and trying to increase and time baby dancing (BD), as some reddit users put it, or sex, around the time of ovulation.
When individuals are ready to start tracking their cycles, there are a few approaches available to them.
Cycle Tracking - tracking when menstruation occurs and other phases of the cycle
Basal Body Temperature (BBT) - tracking body temperature to confirm ovulation occurred
Cervical Mucus Tracking (CM) - tracking cervical mucus to identify fertile window
Ovulation Predictor Kits - using lutenizing hormone (LH) strips to detect the possible time of ovulation
Hormone Tracking - tracking estrogen, progesterone, follicle stimulating hormone (FSH) in addition to LH to detect fertile window and confirm ovulation
Before being able to use these tools, it’s important to understand the menstrual cycle. Many people are familiar with predicting when their period will start in order to be prepared, but the goal now shifts to identifying when ovulation will occur. The timing of ovulation varies between individuals and even from cycle to cycle in the same person.
Learn about the menstrual cycle:
There are 4 main scenes in the play of the menstrual cycle: menstrual, follicular, ovulation, and luteal. In each, there are certain key actors or hormones that ensure the main goal of creating and releasing an egg is achieved such as luteinizing hormone (LH), follicle stimulating hormone (FSH), estrogen, and progesterone.
Scene One: Period or Menstrual Phase = shedding of the uterine lining/reset
Cycle day one is the first day of your period. It can be difficult to determine what is day one - sometimes individuals spot a day or two before and are unsure of whether to count those days. Usually, a day of bleeding and needing a pad/tampon is thought to be day one; however, this still can vary person to person of what’s considered bleeding. The menstrual phase may last about 3-7 days.
Scene Two: Follicular Phase = growth of the egg
This is the phase of the cycle that occurs right after the period. It is a build up and growth phase to mature egg cells. Depending on your period length, it may start on day 6 of your cycle. This is an exciting phase as it’s the lead up to ovulation.
Here is where cervical mucus tracking and “ovulation predictor kits” or OPKs is important as the goal is to find a shift in these assessments to predict ovulation. Follicular phase length will differ as well as when someone’s fertile window will begin. The fertile window is the few days before ovulation, the day of ovulation, and the day after ovulation. These are the days that are recommended to have sex to have sperm available in the fallopian tubes to meet the egg. It’s said that sperm can stay in the female reproductive tract for up to 5 days.
All these tracking zeros in on someone’s personal fertile window to help with timing of sex. The follicular phase may last 11-27 days.
Scene Three: Ovulation = release the egg
Ovulation is everything. Ovulation means the egg is released from its’ follicle and is making its way into the fallopian tube to meet with sperm. If sperm is available and fertilizes the egg, then an embryo is created. An embryo is an egg that was fertilized by sperm. The embryo will make its way to the uterus in about 6 days. Ovulation lasts about 1 day, as that’s how long an egg is viable.
Basal body temperature monitoring helps to confirm ovulation whereas the cervical mucus tracking and ovulation predictor kits are about trying to predict ovulation, but do not confirm that it occurred.
Scene Four: Luteal Phase = provide a supportive uterine environment for the egg to implant
While the hopeful embryo is making its way to the uterus, the uterus is creating a cushy environment for the embryo to implant. The luteal phase may last 10-17 days - this is the “two week wait” or TWW that people may mention on social media.
The luteal phase can be a difficult time as someone is in limbo of whether or not they are pregnant. I liken this time to Schrodinger's cat.
The main hormone in this phase is progesterone, which creates symptoms like fatigue, moodiness, sore breasts. These symptoms make for a less than ideal feeling on top of the anticipation of possibly being pregnant.
In the early stages of TTC, people may pretend they are already pregnant and try to avoid certain foods, alcohol, activities, etc., but as time goes on, it can be hard to change your life for the “maybe”. Often people will revert to their normal after it takes a few months as to not go crazy. Some may “drink till it’s pink” aka until they have a positive test, they won’t change their habits all that much.
Although, healthy habits are imperative - this post won’t dive into those recommendations. Others have and it’s all about what changes fuel someone as opposed to bog them down as stress is not a good ingredient either.
When pregnant, the predominant hormone is also progesterone (albeit in higher doses), which create the same symptoms. People will often “symptom spot” during this time, but the feelings of being in the luteal phase is quite often the same as being pregnant.
Not until someone can test will they be able to figure out if they are pregnant.
This phase is where the nomenclature of “CD” or cycle day will often convert to “DPO” or day post ovulation. Here is where people may see people testing for pregnancy at DPO9 or DPO10. This means they are testing 9 or 10 days after ovulation. The hormone being tested is hCG or human chorionic gonadotropin which is only present when there is a pregnancy.
It usually takes a few days from implantation to appear in a pregnancy test. Implantation means the embryo has burrowed into the walls of the uterus and developing into a pregnancy. It may occur from 6-12 days after ovulation.
People will discuss the different brand tests and which has the earliest detection since waiting can be agonizing. There’s the “FRER” or first response early response test which is thought to have one of the earliest detection and “cheapies” often from companies that sell bulk tests at a more affordable price.
If no implantation then back to Menstrual Phase to reset or if there’s implantation, then to Pregnancy.
Learn about Hormones:
The main ones are luteinizing hormone (LH), follicle stimulating hormone (FSH), estrogen, and progesterone. Each will be in a different amount depending on when they are in the menstrual cycle.
Follicular Stimulating Hormone (FSH)
In the follicular phase (notice the “foll” prefix), the pituitary gland (located in the brain) will release FSH, which will stimulate follicles located in the ovary. The ovary has 100s of follicles - the follicles are where the egg cells are located, protected within them.
FSH will stimulate multiple follicles at once. Only one will become the “dominant follicle” and win out over the rest - it is the one that the egg will be released from and exit into the fallopian tubes.
Luteinizing Hormone (LH)
LH is also produced by the pituitary gland and also stimulates the ovaries. LH will be at a low level, helping to support the growth of the follicles, until it increases drastically and tells the dominant follicle to release the egg cell. This surge is what is being measured with “ovulation predictor kits” or OPKs. When the surge occurs, it indicates ovulation is likely to occur soon - 12-36 hours. Now, when measuring, people may measure in the morning, using their “first morning urine” (FMU), and in the evening. Yet, if someone has a short surge, it is possible to miss that signal. Other people’s surge will last long enough for them to capture it. This is all to say that while it seems straightforward to measure LH with the strips, it can be a bit more complicated.
Estrogen
Estrogen is rising during the follicular phase. It helps to support the growth of the egg. Ovaries produce estrogen and is in response to the stimulation from FSH and LH.
Progesterone
Progesterone is rising in the luteal phase in order to thicken the uterine lining. Here’s where it gets even more interesting - the dominant follicle that released the egg, turns into the “corpus luteum”. The corpus luteum produces progesterone and lasts for about 14 days, unless a pregnancy occurs.
Sometime individuals are provided progesterone during the luteal phase in the event they have had multiple miscarriages without an explanation.
Individuals may choose some products that allow for measuring of all four of these hormones (premom, proov, mira, inito). These are not necessarily clinical grade, so following up with a doctor to formally measure select hormones in the blood is a more accurate representation of levels. In these programs, a urine metabolite of progesterone is used to confirm ovulation.
Learn why it may be taking longer than expected:
Tracking cycles and identifying ovulation can take some time. It’s not easy to afford strips and products and all the time that it takes to test. Partners travel. People have life changing events which can cause shifts in the menstrual cycle. It can be exhausting to keep up with and think about. However, if a couple have been trying to conceive (as effectively as they can with these tools) for over 6 months for a woman over 35 years of age and 12 months for a woman younger than 35, then they can see a provider to investigate.
Learn how to mentally cope with TTC:
This will look different for everyone. There’ll be ebbs and flows. It’s truly a journey and not as quick as it was made out to be in health class where having unprotected sex once would surely lead to a pregnancy.
Not discussed here is the all too often experienced, all too often ignored reality of miscarriages. All the effort and then a loss. This is another battle to figure how to cope and experience. What’s life, though, but a collection of experiences, the good, joyous, delicious ones, and the bad, desperate, agonizing ones. And mostly, just the mundane experience of day-to-day, life.
Resources:
You’ll notice, I’ve used a lot of other branded companies as resources - Modern Reproduction is not endorsing any of them. They just have great content creators that have already created wonderful blogs and visuals. Here’s another resource.
* This blog constitutes general information about genetic testing and medical screening. This blog does not offer or provide medical advice or diagnosis, and nothing in this blog should be construed as medical advice or diagnosis. Do not rely on the information in this blog/article to make medical management decisions. Please consult with a medical professional before making those decisions. Do not delay in seeking professional medical advice if you think you have a medical concern. Do not disregard professional medical advice based on any information received in this blog.
