If you’ve ever thought about wanting to get pregnant, chances are you’ve wondered about whether it might come easily or not. While the majority of those who try will be able to conceive, the CDC states that in the United States, one in five heterosexual 15- to 49-year-old females with no prior births are unable to get pregnant after one year of trying.
So is there a way to know which group you’d fall into? While there’s no single guaranteed indicator of fertility (and remember, it takes good healthy sperm, too!), here are seven things to look out for. It’s never too early to start paying attention to your reproductive health. If you feel something is off, the sooner you can bring it up with your doctor, the better you set yourself up for success when you’re ready to try to conceive.
1. Your cycles are regular: no early, late or missing periods, and no mid-cycle bleeding.
Having regular, predictable cycles is a good sign that you ovulate, which is a prerequisite for getting pregnant (of course, you’ll need to not be taking the birth control pill to discern this!). A healthy cycle is generally thought to be around 28 to 32 days but it can fluctuate up to five to seven days—the key is that there is a cyclical and predictable pattern. (Count the first day of full flow as day one, and go until the day before your next bleeding begins.) An easy way to monitor this is to track your periods using an app where you can record your period and symptoms. It’s easier to identify patterns once you look back and analyze the last few cycles.
If your cycles are constantly shorter it can indicate that you have a lower ovarian reserve, or are potentially not ovulating at all. If your cycles are longer, you may be ovulating later in the cycle (which is fine, just make sure you’re timing intercourse to ovulation), or, again, not ovulating.
If your periods are missing altogether, that means you’re not ovulating. This can be for several reasons such as going through premature menopause or, much more commonly, a hormonal imbalance known as PCOS. The takeaway? If your cycles are not regular you’ll definitely want to talk with your doctor.
2. You have signs of ovulation: cervical mucus and/or a positive LH surge.
One common form of infertility is the lack of ovulation. That’s because you need to release an egg so that it can be fertilized by sperm. By looking out for signs of ovulation, you can figure out whether or not you’re likely ovulating.
Look for changes in your vaginal fluids that occur around cycle days eight to 14 (the days leading to ovulation, assuming a 28-day cycle). Ideally, you want to see a clear, slippery fluid that resembles raw egg whites (this is caused by the increased estrogen levels mid-cycle). This is called cervical mucus and it’s the magic fluid that signifies you’re fertile and ready to ovulate soon. In some people, cervical mucus can show up days before you ovulate. Your most fertile day, and the day you are most likely to ovulate on, is the last day of egg-white cervical mucus.
You can also track your ovulation hormone using at-home ovulation tests (sometimes called an ovulation predictor kit, or OPK). These are urine test strips that measure your levels of LH (luteinizing hormone), which is the hormone that will trigger the release of an egg. When LH surges or peaks (you’ll see a dark line on your test stick), it means that ovulation will likely happen within 24 to 36 hours. This is a good time to have sex or inseminate, seeing that it’s ideal to have sperm ready and waiting for the egg’s arrival. (To learn more about ovulation and at-home testing, check out our ovulation testing guide.)
3. You have a healthy body composition for hormone regulation.
Did you know that fat cells, called adipose cells, are hormonally active? This means that having too much or too little adipose tissue can actually affect your cycles and fertility. There’s a three times higher risk of not ovulating if you struggle with obesity (usually measured by having a body mass index (BMI) greater than 30), compared to those with a BMI of 20 to 24.9.
This is because excessive adipose tissue can affect the conversion of testosterone into estrogen, while increasing insulin and leptin levels—two hormones that directly affect the ovulation process. Having high insulin and/or high leptin can act on the ovaries and interfere with egg development.
But leptin is a major reproductive regulator that you need to make key hormones like LH and FSH (follicle-stimulating hormone). This means that not having enough body adipose tissue, (often flagged in people with a low BMI, less than 19) could also interfere with egg development and ovulation.
It’s a good idea to work towards a harmonious hormonal balance, especially if you notice that your cycles are irregular or you’re not experiencing signs of ovulation. Getting your body into a positive adipose balance also sets you up for a lower risk, healthier pregnancy.
4. You don’t smoke. (If you do, quit now!)
Smoking and nicotine use both disrupt your fertility on multiple levels. Toxic chemicals that enter your body can cause major cellular and DNA damage, which means damage to your eggs and their DNA. Smoking also alters the levels of your reproductive hormones like estrogen, progesterone and FSH. It’s even been shown to decrease egg reserves and cause early menopause.
Nicotine in particular can cause changes to the cells of your fallopian tubes called cilia. These little hair-like cells help sweep and direct the eggs from the opening of the fallopian tube towards the uterus. This is why smoking significantly increases the risk of an ectopic pregnancy (where the embryo implants in the tube instead of the uterus).
Even if an embryo makes it back to the uterus, smoking causes other changes that can prevent that embryo from implanting. The sooner you can quit the habit, the better.
5. You’re under the age of 35.
Egg quality continuously decreases, and it becomes more profound around the ages of 35 to 37, and by the time you’re 38, your eggs have much less energy. This is important since it’s the egg (not the sperm) that’s responsible for supplying the embryo with enough energy (it supplies all the mitochondria, which are like the powerplants for your cells) for it to properly divide and survive until implantation.
The amount of DNA damage also increases in your late 30s because your protection and repair mechanisms don’t work as well as they did in your earlier reproductive years. That’s why we see an increase in genetic and chromosomal abnormalities over the age of 35. This means that it’s more common to make embryos that have too many or too few chromosomes (called aneuploidy), which can lead to infertility (these are embryos that won’t implant) or increased risk of pregnancy loss (these embryos are not compatible with life). For context, the rate of aneuploidy in those aged 31 to 36 is about 34 percent. That rate increases to 42 percent by 37, 58 percent by 40, and 83 percent by 43. That means even if a 43-year-old were able to make five embryos during an IVF cycle, only one would be expected to have the potential to succeed.
This doesn’t mean you can’t get pregnant in your late 30s or even 40s, but it does mean you need to get help sooner if you’re not getting pregnant on your own. If you’re over the age of 35, speak with your doctor if you’ve been trying to get pregnant for six consecutive months or longer without success.
6. You don’t have any major reproductive complications or other conditions.
There are many health conditions that can affect your ability to get pregnant including thyroid dysfunction, endometriosis, PCOS (polycystic ovary syndrome), fibroids, and having a history of a sexually transmitted infection or pelvic inflammatory disease.
What signs of reproductive conditions should you look out for?
- Severe fatigue with abnormal weight gain
- Severe menstrual pain or ovulatory pain
- Heavy menstrual bleeding (saturating pads or overflowing your menstrual cup)
- Irregular, long cycles or absent periods
- Other pelvic pain or vaginal pain
If you’re experiencing any of these, it’s time to see your doctor.
7. Your stress level is manageable.
Stress is a totally normal part of life, and we all experience and perceive it in our own way. Your body has lots of ways of handling short-term or acute stress, but if your body feels like it’s under constant alarm and it doesn’t get a proper recovery period, it can interfere with your ability to get pregnant.
That’s because stress and anxiety keep your body in fight-or-flight mode and the hormones pumped out for stress can affect your reproductive hormones, putting fertility on the backburner. Your body thinks it’s got bigger fish to fry so why would this be a good time to put all your resources into growing a baby human?
Although you might not be able to control your sources of stress, you can manage your reactions to them and override your body’s fight-or-flight mode. For example, a few cycles of breathing exercises that focus on letting out long slow exhales can reduce your heart rate and feelings of anxiety. Pair it with a guided meditation or other stress-management techniques that work for you.