Thanks so much for taking the time to fill out the baby-readiness quiz! Who would have thought that all of those factors can affect fertility?
The predominant narrative is that age is the only thing that impacts fertility, but that’s just not true. Of course, age is one factor that can impact fertility, but there are many others - and most of those are in your control (unlike your age). So, we like to focus on the things you can control rather than the things you can’t control.
Given that, we thought we would run you through the reasons why we asked each question to hopefully help give you a bit more insight into what might be going on with your cycles and your fertility.

The prototypical period in every women’s health book is 28 days. And, while that looks nice on charts and graphs, in reality, women’s cycles aren’t quite so precise. However, a cycle that comes consistently every 28-32 days is ideal for fertility.
If your period is either too short (< 25 days) or too long (> 35 days), that can interfere with your ability to conceive easily.
With periods that are consistently short, there may not be enough time for the fertilized embryo to implant in the uterus.
With periods that are consistently long, that may be an indication of irregular or absent ovulation or hormonal imbalance.

We look for the same Goldilocks phenomenon as above - not too short, not too long. Ideally, you will experience 3-7 days of bleeding.
If you are bleeding too little (< 3 days), that can indicate a low hormonal state (e.g, estrogen, progesterone), which could make it challenging to get pregnant.
If you are bleeding too much (> 7 days), that can indicate an excess hormone state (e.g., estrogen), which would also make it challenging to get pregnant. A high estrogen state is often accompanied by other unpleasant side effects as well (e.g., breast tenderness, clotting, heavy cramping, etc.).

If you are planning to conceive, we generally recommend going off of any form of hormonal birth control at least 3 months prior to trying to conceive (and ideally, at least 6 months prior). Of course, please consult with your doctor before doing so. And, if you are not on hormonal birth control, please make sure that you are using an alternative, non-hormonal form of birth control while you are preparing to conceive (e.g., condoms).

The reason we want to give ourselves plenty of time after going off of birth control is two-fold:
1. Birth control can mask underlying hormonal imbalances while you are on it. For example, if you went on birth control for any reason other than contraception (e.g., acne, painful periods), that indicates a hormonal imbalance. While those symptoms may have subsided while on birth control, birth control did not correct those underlying imbalances and they will likely come back once you discontinue birth control. This is totally addressable, but you need to give your body the time to do so.
2. Once you come off of birth control, the effects of hormonal birth control can increase barriers and therefore time to getting pregnant (e.g., through nutrient deficiencies, altered microbiome function and impaired detox). Coming off of hormonal birth control is an active, rather than a passive, process.

If you want to get pregnant, you need to ovulate. It’s not the only piece of the puzzle, but it’s the centerpiece. Regular ovulation is the foundation of fertility.
One of the first steps in your pregnancy journey should be to make sure that you’re ovulating regularly. Ovulation should be taking place ~12-14 days prior to menstruation each month. And remember, just because you had a period does not mean that you ovulated. Using ovulation strips or progesterone strips is a good way to confirm.

Each month, we have a bastion of information that we can glean from our menstrual cycle. Every ache and pain provides critical information. Every “annoying” symptom is actually a sign - a sign of what’s going on inside of your body. Just like a road sign, it directs you where to go and what to do. And, since a healthy period is the foundation of a healthy pregnancy, it is critical that you pay attention to the signs that it’s sending you if you are looking to get pregnant anytime soon.
Newsflash: PMS is not inevitable. PMS is overwhelmingly common, but it is not normal (i.e., the way your body was designed to operate).
If you have lots of period symptoms, that’s an indicator of an underlying hormonal imbalance. For example, breast tenderness or heavy clotting can indicate excess estrogen and spotting can indicate low progesterone. Both of these hormonal states can make it harder to become pregnant and would ideally be corrected before you start trying.
Sometimes, it’s a minor imbalance that’s easy and quick to fix once you tune in. And sometimes, it’s a more fundamental imbalance that can take more time, energy and effort to correct. The key is to tune in and give yourself time to course correct. Your body is incredibly resilient, especially with the right tools and the right amount of time.

All of these conditions have been shown to potentially interfere with ability to conceive. Most of these are easily addressable once you know they exist. The key is to start early and identify any potential barriers to conception before they jam up your style.
Additionally, according to The American College of Obstetricians and Gynecologists (ACOG), “many chronic medical conditions such as diabetes, hypertension, psychiatric illness, and thyroid disease have implications for pregnancy outcomes and should be optimally managed before pregnancy.” If you are managing a chronic health condition, it is important that you work with your doctor to confirm that your health condition is well-managed prior to pregnancy. For example, uncontrolled autoimmune disease can predispose you towards miscarriage. The same thing is true for a thyroid function that is not tightly managed.

Previous pregnancies are one potential indicator of reproductive function.

Clinically, miscarriage is defined as the spontaneous loss of a pregnancy before the 20th week.
We know that up to 20% of recognized pregnancies end in miscarriage. We are also recognizing pregnancies much earlier given the recent advancements in at-home pregnancy testing. However, the percentage of miscarriages among unrecognized pregnancies may be much higher. As many as 45% of conceptions may end in miscarriage; we don’t know the exact number because a chemical pregnancy is an early pregnancy loss that occurs shortly after implantation. In many cases, a woman will lose the pregnancy before she even realizes that she’s pregnant.
Having a single miscarriage is overwhelmingly common. Most miscarriages occur because the fetus isn't developing normally; for example, some pregnancies may produce only a few fetal membranes, an empty sac or a malformed embryo.
While a single miscarriage can be a normal and natural occurrence, multiple or recurrent miscarriages is something to explore further. Less than 5 percent of women have two consecutive miscarriages, and only 1 percent have three or more consecutive miscarriages. Possible causes of recurrent miscarriage are broad and may include infections, heavy toxic load, diabetes, thyroid disease or autoimmune disorders. In these cases, you will need to resolve the underlying factors before you can sustain a healthy pregnancy.

Age is one factor when it comes to fertility.
Despite the media messaging, it is not the only factor. Likely fertility does decrease with age, but it is not the precipitous drop women are led to believe it is. Your fertility is an extension of your overall health.
One of the reasons that pregnancy risk goes up as you age is because the probability of health problems also goes up as you age.
Because of this, the older you are, the more your health matters when it comes to fertility.

Diet is incredibly important when it comes to fertility. In fact, studies have shown that those who followed the principles of a “fertility diet” reduced their risk of ovulatory infertility by 80-90%. Suffice it to say, food is the foundation of a fertile lifestyle.
While it is important to understand what foods can interfere with fertility outcomes and should therefore be minimized in your diet, it’s even more important to focus on what to add to your eating plan for optimal fertility.
Nim Barnes, founder of Foresight, sums it up well: “...it has been found that in all types of animal life, from insect to mammal, a diet which supports normal adult life is not necessarily sufficient to support reproduction.”
In other words, eating for fertility is not quite the same as eating for daily life.
Barnes continues, “Besides taking in extra calories for growth and energy, you need extra vitamins, minerals, essential fatty acids and amino acids.” Moreover, women on healthy diets have been shown to have better pregnancy outcomes than those on poor diets.
Adding in nutrient dense, fertility-friendly foods (e.g., leafy green vegetables) is just as important as minimizing fertility foes (e.g., lots of sugar, fast food).

Research shows that women who take fertility-supportive supplements get pregnant faster and have better pregnancies. Moreover, studies also show that “The nutritional status of both women and men before conception has profound implications for the growth, development and long-term health of their offspring.”
Supplementation prior to pregnancy makes it easier to get pregnant, increases the likelihood of a healthy pregnancy and sets the stage for a healthier baby. Unfortunately, not all supplements are created equal, so make sure you are choosing quality providers. This will ensure that you are getting the right form of the vitamin at the right dosage with minimal unnecessary additives and fillers.

Many clinical studies have found that vegetarian women have more menstrual difficulties and irregularities than their non-vegetarian peers. Several studies have also corroborated the fact that vegetarians tend to have lower hormone levels than their meat-eating counterparts.
There are two main reasons for this:
1) You need cholesterol to make your sex hormones
2) Certain nutrients are only available in animal products (e.g, vitamin A - retinoids, vitamin D, vitamin B12).

The optimal body mass index (BMI) for fertility is in the normal range between 18.5-24.9 or body fat between ~20-26%. Being overweight or underweight can pose health risks for you and your baby.
Both overweight and underweight women carry increased risk for adverse pregnancy outcomes, but for different reasons. If you are overweight, both you (e.g., pre-eclampsia, gestational diabetes) and your baby (e.g., large for gestational age) can suffer ill health consequences. If you are underweight, both you (e.g., anemia) and your baby (e.g., small for gestational age) can suffer ill health consequences. Since losing weight during pregnancy is not advised, it is important to address your weight prior to getting pregnant if you are overweight or obese. And, since your body will be preferentially nourished over your baby’s body, it is important to address your weight and nutrient status prior to getting pregnant if you are underweight. In both cases, you want to be making these adjustments before you get pregnant.
Note: I’m not a huge fan of BMI measurements, but it’s the most cited clinical measurement that we have to date. I prefer to use body fat measurements, since they are a more accurate reflection of your body composition. Body composition matters because it affects hormone levels. Fat is not inert tissue; it is hormonally-active tissue. The more body fat you have, the more estrogen your body produces. Because of this, as I mentioned above, excess body fat can predispose you to a higher estrogenic state, which can interfere with ovulation. On the opposite end of the spectrum, having too low body fat indicates to your body that you are “starving” and your body then diverts resources from making your sex hormones to making stress hormones. This means you don’t have the raw materials to make adequate sex hormones and ovulation can be impacted as a result. As a nutritionist who has worked with 100+ women, I recognize that every body is different, but generally speaking, being higher or lower than the ranges listed above can interfere with ovulation.

If you have struggled with an eating disorder in the past, you may have underlying nutrient deficiencies that were never fully resolved. In addition, many women who have struggled with eating disorders also experience disrupted or missing periods (e.g., functional hypothalamic amenorrhea) and potentially erratic ovulation. You would want to proactively address both of these things before becoming pregnant in order to conceive easily and sustain a healthy pregnancy.
Also, if you are currently struggling with an eating disorder, it is important for you to work with a trained practitioner to help you manage prior to getting pregnant. If you try to limit your food intake to control your weight, your body will preferentially “feed” your body over your baby’s body. If there isn’t enough nutrition to go around, your body will use the nutrition that is available for your needs first. We know this because there have been several studies that have shown newborns with vitamin or mineral deficiencies while their mothers don’t present with these same vitamin or mineral deficiencies. Therefore, if you artificially restrict calories during pregnancy, your baby is likely not to have sufficient nutrition to grow and will likely not develop normally. It is important to get the support that you need for the benefit of your health and the health of your future child.

Regular movement practices can improve both egg quality and uterine environment, both of which improve your chances of a healthy conception.
Movement contributes to increased circulation and nutrient flow to your ovaries (and therefore, your eggs) and your uterus. Well-functioning circulation brings in the good stuff (e.g., nutrients) and takes away the bad stuff (e.g., toxins). This, in turn, can improve the health of your eggs and your uterine environment.
The key with exercise is to keep in mind the “Goldilocks phenomenon”: not too little, not too much, just right.
On the one hand, excessive exercise can make it tougher to get pregnant. Everyone is different, so let your body be the guide as to what is “too much” for you. If you are missing periods, that may be a sign to pare things back on the exercise front.
On the other hand, if you aren’t moving enough, then your body’s circulation and detoxification systems won’t be operating properly and this can impair your ability to conceive. If you are experiencing heavy periods, spotting or clotting, that may be an indication of stagnant blood and less effective blood flow / circulation.

According to the Mayo Clinic, “Research has linked sitting for long periods of time with a number of health concerns, including obesity and metabolic syndrome — a cluster of conditions that includes increased blood pressure, high blood sugar, excess body fat around the waist and abnormal cholesterol levels.” And these increased risks are independent of other cardiac risk factors like smoking and high blood pressure. Remember, anything that affects your overall health is also likely to affect your fertility. More importantly, “...spending a few hours a week at the gym or otherwise engaged in moderate or vigorous activity doesn't seem to significantly offset the risk.” In other words, working out a few times a week (even at a high intensity) cannot offset sitting all day long. Because of this, it’s not just about adding exercise into your daily routine. It’s about sitting less and moving more overall.

A groundbreaking meta-analysis found organic produce to be:

• ~20-70% higher in antioxidants (depending on type of antioxidant) than conventional produce [The observation of higher antioxidant levels in organic produce has been replicated in other multi-year studies as well].
• 4x lower in pesticides than conventional produce
• Lower in heavy metals (cadmium specifically) than conventional produce

Unfortunately, most of us are unwittingly exposed to more toxins than we would know in the course of daily living. And, our bodies have trouble eliminating substances that they were never designed to process in the first place. For example, 23,000 new chemicals have been created since 1976 and our food supply has changed more in the last 50 years than it did in the previous 10,000 years. Our body is being exposed to many new and unfamiliar compounds and these compounds are accumulating at an increasing pace.
For example, a survey run by the Environmental Working Group revealed that the average woman uses 12 personal care products (containing 168 unique chemicals) on a daily basis. Unlike with drugs, cosmetic products and ingredients (except color additives) do not need FDA premarket approval prior to being released to the public. Moreover, cosmetics regulations have not materially changed since 1938 when the Federal Food, Drug, and Cosmetic Act was put into effect. Given this, there is entirely too little regulation in this area for optimal health. In fact, many of the ingredients allowed in U.S. products (such as benzene and diethanolamine) have been banned in other countries. Because of this, personal care products are a particularly large source of toxic exposure for women.
Another study by the Environmental Working Group identified over 200 industrial compounds and pollutants in a sample of newborn babies’ umbilical cord blood. This means that some percentage of a mother’s toxic body burden is being transferred to her baby. Because of this, upgrading your personal care products and detoxing prior to pregnancy can help minimize the transfer of toxic compounds from mama to baby.

Certain medications are known to interfere with fertility. This is why the American College of Obstetricians and Gynecologists (ACOG) recommends prepregnancy counseling for all women planning to conceive in the next year. They advise that “All prescription and nonprescription medications should be reviewed during prepregnancy counseling. This review also should include nutritional supplements and herbal products that patients may not consider to be medication use but could affect reproduction and pregnancy.”
If you are managing a chronic health condition, it is important that you work with your doctor to confirm that all medications you are on are compatible with fertility and pregnancy. It is also important that your health condition is well-managed.

Certain over-the-counter medications are known to interfere with fertility. The same recommendations apply as above.

This one is pretty straightforward - tobacco smoking is associated with decreased size and quality of egg follicles (and therefore fertility). Because of this, smoking can significantly impair your ability to get pregnant.

Detoxification is an important part of pregnancy preparation. The goal of detoxification is to remove any obstructions to flow or function and open the channels of elimination. In an ideal world, a strong detoxification system encourages any toxins that inevitably get into your system to exit quickly without leaving too much of a trace.
Elimination is the last phase of detoxification, where our bodies excrete toxins that we’ve been exposed to. It is important for you to eliminate toxins from your body frequently and regular bowel movements support this process.

Environmental toxins can be found in many places, including our drinking water.
Although most tap water goes through a disinfection process to kill bacteria and parasites, there are still many compounds that find their way into the water that aren’t addressed by this process. Common contaminants may include lead, copper, pesticides, herbicides, industrial solvents and other synthetic organic chemicals. Unfortunately, municipal water treatment facilities were not designed to take out these sorts of contaminants so you will need a high-quality water filter to effectively process most of these toxic compounds.
For more information about your specific area, please visit: https://www.ewg.org/tapwater/

Environmental toxins can be found in many places, including our air. Air quality is highly dependent on where you live. If you happen to live close to a highway or an industrial facility, the surrounding air quality may be compromised. If so, you may want to invest in a high-quality air filter for your home.
For more information on your specific area, please visit: https://www.airnow.gov/

Your sex hormones and your stress hormones are in the same biochemical pathway. From an evolutionary perspective, your body will always prioritize survival over procreation.
Practically speaking, this means that when we are constantly “stressed” (whether from a long commute or regimented marathon training or significant financial obligations), our bodies divert the raw materials needed to make our sex hormones (e.g., testosterone, estrogen) to make our stress hormones (e.g., cortisol, adrenaline) instead. Over time, that means that we don’t have the necessary sex hormones to get pregnant or sustain a pregnancy.

Adequate sleep is essential for health. Sleep modulates our immune system, hormone levels, muscle repair and memory function, among many other things. Your sleeping / waking cycle also impacts cortisol and melatonin levels, two hormones that can impact fertility. If you are not sleeping well, you may secrete too much cortisol or too little melatonin; both of these hormonal imbalances can impair fertility. Moreover, melatonin is a key antioxidant that supports egg quality.

Engaging in meaningful work is an important part of feeling satisfied & productive and contributing to the world around you. However, if you are working too much, that may contribute to higher stress levels. If you are at a desk job, it can also contribute to an increased number of hours that you are sedentary.

It’s not practical or desirable to eliminate all stress from your life. Therefore, the key is to learn how to effectively cope and manage the stressors that are present in your life. Mindfulness practices have been shown to be beneficial for stress reduction (and in turn, fertility health). A mindfulness practice can reduce the stress you currently experience through your thoughts and feelings, as well as allow you to become better equipped to handle whatever upcoming stress you may face.

Mood matters when it comes to every aspect of your life, including your health and your fertility.
Practically speaking, your thoughts drive your behaviors. So, if you have a mindset that believes in your innate fertility and your ability to conceive, you are more likely to take actions to support your fertility. The opposite is also true.
When I was working in the clinic, I came across many women who weren’t able to conceive, but the doctors could not identify a single physical reason why. In that case, my next step was to explore their mental / emotional world to figure out if something there was blocking them. It may sound a bit woo-woo, but there is a lot of science to support the fact that our bodies mirror our mindset. What you believe (good or bad) eventually manifests in your body. So, it’s important to clean up your mindset just as much as it is to clean up your body and your environment.

Unresolved trauma, whether big or small, can sometimes interfere with fertility, especially if there is past trauma related to sexuality or challenging relationships with your own parents. There is no judgment here, but if this is present for you, we would encourage you to work with a trained therapist to help you process through these feelings and experiences before becoming pregnant.

Is there enough room in your life to welcome a baby?
Physically:
Are your physical surroundings befitting a newborn baby?
Do you have enough space? Is it clean? Is it warm and welcoming?
Mentally & emotionally:
Have you cleared any old thought patterns that aren’t serving you (e.g, anything that would interfere with you being fully present with your baby)?
Have you cleared any old wounds (e.g., things that would hold you back from fully embracing your baby and your present reality)?
Financially:
Do you have your financial ducks in a row?
Do you have enough of a financial cushion to support a baby?
Do you have money set aside for contingencies?
Spiritually:
Do you have a spiritual grounding that resonates with you?
Do you feel like you’re bringing a baby into a welcoming world?
Do you have any unresolved issues surrounding people in your life that have previously passed on?
If you are concerned about your readiness on any of these fronts, it may be holding you back from fully embracing this next stage of life. Addressing these things may help clear the path for a successful conception and pregnancy.

It has been said that a woman’s experience of pregnancy is directly proportional to how much she believes that her partner desires that pregnancy. So, it’s important to make sure that your partner is totally onboard this journey with you. If not, these unstated concerns may affect your ability to conceive. After all, this is a journey that you are planning to take together and it starts with you both opting in fully and completely.
Also, if you have a male partner, it’s important that he is preparing right alongside you. Optimal fertility takes two.