How long to wait?
It is often stated that if you have regular unprotected intercourse, you should give yourself about a year to get pregnant. Of course, this refers to women who have a regular cycle. Cycle disorders such as post-pill menorrhea or PCOS should be treated beforehand if necessary. The Pearl Index describes the probability of pregnancy occurring within a year more precisely: "With regular unprotected intercourse without any form of contraception, the Pearl Index reflects fertility and, depending on age, is around 92(%) for 19-26 year old women, 86-87(%) for women aged 27-34 and 82(%) for women aged 35-39. It then drops to around 0 at around the age of 45-50 with the onset of menopause."Detox
I think it's a great idea to cleanse and detoxify the body before pregnancy so that the unborn child doesn't act as a detoxifier but has a clean start. At the top of the list, of course, is giving up smoking and, if possible, all other toxins. Alcohol should be avoided completely or at least in the second half of the cycle, i.e. from ovulation to the onset of bleeding. When the bleeding starts, there is probably no pregnancy and therefore no embryo that has been damaged by the alcohol. However, this is not certain; there are also pregnancies in which the woman continues to have menstrual-like bleeding.Nutrients
As is almost always the case, a wholesome, varied diet that is as natural as possible and a healthy weight are recommended. Both overweight and underweight make it difficult to get pregnant and stay pregnant. A child growing in the womb needs many nutrients, minerals, trace elements, etc.. Women who become pregnant again only a short time after giving birth often notice that their own nutrient stores have not yet been replenished. The need for calcium, for example, is increased both during pregnancy and while breastfeeding. First our body creates a child with a skeleton and all the trimmings, then breast milk and then the next child. It used to be said that "every child costs a tooth". This no longer has to be the case today, but if a woman does not pay attention to an adequate intake of minerals, symptoms such as bone pain or muscle cramps can develop. It therefore makes sense to replenish your own stores as required. Calcium, magnesium, B12, iron, iodine, folic acid, D3 and omega 3 are the most common candidates for targeted supplementation. Whether an additional intake in the form of capsules or infusion therapy or a targeted diet makes sense and, if so, in what form, varies from woman to woman. In my world there are many vegetarians and vegans. It makes sense to look at iron, omega 3 and B12 first.Folic acid
Something that is almost always prescribed to women who want to have children is folic acid. Folic acid deficiency is the most widespread vitamin deficiency in the western world. This vitamin from the group of B vitamins plays an important role in cell division and blood formation and prevents malformations such as neural tube defects. Folic acid must be activated in the body. As this does not work equally well in all people, it is advisable to take folic acid in combination with already activated folic acid ((6S)-5- methyltetrahydrofolic acid-glucosamine). There are good preparations that contain both forms, as well as many other vitamins and minerals for the fertility phase.Sleep
If we want to replenish our stores, nutrition is only part of the way. Regular, restful sleep is at least as important. With the best nutrient profile in the world, we can't do anything if we don't get enough sleep. Unfortunately, we can't get restful sleep as easily as a vitamin drink. A good start is to pay attention to your rhythm and get enough rest. Shift work is not only a carcinogen but also disrupts our circadian rhythm, which is closely linked to hormone regulation. If there are ways to organize your own day-night rhythm regularly, you should make use of them. For example, get up at the same time every day and go to bed 8 hours before the alarm clock rings. Sleep disorders are a major issue, more on this elsewhere.Menstrual cycle
In addition to the day-night cycle, the menstrual cycle naturally plays a key role in the fertile phase. The fertile phase begins approx. 4 days before ovulation (syn. ovulation) and ends one day after ovulation. Unfortunately, ovulation is not as noticeable as bleeding for all women. The methods of natural family planning (NFP) are very helpful in developing a feeling for your own cycle and the fertile phases. By taking your temperature and observing symptoms, you can find out when your follicle has ruptured. However, it does involve a certain amount of effort and requires a fairly regular rhythm of life. If this sounds too complicated or strenuous, you can also simply take ovulation tests. These are test strips that detect the luteinizing hormone (LH) in the urine. It should be noted that there are different "windows" for the minimum and maximum concentration depending on the manufacturer. As we are not all the same, it is possible that a woman will never be able to detect ovulation with a certain type of test, as her personal LH level is always outside this window. In this case, it may make sense to switch to a test with a different window before diagnosing yourself with anovulatory cycles. Many women find it interesting to get to know their own cycle better. However, one side effect of ovulation tracking can be that the spontaneity of physical intercourse no longer comes first. Some couples cope well with this, but for some it creates a pressure that can stifle desire. Women can also leave it alone and simply have sex at least once every 48 hours, regardless of the cycle phase, to give fertilization a chance.Naturopathy
If there is no absolute infertility, naturopathy offers many possibilities to support conception. Monk's pepper, for example, can help to harmonize the cycle and compensate for symptoms of progesterone deficiency. Damiana promotes blood flow to the female organs and thus supports the development of the uterine lining on the one hand, and acts as a long-term aphrodisiac on the other, thus raising the overall level of desire. In Chinese medicine, an optimal level of kidney yin and jing is regarded as the most important prerequisite for good fertility. The quality of this is influenced on the one hand by our constitution and what we have inherited genetically. On the other hand, it can be maintained through sufficient sleep, a good diet and targeted exercises (Qi Gong, meditation, etc.).Acupuncture
Acupuncture is one of the most studied alternative healing methods. Studies have shown an increased pregnancy and birth rate through the use of acupuncture. An individual combination of points is selected depending on the woman's initial situation. As a rule, two acupuncture sessions take place before ovulation. This supports the blood supply and the build-up of the endometrium (lining of the uterus). The reproductive organs are thus better supplied with blood and Qi and the chances of conception are increased. After ovulation, two further acupuncture sessions are carried out to warm the uterus and support implantation. A combination with moxibustion is often used here. If there is no regular cycle, acupuncture is initially performed weekly to support hormone production. This promotes egg maturation and ovulation.Gynaecologist
It makes sense to discuss your desire to have children at your next gynecological check-up and to check whether everything is in order. The gynecologist will check your vaccinations and, if necessary, change any existing medication. Some medications must be discontinued before you stop taking contraception. If everything else seems to be in order and the couple has been trying to conceive for a long time, it makes sense to measure oestrogen, FSH, prolactin, testosterone and TSH in the first half of the cycle (2nd-5th day of the cycle). In the second half of the cycle (19th-21st day of the cycle or 6d before the onset of bleeding) then progesterone. I also offer these laboratory diagnostics in my practice. LH can be measured mid-cycle to determine ovulation. It rises significantly a few hours before ovulation.ART
After the gynecological check-up, the next step is often to look at the man's fertility: a spermiogram is usually carried out for this purpose. At this point, many people are already on the threshold of a fertility center. Assisted reproductive medicine or technology (ART) is not usually included in our ideas about starting a family and often represents a further emotional threshold. (for unmarried couples often also a financial one...) But: in 2022, almost 5% of all children born in Germany were born after fertilization outside the body. A friend told me that in her postnatal course, only one in eight women got pregnant naturally. That is perhaps typical for Berlin-Mitte. The great thing about ART is that it helps many couples to have the offspring they want. The baby take-home rate is approx. 1:5 with IVF and approx. 1:3 with ICSI. It is therefore advisable to be prepared for several necessary treatment cycles or transfers, despite all the confidence. If there are no major biological obstacles (e.g. age), most couples will be able to have their dream child. Women receive good medical care here. For me, however, most fertility centers are also a classic example of male-dominated medicine. The emotional strain, which is already associated with a pregnancy that is a long time coming, increases for many women as soon as they start the ART cycles. While at the beginning of the journey women could still try to simply let go and let things happen, this is almost no longer possible once ART begins. The calendar fills up with appointments in connection with fertility treatment, the focus comes from outside and usually also the administration of hormones. In my practice, I see many women who want to have children and almost half of them come to me when they are already undergoing ART treatment. The baby-take-home rate is higher with a combination of acupuncture and ART than with acupuncture or ART alone. Holistic treatment is also a good way of cushioning the side effects of ART and providing psychological balance. The acupuncture treatments are not only tailored to the woman's cycle but also to the treatment plan. Of course, women do not have to undergo ICSI or IVF to benefit from the positive effects of acupuncture.Emotions
On the one hand, fertility treatment is a physical challenge for women, but the emotional strain is usually much greater: Many women are familiar with the influence of hormone fluctuations on our emotions through their menstrual cycle or the days leading up to it. If the time of wanting a child is already an emotional challenge in itself, it is even more difficult to handle under the influence of hormones. It's like the pill: some women tolerate the hormones quite well and for others it's hell. There is a whole spectrum in between. Over time, an emotional pendulum between hope and disappointment often develops and the lack of pregnancy can also be a strain on the couple's relationship. Issues such as declining confidence in your own body, failure or recriminations can arise. If there has already been a pregnancy loss in the past, anxiety also plays a major role. Especially in the weeks of pregnancy before the week in which an unborn child was lost. This fear often blocks the joy of a positive pregnancy test and, in the worst case, the woman also has a guilty conscience because she doesn't dare to rejoice.Letting go
The path to having a child is different from the path to a bikini body or buying real estate. It's not the case that a woman just has to follow all the rules and then "TADAA!!!" ...and if she doesn't succeed, it's probably because she hasn't shown enough discipline and commitment. We are reaching the limits of what we can do. If all efforts remain unsuccessful, the best measure is often to put the issue to one side. I know that is much easier said than done. Really letting go is not easy - most of us are much better at holding on. It also doesn't help to say out loud "Never mind, I'll just stay childfree, free and independent" to attract pregnancy. But when we really let go, things often start to move. I don't think I need to give any examples of this, most of us have already experienced it. Genuine letting go is, in a way, the complement to the dominion over nature that ART represents for me. Yin and yang. What helps us to let go? 1. trust in yourself and the process of life are certainly helpful. If you have faith and trust in the universe, you have an advantage here. 2. giving up is another good option. Again - I give it into the hands of Mother Earth or I find someone I trust and hand it over to them. Giving it away is easier than throwing it away. 3. change your focus. This happens during meditation, sport or any other activity on which we can focus our full attention: We no longer have any capacity free for anything else and automatically (at least in that moment) let go of everything else.