What to Expect Before You're Expecting

The Complete Guide to Getting Pregnant


By Heidi Murkoff

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What to expect. . . the first step. Answers to all your baby-making questions.
  • Are there ways to improve our chances of having a girl (or boy)?
  • Does stress affect fertility?
  • Should we be having sex every day? Every other day? Three times a day?
  • I’m 37. Does that mean I’ll have a harder time getting pregnant?
  • How long should we keep trying to conceive before we get some help?
  • What fertility treatments are available—and how will we be able to pay for them?
Expecting to expect? Plan ahead. Here’s everything you need to know to help prepare for the healthiest possible pregnancy and the healthiest possible baby. Filled with practical tips, empathetic advice, and savvy strategies, all designed to help you get that baby of your dreams on board faster. How to get your body into the best baby-making shape. Which foods feed fertility. Which lifestyle habits to quit and which to cultivate. All about baby-making sex, from timing to positions to logistics—and how to keep it sexy. Figuring out your fertility (and his). When to seek fertility help, and the latest on tests, treatments, and reproductive technology. Expecting to become a dad? This book has you covered, too. Plus, all about the family-building options for single women and same-sex couples.



What Can You Expect Before You’re Expecting

(And why does it matter, anyway?)


Pregnancy, as you probably know, is 9 months long (or 38 weeks from conception, if you’re really serious about keeping count). And if you’ve ever been pregnant before, you probably think that’s plenty long enough. Maybe even a little too long, especially once your belly’s the size of a prize-winning watermelon and your breasts have worked their way through the cup alphabet . . . twice. But is 9 months really long enough? Does that time-honored baby-making timetable really stand up to the latest science?

According to experts, no. From the CDC to the American College of Obstetricians and Gynecologists, the March of Dimes, American College of Nurse Midwives, the American Academy of Pediatrics, and the American Academy of Family Physicians—that traditional 9-month timeline has been bumped by this recommendation: It’s time to add more months to pregnancy.

That’s right, more months. At least 3 more, in fact, for a full 12. But before you panic (3 extra months of not seeing my feet? Of passing on the sushi? Of waiting to hold that bundle of joy?), here’s what you need to know: Those extra months aren’t meant to be spent being pregnant, but getting ready to be pregnant.

The truth is, a healthy pregnancy begins before sperm and egg meet up. Before the home pregnancy test announces the good news. Before the queasies kick in and your waistline checks out. Even before you ditch your diaphragm or peel off your patch. A healthy pregnancy begins before you’re expecting—which is why, if you’re planning to get pregnant, you might want to start planning (and prepping) ahead.

What’s New About Getting

Sure, getting pregnant isn’t considered rocket science. It’s biology—for most of us, the really fun kind of biology. And the basic mechanics of baby making aren’t only, well, basic (insert part A into part B, repeat as needed and desired), but they haven’t changed much over the history of human reproduction. And certainly, they haven’t changed much over the 8 years since I delivered the first edition of What to Expect Before You’re Expecting.

That said, there’s plenty that’s new about getting pregnant—especially when it comes to couples who aren’t able to get pregnant the basic way—and that’s why I’m delivering a brand new 2nd edition. In it you’ll find the latest his-and-hers advice on getting ready to get pregnant: from diet (why high protein may lower your fertility) and weight (how it affects fertility and your future baby) to the workplace (how your 9 to 5 job may impact your baby-making job, especially if you work the night shift) and lifestyle (which habits to kick before you get busy). What checkups and vaccines to get, what screenings you’ll need (including up-to-date information on expanded genetic carrier screening), and how to make sure your health insurance has you covered. What medications might need adjusting (including antidepressants), and what supplements you’ll need to stop (or start) popping.

Yes, you’ll find the fertility basics (when and how often to have sex, in what positions, with what lubricants). But this edition goes way beyond those basics—from new tests to assess your ovarian reserve to high-tech ways to track your ovulation (with wearables that sync with smartphones) and check your partner’s sperm count at home (there’s an app for that, too).

There’s a new chapter on the fertility workup: when and how to seek help if you’re having trouble conceiving, distinguishing between subfertility and infertility, a comprehensive section on fertility challenges (from elevated prolactin to PCOS to low sperm count to unexplained infertility). And a brand new chapter devoted to fertility treatments, including the most cutting-edge technology, advanced procedures, and the newest medications. Frozen embryos vs. fresh for IVF, 3-day embryos vs. 5-day, why ICSI is edging out standard IVF, when to consider preimplantation genetic screening, everything you’ll need to know about donor sperm and donor eggs, embryo donation, and surrogacy. How to finance it all. And, if you’ve experienced pregnancy loss, a chapter to help you start over, including treatments for recurrent loss.

Are you a same-sex couple hoping to become a pair of parents? All your conception and pregnancy options are covered, too.

Wondering how Zika virus might affect your baby-making plans? You’ll find out everything you and your partner need to know about protecting the baby you’re hoping to make.

And here’s how. What to Expect Before You’re Expecting—a complete, start-to-cuddly-finish guide to getting pregnant—is everything you need to know to get your body and your partner’s body into the best baby-making shape possible before you start trying to conceive. What baby-friendly foods to order up often, and which fertility-busting foods—and drinks—to keep off the menu. (Hint: Get your sushi while you can, but can the fresh tuna.) How to get your weight where it needs to be for maximum fertility and optimum pregnancy health (packing on too many pounds—or too few—can compromise conception and complicate pregnancy). Which medications need to be shelved (including some surprises, like antihistamines), when to toss your birth control, why your partner should put hot tubs (and spinning classes) on ice, why kicking your smoking habit now can give fertility a boost (while protecting your future baby’s health).

Once you’ve prepped for pregnancy, it’s time to get pregnant. Sounds like the easy (and fun) part—and usually it is. But a little conception know-how can help you fast-track your fertility and make those baby dreams come true sooner. You’ll find out how to pinpoint ovulation, when to schedule in sex, how sex toys and lubes fit in, why wet isn’t wild when it comes to baby-making sex, how to keep on-demand sex spicy—plus the lowdown on sex positions and conception. Have you heard a few conception tales already, or read them on the internet? Fertility fiction and fact are sorted out here, too.

What if you encounter a bump on the way to baby? Fertility challenges—and how to overcome them—are covered, as well as the latest in fertility treatments. You’ll also find out when to let nature take its course, and when to seek help.

Whether you’ve begun your conception campaign already, or you’re just starting to think about getting pregnant, it’s never too late—or too early—to start optimizing your preconception profile. So put time on your side, and add a few months to your baby-making calendar. More pregnancy, it turns out, is more.

May all your greatest expectations come true!


Getting Ready to Get Pregnant


Prepping Before You’re Expecting


Are you gearing up for a pregnancy? Preparing for baby making isn’t only about tossing your birth control (though you’ll need to do that), charting your ovulation (you’ll probably want to do that), and heading to bed (you’ll be happy to do that). It’s also about getting your body—and your partner’s body—into tip-top baby-making shape. From the drinks you and your partner-in-procreation sip to the medications you take, from the habits you’re best off kicking to the supplements you’re best off popping (and not popping)—taking charge of your preconception prep will start you off on the right foot, making conception easier (hopefully) and pregnancy safer and more comfortable (ditto). So before you dive into bed to make that baby, dive into this chapter to find out what steps you should consider taking first.

Your Health Prep

It stands to reason that your overall health has a lot to do with your overall fertility. After all, it takes a healthy body (make that 2 healthy bodies) to make a healthy baby. Which means there’s no better time than now—when that baby-to-be is just a gleam in your hopeful eyes—to make sure that you and your partner are healthy overall. Just about every aspect of your health—from the medications you take to the immunizations you should have to the chronic conditions that need controlling and the dental work that needs doing—can have an impact on your fertility and on your healthy pregnancy to come. So check it all out, starting with those checkups.

Talk the Talk

Are you TTC? You probably are if you’re reading this book—yet you may not have the slightest idea what “TTC” means (it’s short for “trying to conceive”). Lots of fertility acronyms have become part of preconception-speak (check out any fertility website or online support group and you’ll see), and they pop up occasionally in this book, too. Feel a little out of the preconception lingo loop? Here’s a list of some of the acronyms you may encounter during your conception adventure:


2-Week Wait (until you can take a pregnancy test)


Aunt Flo(w), your period


Basal Body Temperature


Birth Control


Baby Dance (aka sex)


Big Fat Negative (pregnancy test result)


Big Fat Positive (pregnancy test result)


Baby-Making Sex


Blood Test


Cycle Day


Cervical Fluid


Corpus Luteum


Cervical Mucus


Cervical Position




Donor Insemination


“Dancing” Partner; spouse, partner, or significant other


Days Past Ovulation


Doing the Dance; Do the Deed (aka sex)


Egg White Cervical Mucus (re: consistency of)


Fertile Thoughts to All


First Morning Urine


Human Chorionic Gonadotropin (pregnancy hormone)


Home Pregnancy Test




Intrauterine Insemination


In Vitro Fertilization


Luteinizing Hormone


Last Menstrual Period


Luteal Phase

O/Big O



Ovulation Predictor Kit


Pee on a Stick (aka pregnancy test)


Polycystic Ovarian Syndrome


Pregnancy; Pregnant


Sperm/Semen Analysis


Trying to Conceive

Preconception Checkups

“I’m young and in good health, and my periods are regular. Do I really need to see a doctor before I start trying to get pregnant?”

The best prenatal care starts long before conception—and it doesn’t stop at your reproductive parts. So now’s a great time to schedule that full-body tune-up. Even if you’ve never had a sick day, it’s easier to tackle health issues before baby’s on board than to play catch-up after your body is already baby building (and this preconception prep is even more essential if you’re overweight or underweight or living with a chronic condition). To make sure all systems are go, make an appointment with your gynecologist (who, by the way, doesn’t have to be your eventual prenatal care practitioner)—and believe it or not, with your dentist, too—for complete pre-prenatal checkups.

Preconception Prep and Chronic Conditions

If you have a chronic health condition (such as diabetes, asthma, a heart condition, epilepsy, high blood pressure, celiac disease, or depression), deciding to start trying to conceive isn’t always as easy as pulling the plug on birth control and getting busy. It’s likely both your preconception prep and your pregnancy care will be a little more involved. But there’s lots of good news—especially since you’re planning ahead.

Though it’s true that there are sometimes risks to fertility, as well as risks for a pregnancy (and baby) if a mom’s chronic condition isn’t well controlled, those risks can be minimized or even eliminated entirely by bringing the condition under control, preferably before sperm meets egg. With the right care and precautions, most chronic conditions are compatible with getting pregnant and having a healthy pregnancy.

But first things first. And your first step on the road to pregnancy should be at your specialist’s office (or at your internist’s, if that’s who oversees your condition) for a preconception appointment. He or she will evaluate how you’re managing your condition and determine whether you’re ready to TTC or need to make some changes before you get going. Maybe you’ll need to tweak your diet (or get more serious about sticking to dietary restrictions), lose or gain some weight, or finesse your fitness. Maybe you’ll need to be weaned off medications that aren’t fertility friendly or may be harmful during pregnancy (including opioids for chronic pain), or switched to meds that are TTC and pregnancy safe. Or alternative therapies may be integrated into your care, such as acupuncture or meditation to relieve stress or pain, or help lower your blood pressure. Maybe you’ll be referred to a high-risk ob (known as a maternal fetal medicine doctor) for your pregnancy care, or maybe you’ll find that your usual ob-gyn will be able to team up with your chronic-condition specialist to offer all the care you need.

See your gynecologist. Your preconception checkup will include a lot of the same tests and screenings you get at your regular annual—plus a lot of prepregnancy-specific ones. Here’s what you can expect:

A Pap test and all the standards of your annual visit, such as a pelvic, breast, and abdominal exam. Get ready to stick out your arm for a blood pressure reading, too.

A screening for, or a followup of, any gynecological conditions that might interfere with fertility or pregnancy, such as irregular periods, polycystic ovarian syndrome (PCOS), uterine fibroids, cysts, or benign tumors, endometriosis, pelvic inflammatory disease (PID), or recurrent urinary tract infections. Now—before you get started on baby making—is the time to get any gynecological conditions diagnosed and treated, because certain ones may prevent you from getting pregnant in the first place, and others can complicate pregnancy.

A weight check. Because your prepregnancy weight has a lot more to do with your fertility, your future pregnancy health, and even your yet-to-be conceived baby’s future health than you might think, you’ll be stepping right up to the scale for a baseline weight check. If that bottom line isn’t where it should be (close to the ideal weight for your size and body type), your doctor can help you set some goals to get your weight conception-ready. See Chapter 2 for more on your weight and fertility.

A urine test to screen for a urinary tract infection and kidney disease.

A blood test. Nobody’s favorite part of the checkup, but a blood draw is typically standard at a preconception visit to get a read on your current state of health. You’ll likely need many of the following tests once you get pregnant anyway, so you might as well get a head start on them now—they may not need to be repeated if you conceive within a few months of this workup:

Hemoglobin or hematocrit to use as a baseline during pregnancy and to test for anemia (many women have lower iron stores than they think, thanks to that monthly flow).

Vitamin D level. Your doctor may test for vitamin D deficiency (some women are deficient) and recommend supplementation as needed.


It Takes Two

Making a baby is always a 2-person production (one from column Mom, one from column Dad). But as is often the case with pregnancy, preconception can be pretty female-centric. It shouldn’t be. Both partners in conception have their work cut out for them before sperm meets egg. Though this entire book will be enlightening for prospective parents of both sexes, the dark shaded “For Dads-to-Be” boxes throughout provide tips, advice, and information specifically geared to wannabe dads. So if you’re looking to become a father, look for these just-for-you boxes.

Rh factor, to see if you are positive or negative. If you are Rh-positive, you don’t have to give Rh factor another thought. If you are negative, your partner should be tested to see if he is positive. If he’s positive, then any baby you conceive has a chance of being Rh-positive, and you may end up developing antibodies to your baby’s blood during pregnancy (not a problem in a first pregnancy, but it can result in an Rh-incompatability in a subsequent pregnancy). That’s important information to have, since Rh-incompatibility can be easily prevented.

Rubella titer, to check for immunity to rubella, and a varicella titer, to check for immunity to varicella (chicken pox); see immunizations for more on the important immunizations you should have before becoming pregnant. If you’re not up to date on any of those vaccines, you should get them now.

Tuberculosis (if you’re at high risk for TB)

Hepatitis B

Cytomegalovirus antibody titers, to determine if you’re immune to CMV (this test isn’t routinely recommended, but you can ask for it). If you have recently had a CMV infection, it’s generally recommended that you wait 6 months—when antibodies appear in the blood—before trying to conceive, since exposure to the virus could be dangerous to a baby-to-be.

Toxoplasmosis titer, if you have a cat, regularly eat raw or rare meat, or garden without gloves. If you turn out to be immune (because you’ve been infected in the past), you won’t have to worry about becoming infected during pregnancy and passing it on to your baby.

Thyroid function. Because thyroid function can affect both fertility and pregnancy, preconception screening is recommended if you have a family or personal history of thyroid condition or have symptoms of or risk factors for a thyroid disorder. Some doctors do routine preconception screening for thyroid function.

Sexually transmitted disease (STD)

A medication review. Whether it’s over-the-counter or prescription, you and your doctor will discuss all the medications you take—including those you pop only occasionally. Depending on the medication (some are safe during pregnancy, others may not be), a change may be in the cards. You’ll also review any vitamin and herbal supplements you take to see if they’re preconception and pregnancy safe.

A discussion about:

When to stop your birth control (your doctor will let you know how long you should ideally wait, if at all, before you can start trying to conceive; see stopping birth control for more)

How to make sense of your cycle and figure out when you’re most fertile (see Chapter 6 for more)

What to eat and not eat while you’re trying to conceive (see Chapter 3)

Whether you should consider any lifestyle changes now that you’re about to start TTC (see your lifestyle prep)

Whether you should consider genetic screening and/or counseling (see genetic screening)

How your age might affect your fertility and impact pregnancy (see getting pregnant after 35)

Any medical problems that should be treated before conception or will need to be monitored during pregnancy. Two examples: If you need allergy shots (or other allergy prevention treatment), the doctor will advise you to take care of them now (you’ll be able to continue to get allergy shots during pregnancy if you start allergy desensitization before you conceive). If you were a PKU baby you’ll need to protect your own future baby by beginning a phenylalanine-free diet 3 months before you conceive, and continuing it throughout pregnancy.

Shaking Your Family Health Tree

Time to call your folks. Not to tell them you’re expecting (hopefully you’ll make that call soon enough), but to get the scoop on the health history on both sides of the family tree—yours and your partner’s. Dig as deeply as you can, and write down everything you unearth so that you’ll be ready to answer the family history questions you’ll be getting from your practitioner. It’s especially important to find out if there’s a history of any medical problems, such as diabetes, high blood pressure, celiac disease, or thyroid disease, and genetic or chromosomal disorders, such as Down syndrome, Tay-Sachs disease, sickle-cell anemia, thalassemia, hemophilia, cystic fibrosis, muscular dystrophy, Huntington’s chorea, or fragile X syndrome in your immediate family or your partner’s (including your children, mothers and fathers, brothers and sisters, grandparents, nieces and nephews, aunts and uncles, and first cousins).

Your family health tree may also clue you in on how your future pregnancy might play out. Are there twins in your future? Fraternal twins can run in families, so look for trends on your side of the tree. Also running in families are some pregnancy complications. Ask your mom and your partner’s mom if she (or her mother) ever had preeclampsia. Research shows that sons and daughters born from pregnancies complicated by preeclampsia may carry genes related to the condition. Ask, too, about gestational diabetes, depression, or other disorders (during pregnancy, postpartum, or in general), and other complications—and have this information at the ready when your practitioner asks for it.

It’ll also help to find out more about your mom’s pregnancies with you and your siblings. That’s because the apple often doesn’t fall far from the mama tree when it comes to gynecological and obstetrical history, which means that a look at your mom’s pregnancy history may give you a peek into your pregnancy future. Keeping in mind that every pregnancy is different (even for the same woman, 2 pregnancies may be very different), moms may predispose their daughters to any number of pregnancy or delivery scenarios—both good (no stretch marks) and not so good (lots of varicose veins). So ask your mother anything you might be wondering about, remembering that her pregnancy story may or may not predict yours: How long did it take you to get pregnant? Did you have morning sickness? Did your pregnancies go full term? How long were you in labor?

Recent travel. If you or your partner live in or have recently traveled to an area where Zika virus is prevalent, your practitioner will counsel you about the best conception plan, including whether you should wait before trying to conceive (see the box Zika and TTC for more).

A family history check. When you’re starting or building on a family, your family tree matters—which is why your doctor will want to check it out. For instance, if there’s a family history of breast cancer, you’re at high genetic risk, and you’re over age 30, the doctor may suggest getting a baseline mammogram for a clear picture of what your breast tissue looks like before all the hormonal changes of pregnancy and breastfeeding begin. Your doctor will also ask about your family history of medical conditions (such as type 2 diabetes, celiac or thyroid disease, or hypertension) and pregnancy conditions (such as preeclampsia) that might affect your pregnancy. See the box shaking your family health tree for more.


On Sale
Oct 3, 2017
Page Count
304 pages

Heidi Murkoff

Heidi Murkoff

About the Author

Heidi Murkoff is the author of the world’s bestselling What to Expect® series of pregnancy and parenting books, with over 43 million copies in print in 44 languages.  She is also the creator of WhatToExpect.com and the WhatToExpect app, a community of 20 million parents, and the face of the app’s week-by-week pregnancy and first year videos. Using the power of the WTE platforms, Heidi works closely with the CDC, HHS, AAP and other public health organizations to share vital messages about maternal and infant health and safety. Her passionate commitment to the wellbeing of all moms and babies led her to found the What to Expect Project, a nonprofit organization dedicated to ensuring that every mom receives the empowering information and nurturing support she needs to deliver a healthy pregnancy, safe delivery, and healthy future to herself and the baby she loves. Along with the WTEP, Heidi advocates actively in Congress for legislation and policies supporting expecting and new moms and families, including military families. Since 2013, she has hosted close to 300 Special Delivery baby showers for tens of thousands of military moms and dads serving far from family and friends at bases around the world. In 2022, she and her husband Erik received the Elizabeth and Zachary Fisher Distinguished Civilian Humanitarian Award for their support of military families.

Visit Heidi on Facebook, Twitter and Instagram @HeidiMurkoff and @WhattoExpect.

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