What are the factors to consider when trying to conceive (become pregnant)?

From the Guidelines

If you're trying to conceive, start by having regular unprotected intercourse every 2-3 days throughout your cycle, particularly during your fertile window, and consider taking a daily prenatal vitamin containing 400-800mcg of folic acid at least 3 months before conception to prevent neural tube defects, as recommended by the American Academy of Family Physicians 1. To increase the chances of conception, it's essential to track your menstrual cycle using a calendar or app to identify ovulation patterns, and consider using ovulation predictor kits that detect luteinizing hormone surges indicating ovulation is approaching 1. Some key points to consider when trying to conceive include:

• Adopting healthy lifestyle habits, such as maintaining a balanced diet rich in fruits, vegetables, and whole grains, achieving a healthy weight, exercising moderately, limiting alcohol, avoiding smoking and recreational drugs, and reducing caffeine intake 1
• Being aware of the risks associated with age, particularly for women over 35, and consulting a healthcare provider for fertility evaluation if you've been trying unsuccessfully for 6-12 months 1
• Managing stress through relaxation techniques, as chronic stress can affect hormone balance and potentially impact fertility 1
• Considering the importance of preconception care, which includes personalized care for men and women to reduce maternal and fetal morbidity and mortality, increase chances of conception, and prevent unintended pregnancies 1 It's also crucial to address any underlying health concerns, such as obesity, chronic hypertension, diabetes, and lifestyle risks, and to evaluate immunization status annually in all women of reproductive age 1. By following these recommendations and adopting healthy lifestyle habits, individuals can increase their chances of conception and improve their overall health and well-being.

From the FDA Drug Label

Clomiphene citrate is indicated for the treatment of ovulatory dysfunction in women desiring pregnancy. Properly timed coitus in relationship to ovulation is important A basal body temperature graph or other appropriate tests may help the patient and her physician determine if ovulation occurred.

Clomiphene citrate is indicated for women trying to conceive who have ovulatory dysfunction.

• The patient should have properly timed coitus in relation to ovulation.
• A basal body temperature graph or other tests can help determine if ovulation occurred. The treatment should be started on or about the 5th day of the cycle and long-term cyclic therapy is not recommended beyond a total of about six cycles 2.

From the Research

Trying to Conceive with Letrozole or Clomiphene Citrate

• Letrozole and clomiphene citrate are two medications used for ovarian stimulation in women trying to conceive, particularly in those undergoing intrauterine insemination (IUI) or in vitro fertilization (IVF) 3, 4, 5, 6, 7.
• Studies have compared the efficacy of letrozole and clomiphene citrate in terms of pregnancy rates, endometrial thickness, and ovarian hyperstimulation syndrome (OHSS) incidence.

Comparison of Letrozole and Clomiphene Citrate

• Letrozole has been shown to have a significantly greater effect on endometrial thickness compared to clomiphene citrate, which can be beneficial for implantation 4, 5.
• Clomiphene citrate, on the other hand, has been associated with a higher number of mature follicles, but also a higher incidence of OHSS 4, 6.
• Pregnancy rates have been found to be comparable between letrozole and clomiphene citrate in some studies, while others have reported higher pregnancy rates with letrozole 3, 4, 5.

Minimal Stimulation Protocols

• Minimal stimulation protocols using letrozole or clomiphene citrate with gonadotropins have been shown to be effective in reducing the risk of OHSS and multiple pregnancies while maintaining comparable pregnancy rates 6.
• The addition of letrozole or clomiphene citrate to IVF cycles has also been found to reduce the total dose of gonadotropin required and the incidence of OHSS, particularly in high responders 7.

Clinical Implications

• Letrozole may be a good alternative to clomiphene citrate in IUI cycles, particularly in women with polycystic ovary syndrome (PCOS) or those at risk of OHSS 4, 5.
• The choice of medication and stimulation protocol should be individualized based on the woman's specific needs and medical history, taking into account factors such as age, ovarian reserve, and risk of OHSS 7.