What are the recommendations for a woman with regular menstrual cycles (menses) who desires to conceive?

From the Guidelines

For someone with regular periods who wants to get pregnant, the most effective approach is to track ovulation using methods like basal body temperature charting, ovulation predictor kits, or fertility monitoring apps, and have intercourse every 1-2 days beginning soon after the menstrual period ends, as this can increase the likelihood of becoming pregnant 1.

Key Recommendations

• Tracking ovulation is crucial to maximize the chances of conception, and methods such as ovulation predictor kits or fertility monitoring apps can be used 1.
• Having intercourse every 1-2 days beginning soon after the menstrual period ends can increase the likelihood of becoming pregnant 1.
• Adopting a healthy lifestyle, including maintaining a balanced diet, exercising moderately, achieving a healthy weight, and taking a prenatal vitamin with 400-800mcg of folic acid daily, is essential for conception 1.
• Avoiding smoking, excessive alcohol, and recreational drugs is crucial, as these can reduce fertility 1.
• Both partners should limit caffeine to 200mg daily (about one 12oz coffee) to minimize its potential impact on fertility.

Preconception Care

• Preconception care is defined as personalized care for men and women that is focused on reducing maternal and fetal morbidity and mortality, increasing chances of conception, and preventing unintended pregnancies 1.
• Women of reproductive age should take a daily supplement of 400 to 800 mcg of folic acid, starting before conception and continuing through 12 weeks of pregnancy, to reduce the risk of neural tube defects 1.
• A mental health assessment should be included in preconception care, as mood and anxiety disorders are highly prevalent in women of reproductive age 1.

Fertility Evaluation

• If you're under 35 and haven't conceived after one year of trying, or if you're over 35 and haven't conceived after six months, consult a healthcare provider for fertility evaluation 1.
• Regular periods typically indicate ovulation is occurring, which is essential for conception, but timing intercourse with ovulation maximizes your chances of pregnancy.
• Even with perfect timing, healthy couples have about a 20-25% chance of conception each month, so patience is important.

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.

The patient in question has regular periods, which suggests that she is likely ovulating.

• No treatment with clomiphene citrate is recommended in this case, as the drug is indicated for the treatment of ovulatory dysfunction.
• Properly timed coitus in relation to ovulation is still important to increase the chances of getting pregnant.
• The patient and her physician may use a basal body temperature graph or other appropriate tests to determine if ovulation is occurring and time coitus accordingly 2.

From the Research

Pre-Pregnancy Preparations

For someone with regular periods who wants to get pregnant, several steps can be taken to prepare the body:

• Maintaining a healthy diet rich in folate, as recommended in Canada's Food Guide to Healthy Eating, with good or excellent sources of folic acid including broccoli, spinach, peas, Brussels sprouts, corn, beans, lentils, and oranges 3
• Taking a daily supplement containing 0.4 to 0.8 mg (400 to 800 μg) of folic acid, as recommended by the US Preventive Services Task Force (USPSTF) 4
• Considering a multivitamin containing 0.4 mg to 1.0 mg of folic acid daily, but not exceeding the recommended dose 3

Folic Acid Supplementation

Folic acid supplementation has been proven to decrease or minimize specific birth defects, particularly neural tube defects:

• Periconceptional folate supplementation reduced the incidence of neural tube defects (odds ratio 0.28,95% confidence interval 0.15 to 0.53) 5
• The American Academy of Pediatrics endorses the US Public Health Service (USPHS) recommendation that all women capable of becoming pregnant consume 400 microgram of folic acid daily to prevent neural tube defects (NTDs) 6
• Women at high risk for neural tube defects or other folic acid-sensitive congenital anomalies may require a higher dose of folic acid, up to 4.0 mg daily 7, 3

Risk Assessment and Counseling

It is essential to assess the risk of neural tube defects and other congenital anomalies:

• A three-generation pedigree on the families of both the pregnant woman and the biological father should be obtained to identify increased risk for congenital birth defects 3
• Women with a history of neural tube defects or other folic acid-sensitive congenital anomalies should be advised to take a higher dose of folic acid, up to 4.0 mg daily 7, 3
• Women should be counseled on the benefits and risks of folic acid supplementation, including the potential for masking vitamin B12 deficiency 7, 3