How to Get Pregnant: The
Basics
We are going to assume that by this point in your life, you have a reasonable grasp of the birds and the bees. But we are not going to assume that you know everything you need to know to get pregnant. Most of us spend our early reproductive years focusing on how not to get pregnant. What you need to know now can be subtly but significantly different. Or at least there are crucial details that may never have been important to you before that are now pretty much key to the whole thing.
We are on occasion astonished at how little many of our clients know about how to conceive a baby—even those who have been obsessing on the subject for a year or more. Even more amazing is how often some basic education is all they need to remove whatever roadblock they’ve been stumbling over. We’ve both celebrated the birth of many babies where our main contribution has been just a guided tour of the female and male reproductive systems, specific instructions on establishing when a couple is most fertile, or advice on when (and how) to have sex when a couple wants to make a baby. So it is exactly those topics we are going to cover in this chapter.
IT ALL STARTS WITH THE MOTHER
The conception of a baby really begins with the conception of that baby’s mother. Female fetuses have oocytes in their ovaries well before birth—the oocytes that will eventually mature into eggs. At birth, a baby girl has roughly 1 to 2 million of them, though they’ll be pared back to “only” about 300,000 by the time she has her first period. Those immature eggs just hang out in the ovaries until puberty, at which point they take turns “ripening,” then bursting out of their follicles to be released through ovulation as part of the menstrual cycle. A trip down the fallopian tubes is only for the lucky few, however, as hundreds of eggs are reabsorbed into the body each month and never released. Just one makes an official debut through ovulation (with, on occasion, a little company—IVF isn’t the only way to have twins, you know!). This process keeps going until all the eggs are gone: menopause.
By contrast, sperm are more about the short term. From first formation to ejaculation, any given sperm has been in a man’s body for about three months at most. And whereas an egg is essentially a solo act, sperm show more of a mob mentality. At puberty, sperm begin to be produced by the testicles—many millions every single day, roughly 5,000 every single minute! It takes only about forty-eight hours to form a sperm and another two weeks for the sperm to mature, during which it gains the ability to “swim” (motility). The testicles store the millions of tiny sperm cells until they are called for in ejaculation, at which point they take off, roughly 40 million to 200 million at a time, mixed in with fluid to create semen. The final bit of development doesn’t occur until the sperm are in the female reproductive tract and the membrane around each one changes in ways that will allow it to penetrate and merge with the egg.
Which brings us to the fun part: having sex. Specifically, vaginal intercourse, but we’re guessing we don’t have to tell you that. Sperm are ejaculated into the vagina. Right off the bat, the semen coagulates, and only about a tenth of the sperm survive to swim on. Perhaps 10 minutes later, the semen liquefies again, which lets the sperm get through the cervix. The sperm move along tiny tracks formed by proteins in fertile cervical mucus. As they progress, they shed their protective coating, a process called capacitation, which leaves them able to penetrate an egg (should they get the chance).
If the timing is right and an egg is on its way down a fallopian tube while the sperm are swimming up it, whichever sperm wins the race and has all the required skills gets to fertilize the egg. This will happen within a few hours of ovulation, if it happens at all, somewhere along the fallopian tube, closer to the ovary than to the uterus. The first sperm in sets off a reaction in the egg that makes it impermeable to any other sperm, although the minions will keep on trying as long as they have any swim left in them.
The union of the egg and the sperm creates what is technically known as a zygote. The zygote finishes the journey into the uterus, swept along by tiny hairs (cilia) lining the fallopian tubes. The trip takes about five days. Upon arrival, the zygote nestles into the endometrium, which will nourish its development. The cells multiply and begin to specialize. After eight weeks, it is an embryo, with about thirty-two more weeks to go before its official debut.
All through this process, the egg, the sperm, and the zygote they create are dancing to a tune called by a cascade of hormones orchestrated by the pituitary gland, operating under the influence, chemically and physically, of their environment. It’s an intricate web, and success depends on everything working as it should, when it should.
Fig. 1: Oocytes develop in follicles in the ovaries until one takes the lead,bursting from its follicle and becoming a mature egg. The egg is drawn into and through one of the fallopian tubes into the uterus. If fertilized on its journey, the egg, now a zygote, attaches to the uterine lining (endometrium). If not, the egg disintegrates by the time it reaches the uterus. Then the endometrium is sloughed off and moves out of the uterus through the cervix and into the vagina as menstrual flow.
Fig. 2: Sperm are first formed in the testes, or testicles, then move into the epididymis to mature further and be stored. At ejaculation, sperm move into and through the vas deferens, mix with fluid from the prostate and the seminal vessels to create semen, and then move through the urethra and leave the body.
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