I get it. It’s really, really hard to stick to a strict fertility diet.
The egg-health fertility diet that worked for me eliminates all dairy, gluten, soy, trans fats, white carbs including pasta, sugar, and sweeteners, and strictly limiting any high carb veggies and fruits like sweet potatoes or oranges.
I don’t eat dates and I don’t eat bananas. Absolutely no molasses, agave, honey, coconut/palm sugar, or even stevia!
Basically no prepared foods, and rarely eating out. And of course absolutely no alcohol or caffeine. I eat tons of healthy organic protein (lentils, beans, nuts, nut butters, pasture-raised organic eggs, some meat), and lots of green leafy veggies.
I do allow myself about one serving of healthy carbs a day, like brown rice or quinoa. OH! AND I don’t eat any “cold” foods, so I have to steam/cook all my greens except for lettuce. To read more about my fertility diet that got me pregnant click here, and to read all the science behind a high-protein/high-fat/low-carb fertility diet click here.
So anyway. Yes, this diet can kind of suck. It is a ton of work. It is super intense. But it makes you SO HEALTHY and it works, so I am super intensely committed to it when trying to conceive. And in fact- it has gotten me pregnant successfully when the doctors said I had no hope (And then a second time also)!
But when I talk to women who decide to implement this diet, they almost always cheat. Which makes me crazy. Why would you do all this work and then sabotage yourself? Don’t cheat!
In this blog I want to talk about three things:
- Setting yourself up for success so you don’t need to cheat
- Safe alternatives to cheating
- What foods are okay to “cheat” on and which are not.
Setting Yourself Up for Success
The NUMBER ONE thing you can do to set yourself up for success on this diet is give yourself a TIME LIMIT. I suggest four months and no longer. Absolutely and completely commit to this diet for four months only and don’t cheat.
After four months, hopefully you will be pregnant if you are doing ALL THE THINGS (read here about ALL THE THINGS I did to beat infertility and get pregnant!)! If you aren’t pregnant, you will mentally need a break after four months.
Please, please, please don’t run out to McDonald’s! Instead, allow yourself the joy of bananas, dates, honey, maple syrup, and unlimited healthy carbs, fruits, and veggies. If you need to, have a glass of red wine here and there. Have a decaffeinated coffee or latte with coconut/almond/cashew milk if you need it.
AND always, always, give yourself a limit for how long in TOTAL you will spend in your life working towards optimal egg health/fertility before you take whatever the next step is in your baby journey. DO NOT just say you will spend unlimited years of your life doing this diet, and everything else, without being prepared for the next step, whatever that might be.
For some of you lucky ones that might be IUI or IVF. For others it might be egg or embryo donation, which are amazing options. For others surrogacy or adoption might be the blessing that completes your family. MAKE A PLAN with your partner TODAY, so you don’t feel like you are floundering (and insanely limiting your diet) forever.
Also, the limited time will give you more motivation to do ALL THE THINGS NOW! Read more about planning your baby journey in my article on How to Manage Infertility Like a Boss!
Safe Alternatives to Cheating
So, even if you limit yourself to four months, there may still be days when you just need a treat. You are feeling down for one reason or another, or maybe you got your period. I know, I’ve been there. You need a treat and you need it STAT. Here are some ideas for spoiling yourself- through food- when you need a special fix.
- Drive to your nearest organic/health food store and buy some ridiculously expensive treat that adheres to the diet. For me, this is the $12 cashew “cheese” along with some gluten-free paleo crackers made only from seeds, nuts, and coconut oil. I buy that, some really expensive organic olives or olive tapenade, and I go home and have myself some pretty fancy tapas. The sheer look of irritation on my husband’s face when we checkout and the price comes up is a sure sign I am spoiling myself.
- Make yourself a “fat bomb” treat made of coconut oil, cocoa powder and almond butter (you can buy these ingredients from Amazon through my links or while you are shopping at your local expensive health food store :-). These treats are incredible and will definitely satisfy your chocolate craving and give you the fats you need. In fact, there’s no reason you can’t have one of these every day (just don’t go overboard with the cocoa since it has a little caffeine in it). Here’s a recipe I like.
- Buy yourself some really expensive fresh organic berries and whip up some coconut cream to eat them with!
- Get some organic tortilla chips or crunchy taco shells and fill them up with some organic salsa, guacamole, beans or meat, lettuce, red onion, olives, and anything else delicious and Mexican.
- Go out to eat somewhere! Some of my favorite places where I can get fertility diet food are Chipotle, Mexican restaurants (just stick with beans, salad, guac, and corn products), and a local place called the Silver Diner which has lots of great local paleo-type options.
What You Can Cheat on . . . And What You Can’t
Okay, let’s get down to brass tacks. There are some parts of the fertility diet that you can cheat on a little bit and not make a huge difference in egg health . . . according to what little research is out there. However, there are some cheats that could totally blow your egg health for potentially up to 90 days. The research that is out there is slim, unfortunately, so we have to make the best with what we have! I’m going to break it down by category, and I’m going to say whether you can have a bite or a serving of each and still be “okay.”
Caffeine- Even one cup of coffee a day is linked to delays in conception, and even half a cup of coffee a day/one cup of tea is linked to three times fewer live births. You can read my full post on caffeine and related studies here. Bottom line? You can have a single sip of caffeinated coffee or tea WITHOUT cream or sugar in it and not worry about blowing your diet. If you need to you can occasionally have a decaf coffee or tea, but be aware that it should always be organic (these are heavily pesticide-laden crops) and you DO NOT want to be drinking decaf on a regular basis because of the toxic processes they go through to become decaf. But, if its the holidays, and you just want to have a decaf coffee with unsweetened coconut/cashew/almond milk JUST THIS ONCE, you can do it without freaking out. Remember there are awesome fertility-safe alternatives like Dandy Blend, Crui Bru, or an organic swiss-process decaf coffee like Kicking Horse (although I’ve found I can’t tolerate it, unfortunately).
Alcohol– Research shows that even women who only drink 5 alcoholic beverages a week (less than one a day) have lowered fertility. I absolutely advise eliminating alcohol completely if struggling with infertility. NOW, as for cheating, a sip of your husband’s beer/wine/scotch is going to be okay, as long as it isn’t a mixed drink with cream or lots of sugar. I never cheated beyond a sip when doing the fertility diet, but I wouldn’t begrudge someone a one time 1/4 glass of red wine. But I personally wouldn’t do more, and not regularly.
Soy– The effect of soy is cumulative in your body, meaning that you’re going to see big impacts from big consumption. The problem is that soy is hidden everywhere- in most processed food, and in foods at restaurants. It’s bizarre, even canned tuna has soy in it. I advise completely eliminating soy, but NOT OBSESSING ABOUT LITTLE BITS. I don’t really understand why you would cheat as I’ve never derived pleasure from soy the way I do from chocolate, coffee, or alcohol. BUT, let’s say you accidentally eat one thing one time that has a tiny bit of soy lecithin in it. Don’t freak out. Or if your husband is eating tamari covered brown rice, you can totally have a couple bites. It’s not enough to make a big difference. BUT you don’t want to be consuming it every day, so no regular consumption of soy. And don’t go crazy and dump a ton of soy sauce on your brown rice. Use coconut aminos ladies! Some nutritionists argue that fermented soy is okay- this would be tamari, tempeh, and miso. While these are certainly healthier, I still advise to avoid soy as even the fermented soy can still have an affect on your hormones. Bottom line: it isn’t the occasional ingestion that is worrisome, but the larger load of soy on your system. Also- some form of soy is present in many supplements. The amount is so processed and so small, that I personally do not worry about this.
Trans Fats– Research shows that trans fat intake reduces fertility- specifically, having trans fats be 2% of your diet doubles your chance of infertility. These are also terrible for your health overall. They are found in gross processed food like pre-made pie crusts and frostings, frozen pizzas, microwave popcorn, and margarine. They used to be in almost all pre-packaged cookies and crackers, but luckily no longer. The FDA no longer considers artificial trans fats safe for human consumption and they are being faded out. BUT if you see “partially hydrogenated oil”- any kind of oil- that means there are trans fats in it. Don’t eat it. Don’t cheat on the gross processed food. Gross. Trans fats can also be found in fried food at fast food places and restaurants. Unfortunately this means that cheating on french fries isn’t a good idea. BUT, if you are out and you want to have ONE sweet potato fry, or ONE fry, as long as you are avoiding trans fats otherwise you can do so without worrying too much. But DO NOT have a whole serving!
Sugar, Sweeteners, & Simple Carbs– So, unfortunately, the research is pretty clear that carbohydrate intake and dietary glycemic load are directly related to infertility. One of the most major studies showed the relation to ovulatory infertility, while others show that it affects egg quality. Here’s my blog post all about increasing protein and fats and lowering carbs for fertility. Here’s the problem- white carbs (sugar, sweeteners, pasta, white rice, potatoes, and high glycemic foods like bananas) cause insulin spikes in the body. These mess with your hormones which can upset egg development. It can also cause inflammation in the body, weaken the immune system, and increase insulin resistance (especially problematic for PCOS). It’s just terrible for fertility. And the worst part is we don’t really know when in the 90 day egg cycle the effect is the greatest. So I advise never ever cheating big time on this. No slices of cake, no brownie sundaes, no pack of cookies. No full bananas, no bowls of white rice, no maple syrup laden paleo desserts. I’m so, so, sorry, but yes, it does all cause insulin spikes. What you CAN do is take small tastes of gluten and dairy free sweets or fruits as long as you keep your sugars low. If you can avoid an insulin spike, then you are okay. For example, ONE small square of organic 85% dark chocolate is a good option for once in a while (but not every day). You can have one bite of banana. You can have one spoonful of white rice. If you make a dark chocolate avocado pie with a little maple syrup sweetener, you need to calculate how many sugars are in each slice and then determine if you can take one spiteful or two. I always tried to never have more than 6 sugars at a time. I think this is the most important part of the diet- it has the most science backing it up AND one big insulin binge could theoretically ruin your eggs for 90 days. So WHY would you risk it?? If you are going to cheat (more than a taste) then do it with something else.
Gluten– The research on coeliacs and fertility is very clear – if you have coeliac disease and you eat a regular diet with gluten you are more likely to have a short cycle, be infertile, and have recurrent miscarriages than if you are on a strict gluten-free diet. There are multiple studies that show this. The theory is two fold- the irritation of the gluten in your system cause inflammation and gut destruction. The inflammation makes your body unwelcome to an embryo and the gut destruction makes it hard for your body to process the needed vitamins and minerals. Only going on a STRICT gluten-free diet cures the woman and heals the infertility. Here’s the problem- even if you don’t test positive for coeliacs there are many, many people who are extremely sensitive to gluten and to the pesticides used on wheat. So, you might still be having low level inflammation and gut issues that lower your fertility. Given the amount of research we have, I think it is wise to go completely gluten-free if you are already diagnosed with infertility or have had recurrent losses. I would not cheat at all. Now, if you don’t have coeliacs, and you one day out of your 90 day egg health diet accidentally get a tiny bit of wheat in something, don’t freak out. The idea is to keep your body calm and inflammation free. A tiny accidental bit isn’t going to set everything off again if you’ve been good. But this isn’t one of the foods that you should be tasting bites of.
Dairy– I basically stick with the same advice for dairy as for gluten. For those of us with lactose and casein (the protein in dairy) intolerances or allergies, dairy can wreak similar havoc on your system as gluten can for the gluten free. AND a ton of people have issues with dairy they don’t even realize. Ditching dairy for me was incredible for me- not only did I get pregnant quickly, but I lost 10 pounds, my acne cleared up, and my blood pressure dropped. I also went from, ahem, many many err, bowel-related bathroom visits per day to just one. It took my years to realize this. I have a whole blog post up where you can read about all the theories and science behind going non-dairy for fertility. So my recommendation is the same as with gluten- don’t cheat at all. Technically ghee should be alright because it is lactose and casein free, but I avoid it out of an overabundance of concern when trying to conceive. Now, if you accidentally get a tiny bit of butter in something, don’t freak out. But do not take a bit of your husband’s ice cream. You want your body to totally chill out and not be getting little hits of the inflammatory substance.
Processed Foods– So the reason for the ban on processed foods is that most of them are filled with so much junk and not nutritious that it isn’t really safe to include them in your diet. HOWEVER, if you are food additive savvy enough to be able to figure out of the ingredients are safe, then you can occasionally include some healthy, organic processed foods that otherwise meet the requirements of the diet. Some examples that I love are organic olive tapenade, coconut culinary milk, unsweetened cashew and coconut milk, organic almond butter, the occasional paleo-style gluten-free cracker (made from nuts and seeds), and for emergencies while traveling organic meat bars like Mighty Bar.
What other parts of the diet do you want me to talk about?
What is the hardest thing for you to avoid cheating on? What is your favorite safe”cheat?”
Leave a note in the comments!
Are you ready to discover YOUR perfect fertility diet?
Tired of all the conflicting fertility diet information? It is up to YOU to take control of your fertility journey and do the research to figure out YOUR perfect fertility diet. I've developed this free e-book as a guide to jumpstart the process. It includes tailored diet information for many infertility diagnoses, such as PCOS, Endometriosis, Anovulation, Luteal Phase Defect, Thyroid Problems, Fibroids, Unexplained Infertility, and more! It is completely free to download! Enjoy!
Hi Anna, great post! Thank you for everything you do for our community! You don’t know how many of us appreciate and love you and you the work you do. Anyway, my question is regarding the safety of Quinoa flour and buckwheat flour. Are these two flours safe to eat on a regular basis? Or do i need to limit my intake of them? Also, what about the safety of green tea and matcha green tea?
Hi Acchma!! Thank you for the nice comments they made me so happy ?. Quinoa and buckwheat flour are both good, just buy organic. Ideally less than 40% of your calories come from carbs so you need to make sure you aren’t overdoing it even with those good flours (check out my post on counting macros for more information). Unfortunately green tea and match both have some caffeine so they are a no go. Baby dust!
Congradulations again and I hope all is well! I love your blog! I keep coming back to it to check for your nutrition tips! 🙂 You mentioned that you eat limited amounts of organic meat but what does that mean? How many times a week? I try to eat meat every other day for only one of my meals on that day. Would love to hear what you do! Thanks so much!!
Hi Julia! When I got pregnant with my son I was only eating meat 2-3 times a week. BUT, when I got pregnant this time I was having one serving of meat a day. I found I couldn’t meat those protein macro recommendations without having one serving of meat! I did a lot of organic chicken and turkey, but did do beef once a week. I think that the research that shows that meat is so bad for fertility was done on women eating unhappy non-organic meat, which yeah, probably does make things worse. Also, I think some people’s bodies handle meat different than others. My mom can eat toast and yogurt and fruit and be happy and energetic. If I ate that I’d be miserable and sugar crashing all day. I need protein and vegetables to be a normal person. So, listen to your body!
So glad you are enjoying the blog!! – Anna
That’s good to know because I’m struggling to keep my protein up with out meat! When I got pregnant the first time I was eating organic and had a serving of sardines or chicken daily and like you maybe once a week of red meat. I’m currently eating a ton of dark leafy greens and excluded added or refined sugar like you did and omg I have seen such a difference in my skin and energy! It’s amazing! Taking out the refined sugar especially has made a huge difference. Thanks for all the tips!
I’m so glad to have found your blog – it’s exactly what I need right now! I had my second miscarriage in December and just found out this week that my FSH is 13.1 so I am pretty devastated (I’m 34). I am motivated to change my diet in line with your recommendations to see if that will help lower my FSH but it is all a bit daunting! I live in London and have a very busy job which often involves travelling so I have no idea how I will be able to manage when I’m away for a week or two at a time. I also have a holiday booked in Italy in a few months time. Do you have any tips for how to handle this?
Thank you so much!
You can do it!! Since wheatgrass is so important with the high FSH, grab yourself some wheatgrass pills for when you are traveling and can’t make a green smoothie daily. Other than that just work very hard at eating proteins, healthy fats, and green veg while traveling! You just have to do the best you can and not freak out about it! Also, you could also just take a break when you are on vacation in Italy, because, I mean . . . pasta and pizza? I would need to take a break 🙂 Best wishes and baby dust!!!!
I wondered if you could give me your thoughts on the my carb, fat and protein ratios. I have been on a low carb diet as I am prone to candida and gut fermentation, so have been on about 65-150g of carbohydrates a day, usually around the 120g mark. My fat intake is about 70-80grams and protein at around 50grams (mostly from fish, eggs, lentils and beans, and hemp protein powder). I am wondering if I am eating the right amounts of things… Your thoughts would be very welcome!
Hi Ray! Ahhhh, macro counting!!! So, obviously it depends on your total caloric intake that you’ve set for yourself. I have a general post up on what little research exists on the ideal macro ratios for fertility (At least their is some!!). If you agree with this research then you probably need a bunch more protein if you are eating 2000 calories a day. Here’s my link on the research. Baby dust!! https://www.tomakeamommy.com/tracking-macros-for-fertility-fat-protein-carbs-ttc/
My husband and I have been trying for two years. We found out that he has male factor infertility and we are now using a sperm donor and IUI. I have had one cycle that didn’t work. I don’t have any fertility issues that I know of, but am wondering if I need to go on this diet anyway? Any thoughts on this would be helpful. I’m a sugar fiend and rely on a cup of coffee every day to wake up. This diet would be a big change for me…I’m already gluten-free and eat organic, but the sugar and caffeine…do you recommend this for all ttc women?
Thank you so much!
HI Bekah!! Well, I wouldn’t recommend it to a 22 year old in great health because she’ll probably get pregnant easily and there’s no need to stress her out with the crazy diet. BUT if you are spending your money on IUI, giving yourself strong medications, and haven’t had success, you might consider it. I mean— the healthier and happier you are before you get pregnant the healthier and happier the pregnancy will be. Babies want their mommas happy and healthy. So, what can you do to be super happy and healthy? Reduce sugar and caffeine? Maybe do a little meditation (Circle and Bloom has a series for IUI, aff link -> https://circlebloom.com/product/ivf-iui-mind-body-program?ref=5531)? Ditch some non-toxics? What do you think your body needs??
I’m just finishing first month of fertility diet and feeling gutted as my period is coming earlier than usual after only 24 days usually pretty regularly 26ish days. Looks like a shortened luteal phase. Any ideas why or what might be going on. Google hasn’t really helped….
HI Clare! I’m so sorry honey!!! Most people see their cycles start to move towards a healthier length (whether that is shorter or longer for them), but there are some women who go in the opposite direction. It could be random, it could be your body settling into it, or there could be something in the diet that just isn’t compatible with you. How are you feeling other than the emotional downs from your period? Have you been more energetic? Do you feel good? If not, think about what you might need to add in to your diet or remove!
Thanks for replying! I feel okay in myself. I use a fertility monitor which this cycle so far is suggesting I am not following the same pattern as usual as I’ve not had any high fertility days asyet. I will give it a bit of time, three months like you suggest and let you know. Thanks for your site I think it’s great x
Baby dust Clare! I hope your body settles perfectly!!
Hi Anna! I just found your blog and am really excited to start implementing these changes to my lifestyle. My husband and I have been TTC for 3 years, and have been told IVF is our only option to conceive. I have DOR (AMH level of .18), high FSH (48.65), and thyroid issues. I’m wanting to take 3-4 months to get myself as healthy as possible, and hopefully conceive naturally or at least help prepare my body and eggs for IVF. My main question for you is about dairy. I’m willing to try going off of it to see if I have sensitivity issues and help with my hormones, but I just recently got to a healthy weight and BMI, and I also have low-ish blood pressure. I’m feeling conflicted about the pros vs. cons of me going dairy-free. Do you have any advice? Thank you so much!
Hannah, did you check out my article on dairy? Here it is: https://www.tomakeamommy.com/milk-not-fertility-super-food-dairy-might-hurting-attempts-conceive/
In general I am a big supporter of avoiding dairy while trying to conceive if you are struggling with infertility diagnoses. BUT it only matters if you have a lactose or casein sensitivity. So if you can get tested or do a good elimination diet to rule out any issues with those, then you could eat it! Best wishes making your decision, and more importantly . . . BABY DUST!
I just found your blog this weekend and have been reading it like crazy!! We have been trying for 3 years now after an 18 week loss and 9 week loss. This year we tried IUI twice and we are getting ready for IVF. Thank you so much for all you have shared in this article. It’s nice to see it broken down to understand which aspects are truly the most important to follow. I have been sugar free and carb free for one month now. I would have a cheat maybe once a week but now I’m learning they were not the good cheats. I was also relying on bananas and sweet potatoes as fillers throughout the day. Have you ever thought about doing a recipe guide? It is very over whelming being new to the fertility diet and trying to think up new recipes that do not all taste the same. Is there any blogger you recommend for reliable recipes?
Hi Samantha!! Great work!!! You’re doing a good job!!! Yes, I have totally promised my readers a recipe guide multiple times and totally failed at producing it! I will try to do this as soon as I can :-). I generally google for AIP/Whole30/Paleo recipes and then just avoid the ones with bananas/dates/tons of sweet potatoes, etc. BABY DUST!
My husband and I have been trying the last three years. We’ve had two miscarriages. You site gives me hope! I started your diet a year ago and misscarried and just kinda gave up. I am 37 and last year was told I have a low egg reserve. I have to children from my first marriage, an 18 and a 16 yr old. I was remarried 3 years ago and my husband hasn’t had children of his own and very much so would love to. So I am starting your diet again. Do you know if intermittent fasting is ok or is it damaging to fertility? Also as the lady who posted last asked about recipes. Do you have any to share? Thank you so much for sharing all your knowledge!!
Thank you, Lindsey
I am so sorry for your loss last year honey! Wishing you tons of baby dust as you start trying again!
So I’m not an expert, but I have noticed many people are getting into intermittent fasting! For me, it makes me totally nervous. My approach is more about nourishing– I know it doesn’t sound like it with all these things I avoid, but truly, I’m always thinking- what does my body need? If I’m fasting, how do I make sure I’m eating a rich enough diet to make healthy eggs and give my body the energy it needs? But, plenty of health coaches might advocate for intermittent fasting. I do generally try to eat my last meal around 6pm and not eat again until breakfast, which is usually at 7. But I personally couldn’t fast beyond that without totally crashing.
Maybe ask your body (in a woo-woo, mind-body, intuitive way), what it needs and what would be best for it?
And, I’m so sorry but I only have the few recipes on my site!! Gotta make that recipe guide!!
Hi there. Thanks for this post. I’m finding the severe restrictions incredibly difficult, expensive and not practical for our family life. I’m wondering if you could do a post (or point me towards one) that focuses instead on what we CAN eat? So far it feels like I can’t eat anything except vegetables 😞
Brook, This is great advice, and I actually started this blog post but haven’t finished it! There is actually a lot you can eat! I’m on it!!
What’s wrong with stevia? I looked it up and it has zero glycemic index.
R- So there are old studies showing Stevia as a contraceptive. Newer studies suggest this isn’t true- but its what held up the FDA approving it- fear that it would lower male and female infertility. Is it probably fine? Sure. But personally I wouldn’t risk it. I also think it tastes gross, haha 🙂
In advance I apologize my English.
I found you from the book it starts with egg.
I am 39 years old and I have a 7 year old son. I’ve been trying for 4 years for a second child but I’ve had four miscarriages in row.
All my tests were done and there were not any problem.
I had an lab work in November and my amh came 1.9
Recently I did a test that shows my fsh is 5.5
Doctors say it’s my age and egg quality. They think the only way for me to have another child is ivf which is not guaranteed.
Actually I’ve started a Mediterranean diet non dairy non gluten since 15 days ago. It is so hard for me but I don’t want to give up.
Actually during these 15 days I had two squares dark chocolate 72% that my husband bought me from Trader Joe’s. Do you think that I ruined my diet??
As if infertility isn’t shameful enough, then there is this article…..
Oh, snap! Erin, I am so sorry. I am not trying to shame anyone. But, I have readers who frequently ask about the science behind different parts of the diet, because they want to either have cheat days, or celebrate holidays, or do 80/20, or whatever. I’m not trying to judge others- you do you. For me, I had to do 100% crazy adherence to the diet, its just the way I work. And, of course, as I’m sure you know, infertility shouldn’t be shameful at all. It isn’t the fault of the person it happened to, and is extremely common. Sending love to you, where ever you are on your journey!
I’m so grateful to have found your site! My husband and I have been trying to conceive for two years. We were diagnosed with unexplained infertility as everything checked out in routine testing for the both of us, but I was still getting my period and negative pregnancy tests every month for those 2 years. As of 2-3 months ago, I’ve followed many of your recommendations including going gluten free and dairy free. I also switched my cleaning products and drank wheatgrass every morning. I also did a generalized, more loose version of your seed cycling. I also visited an acupuncturist 3-4 times. I’ll admit I did cheat a handful of times but we just got a BFP for the first time ever!
Now for my question- now that I have a positive test, should i continue on a gluten free, dairy free, low(er) sugar/carb diet through the pregnancy?