The Preconception Checklist

The Preconception Checklist

What should you both start doing and what should you stop doing? Are you as healthy and fertile as you possibly can be?

Read on to ready yourself for baby making!

Your Menstrual Cycle and Timing of Sex

It’s useful to get to know your natural menstrual cycle, which runs from the first day of a naturally occurring menstrual period to the first day of the next period. The typical women will ovulate 10 to 16 days before their period starts, so in those with a regular cycle, it’s fairly easy to predict when an egg will be released. Sperm can survive in the female reproductive tract for 5–7 days, so prioritising sex to happen from a few days prior to ovulation, up until 10 days before your period may increase your chances of conception.

There are many commercial ovulation predictor kits available that measure the surge of luteinising hormone (LH) that occurs just prior to ovulation that may help you to more accurately pinpoint your ovulation time. It might be worthwhile taking a few months to understand your own cycle prior to actively trying to conceive.


According to the British Infertility Society, people who are overweight or obese are known to take longer to conceive, and the incidence of primary infertility increases with excess weight. In addition, women who are overweight are at greater risk of having problems in pregnancy such as high blood pressure, blood clots and diabetes. If you are overweight or obese, it may be beneficial to put the work in to optimise your weight prior to pregnancy; as a weight loss of even just 5% of your body weight can markedly benefit fertility. The best method of weight loss is a combination of a healthy diet, and increasing your physical activity levels. In contrast, there is evidence that being underweight or malnourished can negatively affect fertility in both men and women, particularly in women who do not have a menstrual period.


Having a healthy and balanced diet is beneficial to overall health, disease prevention and contributing to a long and active life; but what we eat is of even more importance when we’re thinking of creating new life. Be sure to incorporate heathy unsaturated fats, protein and complex carbohydrates into your diet, as well as making sure to have at least five portions of fruit or vegetables every day. Try to avoid particularly greasy and salty foods, as these often offer little nutrition and can adversely affect your overall health if eaten in excess.

Some foods should be avoided when pregnant or trying to conceive: some fish e.g. shark, swordfish and mackerel as they can contain high levels of mercury; liver products as they contain high levels of vitamin A.; raw or undercooked meat as this can harbour toxoplasmosis, and some dairy products e.g. soft blue cheeses and any unpasteurised products as this may risk listeria.


Consumption of a high level of caffeine is associated with a higher rate of spontaneous miscarriage, and is also shown to have numerous negative effects on pregnancy outcomes. The NHS recommends keeping your caffeine intake to less than 200mg per day, or switching to caffeine-free alternatives. For reference, cup of regular instant coffee typically contains around 100mg of caffeine. It’s worth remembering that caffeine also exists in tea, cola, chocolate and other foodstuffs – check the labels on consumables to find out.


We all know smoking is bad for us; but a review by the British Medical Association which focused specifically on the effects of smoking on reproductive health, revealed the multiple negative effects of both active and passive smoking on male and female fertility, pregnancy and child health. Women who smoke are significantly more likely to suffer from delayed conception and infertility, and are at greater risk of pregnancy-related complications such as premature birth and perinatal death. There is conclusive evidence that smoking directly causes damage to sperm, and substantial evidence that smoking contributes to erectile problems. Smoking cannabis in particular has been shown to negatively affect fertility. The good news is that all of these risks and adverse effects can be reduced by smoking cessation.


Drinking too much alcohol can have a detrimental effect on both female and male fertility and the UK Chief Medical Officer recommends that pregnant women and women trying to conceive should ideally cut out alcohol completely.


Some illnesses, for example rubella, are particularly harmful if contracted when pregnant and you should think about being vaccinated. Therefore prior to planning pregnancy is a good time to make sure you are up to date. Speak to your GP practice if you’re unsure which vaccinations you have received. The MMR vaccine is given as two doses, one month apart, and should be completed at least one month prior to pregnancy, so this is something to plan for a few months in advance.


If you are planning pregnancy in the near future, it’s worth thinking about your contraceptive method and when is the right time to stop it. Some methods of contraception can take months to clear from your body, for example the contraception injection; and some require making an appointment for removal by a healthcare professional (e.g. the contraception implant, copper coil or hormonal coil). For those taking the contraceptive pill (either the combined contraceptive pill or the progestogen-only pill); it can take a month or longer for your natural cycle to resume.

So, you might want to think about switching to a barrier method of contraception such as condoms, which does not affect your hormonal cycle, while you ready yourself for having unprotected sex. Using a non-hormonal method of contraception in the run-up to trying to have a baby also helps you to be able to pinpoint your fertile window and maximise your chances of conception.


The NHS recommends all women should take a 400-microgram folic acid supplement for 2–3 months prior to conception, and should continue taking this during pregnancy up until 12 weeks. Folic acid has been shown to reduce the incidence of birth defects such as neural tube defects and heart problems, and also reduces the risk of preterm birth and facilitates healthy growth and development of babies. Some women are recommended to take a higher dose of folic acid e.g. those who have previously had a baby with a birth defect, those with certain medical conditions (e.g. diabetes and epilepsy), and those with a high BMI; so you should check in with your healthcare provider in good time if any of these apply to you.

Vitamin D is also recommended for women trying to conceive; at a dose of 10 micrograms (400 IU) per day. Vitamin D can be naturally made by the body from adequate exposure to sunlight, but unfortunately in the UK, this is unlikely to be sufficient out with the summer months.

If you are worried your diet may be deficient in some way, it’s important to discuss this with your healthcare provider and consider taking additional vitamins or supplements.

Sexually Transmitted Infections

Sexually transmitted infections (STIs) such as chlamydia and gonorrhoea are treatable infections that are known to contribute to infertility in both men and women. In some cases, these infections do not cause symptoms, so it’s worth both yourself and your partner having an STI screen prior to any planned pregnancy.

Regular Medications

Some medications can be harmful to a developing pregnancy, particularly some anti-epilepsy drugs, blood thinners, antibiotics and painkillers. The UK Teratology Information Service publishes useful information leaflets relating to specific medications and pregnancy. Speak to your doctor if you’re taking any medications prior to trying to conceive.

Mental Health and Wellbeing

Trying for a baby can be an emotional time, and couples can feel frustrated if they do not become pregnant right away. It’s easy to become preoccupied with pregnancy, and fall into an obsessive pattern of measuring hormones and having very regimented sexual intercourse to coincide with ovulation. There is conflicting evidence regarding the effect of stress on fertility, however engaging in stress-reduction activities can increase quality of life and overall wellbeing. It’s important when thinking about conception to make sure you and your partner are maintaining intimacy and enjoying your relationship in ways that do not focus on having a baby. Try practicing relaxation techniques with each other, such as a sensual massage, and remember sex can still be spontaneous and fun, even when trying to conceive!

In Summary

It’s beneficial to think about optimising your own health as a couple, prior to trying for a baby, and for some this may require a few months or more of planning and making changes to boost your chance of a healthy conception.

Dr Samantha Miller is a Specialty Doctor in Sexual and Reproductive Health

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