So you’re ready to start trying to get pregnant, now what? A NYC Fertility Doctor’s guide on how to prepare
As a New York city fertility doctor and OBGYN, one of the most common questions I get asked is what to do to prepare, once you are ready to try to conceive. Everyone wants to feel like they are putting their best foot forward and giving themselves the best chance to get pregnant easily and without complication. Before I share my 14 tips on how to prepare, I want to preface my list of recommendations by saying you can never really be/feel PERFECTLY prepared for the exciting, and often chaotic, journey to parenthood. All you can do is do your best. Most of the things I recommend are going to help improve your overall health, as well as improve your chance of conceiving a healthy pregnancy.
There tends to be a lot of focus on trimesters 1, 2, and 3, and postpartum wellness – but, what about the months leading up to pregnancy, aka. “Trimester 0”??? Just like the best work out sessions begin with proper hydration and stretching, beforehand, I think the preparatory work done in advance of pregnancy can make a huge difference to the next 9 months – your physical and mental wellbeing during pregnancy and the health of your future child.
Click here to listen to learn more about the concept of ‘Trimester 0’ and trying to conceive on the Juna Woman’s podcast.
Here are my 14 tips for optimizing your health/fertility and prepping for pregnancy:
- Stop any and all forms of birth control.
This is a fairly obvious one. But, it’s important to understand how long it will take for your fertility to rebound after stopping various forms of birth control. Some forms of birth control are reversible right away (example: the hormone or copper IUD), whereas other forms of birth control (such as pills that have been used for years on end, or the progesterone injection (aka depoprovera)) can take up to 6 months to wear off completely. In most cases, ovulation will return 1-3 months of stopping birth control pills. If you are missing your period for longer than 6 months after stopping birth control, you should definitely see a gynecologist/fertility doctor to investigate this further and rule out any underlying medical issues that could be preventing you from ovulating regularly. Another important point is to stop using lubricants that contain spermicide and switch to fertility-friendly options. Click here to read about what happens to your body when stopping birth control and how to prepare.
2. Figure out if and when you ovulate.
Many women go most of their lives without truly understanding how their menstrual cycle and ovulation works. This is owing to the fact that most of our adolescent and early adulthood was spent PREVENTING pregnancy, rather than being hyperfocused on what is needed to get pregnant on purpose. The first step to learn more about your body, is to start tracking your periods/ovulation. Efforts to try to conceive should be concentrated to the 2-4 days prior to ovulation. Outside of this window, any attempts (while they may be fun) are very unlikely to result in pregnancy. While trying every single day of the month could be fun, it is not feasible or sustainable for most – so it is best to try and be efficient and time when you have sex (or expose yourself to sperm, if doing inseminations in a clinic or at home). If you notice that your periods are irregular or infrequent, this is a major clue that you aren’t ovulating regularly, which can make it really confusing and difficult to know when to time your efforts. If you have irregular cycles you should consult with your doctor.
3. Just say NO to cigarettes/tobacco.
Seriously- when is quitting smoking NOT a doctor’s recommendation?! The scary truth about cigarettes and fertility is that smoking speeds up ovarian aging – making you lose eggs at a faster rate and therefore increases your risk of early menopause. What’s worse is that cigarette smoke is toxic to a pregnancy – it increases the risk of miscarriage, growth problems, and preterm delivery. Quitting smoking is HARD. While some women may be motivated and able to quit cold turkey once they see two lines on that pregnancy test, the majority need time to gently wean themselves off, and may even require the help of nicotine gums/patches or medications to successfully kick the habit. If you are thinking of trying to get pregnant in the next year or two, give yourself time and a realistic plan to quit for good. What about marijuana, you ask? (Or as most patients phrase it – you may be asking for ‘a-friend-of-a-friend’ *wink wink*). The truth is, there aren’t as many longterm, well designed studies. So until there’s more information, we make the assumption that it could be harmful or toxic in pregnancy and advise patients to avoid smoking ANYTHING in pregnancy.
4. Reduce your alcohol intake.
Consistent, excessive alcohol use can be toxic to both the male and female reproductive system. Drinking during pregnancy can result in fetal alcohol syndrome. Because there is no way to reliably establish a ‘safe level’ of alcohol exposure to a developing fetus, it is advised to avoid it altogether while pregnant/. Many people are not aware of early pregnancy until at least 5-6 weeks, if not a few weeks later- when major organs are forming and are particularly susceptible to the negative impact of toxins. it is important to cut down alcohol intake while trying to conceive so that you aren’t inadvertently exposing an early developing pregnancy to large amounts, which could be harmful.
5. Work towards having only 1-2 cups of coffee per day.
I advise all women who are trying to conceive and already pregnant to restrict their caffeine intake to less than 200mg per day. Excessive caffeine intake (3-5 cups a day or more) has been linked to adverse pregnancy outcomes such as miscarriage. A lot of women will cut it out of their life completely once pregnancy is established, which can lead to withdrawal headaches. This is not necessary – it is okay to have some coffee! But if you are someone who wants to be extra conservative and cut it out completely, it is easier and less painful to do it gradually in the months leading up to getting pregnant. Click here to read about a recent controversial study on caffeine and pregnancy and why it doesn’t change my recommendation that caffeine in moderation is OKAY. Also, here is an article about the different sources of caffeine – ie. coffee vs. tea – during pregnancy.
6. Start taking prenatal vitamins.
The biggest difference between multivitamins (which you might already be taking) and prenatal vitamins are that prenatal vitamins contain at least 400mg folic acid per day. Adequate folic acid intake is SO important to prevent neural tube defects such as spina bifida. Thankfully, lots of our everyday foods tend to be fortified with folic acid, and folate can be derived from a diet rich in leafy green vegetables. But to ensure you are getting the recommended amount, it is ideal to be taking prenatal vitamins daily for at least 3 months before getting pregnant. Click here to read more about prenatal vitamins.
7. Get a physical and check in with your doctor about your chronic health conditions.
Woman with medical problems such as high blood pressure, diabetes, etc. should work with their doctor to optimize their condition and overall health before conceiving. Many women may be unaware that they even have any of these issues if they aren’t seeing their primary care doctor as regularly as they should, so it is a good idea to have a routine check-up if it has been over a year. Women with certain medical issues It may benefit from a consultation with a high risk obstetrician to be counseled regarding the risks of their condition to pregnancy and to co-manage their care with their regular OB, once they become pregnant.
8. Review your current medications and supplements with your doctor to make sure they are pregnancy-friendly.
You should discontinue any medications prior to conceiving which could be toxic to a developing fetus and put it at risk of birth defects. How far in advance you should stop certain medications will depend on the type and dose of medication taken and should be discussed with your primary care doctor and OBGYN/fertility doctor. Here is a great resource for looking up specific medications and their potential effects on pregnancy.
9. Ensure you are up to date with cancer surveillance.
Part of making sure you have had a recent health check-up is being up to date with your pap smear and mammograms to ensure there are no precancerous or cancerous cells that need further follow up, investigation, or treatment. God forbid cancer is diagnosed, the additional tests and treatments required are usually not safe or possible during pregnancy. The main worry here is that pregnancy could delay the diagnosis and/or necessary treatment, making the overall prognosis/outcome worse than it could have or should have been.
10. Exercise regularly.
Doing at least 30-40 min of cardio 3 times per week, at a minimum, will optimize you for pregnancy, reduce the risk of pregnancy complications (such as diabetes), and prevent you from excessive or unhealthy amounts of weight gain during pregnancy. Ideally, women should aim to exercise regularly prior to pregnancy as it is much harder and less realistic to initiate a new exercise regimen and stick to it, once already pregnant. The hormonal changes of pregnancy can lead to your ligaments being more lax and your body slightly more prone to strain and injury, which is another reason to not wait until you are already pregnant to start taking on physically challenging exercise for the first time. In short, early pregnancy is not the time to join the crossfit ‘cult’ (or any cult for that matter). Click here to read more about exercise while trying to conceive, during fertility treatment, and once pregnant,
There are very few studies on recent, fad diets such as keto – so it is best to avoid anything harsh/extreme while already pregnant. Some women may think about initiating these types of diets in early pregnancy, to try and play catch up with their weight loss goals, in advance of the inevitable weightgain of pregnancy. The best type of diet to optimize your overall fertility has been studied and the results are pretty unanimous – the best diet for reproductive health is a mediterrenean- that is, high in antioxidants and lean proteins and healthy sources of fats, such as avocado. Click here to read an article about ‘Fertility Diets’.
12. Clean up your cosmetics/home products.
As you gear up to try to conceive, you should make a concerted effort to switch out household/beauty products to cleaner, less toxic versions. Many types of plastic and commonly used hair and makeup products contain fragrance and other types of compounds which are harmful chemicals or ‘endocrine disruptors’ which can interfere with our reproductive system and negatively impact our fertility, and potentially the future reproductive system and hormonal balance of your child. The scary truth is that the use of ‘endocrine disruptors’ in commonly used products, that we put on our skin or use to hold the food/water we ingest, is a huge blind spot, going unregulated by the FDA. Because there is little oversight, we cannot take products at facevalue – read the fineprint, check out the ingredients. If you can’t pronounce or recognize the names of what you are using on or in your body, ditch it. It is also important to know that we cannot live in a bubble – whatever exposures you can reduce will help to protect you and your baby – so just do your best and stay as informed and aware as possible. Click here to read an article on how to clean up your beauty regimen.
13. Check in on any known gynecologic issues.
If you have been told that you have fibroids, endometriosis, etc., I recommend that you have a focused, updated evaluation (ie. pelvic ultrasound and exam) to uncover any issues that should be taken care of prior to conceiving. A common example would be having a large that could distort or take up too much space in the uterine cavity, leading to increased difficulty conceiving, a higher risk of miscarriage, and preterm labor. In the case of this example, your doctor may recommend surgery before you try to get pregnant. Another common example is for women with PCOS who have a longstanding history of irregular periods and ovulation. This is an immediate red flag that it might be hard to time when to try to get pregnant, and you should seek an evaluation with a fertility doctor earlier, instead of waiting months, since you are likely not getting the same number of ‘tries’ to conceive as women who ovulate regularly each month.
14. Have a planned timeline for how long to try and when to seek help.
You can always adjust the timeline and maintain flexibility. But, all too often, time can slip away from us and it’s easy to lose track. There’s no rulebook on when to seek the help of a fertility doctor – here’s a rough guide based on female age: if you are trying for over 1 year at <35 years old, trying for at least 6 months at age 35-40, and if you are trying for more than 3 months at age 40. For patients with known risk factors for infertility (ie. endometriosis, irregular periods) it is NEVER wrong to seek an early evaluation.
These 14 tips aren’t a MUST, they are merely a list of things I think all women should consider and be aware of, from an insider in-the-know. Don’t let the list overwhelm you or make you feel defeated, or worse- JUDGED- for not adhering to every recommendation perfectly. DO YOUR BEST. BE INFORMED. ASK QUESTIONS. And it’s NEVER TOO EARLY to ask for help. Seeking an evaluation from a fertility doctor doesn’t have to happen after 6 months, or 1 year of trying to conceive. I see patients for PRECONCEPTION consultation, or ‘reproductive check-up’, all the time. It doesn’t mean rushing into fertility treatments – the main purpose is to educate, empower, and to identify any potential barriers to conceiving, so that your journey to becoming a mama can be as efficient and successful as possible.