The Preconception Checklist: What to Do Before You Try

The months before you start trying are the easiest time to make changes that matter for a healthy pregnancy. Most of them are simple, and almost none involve buying anything. This checklist follows the CDC, ACOG and ASRM, in roughly the order to do them.

1. Book a prepregnancy visit

ACOG recommends prepregnancy counseling for everyone planning a pregnancy, whatever their gender or sexual orientation, and says it is appropriate even while you are still using contraception.² The CDC suggests bringing a list: your health history, current conditions, all medicines and supplements, vaccinations, and lifestyle questions.¹

At that visit, ACOG advises:²

• Optimizing chronic conditions such as diabetes, high blood pressure, psychiatric illness and thyroid disease before pregnancy.
• Assessing the need for sexually transmitted infection screening.
• Offering the same genetic carrier screening recommended for pregnant women.
• Asking about alcohol, nicotine and drug use, including prescription opioids.
• Screening for intimate partner violence.
• Discussing the ideal interval between pregnancies, if you have had a baby.

2. Start folic acid now

The CDC recommends 400 mcg of folic acid every day for everyone who could become pregnant, starting at least one month before conception.³ The US Preventive Services Task Force recommends 400 to 800 mcg.⁴ Folic acid helps prevent neural tube defects, which form in the first weeks of pregnancy, often before you know you are pregnant.³ If you have had a pregnancy affected by a neural tube defect, the CDC recommendation is 4,000 mcg daily, after talking with your doctor.³

A prenatal vitamin is the easiest way to cover it. Check the dose and whether it has third-party testing, and read methylfolate vs folic acid if you are unsure which form to choose.

3. Review your medicines and supplements

The CDC advises discussing every medicine and supplement you take with your provider before pregnancy, so bring a full list to your visit.¹ Do not stop a prescribed medicine on your own; ask first, because some conditions need to stay well controlled.²

4. Check your vaccines

Some vaccines cannot be given during pregnancy, so get them first. The CDC advises avoiding pregnancy for 28 days after an MMR (measles, mumps, rubella) vaccine, and for 1 month after each varicella (chickenpox) dose.⁵ Ask your doctor whether you need either, and about other vaccines.

5. Stop smoking, drugs and alcohol

The CDC advises stopping alcohol, smoking and certain drugs before pregnancy, because they can cause premature birth, birth defects and infant death.¹ Smoking also affects fertility: in a large meta-analysis cited by ASRM, women who smoked were more likely to be infertile (OR 1.60).⁶ ACOG recommends stopping cannabis if you may become pregnant.⁶

On alcohol while trying, ASRM advises limiting it to minimal or moderate use, and alcohol should stop altogether once you are pregnant because no safe level has been established.⁶

6. Keep caffeine moderate

ASRM says moderate caffeine, about one to two cups of coffee a day, has no apparent adverse effect on fertility or pregnancy outcomes, while high intake (about 500 mg, or more than five cups a day) has been linked to lower fertility.⁶ In pregnancy, ACOG considers under 200 mg a day moderate.¹⁰

7. Work toward a healthy weight

The CDC lists reaching and keeping a healthy weight as a preconception step, since both overweight and underweight carry risks.¹ ASRM notes fertility rates are lower in women who are very thin or obese.⁶

8. Eat for pregnancy, including fish

FDA and EPA advise people who are or might become pregnant to eat 2 to 3 servings a week of fish from their Best Choices list, such as salmon, sardines or canned light tuna, and to avoid the highest-mercury fish, such as shark and swordfish.⁷ Our fertility diet guide covers the rest.

9. Avoid toxic substances

The CDC advises avoiding harmful chemicals, some metals, fertilizer, bug spray, and cat or rodent feces, at home and at work.¹

10. Learn your family health history

Your family history can reveal conditions that might affect a baby, and your doctor may refer you for genetic counseling because of it, or after several miscarriages or infertility.¹

11. Look after your mental health

If worry, sadness or stress do not go away and interfere with daily life, the CDC advises talking with your provider about treatment options before pregnancy.¹

12. Include your partner

Sperm take about 74 days to develop, so a partner’s habits today shape sperm in about three months.⁸ A meta-analysis of 5,865 men linked cigarette smoking to lower sperm count and motility, with bigger effects in moderate and heavy smokers.⁹ Our 90-day sperm health plan turns that into weekly steps.

13. Stop contraception and learn your cycle

Fertility returns at different speeds depending on the method you used; see when to stop birth control for each one. Once you start, ASRM says the fertile window is the six days ending on ovulation, and sex every one to two days in that window gives the highest pregnancy rates.⁶ Our ovulation calculator estimates your window.

14. Know when to ask for help

ASRM defines infertility as no pregnancy after 12 months of regular unprotected sex, and recommends evaluation after 6 months if you are 35 or older.⁶ ASRM notes that earlier evaluation may be justified by your medical history, for example absent or very irregular periods, or a known condition in either partner that affects fertility.⁶ About 80% of couples conceive within six months.⁶ Our guide on how long it takes to get pregnant has the month-by-month numbers.

For everything else at this stage, visit the Prepare hub.