Preconception Health Checklist: What to Do 3 Months Before You Start Trying

Pregnancy preparation is not something that starts the moment a test comes back positive. The quality of the egg that ovulates this month reflects what has been happening in the body for the past 3 months. The sperm in today's ejaculate were produced over the past 72 days. What both partners eat, their health status, the medications they take, and the exposures they avoid in the months before conception directly influence the health of that first embryo.

This preconception checklist is designed for couples who are planning to start trying to conceive in the next 3 months — or who are just beginning to think seriously about it. It covers medical, nutritional, lifestyle, and practical steps for both partners.

For Her: The Preconception Checklist

1. Start Folic Acid Now — Not When You Are Pregnant

Neural tube defects (spina bifida, anencephaly) develop within the first 28 days of pregnancy — often before a woman knows she is pregnant. Folic acid supplementation must begin before conception to provide protection during this critical window.

• Standard dose: 400 micrograms (0.4 mg) daily — suitable for most women
• Higher dose (5 mg daily): For women with a history of neural tube defect in a previous pregnancy, epilepsy on valproate or carbamazepine, or pre-pregnancy BMI above 30
• Timing: At least 1 month before conception — ideally 3 months before

2. Book a Preconception Blood Test Panel

A baseline blood test before conception identifies conditions that should be treated or monitored before and during pregnancy:

• Blood group and rhesus (Rh) status
• Full blood count — checking for iron deficiency anaemia
• TSH (thyroid stimulating hormone) — thyroid disease affects fertility and pregnancy
• Fasting glucose — to screen for undiagnosed diabetes or pre-diabetes
• Rubella immunity — if not immune, vaccination and 1-month deferral of conception
• Hepatitis B surface antigen, hepatitis C antibody, HIV, VDRL — standard preconception infectious screen
• Vitamin D level — deficiency is extremely common in India; supplementation is low-risk and worthwhile
• Haemoglobin electrophoresis — if family history of thalassaemia or sickle cell disease

3. Review All Medications

Some medications taken for chronic conditions are contraindicated or require dose adjustment in pregnancy. Review every prescription and over-the-counter medication with your doctor before conception:

• ACE inhibitors and ARBs (blood pressure): Must be switched to pregnancy-safe alternatives (labetalol, methyldopa, nifedipine) before conception
• Statins: Contraindicated in pregnancy — must be stopped
• Valproate: Highly teratogenic — should not be used in women of reproductive age without extremely specific justification and robust contraception
• Warfarin: Teratogenic in the first trimester — anticoagulation must be discussed with the relevant specialist before conception
• Methotrexate (for rheumatoid arthritis or psoriasis): Must be stopped at least 3 months before conception
• Isotretinoin (for acne): Must be stopped at least 1 month before conception; teratogenic

Do not stop any medication without medical guidance — the risk of undertreated disease may outweigh the medication risk.

4. Achieve a Healthy Weight

Both underweight (BMI below 18.5) and overweight (BMI above 25) are associated with impaired fertility and increased pregnancy complications. Achieving a healthy BMI before conception — through sustainable dietary change and regular exercise — improves both natural conception rates and IVF success rates, and reduces the risk of gestational diabetes, pre-eclampsia, and macrosomia in the resulting pregnancy.

This takes time — starting 3 to 6 months before trying to conceive is realistic and appropriate.

5. Stop Smoking, Minimise Alcohol

Smoking significantly reduces fertility (in both partners), increases miscarriage risk, impairs foetal growth, and increases the risk of sudden infant death syndrome. Stopping smoking completely before conception is the most important lifestyle change many women can make.

Alcohol: Most authorities recommend complete avoidance from the time of trying to conceive. Even moderate alcohol consumption in the first weeks of pregnancy — before a positive test — carries some risk of foetal harm. No safe level of alcohol in pregnancy has been established.

6. Optimise Chronic Medical Conditions

If you have diabetes, hypertension, thyroid disease, epilepsy, or any other chronic condition, the goal is to achieve the best possible control before conception — not to wait and see what happens. Pre-pregnancy HbA1c below 6.5% reduces congenital anomaly risk in diabetic women. Pre-pregnancy TSH below 2.5 mIU/L optimises thyroid function for early pregnancy. Blood pressure control protects both mother and baby.

For Him: The Male Partner Preconception Checklist

Male preconception health is consistently under-emphasised — but sperm quality in the 3 months before conception matters significantly:

• Stop smoking: The highest-yield lifestyle change for sperm DNA integrity
• Reduce alcohol: Below 7 to 10 units per week during the preconception period
• Avoid heat: No hot baths, saunas, laptop on lap, tight underwear
• Maintain a healthy weight: Obesity impairs testosterone and sperm quality
• Stop anabolic steroids if used: These suppress sperm production — recovery takes 6 to 18 months
• Start a male fertility supplement: CoQ10 (ubiquinol 200 to 400 mg), vitamin C, vitamin E, zinc, selenium — supports sperm quality over the next 3 months
• Get a semen analysis: Even if planning natural conception — knowing the baseline before a year of unsuccessful trying allows earlier intervention if needed

Practical Preparation

• Identify your GP or obstetrician for antenatal care — ideally before you are pregnant, so there is no scramble when the test is positive
• If you have a family history of thalassaemia, sickle cell, or other genetic conditions: ensure both partners are tested for carrier status before conception
• Ensure dental health is addressed: Periodontal disease has been associated with adverse pregnancy outcomes; a dental check-up before conception is worthwhile
• Reduce caffeine to below 200 mg/day (approximately 1 to 2 cups of filtered coffee or 2 to 3 cups of tea)
• Establish a sleep routine: Sleep deprivation affects both fertility and early pregnancy outcomes

Frequently Asked Questions

Q1. When should I stop contraception before trying to conceive?

For most hormonal contraceptives (pill, patch, ring), fertility returns within 1 to 3 cycles of stopping. There is no medical evidence that stopping the pill and waiting several months before trying is necessary. Start folic acid at the time of stopping contraception. The injectable contraceptive (Depo-Provera) can suppress ovulation for 6 to 12 months after the last injection — if you are planning a pregnancy in the near term, this is worth factoring into your timing. The IUD (copper or hormonal) can be removed by a clinician and fertility returns promptly.

Q2. I am taking antidepressants. Should I stop before trying to conceive?

Do not stop antidepressants without consulting your psychiatrist. The risk of untreated depression in pregnancy — including suicidality, poor nutrition, and substance use — is typically greater than the risk of most antidepressant medications. SSRIs are the most studied class in pregnancy and, while not risk-free, are generally considered acceptable when the clinical need is established. A preconception psychiatric review will help optimise your regimen.

Q3. My partner and I are both in our early 30s and healthy. Do we really need all these tests?

The core preconception steps — folic acid, stopping smoking, thyroid screening, blood group, rubella immunity, and haemoglobin electrophoresis if applicable — are appropriate for virtually all couples. The more extensive testing (pre-pregnancy glucose, full lipid panel, detailed genetic carrier testing) is reserved for those with specific risk factors. A brief preconception consultation at Solo Clinic can guide which tests are relevant to your specific situation.