Your guide to planning for pregnancy
Whether you're just starting to think about it or have been trying for a while — this guide walks you through preconception prep, your first OB visit, and what to do if things aren't going as planned.
This guide is for educational purposes only and does not constitute medical advice. Always consult your healthcare provider for personalized guidance.
What to do before you start trying
The 3-6 months before you start trying is a genuinely useful window to set yourself up. None of this has to be perfect — even doing a few of these things makes a real difference.
Nutrition & supplements
Start a prenatal vitamin
Look for at least 400-800mcg of folate (methylfolate absorbs better than folic acid), plus iron, iodine, vitamin D, and DHA. Starting 3 months before trying gives your body time to build up folate levels, which matters for early neural tube development. [4]
Eat a fertility-supportive diet
The Mediterranean diet has the most research behind it for fertility: olive oil, leafy greens, legumes, whole grains, fatty fish, and antioxidants. [5] You don't need to be perfect — just lean that way.
Cut back on alcohol and caffeine
Most guidelines recommend stopping alcohol entirely when trying to conceive. For caffeine, under 200mg/day is the widely cited safe threshold. [4]
Exercise & sleep
Aim for 150 min/week of moderate movement
Walking, swimming, yoga, and light strength training support insulin sensitivity and hormonal balance. Very intense exercise loads can suppress ovulation — if that's you, worth a conversation with your OB. [5]
Prioritize sleep
Sleep deprivation disrupts melatonin, cortisol, and reproductive hormones. Aim for 7-9 hours. It's one of the most underrated things you can do for your overall health going into pregnancy. [5]
Mental health & stress
Don't underestimate the emotional side
Even when everything goes to plan, trying to conceive can bring up a lot. Anxiety, relationship strain, and grief when it takes longer than expected are incredibly common. Acknowledging this early — and building support around yourself — is a form of preparation, not pessimism.
Manage stress actively
Chronic stress elevates cortisol, which can disrupt hormonal signaling. Mindfulness, regular movement, acupuncture, and simply having people to talk to all make a real difference.
Review your medications
Some medications can affect ovulation or aren't recommended in early pregnancy. Bring a full medication list to your preconception visit. Never stop anything without medical guidance.
General wellness
Reduce environmental toxins where you can
BPA, phthalates, and pesticides act as endocrine disruptors. Switching to glass food storage, fragrance-free personal care products, and organic produce for the "dirty dozen" are low-effort ways to reduce exposure. [5]
Start tracking your cycle
Understanding your cycle gives you real information about your fertile window. You can use a cycle tracking app, ovulation predictor kits (OPKs), basal body temperature (BBT) charting, or a combination.
Your before-you-try to-do list
Practical things to work through in the 3-6 months before you start trying. You don't have to do all of them — but the more you can tick off, the more informed and supported you'll be.
Medical
- Schedule a preconception visit with your OB-GYN
- Review all medications for pregnancy safety
- Get blood work: AMH, TSH, CBC, vitamin D, iron, folate
- Confirm rubella and varicella immunity
- Check you're up to date on vaccines (flu, Tdap)
- Ask about genetic carrier screening
- Get a dental checkup — gum health matters in pregnancy
Lifestyle
- Start your prenatal vitamin
- Stop smoking and recreational drug use
- Begin tracking your menstrual cycle
Planning
- Talk with your partner about timeline and expectations
- Review your insurance coverage for fertility and prenatal care
- Look into your employer's parental leave policy
What happens at your preconception appointment
A preconception visit before you start trying is one of the most valuable things you can do. Here's what's typically covered — so you can walk in prepared and get the most out of it.
Medical history review
Your doctor goes through your full history — past pregnancies, surgeries, chronic conditions, medications, and family history. Conditions like PCOS, endometriosis, thyroid disorders, and autoimmune diseases are flagged early because they can affect fertility and pregnancy outcomes.
Physical exam and pelvic assessment
A pelvic exam, Pap smear (if due), and sometimes a pelvic ultrasound to check uterine and ovarian anatomy. This can catch structural issues like fibroids, polyps, or ovarian cysts early.
Blood work
Typically includes AMH (to assess ovarian reserve), TSH (thyroid), prolactin, rubella immunity, and often vitamin D, iron, and folate. Your AMH level gives your doctor useful information about your egg supply.
Carrier screening
Genetic carrier testing for conditions like cystic fibrosis, spinal muscular atrophy, and fragile X syndrome is often offered at this visit. Being a carrier doesn't mean you or your baby will be affected, but it helps you make informed decisions.
Supplements and lifestyle guidance
Your OB will typically recommend a prenatal vitamin with at least 400-800mcg of folate and review your diet, alcohol, caffeine, and smoking habits. [4]
Most journeys start here — and that's it
For most people, this is the whole visit. You leave with a prenatal vitamin, a clearer picture of your health, and the go-ahead to start trying. If that's you — that's wonderful. The rest of this guide is here if you ever need it.
If it's taking longer than expected — you're not alone, and there are answers.
About 1 in 7 women experience difficulty conceiving. [2] The sections below are for you.Common reasons conception takes longer
Fertility challenges are more common than most people realize, and more often treatable than people fear.
PCOS
The most common cause of ovulatory infertility, affecting about 1 in 10 women of reproductive age. [6] Highly treatable — most women with PCOS can and do conceive.
Thyroid disorders
Both hypothyroidism and hyperthyroidism can disrupt ovulation and increase miscarriage risk. [7] Highly treatable once identified.
Blocked fallopian tubes
Often caused by prior pelvic inflammatory disease, STIs, or endometriosis. An HSG test identifies blockages. May be addressed surgically or by moving to IVF.
Endometriosis
Tissue similar to the uterine lining grows outside the uterus, causing inflammation and scarring. Affects up to 10% of women. [6] Often goes undiagnosed for years.
Diminished ovarian reserve
Fewer eggs remaining than expected for age. More common in women over 35, but can affect younger women too. AMH and antral follicle count are the standard tests.
Unexplained infertility
When all standard tests come back normal but pregnancy hasn't occurred. Accounts for roughly 30% of infertility diagnoses. [8] Most couples in this category respond well to treatment.
Recurrent pregnancy loss
Defined as two or more clinical miscarriages. Causes include chromosomal abnormalities, uterine structural issues, clotting disorders, and hormonal imbalances.
Weight and metabolic factors
Both underweight and overweight can disrupt hormonal balance and ovulation. Even modest changes — around 5-10% of body weight — can restore regular cycles in some women. [5]
About a third of cases involve the male partner [9]
Infertility is roughly equally split: about a third involves a female factor, a third a male factor, and a third a combination of both. A semen analysis is non-invasive, fast, and should be done early in any fertility workup — not as an afterthought.
When to see a reproductive endocrinologist
A reproductive endocrinologist (RE) specializes in diagnosing and treating infertility. You don't need to wait for your OB to refer you — you can ask for a referral or self-refer at any point.
Standard referral timing [3]
- Under 35 and trying for 12+ months without success
- 35-37 and trying for 6+ months
- 38 or older — referral often recommended right away
- Two or more miscarriages at any age
Go sooner if you have:
- Diagnosed PCOS or endometriosis
- Irregular or absent periods
- Known or suspected tubal issues
- A partner with known sperm concerns
- A history of cancer treatment (chemo or radiation)
- A chronic condition affecting fertility (thyroid, diabetes)
What your first RE appointment looks like
Full fertility workup
Hormone panel (FSH, LH, estradiol, AMH), antral follicle count via ultrasound, and an HSG to check if your tubes are open. Your partner will be asked to do a semen analysis.
A diagnosis — or at least a direction
Most couples leave their first RE appointment with either a clear diagnosis or a working hypothesis. Either way, you finally have information.
A personalized plan
Your RE presents a treatment roadmap specific to your situation — ranging from lifestyle changes and timed intercourse to IUI or IVF. You are never locked into a plan; it can always be adjusted.
What fertility treatment looks like
Treatment is never one-size-fits-all. Your RE will recommend a path based on your diagnosis, age, and goals. Most people start at the least invasive option that makes sense for their situation.
Lifestyle optimization and timed intercourse
Often the starting point for unexplained infertility or mild hormonal issues. Involves targeted cycle tracking, timing intercourse precisely around ovulation, and optimizing the lifestyle factors above.
Ovulation induction (OI)
Oral medications stimulate the ovaries to produce and release eggs on a more predictable schedule. Often used for PCOS or irregular cycles. Typically monitored with ultrasound and combined with timed intercourse or IUI.
Intrauterine insemination (IUI)
Washed, concentrated sperm is placed directly into the uterus around ovulation. Less invasive and less expensive than IVF. Success rates are around 7-10% per cycle unmedicated, rising to 15-25% with medication. [10]
In vitro fertilization (IVF)
Eggs are retrieved after ovarian stimulation, fertilized in a lab, and one or more embryos are transferred to the uterus. Can include preimplantation genetic testing (PGT) to screen embryos for chromosomal abnormalities.
Egg freezing (fertility preservation)
For women not ready to conceive now but wanting to preserve options. Most effective before 35. Also recommended before cancer treatment or for those with diminished ovarian reserve who want more time.
Surgical interventions
Laparoscopic surgery to remove endometriosis lesions or fibroids; hysteroscopy to correct uterine structural issues. Often performed before IVF to improve the uterine environment and success rates.
Third-party reproduction
Includes donor eggs, donor sperm, donor embryos, or gestational surrogacy. Involves additional legal, psychological, and medical coordination.
Insurance coverage varies — check yours early [11]
As of 2025, 25 states and Washington D.C. require some form of fertility coverage, but mandates vary dramatically. Many large employers self-insure and are exempt from state mandates entirely. Call your insurer before starting any treatment.
Sources
- UCLA Health / NICHD. Approximately 85% of couples conceive within 12 months of trying.
- RESOLVE / CDC NSFG. Infertility and Impaired Fecundity in Women and Men in the United States, 2015-2019. National Health Statistics Reports, 2024.
- American Society for Reproductive Medicine (ASRM). Definitions of infertility and recurrent pregnancy loss. Fertility and Sterility.
- ACOG. Preconception Care. Recommends 400-800mcg folic acid preconception; limiting caffeine to under 200mg/day; avoiding alcohol when trying to conceive.
- Chavarro JE, et al. Diet and lifestyle in the prevention of ovulatory disorder infertility. Obstetrics & Gynecology. 2007;110(5):1050-1058.
- CDC. PCOS and endometriosis prevalence data. PCOS affects approximately 6-12% of women of reproductive age; endometriosis approximately 10%.
- Alexander EK, et al. Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum. Thyroid. 2017.
- Practice Committee of the ASRM. Unexplained infertility: a committee opinion. Fertility and Sterility. 2020.
- NICHD. How common is male infertility? Male factor accounts for approximately one-third of infertility cases.
- Fertility IQ / PMC. IUI mean pregnancy rate approximately 9% per cycle; with medication approximately 15-25%.
- MultiState / RESOLVE. As of 2025, 25 states and D.C. require some form of fertility care coverage.
We made this guide because the fertility planning conversation can feel either totally overwhelming or weirdly clinical — and usually both at once. There's a lot to know, and a lot of it matters. But there's also a version of this that starts really simply: eat well, take your prenatal vitamin, book that OB appointment, and start tracking your cycle.
And if the journey turns out to be harder than you expected — please know that harder doesn't mean impossible, and it definitely doesn't mean alone. The right information and the right care team change everything.