The preconception checklist: what to do in the three months before trying

For the woman: tests and supplements

Folic acid, 400 micrograms daily, starting at least one month — ideally three — before conception and continuing through the first trimester. It prevents neural tube defects, and it only works before most women know they are pregnant. Women with diabetes, epilepsy on certain medicines, obesity, or a previous affected pregnancy need a much higher dose, prescribed.

Blood tests: haemoglobin (anaemia is extremely common and worth correcting before pregnancy, not during), thyroid function, blood sugar, blood group and Rh type, vitamin D and B12, and rubella immunity.

Vaccines: rubella if not immune — and then avoid conceiving for a month afterwards. Check tetanus status, hepatitis B, and discuss flu and COVID vaccination with your doctor. Rubella in early pregnancy causes serious birth defects and is entirely preventable.

Existing conditions: thyroid, diabetes, blood pressure, epilepsy, autoimmune conditions, and mental-health medication all need review before conception, because some drugs must be changed to pregnancy-safe alternatives and the change takes time. Never stop a prescribed medicine on your own on discovering a pregnancy — ask.

For the man: the half that gets skipped

Sperm take about three months to make, so the three months before conception are the man's window too. Stop tobacco in every form, cut alcohol, stop anabolic steroids entirely, and get weight and diabetes under control.

Get a check-up: blood sugar, blood pressure, and treatment of any infection. If there is any history of undescended testes, testicular surgery or injury, mumps after puberty, or chemotherapy, get a semen analysis before you start trying rather than a year later.

Avoid heat: saunas, very hot baths, laptops on the lap, long unbroken driving. And review any regular medicines with the doctor — several affect sperm.

Genetic screening is worth discussing for both partners where relevant: thalassaemia carrier status in particular, which is common in several Indian communities, and sickle cell in others. It is a simple blood test and it changes what you plan for.

Both partners: lifestyle and the household

Tobacco and alcohol out, for both. Second-hand smoke counts, so if one partner smokes, the household is exposed. Chewed tobacco and gutkha are not a lesser version of this.

Weight at either extreme reduces fertility in both sexes and raises pregnancy risks. Aim for gradual change rather than a crash diet in the month before trying.

Dental check-up: gum disease is associated with preterm birth, and treatment is easier before pregnancy than during it.

Household hazards: check occupational exposure to chemicals, pesticides, lead and radiation for both partners; sort out pest control and paint work before rather than during pregnancy; and if there is a cat, learn the toxoplasmosis precautions.

Money and leave: know what maternity benefit you are entitled to (26 weeks for the first two children), whether your insurance covers maternity and after what waiting period, and roughly what delivery will cost where you plan to have it. These are easier to arrange before conception than at seven months.

When to see a doctor

Book a pre-pregnancy consultation — the most useful appointment almost nobody takes — particularly if you: are over 35, have any chronic condition or take regular medication, have had two or more miscarriages, a previous preterm birth or a baby with a birth defect, have irregular periods or known PCOS, have a family history of genetic conditions, or have had cancer treatment.

Also see a doctor before trying if you are on any medicine at all — including over-the-counter, ayurvedic and herbal products — so it can be reviewed for pregnancy safety.

This article is general information, not medical advice, and is no substitute for personal medical advice. For any decision about your or your child's health, please consult your doctor.

Frequently asked questions

Q: How soon before trying should I start folic acid? — At least a month, ideally three. There is no benefit in waiting for a positive test — by then the neural tube is already forming.

Q: I am on thyroid medicine. Do I need a change? — Requirements usually rise in pregnancy and the dose is adjusted early, so tell your doctor before conceiving and have levels checked as soon as you get a positive test. Do not stop the medicine.

Q: Should we stop contraception a few months early to 'clear it from the system'? — No. Fertility returns quickly after stopping the pill, condoms or an IUD, and there is no need for a washout period. The injectable is the exception — cycles can take several months to return after it.

Q: Is a full 'pre-pregnancy package' from a private lab worth it? — The tests listed above are the useful core and can be done cheaply, including at government facilities. Expensive panels add tests you do not need. Take the list to your doctor and let them order what applies to you.