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 general educational purposes only and is not medical advice. Fertility and pregnancy planning are personal and can vary based on age, health history, medications, insurance, and goals. Always consult your healthcare provider for guidance specific to you.
What to do before you start trying
The 3–6 months before you start trying can be a useful window to get informed, ask questions, and build support. None of this has to be perfect — even a few small steps can help you feel more prepared.
Nutrition & supplements
Start a prenatal vitamin
Ask your clinician about starting a prenatal vitamin with folic acid or folate, typically 400–800mcg, plus other nutrients that may be appropriate for you. Starting before pregnancy helps support early neural tube development. [4]
Eat a fertility-supportive diet
A Mediterranean-style eating pattern — olive oil, leafy greens, legumes, whole grains, fatty fish, and antioxidant-rich foods — has been studied in relation to fertility and overall health. [5] You don't need to be perfect — just lean that way if it works for you.
Cut back on alcohol and caffeine
Ask your clinician about alcohol and caffeine while trying to conceive. Many guidelines recommend avoiding alcohol when trying or pregnant, and limiting caffeine to under 200mg/day is commonly cited. [4]
Exercise & sleep
Aim for 150 min/week of moderate movement
Walking, swimming, yoga, and light strength training can support overall preconception health. If you're doing very intense training or noticing irregular cycles, it may be worth discussing with your OB or another clinician. [5]
Prioritize sleep
Sleep supports overall health and wellbeing going into pregnancy. Aiming for 7–9 hours is a helpful general goal, though real life is not always perfect. [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
Stress can affect wellbeing, sleep, relationships, and how supported you feel during the process. Mindfulness, regular movement, acupuncture, therapy, or simply having people to talk to may be helpful for some people. You don't need a formal practice — you just need something that works for you.
Review your medications
Bring a full medication and supplement list to your preconception visit, including prescriptions, over-the-counter medications, and herbal products. Some medications may need to be adjusted before or during pregnancy. Never stop anything without medical guidance.
General wellness
Reduce environmental toxins where you can
Some people choose to reduce exposure to chemicals such as BPA, phthalates, and certain pesticides when planning pregnancy. Options like glass food storage, fragrance-free products, or washing produce well can be reasonable low-effort steps if they fit your life. [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. Most people find OPKs the easiest starting point.
Your before-you-try to-do list
Some 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
- Ask whether any blood work is appropriate for you, such as thyroid, blood count, vitamin levels, or fertility-related testing
- Confirm rubella and varicella immunity
- Ask whether you're up to date on recommended vaccines
- 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 can be a helpful way to ask questions, review your health history, and understand what matters for you. Here's what's often covered — so you can walk in prepared and get the most out of it.
Medical history review
Your doctor may go through your full history — past pregnancies, surgeries, chronic conditions, medications, and family history. Conditions like PCOS, endometriosis, thyroid disorders, and autoimmune diseases may come up because they can affect fertility or pregnancy planning for some people.
Physical exam and pelvic assessment
Depending on your history and timing, your clinician may do a pelvic exam, Pap smear if due, or occasionally imaging to better understand uterine and ovarian anatomy.
Blood work
Your clinician may recommend blood work based on your age, history, symptoms, and goals. This can include thyroid testing, immunity checks, vitamin or iron levels, or fertility-related tests such as AMH when appropriate. AMH can provide information about ovarian reserve, but it does not predict exactly when or whether you'll conceive.
Carrier screening
Genetic carrier testing for conditions like cystic fibrosis, spinal muscular atrophy, and fragile X syndrome may be offered at this visit — especially for first-time parents. 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 discuss prenatal vitamins, folic acid or folate, diet, alcohol, caffeine, smoking, and any chronic conditions that may need a pregnancy-specific plan. [4]
Most journeys start here — and that's it
For most people, this is the whole visit. You may leave with a prenatal vitamin recommendation, a clearer picture of your health, and next steps that fit your situation. 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 many people realize, and many have evaluation or treatment options. Understanding what might be going on can help you ask better questions and connect with the right care.
PCOS
A common cause of ovulatory infertility, affecting about 1 in 10 women of reproductive age. [6] PCOS can be associated with irregular or absent periods and excess androgens. Many people with PCOS conceive, sometimes with lifestyle changes, medication, or fertility support.
Thyroid disorders
Both hypothyroidism and hyperthyroidism can affect ovulation and pregnancy planning for some people. [7] Thyroid testing is commonly considered in fertility evaluation and thyroid conditions are often manageable once identified.
Blocked fallopian tubes
Can be associated with prior pelvic inflammatory disease, STIs, endometriosis, or prior surgery. A clinician may use an HSG or other imaging to evaluate whether tubes are open. Treatment options depend on the situation.
Endometriosis
Tissue similar to the uterine lining grows outside the uterus and can cause pain, inflammation, and scarring. It may affect fertility in some people and affects up to 10% of women. [6] It can go undiagnosed for years.
Diminished ovarian reserve
Fewer eggs remaining than expected for age. More common in women over 35, but it can affect younger women too. AMH and antral follicle count are commonly used to assess ovarian reserve. Lower reserve doesn't mean you can't conceive — it may affect timing and planning.
Unexplained infertility
When standard tests do not identify a clear cause but pregnancy has not occurred. Accounts for roughly 30% of infertility diagnoses. [8] "Unexplained" does not mean there are no options; your clinician can discuss next steps based on age, timing, and goals.
Recurrent pregnancy loss
Defined as two or more clinical miscarriages. Causes can include chromosomal abnormalities, uterine structural issues, clotting disorders, and hormonal factors. Ask your clinician whether evaluation is appropriate for your situation.
Weight and metabolic factors
Both underweight and overweight can disrupt hormonal balance and ovulation. For some people, weight or metabolic health changes may improve cycle regularity. [5] This is best discussed with a clinician in a supportive, nonjudgmental way.
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, relatively simple, and is often considered early in a fertility workup rather than as an afterthought. It's not a measure of masculinity or general health, and having information early can save time.
When to see a reproductive endocrinologist
A reproductive endocrinologist (RE) specializes in evaluating and treating infertility. Depending on your insurance and local clinic policies, you may be able to ask your OB for a referral or contact a fertility clinic directly.
Standard referral timing [3]
- Under 35 and trying for 12+ months without success
- 35–37 and trying for 6+ months
- 38 or older — earlier consultation is often recommended
- Two or more clinical 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 or upcoming chemotherapy/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
Some people leave their first RE appointment with a clear diagnosis; others leave with a working hypothesis and a plan for more testing. Either way, you have more information than before.
A personalized plan
Your RE may discuss a roadmap specific to your situation — ranging from lifestyle changes and timed intercourse to IUI or IVF. Plans can often be adjusted as new information comes in.
What fertility treatment looks like
Treatment is not one-size-fits-all. Your RE can recommend a path based on your diagnosis, age, goals, and preferences. Many people start with 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. For some people, this may be enough.
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 often less expensive than IVF. Success rates vary by age, diagnosis, medication use, sperm parameters, and clinic; some sources report rates around 7–10% per cycle unmedicated and higher with medication in selected groups. [10] Your clinician can discuss how many cycles make sense.
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. Success rates vary significantly by age — your RE will give you specific numbers for your situation.
Egg freezing (fertility preservation)
For women not ready to conceive now but wanting to preserve options. Often discussed earlier rather than later, especially before 35, because egg quantity and quality decline with age. It may also be discussed before certain cancer treatments or for some people with diminished ovarian reserve.
Surgical interventions
Laparoscopic surgery to remove endometriosis lesions or fibroids; hysteroscopy to correct uterine structural issues. Sometimes considered before IVF depending on the diagnosis and clinical situation.
Third-party reproduction
Includes donor eggs, donor sperm, donor embryos, or gestational surrogacy. Involves additional legal, psychological, and medical coordination — and for many people, becomes the path to the family they've been working toward.
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 in what they cover, which employers must comply, and whether IVF is included. Many large employers self-insure and are exempt from state mandates entirely. Consider calling your insurer before starting treatment and asking your clinic about financing options if you need them.
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 in a way that supports you, ask about a prenatal vitamin, book that OB appointment, and start tracking your cycle if it feels useful. One step at a time.
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 can make the path feel much less lonely.
Sources
- UCLA Health / NICHD. Approximately 85% of couples conceive within 12 months of trying. nichd.nih.gov
- RESOLVE / CDC NSFG. Infertility and Impaired Fecundity in Women and Men in the United States, 2015–2019. National Health Statistics Reports, 2024. 13.4% of women aged 15–49 (approximately 1 in 7) have impaired fecundity. cdc.gov
- American Society for Reproductive Medicine (ASRM). Definitions of infertility and recurrent pregnancy loss. Fertility and Sterility. Standard referral thresholds: 12 months under 35, 6 months at 35+. asrm.org
- ACOG. Preconception Care. Recommends 400–800mcg folic acid preconception; limiting caffeine to <200mg/day; avoiding alcohol when trying to conceive. acog.org
- Chavarro JE, Rich-Edwards JW, Rosner B, Willett WC. Diet and lifestyle in the prevention of ovulatory disorder infertility. Obstetrics & Gynecology. 2007;110(5):1050–1058. Mediterranean diet, moderate exercise, sleep, and environmental exposures in preconception health.
- CDC. PCOS and endometriosis prevalence data. PCOS affects approximately 6–12% of women of reproductive age; endometriosis affects approximately 10%. cdc.gov
- 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. Thyroid dysfunction and effects on ovulation and miscarriage risk.
- Practice Committee of the ASRM. Unexplained infertility: a committee opinion. Fertility and Sterility. 2020. Unexplained infertility accounts for approximately 30% of cases.
- NICHD. How common is male infertility? Male factor accounts for approximately one-third of infertility cases; combined factor for another third. nichd.nih.gov
- Fertility IQ / PMC. IUI mean pregnancy rate approximately 9% per cycle; with medication approximately 15–25%. pmc.ncbi.nlm.nih.gov
- MultiState / RESOLVE. As of 2025, 25 states and D.C. require some form of fertility care coverage; mandates vary significantly. resolve.org