10 things worth checking first, before you try to get pregnant
Thinking about trying for a baby?
It can be tempting to wait until you stop contraception, start trying, and then see what happens.
But your fertility journey doesn't have to begin with a positive pregnancy test.
The months before conception are an opportunity to look at your menstrual cycle, nutrition, health, lifestyle and reproductive function and address anything that may benefit from attention before pregnancy.
This is the basis of preconception care, preparing the body for pregnancy rather than waiting until pregnancy occurs to start thinking about health.
Australian health guidance recommends seeing your doctor around 3–6 months before trying to conceive, while organisations including the American College of Obstetricians and Gynecologists and the American Society for Reproductive Medicine recommend reviewing medical conditions, medications, nutrition, lifestyle and reproductive health before pregnancy.
Here are 10 things I would consider before trying to conceive.
1. Are you actually ovulating?
Having a monthly period doesn't necessarily tell you everything about what is happening hormonally.
Ovulation is the event that releases an egg and creates the fertile window. Without ovulation, natural conception cannot occur.
For some women, ovulation is relatively predictable. For others, it may be delayed, irregular or absent.
Things that can influence ovulation include:
PMOS (formerly PCOS)
significant weight changes
under-fuelling or excessive exercise
thyroid dysfunction
hyperprolactinaemia
perimenopause
some medications
significant physiological or psychological stress
This is where understanding your menstrual cycle becomes particularly valuable.
Rather than assuming that ovulation happens on day 14, fertility awareness can help you observe what your body is actually doing.
The fertile window isn't necessarily the same from cycle to cycle, even in women who describe their cycles as regular. Research from the American Society for Reproductive Medicine recognises cervical mucus monitoring and other fertility-awareness methods as useful ways of identifying the fertile window.
Ask yourself:
Do I know when I ovulate, or am I simply assuming/guessing?
2. Learn to recognise your cervical mucus
If you're trying to conceive naturally, cervical mucus deserves much more attention than it usually receives.
As oestrogen rises before ovulation, the cervix produces increasingly fertile mucus.
This mucus isn't simply a symptom of ovulation.
It plays an important role in sperm transport and survival.
Fertile cervical mucus creates an environment that allows sperm to move through the cervix and reproductive tract at the right time.
Research has found that changes in cervical mucus correlate closely with the fertile period, and cervical mucus monitoring can help identify the fertile window.
This is one of the reasons I teach the Billings Ovulation Method®.
The Billings Method teaches women to observe their naturally occurring cervical mucus and sensation throughout the cycle, rather than relying solely on predicted ovulation dates.
Your body is already giving you fertility information.
3. Don't assume a "regular cycle" means everything is optimal
A regular cycle can be reassuring, but cycle length alone doesn't tell us everything about reproductive health.
It's worth considering:
How long are your cycles?
Are they consistently regular?
Do you experience very heavy bleeding?
Do you have significant menstrual pain?
Do you have bleeding between periods?
Do you experience pain during sex?
Do you have significant premenstrual symptoms?
Are you noticing changes in cervical mucus?
Do you have a clear pattern of fertility and infertility?
Severe menstrual pain, very heavy bleeding, significant cycle changes or pain with sex deserve assessment rather than simply being dismissed as "normal".
Conditions such as endometriosis, adenomyosis, fibroids and PCOS can affect reproductive health, and identifying them before pregnancy may allow appropriate management and planning.
Preconception care is particularly important for women with existing conditions that can affect pregnancy, including thyroid disease, diabetes, PCOS and endometriosis.
4. Check your iron status - especially if you have heavy periods
Iron is one nutrient I pay particular attention to in women preparing for pregnancy.
Why?
Because pregnancy increases iron requirements, and women who begin pregnancy with depleted iron stores may have less reserve to meet those increased demands.
Heavy menstrual bleeding is also a common reason women become iron deficient.
And importantly:
You can have iron deficiency before you develop anaemia.
This is why looking only at haemoglobin may not tell the whole story.
Depending on your history, your healthcare practitioner may consider a full blood count plus iron studies, which can include ferritin and other markers.
This is particularly relevant if you:
have heavy periods
experience fatigue
follow a vegetarian or vegan diet
have previously had low iron
have a history of iron deficiency during pregnancy
have had an iron infusion
have gastrointestinal issues affecting absorption
Preconception guidance recommends reviewing nutritional status, including iron, as part of preparation for pregnancy.
5. Look at your thyroid before pregnancy
Thyroid hormones play an important role in reproductive function and pregnancy.
Thyroid dysfunction can affect menstrual cycles and ovulation, and thyroid disease has implications for pregnancy outcomes.
This doesn't mean every woman needs an extensive thyroid panel simply because she wants to conceive.
But thyroid assessment may be particularly relevant if you have:
irregular cycles
previous thyroid abnormalities
a personal or family history of thyroid disease
unexplained infertility
recurrent pregnancy loss
symptoms suggestive of thyroid dysfunction
autoimmune thyroid disease
Preconception guidance specifically recommends optimising thyroid disease before pregnancy.
6. Review your medications and supplements
This is one of the simplest, and most important preconception steps.
Don't assume that something is safe during pregnancy simply because it is:
natural
herbal
available over the counter
something you've taken for years
labelled as a "fertility" supplement.
Medications, herbal medicines and nutritional supplements should all be reviewed before conception because some may need to be stopped, changed or adjusted before pregnancy.
This is especially important if you're taking medications for:
acne
thyroid disease
mental health
blood pressure
pain
migraines
allergies
gastrointestinal conditions
autoimmune conditions
And if you're taking multiple supplements, check whether you're accidentally doubling up on nutrients.
More supplements does not automatically mean better fertility.
7. Start thinking about folate before you start trying
Folate is one of the few preconception nutrients for which supplementation has a very clear evidence base.
Folic acid taken before conception and during early pregnancy reduces the risk of neural tube defects such as spina bifida. Australian guidance recommends 400 micrograms of folic acid daily, beginning before conception and continuing through the first trimester for most women. Higher doses may be recommended for women with specific risk factors.
This is important because the neural tube develops very early in pregnancy, often before someone knows they are pregnant.
So don't wait for the positive test.
Ideally, preparation begins before conception.
8. Don't forget iodine and other key nutrients
Folate isn't the only nutrient to consider.
In Australia, the NHMRC recommends that women who are planning pregnancy, pregnant or breastfeeding take 150 micrograms of iodine daily. Iodine is important for thyroid hormone production and the developing baby's brain and nervous system.
However, there is an important caveat:
If you have a thyroid condition, speak with your doctor before taking an iodine supplement.
More isn't necessarily better, and excessive iodine intake can also affect thyroid function.
Depending on your individual diet and health history, other nutrients worth considering include:
iron
vitamin B12
folate
vitamin D
calcium
omega-3 fatty acids
zinc
choline
The goal isn't to take every supplement available.
It's to identify what you actually need.
9. Look at metabolic health, not just your weight
Fertility and metabolic health are closely connected.
This is particularly important for women with PCOS, insulin resistance or irregular ovulation.
Metabolic health can involve:
blood glucose regulation
insulin sensitivity
blood pressure
lipid profile
physical activity
sleep
nutrition
body composition
But this does not mean that fertility preparation should become a weight-loss project.
Women can be metabolically healthy or metabolically unhealthy at a range of body sizes.
The goal is to support physiological health, not to chase a particular number on the scales.
For women with PMOS/PCOS, addressing metabolic health may be particularly relevant because insulin resistance and androgen excess can contribute to ovulatory dysfunction.
10. Don't forget his fertility
This one deserves much more attention.When a couple is having difficulty conceiving, it is surprisingly common for the conversation to become centred almost entirely around the woman. But conception involves two reproductive systems.
Male factors contribute to a substantial proportion of infertility, either alone or alongside female factors.
So preconception preparation should be
"How can we support the reproductive health of both partners?"
For men, this can include considering:
semen analysis where indicated
smoking and recreational drug use
alcohol intake
medications
heat exposure
nutritional status
metabolic health
sleep
physical activity
occupational and environmental exposures
The ASRM notes that lifestyle and health factors in both men and women can be relevant to reproductive outcomes.
And then there's the lifestyle stuff...
You don't need to live in a bubble for six months before trying to conceive, but the basics do matter.
Sleep
Aim for consistent, restorative sleep where possible.
Exercise
Regular physical activity supports general and metabolic health.
Food
Focus on a varied diet containing plenty of vegetables, fruit, whole grains, legumes, nuts, seeds, protein sources and healthy fats.
There isn't one magical "fertility diet". ASRM notes that evidence for specific dietary patterns improving natural fertility in otherwise ovulatory women remains limited.
Alcohol, smoking and recreational drugs
These are worth addressing before conception. ASRM recommends discouraging smoking and recreational drug use and limiting alcohol while trying to conceive.
Environmental exposures
You don't need to become afraid of everything around you.
But reducing unnecessary exposure to known endocrine-disrupting chemicals where practical is a reasonable part of a broader healthy lifestyle. ASRM recommends that reproductive-aged men and women limit exposure to endocrine-disrupting chemicals where possible.
And finally: understand your fertile window
This is where all of the above comes together.
Knowing when you are fertile is one of the most useful pieces of information when trying to conceive naturally.
The fertile window is approximately the six days ending on ovulation, with the highest probability of conception generally occurring in the days immediately before ovulation.
The challenge is that ovulation doesn't necessarily happen on the same calendar day every month. That's why simply counting cycle days, or relying on an app's prediction, can be misleading. Fertility awareness methods can help you identify changes occurring in your body during your actual cycle.
Cervical mucus monitoring is one of the fertility-awareness approaches supported in the fertility literature, and research suggests that mucus changes can help identify the fertile window.
This is where the Billings Ovulation Method® can be particularly valuable.
It isn't about predicting your cycle, but observing your cycle.
So, what should you actually do?
You don't need to overhaul your entire life the moment you decide you might want a baby.
Instead, think about preconception preparation as a process.
3–6 months before trying:
Understand your cycle
Learn what your normal looks like.
Review your health history
Especially thyroid, PCOS, endometriosis, previous pregnancies and menstrual problems.
Check nutritional status where indicated
Particularly iron and other nutrients relevant to your individual history.
Review medications and supplements
Including herbal medicines.
Start taking folate
And discuss iodine and other pregnancy-specific nutrients.
Support metabolic health
Through nutrition, movement, sleep and sustainable lifestyle habits.
Consider your partner's health
Fertility is a shared responsibility.
Learn your fertile signs
Don't rely entirely on an app to tell you when you're fertile.
Fertility preparation doesn't have to be complicated
One of the biggest misconceptions about preconception care is that you need an enormous supplement regime, a restrictive diet and a perfectly optimised lifestyle.
You don't. The purpose of preconception care is to identify the things that are actually relevant to you. For one woman, that might be iron deficiency. For another, it might be irregular ovulation associated with PCOS.
For someone else, it might be thyroid management, coming off hormonal contraception, understanding cervical mucus or addressing significant menstrual pain.
And sometimes the most useful thing you can learn is simply:
What is my body doing each month?
Your menstrual cycle provides a window into your reproductive health.
Learning to observe it can help you understand your fertility rather than simply waiting for an app to predict it.
Preparing for pregnancy in Wollongong
As a fertility naturopath in Wollongong, I work with women who want to prepare for pregnancy naturally and understand their reproductive health more deeply.
This can include looking at preconception nutrition, menstrual cycle health, ovulation, PCOS, nutritional status and lifestyle, while working alongside your GP, obstetrician, fertility specialist or other healthcare providers where appropriate.
I also teach the Billings Ovulation Method®, a fertility awareness method that helps women recognise their naturally occurring fertility and infertility patterns through observation of cervical mucus and sensation.
Whether you're thinking about pregnancy in the next few months or simply want to understand your fertility before you're ready to conceive, you don't have to wait until you have a fertility problem to start learning about your reproductive health.
Your fertility journey can begin before the pregnancy test.
References
American College of Obstetricians and Gynecologists & American Society for Reproductive Medicine. Prepregnancy Counseling.
American Society for Reproductive Medicine. Optimizing Natural Fertility: A Committee Opinion.Fertility and Sterility, 2022.
Healthdirect Australia. Planning for your pregnancy.
NHMRC. Iodine Supplementation for Pregnant and Breastfeeding Women.
Healthdirect Australia. Folate.
Healthdirect Australia. Iodine and your health.
ACOG. Good Health Before Pregnancy: Prepregnancy Care.
