An OB-GYN's guide to your preconception appointment
LAST UPDATED: Aug 31, 2020
10 MIN READ
HERE'S WHAT WE'LL COVER
While you may have heard about the several appointments you'll need during pregnancy, there's a very important visit that comes before even trying to conceive: the preconception appointment. The thing is, as useful as these appointments can be, they’re not often suggested by many healthcare providers — and not all patients know to request them.
I believe the preconception appointment is an excellent way to set yourself up for the healthiest pregnancy possible. That’s why I’ve put together this guide for the appointment, including what exactly the appointment is, what you can expect to talk about, and the questions I recommend asking your healthcare provider.
What’s a preconception appointment?
A preconception appointment is a visit with your healthcare provider (either a general practitioner, OB-GYN, or midwife) where you can get all kinds of questions answered about fertility, getting pregnant, the early parts of pregnancy, and anything you need to know based on your medical history. This appointment ensures you’re getting medically accurate information right from a trustworthy source — plus, you’ll have the opportunity to talk through anything you need more insight into or don’t quite understand.
Before we dive in, a quick note: Not every healthcare provider will cover the exact same things in a preconception appointment. If any of these topics aren’t brought up, feel free to ask questions about anything you’d like to learn more about.
What can you expect to talk about in a preconception appointment?
A preconception appointment will most likely cover everything you need to know before trying for kids, as well as anything in your family or medical history that might make conception more difficult or potentially cause any issues during pregnancy. If you haven’t already gotten a Pap smear at a recent physical exam, you’ll sometimes have the opportunity to do that in this appointment.
Here’s a brief overview of what you might discuss:
Your plans for kids
When it makes sense for you to go off birth control (if you’re on it)
How your birth control might impact ovulation (and for how long)
Your medical, surgical, and family health history (including medications)
Alcohol consumption and smoking (and their effects)
How your body-fat percentage could affect conception
Pre-pregnancy tests and vaccinations
Prenatal vitamin recommendations
How to actually start trying to conceive
Below, I’ll walk you through the specifics of each of these discussion topics and give you a quick list of questions you can bring to your appointment.
Your plans for kids (and when to go off birth control)
When you show up for your appointment, you’ll have the chance to talk with your healthcare provider about when you’d ideally like to conceive, how many kids you’d like to have, and how you’d like to conceive (i.e., using your eggs, uterus, your partner’s sperm, donor sperm, donor eggs, donor uterus, gestational carrier, etc.).
Depending on your answers, your healthcare provider can give you insight into when you might want to start trying to get pregnant (if you want a lot of kids, they might suggest you start earlier) and what plans you need to set in motion now. A big part of those plans, of course, is going off birth control if you’re on it.
You and your healthcare provider will go over any contraceptives you’ve been using and their potential effects on your cycle and fertility. To give you an idea of time-to-pregnancy after different types of birth control, here’s the percentage of people who got pregnant 12 months after stopping the following methods (according to one 2018 meta-analysis of 22 studies involving ex-contraceptive users ranging in age from late teens to early 40s):
74.7% of ex-implant users
77.74% of ex-injection users
87.04% of ex-oral contraceptive users
84.75% of ex-IUD users (no difference based on type of IUD)
If you’re on Depo-Provera (the birth control shot), your healthcare provider may recommend you stop the shots earlier than you would other types of birth control — that’s because Depo can affect ovulation for up to 22 months after stopping.
If you’re on hormonal birth control to manage the symptoms of health conditions like polycystic ovary syndrome (PCOS), endometriosis, uterine fibroids, or premenstrual dysphoric disorder (PMDD), you can talk with your doctor about alternative non-hormonal options (like over-the-counter pain medications).
Questions to ask:
Based on your plans for kids, when would your healthcare provider recommend going off birth control?
Can you expect a quick return to regular ovulation and cycles after going off your specific birth control method?
If you’re using hormonal birth control to manage symptoms, what can you take instead that won’t prevent pregnancy or impact conception?
Your medical, surgical, and family health history
Come to your appointment prepared to fill out a detailed intake form. This means writing down any medications you take and their doses, and talking to your family about their health history.
Your healthcare provider will likely ask detailed questions about your medical, surgical, and family history — and go over any medical conditions that might impact pregnancy or be impacted by pregnancy (i.e., thyroid conditions, polycystic ovary syndrome, high blood pressure, diabetes). They might also recommend testing for genetic conditions if your family history calls for it, and talk about any conditions that need to be treated (medically or surgically) before trying to conceive. (For example: The optimal thyroid-stimulating hormone, or TSH, level is 2.5 if you’re trying to get pregnant. If you've had thyroid issues in the past, you can talk to your healthcare provider about testing your TSH.)
If you have a history of irregular cycles, be sure to mention that to your healthcare provider. They can give you blood tests to measure your fertility hormones and see if there are any imbalances or other issues that might be causing the irregularity. Since those tests typically need to be done on day 3 of your cycle for the most accurate results, if you aren’t regularly ovulating or getting a period, your healthcare provider might trigger your period with progesterone and count that as bleeding as day 1. Preconception appointments become all the more important if your cycle is irregular because they can help you figure out what’s going on and determine the best steps to take for conception.
If you’ve given birth through cesarean section (aka C-section) in the past, this appointment is also a good time to talk to your healthcare provider about your delivery options. You can have a vaginal birth after C-section (or VBAC) or repeat C-section, but some hospitals and clinics don’t offer VBAC as an option. Why? An OB-GYN needs to be on-site 24/7 in case the birthing person experiences the very rare (only a 1% chance) but life-threatening complication of uterine rupture (tearing of the uterus) — and some hospitals and clinics don’t have a large enough staff to ensure that can happen. If you’re interested in a VBAC, you can check with your healthcare provider to see if that’s an option with your current care team.
Questions to ask:
Do any of the conditions in your personal or family health history indicate any testing needs before trying to conceive?
Does your cycle history indicate any testing needs before trying to conceive?
Could any of the conditions in your personal or family health history cause issues for conception or pregnancy? If so, what can you do to manage those issues?
Does your healthcare provider recommend any genetic testing before trying to conceive?
If you have a partner, does your healthcare provider recommend they go through any testing?
If you’ve given birth through C-section before and are interested in VBAC, is VBAC an option with your current care team?
Any medications you’re currently taking
Some of the medications you’re taking right now will be fine to continue taking if you get pregnant, but some will have to be stopped during pregnancy. Retin-A (an acne medication), many cholesterol medications, some psychiatric medications (like lithium), and ibuprofen are all examples of what cannot be taken during pregnancy. Talk to your healthcare provider about the ones you use regularly — they can work with you to find alternatives that won’t impact pregnancy.
Questions to ask:
Are any of your regular medications potentially harmful if you were to get pregnant?
If so, are there safer alternatives?
If you go off any medications while trying to get pregnant or while pregnant, when would it be safe to get back on them after giving birth?
Lifestyle changes or adjustments
Your healthcare provider will talk to you about modifications you can make to increase your chances of conception, like moderating alcohol and coffee consumption or quitting smoking.
The research is mixed around drinking alcohol while trying to get pregnant — many studies show that having 1-2 drinks a day won’t affect fertility, while some show that this level of moderate drinking can be harmful. That said, if you get pregnant, ACOG says no to drinking any amount of alcohol.
If you’re a heavy caffeine drinker, your healthcare provider might recommend cutting back to 1-2 cups of coffee a day.
When it comes to smoking, the science is pretty clear: Smoking cigarettes adversely affects fertility in both people with ovaries and people with sperm. That said, quitting can make a huge difference — and pretty quickly. In just three months after quitting, positive changes can be observed in egg quality.
Questions to ask:
How could your current alcohol or caffeine consumption level impact conception?
If you have a partner, does your healthcare provider recommend they evaluate alcohol consumption, too?
If you smoke, does your healthcare provider have recommendations for quitting?
Your weight and conception
People of all weights and sizes have gotten pregnant and gone on to have healthy pregnancies. That said, big weight fluctuations in either direction can affect your hormones and make getting pregnant more difficult — additionally, lower or higher body-fat percentages could also have an impact.
Your healthcare provider will likely discuss your weight and how it might play a role in your chances of conception or your pregnancy. They may also discuss how much weight gained during pregnancy can be expected based on your current weight. It’s important to remember, though, that all bodies are totally unique — your healthcare provider is here to answer your questions and give advice based on the data around other people’s experiences.
Questions to ask:
How might your body-fat percentage impact conception and pregnancy?
If you’re getting regular periods, are there other ways your body-fat percentage might affect things?
If you’re not getting regular periods, what’s the minimum weight gain or loss that could potentially restore regular cycles? Are there any other possible causes for the irregular periods?
Tests and vaccinations
Some sexually transmitted infections (STIs) can impact fertility, so it’s important to talk with your healthcare provider about making sure you’ve been recently tested — the same goes for your partner if you have one. (You will likely also have the chance to do STI testing in early pregnancy.)
In terms of vaccines, there are two you can’t get while pregnant: the varicella vaccine to prevent chickenpox and the measles, mumps, and rubella (MMR) vaccine. If you’re not already immune to these illnesses, your healthcare provider might recommend getting these vaccines prior to conceiving.
Questions to ask:
What STI tests or vaccines does your healthcare provider recommend before pregnancy?
Are there any vaccines that might need to be administered again before pregnancy because past immunity might have worn off?
When to start taking prenatal vitamins (and which ones to take)
At your preconception visit, your healthcare provider will likely recommend taking a prenatal vitamin. The American College of Obstetricians and Gynecologists (ACOG) has official guidelines for all reproductive-aged people with ovaries to take prenatal vitamins with 400 micrograms of folate to support fetal neural tube (brain and spine) development.*
Questions to ask:
Does your healthcare provider recommend any particular brand of prenatal vitamins?
Does your healthcare provider recommend any nutrients other than folate or folic acid?
Does anything in your medical history indicate you might need higher levels of any nutrients?
How to start trying to conceive
Your healthcare provider might have specific recommendations for the best ways to increase your chances of overlapping sex (with a partner who has a penis) with the time of your cycle when you’re the most fertile: the five days leading up to and the day of ovulation (when the ovary releases an egg for fertilization).
Depending on your healthcare provider, they might mention tracking ovulation to identify your fertile window. You can do this by monitoring ovulation test results, cervical mucus, or basal body temperature (BBT). You can absolutely ask for your healthcare provider to walk you through each of these methods, but here’s a refresher in case you’re curious now:
Ovulation tests detect luteinizing hormone (LH) in your urine, which surges about 24-48 hours before ovulation. Other than an ultrasound, ovulation tests are one of the most accurate ovulation predictors because they rely on the biological factors (read: hormones) that are directly involved in the egg’s release.
Cervical mucus tracking involves looking at the changes in the fluid produced by your cervix to pinpoint where you are in your menstrual cycle.
BBT tracking uses your basal body temperature (your body’s temp at rest) to identify natural changes that indicate ovulation has occurred. Note that BBT is affected by a whole host of factors, making body temperature alone not a super accurate marker of ovulation.
Once you’ve identified your fertile window, your healthcare provider will likely recommend timing sex around those six days to improve the odds of sperm meeting egg at the right time. Talk to them about the exact number of times they suggest having sex during that period (every other day is a common rec).
If you’re considering or planning on using a fertility treatment, you can discuss the options with your healthcare provider (intrauterine insemination, or IUI, versus in-vitro fertilization, or IVF, versus at-home insemination). Your healthcare provider might have a recommendation for a local fertility clinic or have insight into any clinics you’re already considering.
Regardless of how you’re planning to conceive (with or without a fertility treatment), you can discuss your chances of conception each month of trying with your healthcare provider. Here’s what the data says: According to the American Society for Reproductive Medicine (ASRM), most 30-year-olds have a 20% chance of conceiving each month — and most 40-year-olds have a <5% chance of conceiving each month. Your chances could be impacted by a number of individual factors, so be sure to chat with your healthcare provider about what you might expect.
Your healthcare provider will typically suggest coming back in if you’re under 35 and haven’t gotten pregnant after a year of trying, or if you’re over 35, after six months of trying. If you experience two consecutive miscarriages or chemical pregnancies, that would also be a time to check in.
Questions to ask:
Does your healthcare provider recommend one way to track ovulation over another?
How often does your healthcare provider recommend having sex and over what period of time?
What does your healthcare provider believe your unique chances of conception per month are, based on the data?
Does your healthcare provider have any specific recommendations for when to check back in after trying to conceive for a certain period of time?
If you’re considering or planning on using a fertility treatment, does your healthcare provider have recommendations for fertility clinics or fertility specialists?
Can your healthcare provider walk you through the latest research around COVID-19 and pregnancy — and how the pandemic might impact your experience? (Modern Fertility also regularly updates this article.)
Can preconception counseling be part of your annual exam?
Traditionally, your annual physical exam includes a breast exam, pelvic exam, and Pap smear if you need it. A lot of the time, as you prepare for this annual visit, you might be thinking of specific health problems that have come up throughout that year. Theoretically, if a healthcare provider has the time, they can answer all of your questions about getting pregnant during that annual visit. But because of the exams that need to be conducted and the other topics or issues you might need to discuss, there often isn’t enough time to do it all.
Billing is also a factor. Under the Affordable Care Act, annual visits are totally covered. But any visits that specifically pertain to fertility would likely be medically coded differently and involve a copay or out-of-pocket costs — potentially complicating things if you want to combine an annual visit with a preconception visit.
The one good thing about COVID-19 is the healthcare system can now handle more telemedicine appointments. While you will have to go in for your annual visit so you can have the in-person exams I mentioned earlier, the preconception appointment can absolutely be done by video. You can bring up your interest in preconception care at your annual visit and schedule some follow-up time via video.
* This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.
If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.