When a woman decides to conceive, she begins her preparation to make her pregnancy and baby as healthy as possible. A preconception check-up give her the chance to make “an ounce of prevention (is) worth a pound of cure,”  while making Benjamin Franklin proud.

Consulting your OB/GYN before you get pregnant will help determine if there’s anything that could negatively impact you and your baby’s health. It will also give you a chance to correct these things to ensure a healthy pregnancy. Here are some important factors to note when going into a preconception check-up:

  • Diet and lifestyle
  • Medical and family history
  • Current medications
  • Reviewing the need for any vaccinations

Below are the most important health checks you should get before deciding to conceive, and answers to the most common FAQs that women and couples ask before starting to grow their family.

1. When is the best time during the menstrual cycle to conceive?

It is well established that the more a woman has intercourse before ovulation, the higher the chance for conception. This makes sense since more sex allows more sperm into the female reproductive tract. Ovulation occurs 1-2 days following detection by an ovulation prediction kit (OPK). We advise couples to have relations every day to every other day over the three days prior and up to the day of ovulation.

2. When should I start trying to get pregnant after stopping birth control pills or an IUD?

For your reassurance, neither the birth control pill (BCP) or IUD have negative effects on subsequent fertility. After stopping BCPs, a woman should wait for one normal menstrual cycle to ensure the resumption of regularity before attempting to conceive. In almost all women, menses and fertility should return to normal within 90 days of stopping birth control.

3. Am I getting too old to have a baby?

While men who don’t start making sperm until after puberty, women are born with all the eggs they’ll have their entire lives. Women are at the peak of their fertility in their 20s; after age 30 fertility starts a slow but steady decline. Under age 30 a woman’s monthly natural pregnancy rate is about 20%, declining to roughly 10% by age 35 then to 5% at age 40. As a woman ages, she has an increased risk of miscarriage from chromosomal abnormalities of the egg and embryo.

Men are not excused from the biological clock. Many studies have shown a man’s sperm production declines with age and fertility appears to wane after age 40. Men above age 45 have approximately 5 times as long to achieve a pregnancy compared with men less than 25 years of age as well as an increased risk of miscarriage, preterm birth, birth defects, and autism. Men older than 40-45 have a twice as likely risk of an autistic child and five times higher risk of a child with schizophrenia.

4. How can I make sure my diet is healthy?

While no particular food impacts fertility, the consequences of eating too much or too little can certainly weaken the ability to get pregnant.

In the U.S., nearly 50% of women are overweight. Infertility can be contributed by women being either overweight or underweight. Having an unhealthy weight can reduce fertility by twenty-five percent. Women with a low body mass index (BMI) can experience ovulation dysfunction often associated with the very common (but not yet well-known) female athlete triad.

The female athlete triad is a potentially life-threatening disorder from an energy deficit – expending more energy than you are replacing with calories. The “triad” often includes eating disorders (but not always), bone loss, and amenorrhea (lack of menstrual periods).

With a high BMI, women are at higher risk for pregnancy complications such as:

  • Miscarriage
  • Gestational diabetes and hypertension
  • Preeclampsia
  • Preterm delivery
  • Stillbirth
  • Cesarean or instrumental delivery
  • Shoulder dystocia
  • Fetal distress and early neonatal death
  • Small-for-gestational-age (as well as large-for-gestational-age) infants

In men, obesity results in a hormonal disturbance that causes decreased testosterone and sperm counts. The Journal of the American Medical Association indicated that nearly 40% of U.S. adults were obese in 2015 and 2016, representing a sharp increase from a decade earlier. The Mediterranean diet has been shown to increase success with IVF and was selected as the healthiest overall diet by the US News & World Report.

5. What vitamins and minerals should I take before trying to get pregnant?

The American College of Obstetricians and Gynecologists (ACOG) recommends taking 0.4 mg of folic acid several months before trying to conceive and to continue taking it throughout the pregnancy. Folic acid has been shown to reduce the risk of spina bifida which are birth defects that occurs when the spine and spinal cord don’t form properly.

Vitamins and minerals play important roles in all body functions. In addition to folic acid, pregnant women need about double the amount of iron than non-pregnant women. Iron helps them make more blood to carry oxygen to the baby. The daily iron requirement (27 mg) is provided in most prenatal vitamins which contain all the vitamins and minerals needed during pregnancy. Iron-rich foods include:

  • Lean red meat
  • Poultry
  • Fish
  • Dried beans and peas
  • Iron-fortified cereals
  • Prune juice

Calcium is also needed during pregnancy to build the baby’s bones and teeth. All women over nineteen, pregnant or not, should receive 1,000 mg of calcium daily. Good sources of calcium include milk and other dairy products such as cheese and yogurt. For women who cannot tolerate milk, other calcium sources include broccoli, dark leafy greens, sardines, or a calcium supplement.

Vitamin D works with calcium to help the baby’s bones and teeth develop. It also promotes healthy skin and eyesight. It is recommended for all women to take 600 international units of vitamin D3 per day. Good sources of vitamin D are milk fortified with vitamin D and fatty fish such as salmon. Sunlight exposure is also a source of vitamin D.

6. Can my lifestyle affect my pregnancy?

Three factors that can directly affect reproductive and pregnancy health are tobacco use, body weight, and alcohol use. Smoking, drinking alcohol, and using drugs during pregnancy can have harmful effects on a baby while inside her mom. Alcohol use by women can reduce fertility and, if consumed during pregnancy, alcohol can cause mental retardation of the baby, otherwise known as fetal alcohol syndrome.

Tobacco use has been shown to increase the risk of miscarriage, ectopic pregnancy (a life-threatening condition where the pregnancy implants outside the uterine cavity, usually in the fallopian tube), and genetic alterations of the sperm. During pregnancy, tobacco use increases the risk of fetal low birth weight and congenital disabilities.

Approximately one-third of all men and women in the U.S. smoke cigarettes. Smoking even half a pack of cigarettes per day causes a 40% to 60% increase in infertility. Smoking (even second-hand smoke) also accelerates the loss of eggs and results in higher rates of miscarriages, ectopic pregnancies, an earlier onset of menopause, and possible genetic damage to eggs and sperm. In male smokers, sperm counts are reduced by an average of 22% and sperm fertilization potential is decreased.

7. Do I have any restrictions on activity?

To optimize your fertility and pregnancy health, we recommend mild to moderate exercise. The American Heart Association advises at least 30 minutes of aerobic exercise five days per week. During pregnancy, the Centers for Disease Control and Prevention (CDC) recommend women maintain the same degree of exercise as long as there is no medical restrictions.

8. Can existing medical conditions affect my pregnancy?

Unstable medical conditions—such as diabetes mellitus, high blood pressure, depression, and seizure disorders—can cause problems during pregnancy. Therefore, attempts at conception should be deferred until your health is optimal and your doctor considers it safe for you to conceive and carry a baby..

Uncontrolled medical conditions can result in significant harm to you and your baby. Some medications used to treat a disease can also risk harm to your baby. Medications falling in categories A and B are the safest while C and D progressively increase risk to the baby. Category X medications are contraindicated in pregnancy.

9. Can I prevent infections?

Vaccinations can prevent some infections. However, some vaccines are not safe to use during pregnancy. It is important to know which vaccines you may need and to get them before becoming pregnant.

  • The following vaccines are safe to be given during pregnancy – Tdap (tetanus, diphtheria, and pertussis), influenza (inactivated)
  • The following vaccines should be avoided in pregnancy – MMR (measles, mumps and rubella), varicella (for chicken pox), influenza (live attenuated)
  • The following antibody levels should be checked before pregnancy for vaccination as needed: rubella and varicella

If a pregnant woman acquires rubella (the German measles), the baby is at risk of congenital rubella syndrome with risks including miscarriage, stillbirth, mental retardation, and deafness. Varicella during pregnancy risks life-threatening pneumonia for the mother. If varicella is acquired within the week of delivery, then the baby is at risk for a rare condition known as neonatal varicella syndrome that comes with potentially life-threatening complications.

10. Why is it important for my partner and me to share our family health histories with our health care professional?

Know your genes!

Some health conditions occur more often in certain families or ethnic groups. These conditions are called genetic or inherited disorders. If a close relative has a specific illness, you or your baby could be at higher risk of having it. ACOG recommends certain diseases be tested in the both of the couple trying to have a baby, although hundreds of genetic mutations can be tested in commercial labs.

If the couple are carriers of the same genetic mutation, they typically have no symptoms but the baby has a 25% risk of inheriting the both gene mutations that will result in the full disease – sometimes life-threatening. With the use of in-vitro fertilization (IVF), embryos also can be screened for a specific genetic disease that both members of a couple are known to carry.  Alternatively, screening can be performed early on in pregnancy.

ACOG recommends providing all women with information on genetic carrier screening before becoming pregnant.

11. Should I conceive if my partner or I have been exposed to the Zika virus?

Infection of the Zika virus occurs through a mosquito bite. The virus can be passed between a man and a woman through sexual transmission then from the woman to her baby during pregnancy and can result in serious fetal brain birth defects, especially if caught in the first trimester. If a woman or man travels to a Zika endemic area, the CDC recommends deferring pregnancy for two months for the woman and three months for the man to reduce the risk of infection for the fetus.