The months before conception shape the health of the pregnancy and the baby. Many couples visit a pharmacy long before they see a prescriber or fertility specialist, so every contact is a chance to prepare them. Aim to start these steps at least three months before trying.
In the pharmacy
Start now
- Folic acid 400 mcg daily for her, from at least one month before conception until 12 weeks of pregnancy, to lower the risk of neural tube defects such as spina bifida.
- Higher-dose folic acid (5 mg, on prescription) is needed if she has had a pregnancy affected by a neural tube defect or either partner has a family history of one, or she has diabetes, sickle cell disease or thalassaemia, coeliac disease or another absorption problem, takes antiepileptic medicines, or has a BMI of 30 or more. Use our folic acid dose checker, and refer her to a prescriber.
- Vitamin D, especially where sun exposure or diet is limited.
- For him: coenzyme Q10. Sperm take about three months to develop. In a placebo-controlled trial, coenzyme Q10 200 mg daily for 6 months raised CoQ10 and ubiquinol levels in semen and improved sperm motility. Recommend it for at least three to six months.
Lifestyle for both
- Stop smoking, alcohol and recreational drugs.
- Aim for a healthy weight: excess weight and very low weight both reduce fertility.
- Limit caffeine to 200 mg a day (about two mugs of instant coffee).
- For him: avoid anabolic steroids and testosterone, which switch off sperm production, and avoid prolonged heat around the testes (laptops on the lap, hot baths).
Check their medicines
Ask about every regular medicine. Some need changing before conception, for example sodium valproate and some other antiepileptics, isotretinoin, methotrexate, warfarin, ACE inhibitors and angiotensin receptor blockers, and statins. Advise her to see her prescriber before trying, and never to stop an epilepsy or mental health medicine without specialist advice.
Refer to a prescriber
- She needs higher-dose folic acid or a medicine review.
- Long-term conditions such as diabetes, high blood pressure, sickle cell disease or epilepsy.
- No pregnancy after 12 months of trying, or 6 months if she is 35 or over, or sooner with irregular periods, known PCOS/PMOS or endometriosis, or a known problem in him.
In the clinic
Assess her
- Blood pressure, weight, BMI and waist size.
- Blood sugar, particularly with PCOS/PMOS, a family history of diabetes or a previous large baby.
- Full blood count for anaemia, and treat iron deficiency.
- Sickle cell status of both partners, with genetic counselling where both carry a trait.
- HIV, hepatitis B and syphilis, and rubella immunity.
- Cycle regularity: irregular cycles may point to PCOS/PMOS, thyroid disease or high prolactin.
Review and adjust medicines
Switch or stop medicines that may harm a pregnancy, in discussion with specialists where needed, and plan control of long-term conditions such as diabetes and high blood pressure before conception. Prescribe folic acid 5 mg where indicated, continued throughout pregnancy for sickle cell disease or thalassaemia.
Refer to a fertility specialist
- No pregnancy after 12 months of regular unprotected sex, or after 6 months if she is 35 or over (American Society for Reproductive Medicine; NICE advises earlier referral from age 36).
- Earlier with irregular or absent periods, known PCOS/PMOS or endometriosis, previous pelvic infection, or a known male fertility problem or previous testicular surgery.
Key references
- World Health Organization. WHO recommendations on antenatal care for a positive pregnancy experience. 2016.
- National Institute for Health and Care Excellence (NICE). Fertility problems: assessment and treatment (CG156).
- NHS. Foods to avoid in pregnancy (caffeine). nhs.uk
- Balercia G, et al. Coenzyme Q10 treatment in infertile men with idiopathic asthenozoospermia: a placebo-controlled, double-blind randomized trial. Fertil Steril 2009;91(5):1785-1792.
Prepared by the Draxer Clinical Advisory Department for health professionals. It supports, and does not replace, clinical judgement and national guidelines.