Before You Try: Preconception Care
If you're reading this, you're most likely ready to have a baby, or maybe you've been trying for a while. You may be feeling a roller coaster of emotions; it's an exciting time! But before you jump off that cliff, consider slowing down for a short period of time for preconception care to give yourself the best chance of conceiving, having a healthy pregnancy, and a healthy baby.
What is preconception care?
Preconception care is 3-6 months of intentionally taking extra good care of yourself, while also doing some light investigation to see if anything could be impeding your chances of a healthy pregnancy and addressing the issues beforehand.
The timing matters, because the egg you ovulate this month didn't start developing this month; it went through a year-long process. The final stretch of that journey is roughly 90 days, and during those last three months, your ovarian follicle relies heavily on your metabolic health and nutritional status and is sensitive to your stress and environment.
The same logic applies to your partner, and on a similar clock. More on that below.
What are some things you can do for preconception care?
Below you will find some smart places to start:
Fill your nutrient gaps
Lower your toxin load
Track your cycles
Bring your partner in
Tend your microbiome
Get to the dentist
Check your thyroid (if necessary)
Learn how all of it shapes gene expression in your future child
None of this requires perfection. It requires a head start.
First, tell your doctor you're trying
Book a visit and tell your doc, and tell them, "I'm planning to get pregnant in the next several months." He or she should be impressed by your thoughtfulness for seeing them ahead of time.
They should also check your immunizations and prescriptions, offer genetic screening, check for STIs, perform a cervical screening, and obtain baseline lab work.
Some medications aren't safe in pregnancy and need to be switched out, and switching takes time. Please don't stop anything on your own, though. For a lot of conditions, going untreated is riskier for you and your baby than the medication ever was. These decisions should be made carefully with your prescribing physician.
Fill your nutrient gaps
You want to support your nutritional status before you start trying. There are strong links between your health before your pregnancy and the future health of your pregnancy and of your child. Waiting to supplement with a prenatal once you're pregnant is often a "too little, too late" scenario to make those improvements.
There's another practical reason too. The first trimester is when eating well gets harder. Many women become averse to vegetables and animal protein exactly when they need them most, and some struggle to eat much of anything through the nausea. If your stores are already full, that stretch is far less costly.
And here's something most people don't know. In the first few weeks after conception, before the placenta has even formed, your embryo is fed by your endometrium and the yolk sac. Whatever you built up beforehand is literally what your baby is living on.
Take vitamin D as an example. Women who go into fertility treatment with sufficient vitamin D tend to have better pregnancy and live birth rates than women who are deficient. Low vitamin D is also linked to a higher risk of bacterial vaginosis in pregnancy, which matters because bacterial vaginosis is associated with preterm birth.
What can you do now?
Build most of your meals around real, nutrient-dense food. Well-sourced animal protein like organic chicken, low-mercury fish, pastured eggs, and grass-fed beef, plus bone broth and liver if you can stomach them.
Eat lots of colorful vegetables and berries.
Start a good prenatal now, not when you get a positive test. Look for methylated folate, B6, B12, choline, zinc, iodine, and iron on the label.
Think about adding vitamin D and a quality fish oil (ideally, check your Vitamin D levels with your doctor).
See my prenatal recommendations and get 10% off your prenatal supplements here.
I earn a small commission if you purchase through this link, at no extra cost to you.
Lower your toxin load
This one can feel overwhelming, so let's make it concrete.
The American College of Obstetricians and Gynecologists takes this seriously enough that they tell doctors to ask about environmental exposures at your prepregnancy visit. Environmental toxins are linked to infertility and miscarriage, to preterm birth and low birth weight, and to neurodevelopmental issues like ADHD and autism. We still don’t understand everything; more research is needed, and I think that's worth holding onto so you don't spiral about this.
You can't control everything. You can control quite a bit:
Reduce plastics. Store and heat in glass instead. Heating food in plastic can increase your exposure to compounds that disrupt hormones.
Read your personal care labels. Skip phthalates, parabens, oxybenzone, and triclosan. Choose "fragrance-free" over "unscented," because unscented products often contain multiple scents mixed to cancel each other out, still bound up with phthalates.
Skip the high-mercury fish. Shark, swordfish, king mackerel, and tilefish. Eat a variety of other kinds instead.
Wash your produce, and cook at home when you can. Fast food is associated with higher phthalate exposure.
Look at your water and your workplace. Check local advisories. Some jobs carry more exposure than others, including agriculture, manufacturing, dry cleaning, cleaning services, salons, and healthcare.
A word about the word "detox."
Reducing what comes in is well supported. Actively "detoxing" with protocols, supplements, or cleanses is a different claim, and I want to be straight with you: there isn't good human evidence that it improves fertility outcomes. What I can tell you is that the boring basics genuinely help your body detox. Daily bowel movements. Enough fiber. Enough protein. Breaking a sweat regularly.
If you do want to work with someone on something more targeted, do it in the months before you start trying. Not while you're trying, and not while you're pregnant.
Track your cycles
Your cycle tells you so much about your health and fertility. Most of us were never taught to listen. East Asian medicine has always read the cycle and the period closely as important diagnostic information.
Start with the basics. How long is your cycle? Are you ovulating, and roughly when? Cervical mucus changes, basal body temperature, and ovulation strips will all help you answer that. If you're coming off hormonal birth control, give yourself a few cycles to see your own pattern before you draw any conclusions from it.
Then pay attention to your period itself. Heavy bleeding, dark or clotted flow, and very bright red blood are read as signs of inflammation or a lining that could use some support. Very light or pale bleeding is read as pointing toward depletion. Diet changes, castor oil packs, acupuncture, abdominal massage, and herbal medicine are the usual tools, and which one fits depends entirely on what your bleeding is telling you.
For the next two or three cycles, write down:
How many days you bleed
What products you use and how often you change them
The color of the blood
Whether you see clots, and roughly how big
Whether you have pain, and whether it comes before, during, or after
Then bring those notes to whoever you're working with. They're more useful than you could imagine.
Bring your partner in
Here's the part that usually gets left out entirely.
Male factor is involved in roughly half of infertility cases, and it's the sole cause in something like 20 to 30 percent. And yet preconception care is almost always framed as a woman's project, something she does alone while he waits.
His clock is nearly the same as yours. Sperm takes about 74 days to make, plus a couple more weeks to mature and travel. Which means the sperm that could conceive your baby three months from now is being made right now, and it's responsive to what he eats, how much he drinks, how hot he gets, whether he smokes, and what he's exposed to during that whole window.
This isn't only about whether you get pregnant, either. Men whose partners have had recurrent pregnancy loss tend to have higher rates of sperm DNA fragmentation than men whose partners haven't, and sperm DNA damage has been linked to roughly double the risk of miscarriage.
What he can do in the same three to six months:
Cut back on alcohol, and quit smoking or vaping
Eat a diet rich in antioxidants
Keep the heat down. Laptop off the lap, and give the sauna and hot tub a rest for now
Make the same product and food swaps you're making
Get a semen analysis if you've been trying a while, rather than assuming the problem is on your side
When this becomes something you're doing together, it gets a lot easier to sustain, and a lot less lonely.
Tend your microbiome
Your microbiome is the enormous community of microorganisms living in and on you. They help train your immune system, produce certain vitamins, and keep inflammation in check.
When most people hear "microbiome," they think gut. But you also have a distinct community in your vagina and your uterus. A vaginal environment dominated by lactobacilli is generally the healthier setup, and when that community gets disrupted, it's associated with reproductive and pregnancy complications.
There's no such thing as a perfect microbiome. Yours is yours. The goal is plenty of the helpful species and not much of the disruptive ones.
How to help it along:
Eat fiber daily. Aim for 20- 30 g per day from a variety of sources.
Add fermented foods and prebiotic-rich foods.
Cut back on what feeds the unhelpful populations: added sugar, refined carbs, alcohol.
If you think you might have a vaginal infection, treat it properly instead of waiting it out.
Breathable cotton underwear, and please skip anything marketed for internal "cleaning."
Get to the dentist
This one surprises almost everybody.
Your mouth has its own microbial community, and gum disease is associated with pregnancy complications. A 2022 review of 30 studies found that periodontitis was significantly associated with the risk of preeclampsia. The likely explanation is that chronic gum infection creates inflammation that doesn't stay in your mouth.
While more research in this area is needed to understand the association, we do know that healthy gums are good for you.
Oral bacteria increase significantly in early pregnancy, and neither early nor late pregnancy is a great window for dental work. So get checked before you start trying.
In the meantime: brush, floss, eat well, and keep working on that gut from the last section. It’s all connected.
Check your thyroid (if necessary)
Thyroid dysfunction is linked to trouble conceiving, miscarriage, and to problems in pregnancy and fetal development. Thyroid function can take months to shift, which is exactly why you’d want to know early.
Underactive signs include fatigue, weight gain, feeling cold or having cold hands and feet, dry skin, thinning at the outer edge of your eyebrows, constipation, and brain fog.
Overactive signs are anxiety, irritability, shakiness, insomnia, and skipped periods.
If you have symptoms, ask for the fuller panel: TSH, free T4, free T3, TPO antibodies, and thyroglobulin antibodies.
Learn how all of it shapes gene expression in your future child
This is the part I find most motivating. The idea is this. Your habits may influence more than your ability to get pregnant and how your pregnancy goes. They may influence which of your genes get switched on and off, and how that pattern gets passed down. That's epigenetics.
The science is emerging, but everything the epigenetics research points to is stuff that's worth doing regardless. The vegetables, the walk, the sleep, the work you put into managing your stress. None of it is only about you, and none of it is only about the next nine months. Hopefully your future generations will benefit from all your efforts.
Where to start
If this feels like a long list, pick these four and let the rest follow:
Start a good prenatal today
Start tracking your cycle
Have the conversation with your partner about the shared timeline
Book a dental check and see your GYN or primary care doctor for a prenatal check
When to get help
It can feel like a lot to do on your own, and there is a lot of information out there to navigate.
That's exactly why I built the Root Care Fertility Coaching Program. It takes about 3-4 months to complete; it’s 1:1 with me, and it matches and works with your biology.
References
Morphology and Physiology of the Ovary. Endotext, NCBI Bookshelf (NBK278951). Folliculogenesis requires close to a year from primordial follicle to ovulation; the final gonadotropin-dependent phase is much faster. Gougeon's classic estimate is that pre-antral follicles require about 85 days to reach ovulation.
Stephenson J, Heslehurst N, Hall J, et al. Before the beginning: nutrition and lifestyle in the preconception period and its importance for future health. Lancet. 2018;391(10132):1830-1841.
Chu J, Gallos I, Tobias A, et al. Vitamin D and assisted reproductive treatment outcome: a systematic review and meta-analysis. Hum Reprod. 2018;33(1):65-80.
Ma L, Zhang Z, Li L, Zhang L, Lin Z, Qin H. Vitamin D deficiency increases the risk of bacterial vaginosis during pregnancy: evidence from a meta-analysis based on observational studies. Front Nutr. 2022;9:1016592.
American College of Obstetricians and Gynecologists. Reducing Prenatal Exposure to Toxic Environmental Agents. Committee Opinion No. 832. July 2021.
Agarwal A, Mulgund A, Hamada A, Chyatte MR. A unique view on male infertility around the globe. Reprod Biol Endocrinol. 2015;13:37.
Amann RP. The cycle of the seminiferous epithelium in humans: a need to revisit? J Androl. 2008;29(5):469-487. Recommends citing ~74 days, attributed to Heller and Clermont (1964).
McQueen DB, Zhang J, Robins JC. Sperm DNA fragmentation and recurrent pregnancy loss: a systematic review and meta-analysis. Fertil Steril. 2019;112(1):54-60.
Robinson L, Gallos ID, Conner SJ, et al. The effect of sperm DNA fragmentation on miscarriage rates: a systematic review and meta-analysis. Hum Reprod. 2012;27(10):2908-2917.
The Microbiome. Harvard T.H. Chan School of Public Health, The Nutrition Source.
Younes JA, Lievens E, Hummelen R, van der Westen R, Reid G, Petrova MI. Women and Their Microbes: The Unexpected Friendship. Trends Microbiol. 2018;26(1):16-32.
Periodontitis and Preeclampsia in Pregnancy: A Systematic Review and Meta-Analysis. 2022. [VERIFY author list and journal before publishing.] Thirty studies; periodontitis associated with increased preeclampsia risk, OR 3.18 (95% CI 2.26-4.48).
Sgolastra F, et al. Periodontitis and preeclampsia meta-analysis, 2013. See also Wei BJ, et al. Periodontal Disease and Risk of Preeclampsia: A Meta-Analysis of Observational Studies. PLoS One. 2013;8(8):e70901.
Fujiwara N, Tsuruda K, Iwamoto Y, et al. Significant increase of oral bacteria in the early pregnancy period in Japanese women. J Investig Clin Dent. 2017;8(1).
Practice Committee of the American Society for Reproductive Medicine. Subclinical hypothyroidism in the infertile female population: a guideline (2024). Fertil Steril.
