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Your Preconception Checklist: 7 Things You Should Be Doing, According to an OB/GYN

Dec. 7, 2021 - Eden McCleskey

Some people have always known they wanted to become parents. Others may have found themselves caught off-guard by a sudden interest in babies and all things cute and small. Either way, when you know, you know. Assuming your stars, circumstances and partner are in alignment, it might be time to start thinking about "trying."

Before you … ahem … get down to business, there are a few important things about preconception you should know. We spoke with Dr. Lexanne Mauney, a Houston Methodist OB/GYN and mother of two, about ways to boost your chance of successful conception, steps to help protect you and your baby during pregnancy and advice to help put it all in perspective.

Here are her top suggestions for couples hoping to put a bun in the oven this year.

1. Start taking prenatal vitamins

Surprised to see this as the first step, before consulting your doctor or stopping your birth control method? It's because doctors recommend women begin taking certain vitamins and minerals — most importantly folate — up to three months before they start trying to get pregnant.

In fact, the CDC recommends all women of childbearing age take 400 micrograms of folate every day because it's difficult to consume that amount from food alone and half of all pregnancies are unplanned.

Why is folate so important? It helps protect the baby's brain and spinal cord from neural tube defects like spina bifida, anencephaly and Chiari malformation. About 30 years ago, studies linked inadequate amounts of folate to these neural tube defects, with effects ranging in severity from lifelong motor impairment to stillbirth. Getting enough folic acid, a type of B vitamin, before and during pregnancy prevents most neural tube defects.

Prenatal vitamins also contain important ingredients for both mom and baby, including extra iron, DHA (an Omega-3 fatty acid), A, D, B6 and B12. So, even after conceiving, you will need to stay on them the duration of pregnancy.

"Because you have to be on them for so long, I recommend to my patients that they choose an inexpensive over-the-counter brand, whatever is easiest for them to take," Dr. Mauney says.

2. Select an OB/GYN and make a preconception appointment

If you already know who you want to take you through your journey, from preconception to pregnancy to delivery and beyond, then congratulations! This step should be fairly easy for you. Call up your doctor's office and request a preconception appointment.

If you don't already have a designated OB/GYN or you have a gynecologist who doesn't do obstetrics or you just aren't sure, now's the time to ask for recommendations and do your research. While women who aren't pregnant usually see their OB/GYN just once a year, pregnant women typically see theirs 15 times in a year, more if issues develop or pregnancy runs long. Convenience, comfort, bedside manner, trust and expertise are critical ingredients as you take this relationship to the next level.

At a preconception appointment, you and your doctor will discuss any health issues or medication you are taking that could affect your pregnancy. Although patients are never encouraged to change treatments abruptly, there may be safer alternatives that are recommended during pregnancy. This is a good time to make sure you're up to date on your vaccines and preventive care, including your latest Pap smear.

"We also offer optional carrier screening at this appointment, which looks to see if you're a carrier for cystic fibrosis, spinal muscular atrophy, sickle cell anemia and a variety of other autosomal recessive disorders," Dr. Mauney explains. "If the mom-to-be does have the gene, we then test the dad-to-be for it and identify the risks."

3. Pull the goalie

This is it: The moment of truth. Where the rubber meets the, uh, drawer, I guess? When you're officially ready to conceive, it's time to put your usual method of birth control aside. If you take the Pill or use condoms, you can stop. If you have an IUD or subcutaneous birth control insert, make an appointment to get it removed — better yet, combine it with your preconception appointment.

Dr. Mauney stresses to her patients not to stop using their birth control until they're actually ready to get pregnant.

"If you miss one or two birth control pills, you can get pregnant," she says. "If you have your IUD removed, you can theoretically go home and get pregnant that day. It takes almost no time to clear your system, so don't discontinue it early, especially if there's a big event or reason why you don't want to be pregnant yet."

4. Track your period

If you weren't already doing this, or you had hormonal birth control keeping you on an artificial schedule, now is the time to start keeping track of when your period naturally comes each month. How long it stays and how heavy or light it is aren't as important as tracking the number of days there are in your cycle (that is, between the first day of your period and the day your next month's period starts).

Ideally the length of your cycle will be roughly the same month after month. If you notice a variance of more than one week, you should tell your OB/GYN — regardless of whether you are trying to get pregnant. "It could be nothing, or a sign of a few different things, but it's better to get it checked out," says Dr. Mauney.

Knowing the duration of your cycle helps narrow down your ovulation period. If you have a shorter cycle (about 21 days) or longer cycle (about 35), your ovulation window might be trickier to nail down than someone with a standard 28-day cycle (more below).

Note: The day your period starts is Day 1 of your cycle. You always want to make note of Day 1 in your calendar, because if you do get pregnant, they'll ask you — many times — when your last period started. It's how they time everything out.

5. Track your ovulation

Although this step is definitely optional, if you're the type who really wants to go the extra mile to make sure you've optimized your chance of conceiving in a given month, Dr. Mauney recommends testing yourself for ovulation. You can buy ovulation predictor tests that look similar to pregnancy tests at a drug store. You can also order the small, flexible ovulation test strips from Amazon; a pack of 50 will run you around $20, so it's the most affordable option.

You might need to use 5-10 per month to measure the precise surge in your luteinizing hormone, which signals ovulation is about to occur. Note that the day you test positive is not the same thing as the day you ovulate. The hormone surge the test detects typically occurs about 24 to 36 hours before the actual egg drops.

TMI alert: The thing you are actually testing is your pee, not your blood or your cervical mucus. The drug store tests usually have you pee directly on the stick; the mail order strips usually require you to pee in a cup and dip the strip in for a specific amount of time. Make sure you read and follow directions closely.

For people with a 28-day cycle, ovulation can occur anywhere from Day 10-20, so Dr. Mauney recommends testing every day starting on Day 10 until you get a positive result. If you have a shorter cycle, you may want to start testing yourself on Day 7 instead of Day 10. If you have a longer cycle, you should probably still start testing on Day 10; just be aware you may have to go longer than Day 20.

Make note of the day you tested positive (remember the day your period starts is Day 1). If you got a positive on Day 14, next month you can test on Day 12 and keep checking daily. After a few months, if your pattern is consistent, you don't need to keep checking.

If you don't get a positive ovulation test the first month, try again the next month every day beginning on Day 7. If you still don't get a positive result, make an appointment with your doctor to get checked out.

6. Have sex during your fertile window

This step is definitely not optional; it's pretty crucial to achieving the desired result.

If you get a positive ovulation test, have sex that day and the day after. The next month, you should aim to have sex on the five days prior and two days after the day you tested positive. (If that feels like too much, every other day during that week should suffice.)

If you have not tested for ovulation, that's no problem. Dr. Mauney recommends having sex every other day beginning on Day 10 and until Day 20, assuming you have a typical length cycle. If you have a shorter or longer cycle, discuss with your doctor how to adjust your window accordingly.

And no, you don't need to lie down with your hips elevated for 30 minutes after ejaculation. That's fine if you want to try anything that might possibly boost your chances, but there's no scientific evidence it helps sperm reach the cervix.

7. Be patient, don't stress

If you are under 35 years old, doctors recommend you try for 12 months before making an appointment with your doctor to check into fertility. If you are older than 35, doctors recommend giving it six months before scheduling an assessment. Despite what some of your friends may have told you, it is very rare to get pregnant without trying or in your first month of trying.

"One thing that is scientifically proven to temporarily affect fertility is high levels of stress," Dr. Mauney says. "It raises your cortisol levels and can cause delayed or absent ovulation or irregular periods. I tell all my patients to work really hard on not expecting immediate results, because when you don't get them, you go straight into stress mode, and it can become a vicious cycle."

It may interest you to know that rates of infertility are rather low. Approximately 9% of men and 11% of women have identifiable fertility issues, meaning 90% of people do not. It just takes a little time; give yourself some grace.

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