Preconception & Fertility · Newport Beach · 2026

Preconception Care & Fertility
Planning Your Pregnancy

The healthiest pregnancies start before conception.

Preconception care is the medical preparation that happens before you conceive — optimizing your health, identifying risk factors, and giving your baby the best possible start. Whether you are actively trying, planning ahead, or struggling to conceive, this guide covers what the evidence says about pregnancy preparation, fertility basics, and when to seek specialist evaluation.

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◆ Short Answer

The Canonical Answer

Preconception care is the evidence-based medical preparation that occurs before conception, ideally beginning 3 to 6 months before trying to conceive ACOG CO #762. It includes folic acid supplementation (400–800 mcg daily, starting at least 1 month before conception to reduce neural tube defect risk by up to 70%) CDC 2024, genetic carrier screening, medication review for teratogen exposure, immunization updates, chronic disease optimization, and lifestyle counseling. Infertility is defined as the inability to conceive after 12 months of regular unprotected intercourse (women under 35) or 6 months (women 35+) ASRM 2024. Initial fertility evaluation begins with the OBGYN and includes hormonal testing, imaging, and semen analysis. At Broad Medical Group, Dr. Jennifer Broad provides comprehensive preconception visits and initial fertility assessment for patients in Newport Beach and Orange County.

Medically reviewed by Dr. Jennifer Broad, MD, FACOG Board-Certified Obstetrician-Gynecologist · Newport Beach, CA

Last reviewed: April 2026 Next review: October 2026

Consultation room at Broad Medical Group â€

Planning a Pregnancy? Start Here

Preconception care is the medical preparation that happens before conception — and it is one of the most effective interventions in obstetrics. The goal is straightforward: identify and address health risks before they can affect a developing pregnancy.

ACOG recommends that all women of reproductive age receive preconception counseling, whether they are actively planning a pregnancy or simply considering one in the future. Ideally, preconception care begins 3 to 6 months before trying to conceive, though it is never too late to start. Even a single preconception visit provides meaningful clinical value.

A preconception visit with Dr. Broad at Broad Medical Group covers:

Health optimization — managing chronic conditions (diabetes, hypertension, thyroid disease) to reduce maternal and fetal risk
Genetic carrier screening — testing for conditions like cystic fibrosis and spinal muscular atrophy before conception, when results can inform reproductive planning
Medication review — identifying teratogenic medications and transitioning to pregnancy-safe alternatives
Immunization review — ensuring immunity to rubella and varicella (vaccines that cannot be given during pregnancy)
Lifestyle counseling — nutrition, supplementation, substance cessation, weight optimization, and mental health assessment

The preconception visit is also the time to discuss any prior pregnancy complications, surgical history, family history of genetic conditions, and personal concerns about fertility. Patients with a history of high-risk pregnancy factors benefit especially from early planning.

ACOG Guideline

ACOG Committee Opinion #762 (Preconception Counseling): “All women of reproductive age should receive preconception care, which includes screening for and management of conditions that may affect a future pregnancy.” This includes optimizing chronic disease, reviewing medications, providing immunizations, initiating folic acid, and offering genetic carrier screening.

The Preconception Checklist

This is the evidence-based preparation every woman should consider before trying to conceive. Not every item applies to every patient, but the list provides a comprehensive framework that Dr. Broad works through during your preconception visit.

Action Item	Details	Timing
Start folic acid	400–800 mcg daily. Reduces neural tube defect risk by up to 70%. Higher doses (4 mg) if prior NTD or on certain medications.	1–3 months before conception (ideally 3)
Update immunizations	Rubella (MMR) and varicella — check titers, vaccinate if non-immune. Must wait 4 weeks after live vaccine before conceiving. Tdap and flu also recommended.	At least 1 month before conception
Medication review	Teratogen assessment — review all prescription and over-the-counter medications. Common switches: ACE inhibitors to labetalol, valproic acid to alternative, isotretinoin discontinued.	3–6 months before (allows transition time)
Chronic condition management	Optimize diabetes (A1c <6.5% before conception), hypertension (medication adjustment), thyroid (TSH goal 0.5–2.5 in first trimester), autoimmune conditions.	3–6 months before
Dental health	Complete dental exam and any needed treatment. Periodontal disease is associated with preterm birth and low birth weight.	Before conception
Weight optimization	BMI 18.5–24.9 is ideal. Both underweight and overweight/obesity increase risks including gestational diabetes, preeclampsia, and miscarriage.	Ongoing — start early
Substance cessation	Stop smoking, alcohol, and recreational drugs. No safe level of alcohol during pregnancy. Smoking cessation resources available.	Immediately — ideally before conception
Genetic carrier screening	Minimum: cystic fibrosis, SMA, hemoglobinopathies. Expanded panels available (100+ conditions). Ideally both partners tested.	Before conception (allows time for results and counseling)
Mental health assessment	Screen for depression, anxiety, and prior perinatal mood disorders. Establish treatment plan before conception. Medication adjustments if needed.	At preconception visit

Clinical Illustration â€" Preconception preparation timeline (checklist items mapped to months before conception)

Preconception preparation timeline. Based on ACOG Committee Opinion #762, 2019.

Patient Tip

Start folic acid now, even if pregnancy is months away. Neural tube closure occurs at 28 days after conception — often before a woman knows she is pregnant. Because nearly half of pregnancies in the United States are unplanned, the CDC recommends that all women of reproductive age consume 400 mcg of folic acid daily. If you are actively planning, aim for 400–800 mcg starting at least one month before conception, ideally three.

Fertility Basics: Understanding Your Cycle

Understanding your menstrual cycle is the foundation of fertility awareness. Conception requires that sperm be present in the reproductive tract around the time of ovulation. The fertile window spans approximately 5 days before ovulation plus the day of ovulation itself — a total of about 6 days per cycle. The highest probability of conception occurs with intercourse in the 1 to 2 days immediately before ovulation.

For women with regular 28-day cycles, ovulation typically occurs around day 14. However, cycle length varies considerably between individuals and even between cycles in the same person. Several methods can help identify your fertile window:

Ovulation Timing Tools

Ovulation predictor kits (OPKs) — detect the luteinizing hormone (LH) surge that precedes ovulation by 24 to 36 hours. The most practical and widely recommended method for most patients. Used like a urine pregnancy test.
Basal body temperature (BBT) tracking — body temperature rises 0.5–1.0°F after ovulation due to progesterone. Confirms that ovulation has occurred but does not predict it in advance (retrospective only). Requires consistent morning measurement before getting out of bed.
Cervical mucus observation — estrogen-driven changes produce clear, slippery, “egg-white” mucus around ovulation. Presence of fertile-quality mucus signals the approaching fertile window.

Timing Intercourse

For couples trying to conceive, intercourse every 1 to 2 days during the fertile window maximizes the chance of conception. There is no evidence that specific positions, lying still afterward, or other popular recommendations improve success rates. Daily intercourse is fine — it does not meaningfully reduce sperm quality in men with normal semen parameters.

For more on ovulation-related symptoms, see our Ovulation Pain (Mittelschmerz) blog post.

When to See a Fertility Specialist

Definition of Infertility

Infertility is clinically defined as the inability to conceive after 12 months of regular, unprotected intercourse in women under 35. For women 35 and older, evaluation should begin after 6 months. This earlier threshold reflects the natural decline in ovarian reserve and egg quality that accelerates after age 35 — delaying evaluation wastes valuable reproductive time.

Important Note

The infertility timeline depends on age. Women under 35: evaluation after 12 months of trying. Women 35 and older: evaluation after 6 months. Women with known risk factors — irregular cycles, endometriosis, prior pelvic surgery, or recurrent pregnancy loss — may warrant earlier evaluation regardless of age. Do not wait if you have concerns; an initial conversation costs nothing and may save months.

Initial Fertility Workup at Your OBGYN

Before referral to a reproductive endocrinologist (REI), your OBGYN can perform the initial evaluation. Dr. Broad offers the following basic fertility workup:

Day 3 hormonal testing — FSH, estradiol, and AMH (anti-Müllerian hormone). These tests assess ovarian reserve — the quantity (though not quality) of remaining eggs.
Semen analysis — male factor accounts for approximately 30–40% of infertility cases. A semen analysis evaluating count, motility, and morphology is one of the first tests ordered. Referral for specimen collection is arranged through the office.
Tubal evaluation — hysterosalpingogram (HSG) or saline infusion sonography (SIS) to assess whether the fallopian tubes are open and the uterine cavity is normal.
Thyroid function — TSH and free T4. Both hypothyroidism and hyperthyroidism can impair fertility and increase miscarriage risk.
Ovulation confirmation — cycle history, mid-luteal progesterone level, or ovulation tracking as discussed in the previous section.

When to Refer to a Reproductive Endocrinologist (REI)

Referral to a fertility specialist is recommended when:

Initial treatments (ovulation induction, timed intercourse) have not resulted in pregnancy
Tubal factor infertility is identified (blocked tubes)
Severe male factor infertility (very low count, motility, or morphology)
Age over 40 — time-sensitive, and advanced reproductive technologies may be indicated early
Recurrent pregnancy loss (two or more consecutive losses)
Patient desires IVF, egg freezing, or other assisted reproductive technology

Dr. Broad works with several excellent reproductive endocrinology practices in Orange County and provides collaborative care throughout the referral process.

Fertility-Friendly Lifestyle

Evidence Over Fads

The internet is saturated with fertility advice — much of it unproven, some of it harmful. This section covers only recommendations supported by clinical evidence. The basics matter most: maintain a healthy weight, take your folic acid, avoid known toxins, and do not let the pursuit of optimization become a source of stress.

Exercise

Regular, moderate exercise is beneficial for fertility. However, excessive exercise — particularly high-intensity endurance training — can suppress ovulation through hypothalamic dysfunction. The goal is consistency and moderation: 150 minutes per week of moderate-intensity activity (brisk walking, swimming, cycling) is appropriate. If you have been doing intense training and have irregular periods, this is worth discussing at your preconception visit.

Nutrition

A Mediterranean-style dietary pattern is the best-studied eating pattern for fertility — rich in vegetables, fruits, whole grains, legumes, fish, and olive oil, with limited processed food and red meat. There is no single “fertility food” that will significantly change your chances, but overall dietary quality contributes to hormonal balance, ovulatory function, and healthy weight.

Weight

Both underweight (BMI <18.5) and overweight/obesity (BMI ≥25) are associated with reduced fertility. Excess weight can impair ovulation, reduce IVF success rates, and increase pregnancy complications. Being underweight can cause anovulation. A BMI of 18.5–24.9 is associated with the best reproductive outcomes. Even modest weight loss (5–10% of body weight) in overweight patients can restore ovulatory cycles.

Caffeine

The evidence on caffeine and fertility is mixed, but most guidelines recommend limiting intake to less than 200 mg per day (roughly one 12-ounce cup of drip coffee). Higher intake may be associated with longer time to conception and increased miscarriage risk, though the data is not definitive. Moderate consumption appears safe.

Environmental Exposures

Endocrine-disrupting chemicals (EDCs) — found in certain plastics (BPA), pesticides, personal care products, and non-stick cookware — may affect reproductive hormones. Practical steps: avoid heating food in plastic containers, choose fragrance-free products when possible, wash produce, and limit exposure to known chemicals. The evidence base is growing but not yet definitive for most individual chemicals.

Stress

The relationship between stress and fertility is complicated. While severe physiologic stress can suppress ovulation, the evidence that everyday psychological stress directly causes infertility is mixed and often overstated. What is clear: the experience of trying to conceive and fertility treatment is inherently stressful, and quality of life matters. Stress management — whether through exercise, mindfulness, therapy, or social support — is worthwhile for its own sake, even if the direct fertility benefit is uncertain.

Supplements with Actual Evidence

Folic acid (400–800 mcg daily) — the single most important preconception supplement. Prevents neural tube defects. Non-negotiable.
Vitamin D (if deficient) — deficiency is common and has been associated with reduced fertility in some studies. Check levels; supplement if below 30 ng/mL.
CoQ10 (emerging evidence) — some data suggests CoQ10 supplementation may improve egg quality, particularly in women over 35. The evidence is promising but not yet definitive. Doses in studies range from 200–600 mg daily.
Omega-3 fatty acids — may support hormonal balance and have general health benefits. Can be obtained through diet (fatty fish) or supplementation.

Dr. Broad reviews supplement use at your preconception visit and recommends based on your individual health profile.

Conditions That Affect Fertility

Several gynecologic and medical conditions can impact your ability to conceive. If you have been diagnosed with any of the following, preconception planning is especially important. Each condition has a dedicated page on this site with more detailed information:

Endometriosis

Endometriosis affects an estimated 10% of reproductive-age women and is found in up to 50% of women with infertility. It can impair fertility through inflammation, adhesion formation, distortion of pelvic anatomy, and impaired egg quality. Mild to moderate endometriosis may not require treatment before attempting conception, while more severe disease often benefits from surgical or medical management.

Uterine Fibroids

Not all fibroids affect fertility — location matters more than size. Submucosal fibroids (those that distort the uterine cavity) have the greatest impact on implantation and may warrant removal before conception. Intramural and subserosal fibroids may or may not affect fertility depending on size and position.

Polycystic Ovary Syndrome (PCOS)

PCOS is the most common cause of anovulatory infertility. Women with PCOS may have irregular or absent periods, indicating that ovulation is not occurring regularly. The good news: PCOS is one of the most treatable causes of infertility. Ovulation induction with medications like letrozole is often effective. Weight loss of even 5–10% can restore ovulatory cycles in overweight patients with PCOS.

Thyroid Disorders

Both hypothyroidism and hyperthyroidism can impair ovulation and increase miscarriage risk. Thyroid function should be optimized before conception. For hypothyroidism, the goal TSH during early pregnancy is 0.5–2.5 mIU/L, which may require medication dose adjustment. Thyroid testing is a standard part of Dr. Broad’s preconception workup.

Age-Related Fertility Decline

Fertility declines naturally with age, with the most significant change occurring after 35 and accelerating after 40. This is primarily due to decreasing egg quantity and quality. By age 40, the per-cycle probability of natural conception is approximately 5%, compared to 20–25% at age 30. Age-related decline affects egg quality, which no supplement or lifestyle modification can fully reverse. This is why earlier evaluation (at 6 months rather than 12) is recommended for women 35 and older.

Key Takeaways

Start preconception care 3 to 6 months before trying to conceive — folic acid, immunizations, medication review, and chronic disease optimization reduce risk for both mother and baby.
Folic acid (400–800 mcg daily) is the single most important preconception supplement — start at least one month before conception, ideally three (ACOG, CDC).
The fertile window is approximately 6 days per cycle — the 5 days before ovulation plus the day of ovulation. Ovulation predictor kits are the most practical timing tool for most patients.
Infertility evaluation starts after 12 months (under 35) or 6 months (35+) — initial workup can be done by your OBGYN before specialist referral.
Address underlying conditions first — endometriosis, PCOS, thyroid disorders, and fibroids all have dedicated management strategies that can improve fertility outcomes.
Focus on evidence-based lifestyle factors — healthy weight, moderate exercise, Mediterranean diet, limited caffeine, and substance avoidance. Skip the fads.

References & Clinical Sources

American College of Obstetricians and Gynecologists. Committee Opinion No. 762: Prepregnancy Counseling. Obstetrics & Gynecology, 133(1), e78–e89. 2019.
American Society for Reproductive Medicine. Diagnostic Evaluation of the Infertile Female: A Committee Opinion. Fertility and Sterility, 116(5), 1255–1270. 2021. Reaffirmed 2024.
Centers for Disease Control and Prevention. Folic Acid Recommendations for the Prevention of Neural Tube Defects. Updated 2024.
American College of Obstetricians and Gynecologists. Committee Opinion No. 691: Carrier Screening for Genetic Conditions. Obstetrics & Gynecology, 129(3), e41–e55. 2017. Reaffirmed 2023.

Related Resources

Ready to Start Planning?

Whether you are thinking about pregnancy in the next few months or the next few years, a preconception visit gives you a clear, personalized plan. Dr. Broad is accepting new patients in Newport Beach and Orange County.

Schedule a Preconception Visit →

Broad Medical Group — Newport Beach, California

Medical Disclaimer: This content is for educational purposes only and does not constitute medical advice, diagnosis, or treatment. Consult Dr. Jennifer Broad or your healthcare provider for guidance specific to your situation. Current as of April 2026. If you are experiencing a medical emergency, call 911 immediately.