Synopsis
Improve preconception health and modifiable fertility factors with specific, non-judgemental interventions while avoiding unsupported restrictions, supplement claims and treatment delay.
- Offer vaginal intercourse every 2 to 3 days when this is the chosen route; timing every attempt to an ovulation app can add pressure without improving on regular exposure.
- Advise the person who may become pregnant that avoiding alcohol is the safest approach; excessive alcohol also harms semen quality.
- Smoking reduces female fertility and is associated with poorer semen quality; offer evidence-based cessation support and address passive smoke exposure.
- BMI of 30 kg/m² or above is associated with longer time to conception and reduced male fertility; in anovulatory people, supported weight reduction can improve ovulation.
- BMI below 18.5 with irregular or absent menstruation warrants nutritional and exercise review because weight restoration can improve conception chance.
- Ask specifically about prescription, over-the-counter and recreational exposures including GLP-1 agonists, testosterone, finasteride, NSAIDs, lubricants, anabolic steroids and cannabis.
- Use folic acid 400 micrograms daily ideally for about 3 months before conception and through the first 12 weeks; use 5 mg daily only for defined higher-risk indications, not BMI 25 or above alone.
- Check rubella status when vaccination is absent or uncertain, vaccinate susceptible people and advise avoiding pregnancy for at least 1 month afterwards.
Key red flags
Bradycardia, hypotension, syncope, electrolyte disturbance, very low intake or rapid weight loss requires urgent medical and eating-disorder assessment.
Severe hypertension, decompensated cardiac disease, uncontrolled diabetes or another major condition may make pregnancy immediately unsafe and needs specialist pre-pregnancy review.
Dependence with risk of alcohol, benzodiazepine or opioid withdrawal requires supervised clinical management rather than abrupt unsupported cessation.
Current interpersonal violence, reproductive coercion or sexual abuse requires private safeguarding assessment and person-led support.
Planned chemotherapy, pelvic radiotherapy or gonadal surgery needs expedited fertility-preservation discussion before treatment wherever possible.
Investigation priorities
Identify prescribed, over-the-counter, complementary, recreational and performance-enhancing exposures affecting fertility or pregnancy.
Management branches
A person or couple is planning pregnancy or starting fertility assessment.
- Ask about conception route and frequency, smoking, alcohol, weight trajectory, nutrition, exercise, medicines, substances, chronic disease, vaccination and occupational hazards.
- Prioritise high-impact and time-sensitive issues with the person, explicitly separating pregnancy safety, general health and evidence for fertility.
- Begin appropriate fertility investigation or referral in parallel when age or a known cause makes delay harmful.