Preconception Health Checklist for Both Partners

Before you start trying

Begin folic acid (400–800 mcg daily) at least one month before conception to reduce neural-tube defects. Update vaccinations, review medications with a clinician, and manage chronic conditions such as diabetes, hypertension, and thyroid disease.

Both partners benefit from reducing alcohol, stopping smoking, limiting caffeine, achieving a healthy weight, and getting STI screening. Dental health and mental wellbeing matter too.

Preparing before conception

Preparing for pregnancy improves outcomes for both parent and baby. Key steps include starting folic acid at least a month before trying, reviewing medications with a clinician, updating vaccinations, and managing chronic conditions such as diabetes, thyroid disease, and high blood pressure. Both partners benefit from healthy weight, good nutrition, and stopping smoking.

A shared responsibility

Fertility and a healthy pregnancy depend on both partners, so sperm health, alcohol and substance use, and overall wellbeing matter for everyone involved. A preconception check-up is a good time to discuss family history, screen for infections, and address any concerns, setting the stage for a healthier pregnancy.

Why Preconception Health Matters for Both Partners

Preconception care is the set of health interventions — lifestyle, medical, and nutritional — taken before attempting pregnancy to optimise outcomes for both the parent-to-be and the future child. While much preconception guidance historically focused exclusively on women, research over the past two decades has made it unambiguous that paternal health at conception also significantly affects embryo quality, pregnancy outcomes, and even the long-term health of children. Sperm DNA integrity, paternal BMI, smoking status, and micronutrient levels all influence fertilisation capacity and early embryo development.

The preconception period ideally begins three to six months before attempting conception. This timeline is chosen deliberately: it takes approximately 74 days for a sperm cell to mature from a precursor cell to an ejaculated sperm — a process called spermatogenesis. Improvements to male lifestyle and nutrition therefore take at least three months to be reflected in semen quality. For women, the egg matures over a shorter final developmental period but the follicle environment develops over months before ovulation. Three months of healthy habits creates a better biological environment for both gametes.

Medical Review and Screening Tests

Both partners should arrange a preconception health review with their GP or a sexual and reproductive health clinician. For women, this visit should include blood pressure measurement, BMI assessment, a full blood count, blood group and rhesus factor, rubella and varicella immunity status, thyroid function (TSH), blood glucose screening if risk factors are present, and cervical screening if overdue. Discussion of any chronic conditions — diabetes, epilepsy, hypertension, autoimmune disease, depression — is essential because some medications require adjustment before pregnancy and some conditions need to be well-controlled before conception.

For men, the preconception review is less formally established in most healthcare systems but is equally valuable. Blood pressure, BMI, and a discussion of medications are a starting point. If there is any history of testicular surgery, infection, or known subfertility, a semen analysis provides a clear baseline. Both partners should be tested for STIs — including chlamydia, gonorrhoea, and HIV — particularly if either has had new partners in the past year, because untreated infections can be transmitted to a partner and, in the case of HIV and syphilis, to the fetus.

Vaccinations and Infection Risks

Rubella (German measles) infection in early pregnancy can cause severe fetal abnormalities including deafness, heart defects, and cataracts — collectively termed congenital rubella syndrome. Vaccination provides long-lasting immunity but cannot be given during pregnancy. Checking rubella immunity before conception and vaccinating if not immune — then waiting one month before attempting pregnancy — is a straightforward and highly effective preventive step.

Varicella (chickenpox) in pregnancy can cause fetal varicella syndrome in the first 20 weeks and severe neonatal varicella if the mother develops the infection close to delivery. Women who have not had chickenpox and are not immune should receive the varicella vaccine at least one month before attempting conception. Hepatitis B vaccination is recommended for individuals with occupational or personal risk. COVID-19 vaccination is generally recommended to be up to date before pregnancy, and vaccine safety in pregnancy has been extensively studied.

Folic Acid, Supplements, and Nutrition

Folic acid (vitamin B9) supplementation is one of the most evidence-based preconception interventions. Adequate folic acid in the weeks around conception reduces the risk of neural tube defects — such as spina bifida and anencephaly — by up to 70%. Neural tube closure occurs between 21 and 28 days after conception, often before many women know they are pregnant. Starting folic acid at least one month — ideally three months — before attempting conception ensures adequate tissue levels at the critical period. The standard recommended dose is 400 micrograms daily; women with a previous neural tube defect pregnancy, diabetes, obesity, or taking anti-epileptic medications require 5 mg daily under medical supervision.

Vitamin D deficiency is common in many populations and is associated with adverse pregnancy outcomes including preeclampsia and preterm birth. A supplement of 10 micrograms (400 IU) daily is recommended throughout pregnancy and preconception in most UK and European guidelines; higher doses may be needed if blood levels are deficient. Iodine, essential for fetal brain development, is another frequently inadequate nutrient in Western diets — a preconception multivitamin that includes iodine is a practical solution. Men benefit from antioxidant micronutrients including zinc, selenium, vitamin C, and vitamin E, which support sperm DNA integrity and motility.

Lifestyle Adjustments for Both Partners

Smoking is one of the most harmful habits for reproductive health. In women, it reduces ovarian reserve, impairs tubal ciliary function, increases miscarriage risk, and is associated with placental complications. In men, smoking reduces sperm count, motility, and morphology, and significantly increases sperm DNA fragmentation. Quitting smoking before conception is one of the highest-impact changes either partner can make. NHS Stop Smoking services, nicotine replacement therapy, and varenicline (with clinician guidance) are effective options.

Alcohol has no established safe level in pregnancy and should be avoided by women from the point of attempting conception, because the most vulnerable period for fetal alcohol effects is the first trimester — again, before many pregnancies are confirmed. Men should limit alcohol to low levels: heavy drinking reduces testosterone, impairs sperm production, and elevates spermatozoal DNA damage. Recreational drugs — including cannabis — have documented negative effects on both male and female fertility and on fetal development and should be stopped completely.

Weight management is relevant for both partners. Obesity in women is associated with anovulation, insulin resistance, increased miscarriage risk, and higher rates of gestational diabetes and hypertension. Obesity in men is associated with lower testosterone, elevated oestrogen (from peripheral aromatisation in fat tissue), reduced sperm parameters, and increased sperm DNA fragmentation. Even a modest weight reduction of 5–10% in overweight individuals can substantially improve hormonal profiles and reproductive outcomes. Conversely, underweight women — particularly those with low body fat from restrictive eating or excessive exercise — often experience hypothalamic anovulation.

Mental Health and Relationship Preparation

Pregnancy and parenthood place significant demands on mental health and relationships. Addressing pre-existing anxiety, depression, or trauma before conception allows for more stable management during pregnancy, when some medications require adjustment and when emotional wellbeing has direct effects on foetal cortisol exposure and stress programming. If you are on antidepressants or anxiolytics, discuss medication safety in pregnancy with your prescriber well before attempting conception — many are considered compatible with pregnancy, but some are not, and transitions take time.

For couples, preconception is a valuable time to discuss expectations around parenting roles, financial planning, support networks, and the emotional journey of trying to conceive — particularly if challenges are anticipated. Fertility journeys, even uncomplicated ones, carry emotional weight, and couples who have discussed their values and support strategies in advance are better equipped to navigate them together.

Environmental and Occupational Considerations

Certain occupational exposures pose risks to fertility and early pregnancy. These include organic solvents (used in paint, dry cleaning, and semiconductor manufacturing), pesticides, heavy metals (lead, mercury, cadmium), ionising radiation, and prolonged high heat (relevant for male fertility — elevated scrotal temperature from saunas, hot tubs, and laptop heat is associated with reduced sperm quality). If you or your partner work in an environment with potential reproductive hazards, reviewing exposures with an occupational health advisor and taking appropriate protective measures before and during pregnancy is important.

Endocrine-disrupting chemicals (EDCs) — found in certain plastics (BPA), pesticide residues on food, and some personal-care products — can interfere with hormone signalling in both partners. Practical harm reduction includes choosing glass or stainless steel food storage over soft plastics, eating a varied diet with organic produce where possible, and reviewing ingredient lists in personal-care products for known EDCs. These are reasonable precautions; the evidence does not support panic, but it does support informed reduction of exposure.

Frequently Asked Questions

Q: How soon after stopping contraception can we try to conceive? A: For barrier methods, immediately. For combined oral contraceptives and progestogen-only pills, fertility typically returns within one to three months of stopping, though some women conceive in the first post-pill cycle. For the hormonal injection (Depo-Provera), fertility may take 6–18 months to return. For IUDs — both copper and hormonal — fertility returns promptly after removal. The preconception period is a good time to transition from highly effective contraception and let your cycle regulate while completing preconception health steps.

Q: Do men need to take any specific supplements before conception? A: Evidence supports antioxidant supplementation for men with known sperm parameter abnormalities — particularly combinations of vitamin C, vitamin E, zinc, selenium, and CoQ10. For men with normal semen parameters and a healthy diet, the benefit is less clear, but a daily supplement with these micronutrients is unlikely to cause harm and may support optimal sperm quality. Folic acid is also relevant for men — folate is involved in sperm DNA methylation and deficiency has been linked to increased sperm aneuploidy.

Q: Is it safe to continue exercising intensively during the preconception period? A: Moderate to vigorous exercise is beneficial for overall reproductive health in both men and women. However, extreme endurance training — marathon-level training volumes, very low body fat — can suppress the hypothalamic-pituitary axis in women, causing anovulation. For men, very intense exercise combined with anabolic steroid use (including testosterone supplementation) can profoundly suppress sperm production, sometimes to azoospermia. Recreational and fitness-level exercise is not a concern.

Q: Should we do genetic carrier screening before trying to conceive? A: Expanded carrier screening for conditions such as cystic fibrosis, spinal muscular atrophy, fragile X syndrome, and other genetic conditions is increasingly available and can be done preconceptionally. If both partners carry a recessive variant for the same condition, each pregnancy has a 25% chance of being affected. Knowing this before conception allows informed decisions about pre-implantation genetic testing, prenatal diagnosis, or other options. Discuss with your GP or a genetic counsellor if you have a family history of any genetic condition or ethnic background associated with higher carrier rates.