What should you do if you decided to get pregnant?
Start prenatal vitamins : one tablet per day. Make sure that It contains 1mg of folic acid and has 5000 units (not more) of vitamin A
Visit your gynecologist : for history, exam, pap test and vaccination history.
Preconception labs : to assess the safety of pregnancy. Tests should include hepatitis B surface antigen, hepatitis C antibody, HIV, blood type, blood count, prolactin, TSH (thyroid function), cultures for gonorrhea and Chlamydia.
Genetic screening : to assess the carrier state of the parents for common genetic diseases and the risk for transmission to children. Basic tests include common mutation for cystic fibrosis, spinal muscular atrophy and fragile X syndrome. Additional tests are related to ethnicity: hemoglobin abnormalities in blacks, Mediterraneans and Asians, Ashkenazi profile for European Jews, Tay Sach disease for Jews and French Canadians. Another approach is to apply a ‘universal genetic test’ that encompasses a large number of genetic mutations for many diseases irrespective of ethnicity to allow for detection of rarer genetic diseases or even to sequence the whole genes related to theses diseases.
Lifestyle factors : better nutrition e.g one serving of small fish per week , stop smoking, avoid alcohol and reduce exercise if doing strenuous training
Worried? have a risk factor? or wants a more proactive approach?: Obtain a sperm analysis, HSG to test if the tubes are open and ovarian reserve tests to investigate the function of the ovaries (vaginal ultrasound and blood work).
Intercourse: have regular intercourse three times a week without attempting to monitor or to time ovulation.
For How Long should you try to conceive before moving to the next step?
a. If a fertility factor known or detected e.g abnormal sperm analysis, blocked fallopian tube, no ovulation, low ovarian reserve, carrier of genetic mutation… you should seek consultation with a reproductive endocrinologist
b. If no fertility factor is known:
1. Female age < 35 years try to conceive for one year before seeking consultation with a reproductive endocrinologist
2. Female age ≥ 35 years seek consultation within 6 months if not pregnant