Trying to conceive – what helps and when to ask

The healthiest thing you can do for a pregnancy happens before it begins. The baby's neural tube forms in the first weeks, often before anyone knows there is a pregnancy, which is why some steps have to be early to matter at all.

1. 1Start folic acid now rather than when a test is positive. It reduces the risk of neural-tube defects, and the benefit is in those first weeks.
2. 2Have a check-up. Blood pressure, HIV status, immunity to rubella, diabetes and anaemia are all worth knowing about before rather than during.
3. 3Review your medicines with a clinician or pharmacist. Some regular medicines need changing before conception — do not stop anything yourself.
4. 4Stop smoking and stop alcohol. There is no established safe amount of alcohol in pregnancy, and stopping before conception avoids the earliest weeks entirely.
5. 5If you have a long-term condition — epilepsy, diabetes, thyroid disease, high blood pressure, HIV, a mental health condition — get it well controlled first. This is the single biggest thing you can plan for.

• Conception is possible in the days leading up to and including ovulation, which in a regular cycle falls roughly in the middle.
• Having sex every two to three days across the cycle covers the fertile window without anyone having to track anything.
• Cycles vary between people and between months, so a rigid calculation is less reliable than regular frequency.
• Most couples who conceive do so within a year of trying.

• After about a year of regular unprotected sex without conceiving.
• After about six months if the woman is over 35, because time matters more then.
• Sooner if periods are very irregular or absent, if there is known endometriosis, a history of pelvic infection or surgery, or a known problem on either side.
• Sooner if there has been more than one miscarriage.

Assessment looks at both partners from the start — roughly half of fertility difficulty involves a male factor, and a semen analysis is quicker and simpler than most of the tests done on the female side. Ask for both to be assessed rather than only one.