Before TTC, do a quick health inventory: are your chronic conditions managed (thyroid, diabetes, blood pressure)? Have you had a dental cleaning recently? Is your BMI in a healthy range? Are you taking any medications that need to be switched? Have you addressed mental health needs? These aren't prerequisites — they're optimizations that improve your odds and your pregnancy experience.
Physical Health Check
Weight
BMI is an imperfect measure, but extremes on either end affect fertility. Underweight (BMI <18.5) can cause anovulation — your body may suppress ovulation when energy reserves are too low. Overweight and obesity (BMI >30) disrupt hormone levels, increase insulin resistance, and are associated with longer time to conception and higher miscarriage rates. Even a 5–10% weight change in the right direction can meaningfully improve fertility outcomes.
Dental Health
This surprises most people: untreated periodontal (gum) disease is associated with preterm birth and low birth weight. Dental procedures involving X-rays and anesthesia are trickier to schedule during pregnancy. Get a cleaning and address any outstanding dental work before conceiving.
Chronic Conditions
| Condition | What to Optimize Before TTC |
|---|---|
| Thyroid disease | Get TSH below 2.5; adjust levothyroxine dose with your endocrinologist |
| Diabetes (Type 1 or 2) | A1C below 6.5% ideally; poor glucose control increases birth defect risk significantly |
| Hypertension | Switch to pregnancy-safe medication (labetalol, nifedipine); aim for BP <140/90 |
| Epilepsy | Work with neurologist to switch to a lower-risk anticonvulsant if possible |
| Autoimmune conditions | Review medications; some biologics and DMARDs must be stopped before conception |
| Depression/anxiety | Establish a treatment plan that works for pregnancy; don't stop medications without medical guidance |
Mental Health
TTC can be emotionally intense, especially if it takes longer than expected. If you're managing anxiety, depression, or other mental health conditions, talk to your provider about a plan that continues through pregnancy. Untreated mental health issues during pregnancy carry their own risks. The goal is a treatment approach that keeps you well — not the absence of treatment.
Substance Use
- Quit smoking: Both partners. Smoking reduces egg quality, damages sperm DNA, and increases miscarriage risk.
- Limit alcohol: No confirmed safe amount for TTC or pregnancy. The safest approach is to stop entirely.
- Stop recreational drugs: Including marijuana — it affects sperm quality and may impair implantation.
- Caffeine: Under 200 mg/day (one standard cup of coffee).
Get Your Complete Pre-TTC Checklist
Our preconception checkup guide covers everything to discuss with your doctor before you start.
Read the Checkup Guide