Preconception Doctor Visit: Which Tests, What to Ask?

Preconception doctor visit should be done 3-6 months before trying to conceive. Both to optimize existing health issues and identify early factors that could create difficulties. More comprehensive than standard annual gynecology exam.

Doctor selection: Gynecologist or family physician sufficient for start. Go directly to fertility specialist: 35+ age + 6 months trying, 40+ direct, known PCOS/endometriosis, previous recurrent miscarriage (2+), male factor suspicion, irregular periods.

Standard blood tests: Complete blood count (anemia), glucose + HbA1c (diabetes), TSH + fT4 (thyroid; if you take thyroid medication, your doctor sets your target), liver enzymes, creatinine, B12, ferritin, vitamin D (25-OH-D), lipid profile.

Infection/immunity screening: Rubella antibodies (if missing → vaccinate + wait 1 month), Varicella antibodies (same), Hepatitis B/C, HIV, Syphilis, Toxoplasma (cat owners), HPV (if no Pap in 3 years).

Genetic screening (recommended): Hemoglobin electrophoresis (thalassemia, sickle cell — more common in some ancestries such as Mediterranean, African, South/Southeast Asian and Middle Eastern), Cystic fibrosis carrier (both partners), consanguineous marriage → karyotype + extended panel.

Vaccination status: Live vaccines (rubella, varicella) — wait 1 month before pregnancy. Hep B series (3 doses), Influenza (seasonal), Tdap (one dose at 27-36 weeks), COVID-19 per current recommendations.

10 questions to ask:

1. Which medications safe in pregnancy, which to change?
2. Folic acid dose? Multivitamin recommendation?
3. Which vaccines not current?
4. BMI/weight target? Dietitian needed?
5. Does my cycle indicate ovulation?
6. Genetic screening?
7. Tests for partner?
8. Family history → additional screening?
9. How long to try before returning?
10. Ideal fertile window, tracking method?

Partner preconception visit: Semen analysis if needed, complete blood count + glucose + lipid, STI screening, genetic carrier screening, chronic disease optimization, medication review (testosterone, finasteride affect fertility), lifestyle counseling.

Chronic disease optimization:

• Diabetes: HbA1c <6.5, insulin transition, retinopathy eval
• Hypertension: Switch from ACE inhibitors to labetalol/methyldopa
• Hypothyroidism: TSH <2.5, levothyroxine adjustment
• Epilepsy: Anticonvulsant change (valproic acid teratogenic)
• Depression: SSRI evaluation, therapy continuation

Practical checklist (prepare before appointment):
☐ Bring vaccination card
☐ Write family health history (2 generations)
☐ Write previous pregnancy histories
☐ List all medications and supplements
☐ Menstrual history (last 6 months)
☐ Allergies
☐ Write your questions (10 above)