Your Preconception Checkup: Which Tests and What to Ask

Try to see your doctor 3-6 months before you start trying to conceive. This visit helps get any existing health conditions under good control and catches anything early that could make pregnancy harder. It goes further than your usual annual well-woman exam.

Who to see: an OB-GYN or a family physician is a fine place to start. Go straight to a fertility specialist if you are 35 or older and have been trying for 6 months, if you are 40 or older (no need to wait), or if you have known PCOS, endometriosis, or ovulation problems, 2 or more previous miscarriages, a possible male factor, or irregular periods.

Standard blood tests (preconception panel):

• Complete blood count (screens for anemia)
• Fasting glucose and HbA1c (diabetes, insulin resistance)
• TSH and free T4 (thyroid; if you take thyroid medication, your doctor will set your target)
• Liver enzymes (ALT, AST)
• Creatinine (kidneys)
• B12, ferritin, vitamin D (25-OH-D)
• Lipid panel (especially with PCOS or obesity)
• White blood cell differential

Infection and immunity screening:

• Rubella (German measles) antibodies: if you aren't immune, get vaccinated and wait 1 month before trying
• Varicella (chickenpox) antibodies: the same, vaccine + wait 1 month
• Hepatitis B (HBsAg) and hepatitis C
• HIV: with treatment, passing it to the baby can be prevented
• Syphilis (VDRL/RPR)
• Toxoplasma IgG/IgM (if you have cats)
• HPV/Pap test if you haven't had a Pap smear in the last 3 years

Genetic screening (recommended):

• Hemoglobin electrophoresis: for thalassemia and sickle cell disease, which are more common in families of Mediterranean (including Türkiye), African, South or Southeast Asian, and Middle Eastern ancestry
• Cystic fibrosis carrier screening (for both partners)
• Tay-Sachs (especially in families of Ashkenazi Jewish ancestry)
• If you and your partner are blood relatives (such as cousins): karyotype and expanded carrier screening
• Genetic counseling if a genetic condition runs in the family

Vaccines:

• Rubella and varicella are live vaccines: if you need them, get them now and wait 1 month before trying
• Hepatitis B series (3 doses)
• Flu shot (seasonal)
• Tdap (tetanus, diphtheria, whooping cough): one dose during pregnancy, at weeks 27-36
• COVID-19: follow current recommendations

10 questions to ask your doctor:

1. Which of my current medications are safe in pregnancy, and which should I change?
2. What folic acid dose should I take? Do you recommend a specific prenatal vitamin?
3. Which of my vaccines are not up to date?
4. What is a healthy weight target for me? Should I see a dietitian?
5. Do my cycles suggest I'm ovulating? Do I need any other tests?
6. Should I have genetic screening? Which tests?
7. Which tests should my partner have?
8. Does my family history (diabetes, high blood pressure, etc.) call for extra screening?
9. How long should we try before coming back to see you?
10. When is my fertile window, and how do you suggest I track it?

A preconception visit for your partner:

• Semen analysis if needed (for example, if you have been trying for a long time)
• Complete blood count, glucose, lipids
• Screening for sexually transmitted infections
• Genetic carrier screening
• Getting any chronic conditions under control
• Medication review (testosterone, finasteride, and some other drugs affect fertility)
• Lifestyle advice (smoking, alcohol, heat)

If you have a chronic condition, get it well controlled first:

• Diabetes: target HbA1c below 6.5%, possibly switching to insulin, and an eye exam for retinopathy
• High blood pressure: switching from ACE inhibitors to a pregnancy-safe option such as labetalol or methyldopa
• Hypothyroidism: TSH below 2.5, adjusting your levothyroxine dose
• Epilepsy: reviewing your seizure medication with your doctor (valproic acid can cause birth defects; never stop or change it on your own) and a higher folic acid dose
• Asthma, lupus, rheumatoid arthritis: getting the condition stable and checking that your medications are safe
• Depression: reviewing your SSRI and continuing therapy

Practical checklist (get ready before your appointment):
☐ Bring your vaccination record (ask your primary care office for a copy if you don't have one)
☐ Write down your family health history for 2 generations (parents, grandparents, siblings)
☐ Write down any previous pregnancies (miscarriages, births, complications)
☐ List all your medications and supplements, with doses
☐ Note your period history (dates for the last 6 months, average cycle length, regularity)
☐ List any allergies
☐ Write down your questions (the 10 above)