Starting a Family? What to Know First

Whether you are actively trying to conceive or simply thinking about it for the future, there are a number of things that a pre-conception consultation can help with. Many women only see a gynaecologist once they are already experiencing difficulty, but a proactive approach can make a real difference. In my clinic, I see women at both ends of the spectrum — those who want to plan ahead and those who have already been trying for some time. In both cases, a structured assessment gives clarity and direction.

Age and fertility: what the numbers actually show

This is a conversation I have frequently, and I believe in being honest rather than vague. Female fertility is closely linked to age because women are born with a finite number of eggs, and that number declines steadily throughout life. At birth, you have roughly one to two million oocytes. By puberty, around 300,000–400,000 remain. By age 30, the number has dropped further, and the decline accelerates significantly after 35.

In practical terms: a healthy 30-year-old woman has approximately a 20% chance of conceiving in any given menstrual cycle. By 35, that figure drops to around 15%. By 40, it is closer to 5%. These are averages, and individual variation is significant — some women conceive easily at 40, while others struggle at 30. But the overall trend is real and driven by both egg quantity and egg quality. Chromosomal abnormalities in eggs increase with age, which is why the risk of miscarriage also rises after 35.

I share these statistics not to cause alarm but to help women make informed decisions about timing. If you are in your early thirties and know you want children, it is worth thinking about sooner rather than later. If you are not ready yet, an AMH blood test and antral follicle count on ultrasound can give you a snapshot of your ovarian reserve — a useful data point, though not a guarantee in either direction.

What is a pre-conception assessment?

A pre-conception appointment is an opportunity to review your general health, gynaecological history, and any factors that might affect your ability to conceive or your pregnancy outcomes. It typically includes:

• A review of your menstrual cycle regularity and any history of gynaecological conditions
• A cervical screening check (if you are due)
• Discussion of any medications you are taking and their safety in pregnancy
• Advice on folic acid supplementation and lifestyle optimisation
• Baseline blood tests if indicated (thyroid function, rubella immunity, vitamin D)
• Pelvic ultrasound to check the uterus and ovaries

Tracking ovulation

Understanding your cycle is one of the most practical things you can do when trying to conceive. Ovulation typically occurs around 14 days before your next period — not 14 days after the start, which is a common misconception if your cycle is longer than 28 days.

There are several methods to identify your fertile window:

• Basal body temperature (BBT): Your resting temperature rises by approximately 0.2–0.5°C after ovulation due to progesterone. Tracking this daily with a sensitive thermometer can confirm that ovulation has occurred, though it tells you after the fact rather than predicting it in advance.
• Ovulation predictor kits (OPKs): These urine tests detect the surge in luteinising hormone (LH) that occurs 24–36 hours before ovulation. They are widely available and reasonably reliable. I recommend testing from around day 10 of your cycle if you have a regular 28-day cycle, adjusting earlier or later if your cycles vary.
• Cervical mucus: In the days leading up to ovulation, cervical mucus becomes clear, stretchy, and slippery — often described as resembling raw egg white. This fertile-quality mucus facilitates sperm transport and is a good physiological indicator.

I generally advise couples to have regular intercourse every two to three days throughout the cycle rather than trying to time it precisely to ovulation. This reduces pressure and ensures sperm are present in the reproductive tract whenever ovulation occurs.

Don’t forget the male partner

This is something I always raise early in the conversation: 40–50% of fertility problems involve a male factor. Despite this, the investigation focus often falls disproportionately on the woman. A semen analysis is a simple, non-invasive test that should be one of the first investigations done. It assesses sperm count, motility, and morphology. If the results are abnormal, the male partner should be referred to a urologist or andrologist for further assessment. There is no point in a woman undergoing extensive investigations if a significant male factor has not been excluded first.

Pre-conception supplements

Supplementation before conception is genuinely evidence-based, not just a wellness trend. Here is what I recommend:

• Folic acid 400mcg daily: This should be started at least three months before you begin trying to conceive and continued through the first 12 weeks of pregnancy. It reduces the risk of neural tube defects such as spina bifida. Women with a higher risk (BMI over 30, diabetes, family history of neural tube defects, or taking anti-epileptic medication) should take 5mg daily on prescription.
• Vitamin D 10mcg (400 IU) daily: Recommended for all adults in the UK, and particularly relevant for women planning pregnancy. Vitamin D deficiency is extremely common in the UK and is associated with adverse pregnancy outcomes including pre-eclampsia and gestational diabetes.
• Iodine: Essential for foetal brain development. Many prenatal vitamins include it, but it is worth checking. The recommended intake is 150mcg daily pre-conception, rising to 200mcg in pregnancy.

I generally advise against mega-dose supplements marketed with fertility claims. A good quality prenatal multivitamin covering folic acid, vitamin D, iodine, and iron is sufficient for most women.

Pre-conception blood tests

Beyond standard health checks, there are specific blood tests I consider valuable before conception:

• Rubella immunity: If you are not immune (through vaccination or prior infection), you should be vaccinated before conceiving, as rubella in pregnancy can cause serious birth defects. The vaccine requires a one-month gap before trying to conceive.
• Thyroid function (TSH): Undiagnosed hypothyroidism can impair fertility and increase the risk of miscarriage. Ideally, TSH should be below 2.5 mIU/L before conception.
• Iron stores (ferritin): Starting pregnancy with depleted iron stores sets you up for significant anaemia as the pregnancy progresses and blood volume expands. I like to see ferritin above 30 μg/L before conception.
• Vitamin D: As above — correct any deficiency before you conceive rather than playing catch-up during pregnancy.

Lifestyle factors

Lifestyle has a measurable impact on fertility, and these are conversations I have openly with patients:

BMI: Both underweight (BMI below 18.5) and overweight (BMI above 30) affect ovulation and reduce the chance of conception. NICE guidelines recommend a BMI between 19 and 30 for optimal fertility outcomes. Even a modest weight change — 5–10% — can restore ovulation in women with weight-related anovulation.

Smoking: Reduces fertility in both women and men. In women, smoking accelerates the depletion of ovarian reserve and brings menopause forward by an average of one to four years. In men, it reduces sperm quality. Stopping is one of the single most impactful things a couple can do.

Alcohol: There is no known safe level of alcohol in pregnancy, and heavy drinking reduces fertility. I advise women to stop or significantly reduce alcohol intake when actively trying to conceive.

Caffeine: Moderate caffeine intake (up to 200mg per day — roughly two cups of coffee) is considered acceptable, but high intake may be associated with reduced fertility and increased miscarriage risk.

When should you seek help?

The general guidance is to seek investigation if you have been trying to conceive for 12 months without success if you are under 35, or 6 months if you are over 35. However, you should seek earlier assessment if:

• Your periods are irregular or absent
• You have a known gynaecological condition (endometriosis, PCOS, fibroids)
• You have a history of pelvic inflammatory disease or sexually transmitted infections
• You or your partner have any known medical conditions that may affect fertility
• You are over 40 — in which case I would recommend an assessment from the outset, even before you start trying

Do not wait and hope if any of these apply to you. Fertility investigations are straightforward — blood tests, an ultrasound, a semen analysis — and early assessment gives you the most options.

Early pregnancy care

If you do conceive, the early weeks of pregnancy can be an anxious time. An early pregnancy scan (typically from 7 weeks) can confirm the pregnancy location, viability, and dates. For women with a history of miscarriage or ectopic pregnancy, early monitoring can provide essential reassurance. I offer early pregnancy consultations as part of my practice because I know how much that first scan matters — not just clinically, but emotionally.