What are the recommended lifestyle changes and interventions when trying to conceive?

Preconception Lifestyle Recommendations

Women trying to conceive should take 400-800 mcg of folic acid daily starting before conception, achieve or maintain a healthy weight, engage in regular moderate-intensity exercise (30 minutes daily for at least 5 days per week), and optimize management of any chronic medical conditions. 1

Essential Supplementation

• Folic acid supplementation is mandatory: Take 400-800 mcg daily starting before conception and continuing through 12 weeks of pregnancy to reduce neural tube defects 1
• Women with obesity or history of neural tube defects should take higher doses (5 mg daily) 1
• Vitamin D: Check levels and supplement if deficient 1
• Consider a daily multivitamin, which may improve chances of achieving and maintaining pregnancy beyond just preventing birth defects 2

Weight Optimization

Weight management before conception is critical and strongly recommended across multiple guidelines. 1

• Women with obesity (BMI ≥ 35 kg/m²) who are anovulatory should undergo intensive structured lifestyle management for a minimum of 6 months before considering other interventions 1
• Even modest weight loss (10.2 kg) in anovulatory women with obesity can restore ovulation in 90% of cases and achieve live birth in 67% 1
• Stop all weight loss medications before attempting conception 1
• For women with PCOS and BMI ≥ 35 kg/m² who remain infertile after 6 months of lifestyle intervention, bariatric surgery may be considered, though this recommendation is controversial 1

Physical Activity

• Target 30 minutes of moderate-intensity exercise for at least 5 days per week 1
• Alternative recommendation: Work toward 150 minutes per week 1
• Regular physical activity improves fertility outcomes and prepares the body for pregnancy 1

Dietary Modifications

Adopt a Mediterranean-style dietary pattern rich in specific fertility-promoting foods. 2, 3

• Increase consumption of:

  • Whole grains 2
  • Omega-3 fatty acids and fish 2
  • Soy products 2
  • Dietary fiber 3
  • Plant-based proteins 3
  • Folate-rich foods in addition to supplementation 1

• Reduce or eliminate:

  • Trans fats 2, 3
  • Red meat 2
  • Refined carbohydrates 3
  • Added sugars 3
  • Fast foods and processed foods 4

Chronic Disease Management

All chronic conditions must be optimally controlled before conception. 1

• Hypertension: Ensure blood pressure is controlled and switch to pregnancy-safe medications 1
• Diabetes: Achieve optimal glycemic control before conception 1
• Thyroid disorders: Optimize thyroid function 5
• Depression and anxiety: Screen for mood disorders and adjust medications to pregnancy-safe options before conception, as untreated mental illness carries significant risks 1

Substance Use and Environmental Factors

• Smoking cessation is essential - smoking adversely impacts reproductive performance 1, 6
• Alcohol: Avoid or minimize consumption 1
• Caffeine: Moderate consumption in recommended amounts does not appear to affect fertility 3
• Assess and minimize exposure to environmental pollutants 6

Immunizations and Screening

• Review and update immunization status annually 1
• Screen for sexually transmitted infections 1
• Assess for physical, sexual, or emotional abuse and provide appropriate referrals 1

Timing and Reproductive Planning

• Discuss reproductive goals at each healthcare visit, as plans may change with life circumstances 1
• Time intercourse to coincide with ovulation (typically 5-10 days after ovulation induction if using medications) 5
• Use basal body temperature charting or ovulation predictor kits to identify fertile window 5
• Consider birth spacing and inter-pregnancy weight management for subsequent pregnancies 1

Common Pitfalls to Avoid

• Do not delay addressing obesity: Achieving optimal weight may take months to years, and maternal obesity originates long before pregnancy 1
• Do not assume gluten-free diets are necessary: There is no evidence to exclude gluten unless celiac disease is present 3
• Do not overlook male partner factors: Male fertility issues, including diabetes, erectile dysfunction, and lifestyle factors like smoking, directly impact conception success 1
• Do not continue teratogenic medications: Many commonly prescribed medications are unsafe in pregnancy and must be switched before conception 1

Special Considerations for Infertility Treatment

• Women with polycystic ovary syndrome benefit particularly from pregnancy risk counseling and lifestyle optimization 1
• If ovulation induction is needed, clomiphene citrate starting at 50 mg daily for 5 days is first-line, with treatment not recommended beyond six total cycles 5
• Pelvic examination is necessary before each treatment cycle to exclude ovarian cysts or enlargement 5