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Approximately 50% of pregnancies in the United States are unplanned and once pregnancy is confirmed, it can be challenging to treat medical conditions, change lifestyle and habits. It is best to assess risks for certain conditions at least 3-6 months prior to pregnancy and make adjustments when necessary. Preconceptual counseling with a fertility specialist may be helpful in improving fertility rates and overall pregnancy outcome.

All women should consume 0.4mg of folic acid daily starting 2-3 months prior to attempting pregnancy. The supplement can be in the form of consuming folic acid rich foods or through supplemental pills. Prenatal vitamins typically contain an adequate amount of folic acid and may be an alternative to using folic acid alone.

It’s important to maintain a well-balanced diet prior to and during pregnancy. Additionally, an adequate level of physical activity will improve blood flow to the uterus and ovaries, reduce stress and improve ovulation function.

Prediction of ovulation and timing of intercourse are important factors in enhancing fertility. Documentation of cycle length and estimation of ovulation date will improve the fertility potential as well. The egg is viable for 24 hours in the fallopian tube and the sperm can be present in the female genital tract up to 3-4 days following intercourse. Ovulation predictor kits can be useful in estimating ovulation so that the intercourse can be timed. If menstrual cycles are irregular, ovulation is either irregular or absent, and in such cases, it is recommended to seek an evaluation from a fertility specialist followed by ovulation induction.

Women with regular menstrual cycles should attempt pregnancy for one year before starting infertility work up if they are under the age 35. Over 35, it is recommended to start evaluation after 6 months of unprotected intercourse. If there are medical problems, a known male issue or a history of irregular menstrual cycles or pelvic infection, the workup needs to be initiated immediately. If pregnancy is not accomplished based on the above criteria, a consultation with a fertility specialist is recommended. A fertility specialist is a four-year residency trained obstetrician and gynecologist who received fellowship training for three additional years in reproductive endocrinology and infertility.

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