When to Start Trying to Conceive: The Medical Readiness Checklist

TL;DR

• Timing: Begin preconception preparation before you start trying. ACOG frames the conversation around whether you hope to conceive in the next year and advises optimising any chronic condition first (ACOG Committee Opinion No. 762, 2019).

• Folic acid: Start 400 micrograms daily at least one month before conception, ideally two to three months, and continue through early pregnancy (CDC, USPSTF 2023). Folic acid is the only form of folate proven to prevent neural tube defects.

• Female screening: A standard preconception panel covers blood count and iron, thyroid, blood sugar, rubella and varicella immunity, hepatitis B, blood group, vitamin B12, folate and vitamin D. A fertility hormone panel is added if cycles are irregular.

• Male screening: A semen analysis is the core male test. Male factor contributes to roughly 50% of all infertility cases globally - male is solely responsible in about 20% and a contributing factor in another 30-40% (StatPearls). The Indian Council of Medical Research figure for "male solely responsible" is around 10-15%, considered conservative by Indian commentators.

• Vaccines: MMR and varicella are live vaccines and cannot be given in pregnancy, so confirm immunity beforehand. Flu and Tdap are not live and are given during pregnancy (CDC).

• India context: NFHS-5 found 57% of women aged 15-49 are anaemic and 24% are overweight or obese; both affect fertility and pregnancy outcomes.

Quick Answer: The best time to begin preparing for pregnancy is before you start trying, not after a positive test. ACOG Committee Opinion No. 762 (2019) recommends that prepregnancy counselling take place before conception, and can begin with a single question "Would you like to become pregnant in the next year?" and that chronic conditions such as diabetes, hypertension, thyroid disease and psychiatric illness be optimally managed beforehand. The two most time-sensitive steps are starting 400 micrograms of folic acid daily at least one month before conception, since the neural tube closes during the third and fourth weeks of pregnancy (CDC, US Preventive Services Task Force 2023), and confirming immunity to rubella and varicella, because those vaccines are live and cannot be given once pregnant (CDC). For Indian couples, two background figures shape the urgency: the National Family Health Survey (NFHS-5, 2019-21) found 57% of women aged 15 to 49 are anaemic, and a 2024 meta-analysis of 27 Indian studies in Child's Nervous System estimated the birth prevalence of neural tube defects in India at 9.46 per 1,000 births, well above the 0.5 to 2 per 1,000 typical in countries with mandatory folic acid fortification.

How Important Is Preconception Care?

Pregnancy is often thought of as a nine-month journey, but the medical evidence points to the months before conception as the period where preparation has the most effect. The reason is biological timing. Several of the most important developmental events, and the screening that protects against them, have to happen before a pregnancy is even confirmed.

Folic acid is the clearest example. The neural tube, which becomes the baby's brain and spine, folds and closes during the third and fourth weeks of pregnancy, often before anyone knows they are pregnant (CDC, Neural Tube Defects). For folic acid to do its job, it has to be in the body before that window, which is why both the CDC and the 2023 US Preventive Services Task Force recommendation specify starting at least one month before anticipated conception and continuing through the first 2 to 3 months of pregnancy.

This is not an abstract concern in India. The 2024 systematic review and meta-analysis in Child's Nervous System by Krishna et al. (DOI 10.1007/s00381-024-06627-x) pooled 27 Indian studies and estimated the birth prevalence of neural tube defects at 9.46 per 1,000 births (95% CI 8.01-10.91), with the authors specifically calling for preconception folic acid supplementation and food fortification as the prevention strategies India most needs.

In India, there is an added reason to prepare early. According to NFHS-5 (2019-21), conducted by the International Institute for Population Sciences for the Ministry of Health and Family Welfare, 57% of women aged 15-49 are anaemic (up from 53% in NFHS-4), and 24% of women of reproductive age are overweight or obese. Both conditions influence fertility and pregnancy outcomes, and both are far easier to identify and address in the months before conception than during a pregnancy already underway.

When Should You Start Preparing to Conceive?

There is no single calendar date that applies to everyone. ACOG Committee Opinion No. 762 (2019, Obstet Gynecol 133(1):e78-89) does not specify a fixed number of months. Its guidance is that prepregnancy counselling should take place, that it can begin with the simple question "Would you like to become pregnant in the next year?", and that it should occur several times across a woman's reproductive lifespan.

What ACOG does emphasise is the substance, not the schedule: chronic medical conditions such as diabetes, high blood pressure, thyroid disease and psychiatric illness all have implications for pregnancy and should be optimally managed before conception.

In practical terms, the start of preparation is driven by what needs doing rather than a countdown. Folic acid should be started at least one month before trying. A man's lifestyle changes take about three months to show in a semen analysis, because sperm production takes roughly 72 to 74 days. A poorly controlled thyroid or blood sugar level may take longer still to bring into range. A reasonable approach is to see a doctor for a preconception review a few months before you plan to try, so there is time to act on whatever the screening finds.

What Does the Female Preconception Panel Cover?

A preconception review for the woman typically includes a panel of blood tests and a basic gynaecological assessment. Your doctor will decide which to apply to you.

• Complete blood count with ferritin. Screens for anemia and measures iron stores. Particularly relevant in India, where NFHS-5 found 57% of women of reproductive age are anaemic.

• Thyroid function (TSH and Free T4). Thyroid dysfunction can disrupt ovulation and affect pregnancy. For women with thyroid autoimmunity, a lower TSH target before conception is sometimes used, but this is a context-specific clinical decision.

• HbA1c or fasting glucose. Screens for diabetes or prediabetes, which are best identified and controlled before pregnancy.

• Rubella IgG and varicella IgG. Confirms immunity. The vaccines are live and cannot be given once pregnant.

• Hepatitis B serology. Identifies infection or immunity status, relevant to preventing transmission to the baby.

• Blood group and Rh factor with antibody screen. Important for identifying Rh-negative status and planning care accordingly.

• Vitamin B12, folate and vitamin D. Nutritional markers relevant to fertility, egg health and early fetal development.

• Kidney and liver function. Establishes a baseline of metabolic health.

• Cervical screening (Pap smear) and a pelvic ultrasound. Checks for cervical cell changes and structural findings such as fibroids, cysts or features of PCOS.

• STI screening, including HIV, syphilis and hepatitis C. ACOG advises that the need for STI screening be assessed at preconception counselling.

If your cycles are irregular, or if you are over 35, your doctor may add a fertility hormone panel: AMH as a marker of ovarian reserve, along with FSH, LH, estradiol, prolactin and progesterone, timed to the correct day of your cycle.

What Does the Male Preconception Workup Involve?

Preconception planning often focuses almost entirely on the woman, but the male partner's health is half the equation. The relevant numbers need to be read carefully, because two different things often get blended together. Per StatPearls (NCBI Bookshelf, NBK562258) the male is solely responsible in about 20% of infertility cases and a contributing factor in another 30 to 40%, with the overall male factor contributing to about 50% of all infertility cases. The WHO 2023 global infertility report estimated that 1 in 6 people (17.5%) experience infertility in their lifetime.

The Indian Council of Medical Research figure, cited in The Established (2026) via the Population Foundation of India, puts male infertility at roughly 10-15% of couples' infertility in India, and the article notes this figure is "likely conservative, shaped by limited volunteer participation." Other Indian sources put the male contributing factor closer to 40-50%, in line with global data. What is not in dispute is that the male partner should be evaluated rather than assumed to be fine.

The core male tests are straightforward:

• Semen analysis. The single most important male fertility test. It measures sperm count, motility (especially progressive motility), morphology and volume.

• Metabolic and nutritional screening. Blood count, fasting glucose, lipid profile, vitamin D and B12 give a baseline picture of general health.

• Infection screening. Hepatitis B, HIV and other STI testing as appropriate.

There is a reason to test, and to act, early. Sperm production takes roughly 72 to 74 days, which means a semen analysis reflects a man's health and habits over the previous three months. Smoking, heavy alcohol use, obesity, heat exposure and chronic stress can all affect sperm count, motility and quality, and because of that 72 to 74 day cycle, improvements made through lifestyle change take about three months to show up in the results.

Which Vaccinations Should You Confirm Before Conception?

Some vaccines are live-attenuated, meaning they contain a weakened form of the virus, and cannot be given during pregnancy. This is why immunity should be confirmed before you conceive.

The practical takeaway: the live vaccines, MMR and varicella, are the ones with a real deadline. Rubella infection in pregnancy can cause serious birth defects, which is what makes confirmed immunity important. If a blood test shows you are not immune, you need to act before conception, not after.

How Does the Mylo Care Fertility Range Fit Into This?

For Indian couples preparing for pregnancy, the Mylo Care fertility range is a nutritional support layer that sits alongside, never in place of, the medical screening described above. Supplements do not replace preconception testing or treat infertility; they support general nutritional readiness while the medical workup does its job.

Mylo Ovaluna Conception Fertility Capsules are a 60-capsule preconception supplement for women, formulated with CoQ10, L-methylfolate, zinc, vitamin D2, vitamin B12 and Shatavari. Understanding what these ingredients are matters more than seeing them listed:

• L-methylfolate is the bioactive form of folate, the B vitamin the body uses for cell division and early neural development. The CDC is explicit that folic acid is the specific form proven to reduce neural tube defects, and the dedicated 400 microgram folic acid intake remains the established recommendation. L-methylfolate is a legitimate folate source in a supplement, but should be understood as the active form of folate, not as a replacement for the folic acid recommendation. If you are trying to conceive, take a dedicated 400 mcg folic acid supplement as the established baseline regardless of what else you take.

• CoQ10 (coenzyme Q10) is a compound involved in mitochondrial energy production, included in fertility supplements for its role in cellular metabolism in oocytes, which are highly mitochondria-dependent.

• Zinc, vitamin D2 and vitamin B12 are micronutrients relevant to general reproductive and metabolic health — the same markers a preconception blood panel checks.

• Shatavari is the classical Ayurvedic name for Asparagus racemosus, classified in Ayurveda as a rasayana and a stri-rasayan (women's tonic). It contains shatavarins (steroidal saponins) and is traditionally used as a women's reproductive and general tonic. Modern evidence is strongest for lactation support (multiple RCTs); for fertility specifically, evidence is mainly traditional-use rather than RCT-level. Treat it as a traditional ingredient with women's wellness associations rather than as a clinically proven fertility treatment.

Mylo Clinic offers gynaecologist consultations and structured care packages within the app for couples planning their journey together.

The honest framing remains: start a dedicated 400 microgram folic acid supplement at least one month before trying as the established baseline, keep all medical screening on track, and treat any fertility supplement as an addition to that foundation, not a substitute for it.

Frequently Asked Questions

When should I start preconception health planning? Before you start trying. ACOG Committee Opinion No. 762 (2019) advises that prepregnancy counselling happen before conception and that chronic conditions be well controlled first, framing it around whether you hope to conceive within the next year. A practical step is a preconception review a few months ahead, so there is time to act on what the screening finds.

When should I start taking folic acid? At least one month before trying to conceive, at 400 micrograms daily, continuing through early pregnancy (CDC, USPSTF 2023). The neural tube folds and closes during the third and fourth weeks of pregnancy, often before a pregnancy is confirmed, so folic acid needs to be in your body beforehand. The CDC is specific that folic acid is the only form of folate proven to prevent neural tube defects.

What blood tests should every woman do before pregnancy? A standard preconception panel covers complete blood count with ferritin, thyroid function, blood sugar, rubella and varicella immunity, hepatitis B, blood group and Rh, vitamin B12, folate and vitamin D, and kidney and liver function. A fertility hormone panel including AMH is added if cycles are irregular or you are over 35. Your doctor will tailor the list to you.

Should my husband also get tested before we try to conceive? Yes. Male factor contributes to about 50% of all infertility cases globally — solely responsible for roughly 20%, contributing in another 30-40% (StatPearls). A semen analysis is the core male test, alongside basic metabolic and infection screening. Sperm health responds to lifestyle changes over about a three-month window because spermatogenesis takes 72-74 days.

Which vaccines do I need to check before pregnancy? Confirm immunity to rubella and chickenpox, because the MMR and varicella vaccines are live and cannot be given during pregnancy. If you are not immune, get vaccinated before conception and wait one month before trying (CDC). Flu and Tdap are not live vaccines and are given during pregnancy — Tdap usually in the third trimester, flu at any stage.

How long does it usually take a healthy couple to conceive? Most healthy couples under 35 conceive within about a year of regular unprotected sex. If you are over 35, doctors generally suggest seeking a fertility evaluation after about six months of trying. Earlier consultation is sensible if there is known PCOS, irregular cycles or a male-factor concern.

Why is the Indian context different from global preconception advice? NFHS-5 found 57% of women aged 15-49 are anaemic and 24% are overweight or obese in India. The 2024 meta-analysis of 27 Indian studies estimated neural tube defect birth prevalence at 9.46 per 1,000 births, several times higher than the 0.5 to 2 per 1,000 typical in countries with mandatory folic acid fortification of staple foods. These background figures make Indian preconception preparation, especially folic acid plus iron status, more time-sensitive, not less.

Sources

• ACOG Committee Opinion No. 762: Prepregnancy Counseling. Obstetrics and Gynecology 2019;133(1):e78-e89. DOI: 10.1097/AOG.0000000000003013. PMID 30575679. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/01/prepregnancy-counseling

• Centers for Disease Control and Prevention. About Folic Acid. https://www.cdc.gov/folic-acid/about/index.html

• Centers for Disease Control and Prevention. Neural Tube Defects. https://www.cdc.gov/birth-defects/about/neural-tube-defects.html

• US Preventive Services Task Force. Folic Acid Supplementation to Prevent Neural Tube Defects: Preventive Medication. 2023. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/folic-acid-for-the-prevention-of-neural-tube-defects-preventive-medication

• Krishna SR et al. Burden of neural tube defects in India: a systematic review and meta-analysis. Child's Nervous System 2024. DOI: 10.1007/s00381-024-06627-x. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11579090/

• International Institute for Population Sciences. National Family Health Survey (NFHS-5) 2019-21 Key Insights. https://india.unfpa.org/sites/default/files/pub-pdf/nfhs_5_key_insights.pdf

• Let S et al. Prevalence and determinants of anaemia among women of reproductive age in Aspirational Districts of India: an analysis of NFHS 4 and NFHS 5 data. BMC Public Health 2024. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10860231/

• World Health Organization. 1 in 6 people globally affected by infertility. 4 April 2023. https://www.who.int/news/item/04-04-2023-1-in-6-people-globally-affected-by-infertility

• Leslie SW, Soon-Sutton TL, Khan MAB. Male Infertility. StatPearls (NCBI Bookshelf). NBK562258. https://www.ncbi.nlm.nih.gov/books/NBK562258/

• The Established (2026). Why male infertility in India is still ignored. (citing ICMR via Population Foundation of India). https://www.theestablished.com/self/health/male-infertility-in-india-silence-1099385