Proper Nutrition
Good nutrition must assume a high priority for a women and man who are planning to have a baby. The diet should contain adequate protein, fruit and vegetables. Women are often prescribed a folic acid supplement, since a deficiency of that vitamin has been linked to certain birth defects. Folic acid, zinc and antioxidant vitamins such as vitamin C have been shown to improve a man's fertility. The energy supplement l-carnitine may improve the motility of sperm. Excessive ingestion of vitamins A and D may increase the risk of birth defects--so don't overdo vitamins. We advise our patients to avoid herbal supplements, since these substances are unregulated and of unproven value.

Obesity increases the risk of some pregnancy complications and perhaps, some birth defects. Radical weight loss during the time of conception and early pregnancy may also increase the chance of some birth defects. If a woman desires to lose weight, it is better to delay conception until dieting is completed.

Certain foods should be avoided by women who are trying to conceive. Most important are the large fish that contain high concentrations of mercury. These include tuna, shark, halibut and tilefish. Also to be avoided are certain fresh water fish harboring increased levels of the contaminant PCB, including some catfish and farm raised wild salmon. Please note that appropriate fish consumption is healthy and associated with decreased pregnancy complications. Once you are pregnant it is also wise to avoid unpasteurized soft cheeses such as feta and brie.

Tobacco
The most important step that a man or woman can take prior to conception is to stop smoking cigarettes. Cigarette smoking can damage eggs and sperm. Women who smoke have an increased rate of pregnancy complications. Exposure to side stream (passive) smoke is also dangerous. You may need to discuss this issue with fellow workers, employers or family members.

Alcohol
Alcohol is also toxic to eggs, sperm, and developing babies. We recommend abstinence for both partners. Marijuana has deleterious effects on both the man and the woman. Again, side stream smoke exposure must be avoided. If you need help with other substance abuse problems, please get it before creating a new life.

Caffeine
It is also wise to restrict your caffeine intake to no more than one cup of coffee (or its equivalent) per day.

Exercise
Proper exercise is part of the optimal preparation for childbearing. It is rare for excessive exercise to decrease a man's fertility. Too much running or high impact aerobics may interfere with ovulation and lessen a woman's chance of becoming pregnant. Once a woman conceives, there are common sense limitations on exercise to be discussed with a physician. Certain high risk pregnancies will require definite cutbacks in exercise and activity.

Travel
High altitude airplane travel exposes us to cosmic radiation which in very high dose may damage a developing fetus. The average business or pleasure traveler will not receive enough radiation to be a problem. Women who work as pilots or cabin attendants may need to modify their work schedules to avoid too much radiation. Strenuous activities at high altitude, for example, skiing above 6000 feet above sea level, should be avoided once you are pregnant.

Mental Health
As you optimize your nutrition and physical activity you should also think about your emotional state. The stresses of infertility on your sex life, self-esteem and time schedules may bring underlying problems between spouses, family members, and/or workers to crisis levels. Don't ignore warning signs: insomnia, anxiety, withdrawal from others, etc. Try to keep in touch with your spouse's emotional state. Talk to loved ones. Make adjustments in your work or family obligations. Seek outside or professional help if necessary. Maintaining your emotional health will not only lessen the pain of fertility problems but also improve your chances for success!

General Health
As you anticipate pregnancy, update the evaluation and care for your general medical health. If you have any ongoing medical or dental problems, be sure to visit your family physician, specialist, or dentist to get your condition in optimal control. Discuss any medications you have been prescribed. Is it OK to be on these drugs as you conceive and carry a pregnancy? In some cases you ought to have a preconceptional consultation with a high risk pregnancy specialist in order to anticipate and plan for potential complications. Prior to pregnancy, you may want to have thought through options for prenatal testing such as amniocentesis and chorionic villous sampling.

Certain preventive tests are much easier to accomplish while you are not pregnant. Have your Pap test, mammogram, dental work, x-rays and diagnostic tests completed before conception. You may wish to consider immunization against rubella (German measles) before pregnancy. Special attention should be directed to genetic testing. Depending on your family history and ethnicity, screening tests for cystic fibrosis, Tay Sachs disease, sickle cell disease, thalassemia, chromosome rearrangement or a host of other conditions may be appropriate.

While we are "against" the use of herbal supplements we are interested in other alternative treatments such as acupuncture.

Immunization
The government now recommends that women who will be pregnant during the winter months (flu season) receive a flu shot. . Certain vaccinations , such as German measles (rubella), are to be avoided while pregnant.

Environment
Evaluate your home and work environment for other stresses and toxins. Don't overlook noise, shift work, solvent vapors, exposure to infectious diseases and lack of sleep and recreation.

The Optimal Frequency of Intercourse
Only after you have "put your house in order" is it time to focus on the process of getting pregnant. Identifying ovulation, that time in a woman's cycle when her egg is available to be fertilized is a key to becoming pregnant. A woman who has regular menstrual cycles releases her egg 12 to 16 days before the onset of the next menstrual flow. Once released the egg is fertilizable for 12-24 hours.

Much is said about the ideal frequency of intercourse for promoting pregnancy. Most advice is based on theory rather than scientific proof. We suggest you have intercourse about every other day around the time of ovulation. If your libidos drive you to more frequent coitus, go ahead.

You may benefit from more precise identification of ovulation. Perhaps your work schedules make frequent intercourse difficult. Perhaps, one or both of your natural inclination is to have sex less frequently than every other day. Perhaps, a condition in the man or woman has created a narrower "window of opportunity" for the sperm to successfully swim through the woman's reproductive tract and fertilize the egg. Ways to pinpoint ovulation include awareness of cervical-vaginal discharge and midcycle pelvic pain, basal body temperature and detection of a preovulatory hormone signal in the urine.

Over-the-counter urine tests which detect ovulation can be handy or frustrating, depending on your circumstances. If you are able to use these kits successfully you should focus your efforts on both the day you first see the "color change" and the following day.

Technique
We receive many questions about techniques of intercourse. The average woman is most fertile having intercourse on her back and remaining in a comfortable reclining position for at least 15 minutes afterwards. If we note an unusual position of the woman's cervix on vaginal examination, we might recommend either propping the hips or rolling over to a face down position during or after coitus.

	It is commonplace and normal to feel liquid running out of the vagina after intercourse.
	Female orgasm is not essential for conception to occur.
	The use of lubricants may diminish the chance for conception.
	Many couples want to influence the gender of their conception. There is no convincing evidence that the timing or technique of intercourse has any effect on the sex of the offspring. Any attempt to manipulate these factors may decrease your absolute chance to conceive.