Which assessments are done at a pre-pregnancy check-up, when to see a doctor and which tests are requested? Information for those planning pregnancy.
A pre-pregnancy check-up is the consultation and investigations done to assess the prospective mother's state of health and to identify in advance the risks that may affect pregnancy. The aim is to bring existing illnesses under control, to review the medicines used and to build a preparation plan suited to pregnancy. You do not need to be having difficulty conceiving for this consultation. When you are planning a pregnancy, you can see an obstetrics and gynaecology specialist.
When should you go for a pre-pregnancy check-up?
If possible, applying a few months before starting to try for pregnancy gives time to complete the necessary preparations. If you have a chronic illness, use medicines regularly or had a problem in your earlier pregnancies in particular, it is important not to postpone the assessment. You do not need to wait for a particular day of your period for a pre-pregnancy check-up. If there is an investigation that has to be done according to the day of your period, your doctor plans it separately.
What is assessed at the first consultation?
Your doctor takes information on the following subjects:
- Your age, your menstrual pattern and how long you have been trying for pregnancy.
- Your earlier pregnancies, births and any history of miscarriage or ectopic pregnancy.
- The operations you have had and any gynaecological conditions known to you.
- Chronic illnesses such as diabetes, thyroid disease and hypertension.
- The medicines, vitamins and herbal products you use.
- Inherited diseases in your family and, if there is one, marriage between relatives.
- Your habits of diet, weight, smoking, alcohol and physical activity.
Where necessary, the timing suitable for pregnancy is determined together with the doctors of the other specialties who follow you. You should not stop the medicines you use regularly on your own decision.
Are a gynaecological examination and ultrasound done?
A gynaecological examination and ultrasound may be planned according to your medical history, your complaints and your earlier findings. The uterus and ovaries are assessed to investigate whether there is a fibroid, an ovarian cyst or any other finding that could affect the plan for pregnancy. If your cervical screening is due, a smear and/or HPV test may also be considered. These tests do not need to be repeated for every pregnancy plan; your age, your earlier results and your screening interval are taken into account.
Which blood tests are requested before pregnancy?
It is not necessary to apply the same broad package of tests to everyone. According to your earlier results and your state of health, the following investigations may be considered:
- Full blood count: to investigate conditions such as anaemia.
- Blood group and Rh information: to be determined if not previously known.
- Blood sugar and thyroid tests: according to illness history, symptoms or risk factors.
- Assessment of infection and immunity: according to vaccination records, illnesses you have had and your risk situation.
- Genetic carrier screening: taking into account national screening programmes, family history and the carrier status of the partners.
Vitamin and mineral levels may also be examined according to your dietary habits, symptoms or a suspicion of deficiency. The choice of tests is made by considering how the result will change the follow-up or treatment plan.
Why are folic acid and vaccines important?
Folic acid helps to reduce the risk of some congenital problems linked to the development of the baby's brain and spinal cord. In general, it is recommended that daily folic acid be started at least one month before pregnancy and continued in the first weeks of pregnancy. A different dose may be needed in some risk situations; your doctor determines the suitable dose. Your vaccination history is also reviewed. Completing missing vaccines and the time to be waited for pregnancy after some live vaccines are arranged according to the pregnancy plan.
Does everyone planning a pregnancy need an AMH test?
No. The AMH test is not a "fertility test" necessary for everyone. AMH and the follicle count by ultrasound help to assess ovarian reserve and, when needed, to predict the likely response to medicines in IVF treatment. But AMH alone does not show egg quality or the likelihood of conceiving naturally. A low AMH result does not mean that you definitely cannot conceive, just as a normal result does not give a guarantee of pregnancy. The necessity of the test is determined according to your age, your history and the treatment plan to be made.
When should an assessment be made if pregnancy does not occur?
If there is no known risk factor, a fertility assessment may be considered when pregnancy does not occur despite regular, unprotected intercourse. The time to be waited gets shorter as age advances; those who begin trying at an advanced age are advised to consult their doctor without waiting out these periods. These periods do not mean that you have to wait for a pre-pregnancy check-up; the preparation consultation can also be held before you start trying for pregnancy.
In which situations should you see a doctor without waiting?
In the following situations, an assessment can be made before the expected periods are over:
- Markedly irregular periods or no periods for a long time.
- Known endometriosis, tubal disease or a history of ectopic pregnancy.
- A history of ovarian surgery, chemotherapy or radiotherapy.
- A family history of early menopause or a known risk.
- A known sperm problem in the partner.
- Sexual function or relationship problems that could make pregnancy difficult.
Recurrent pregnancy losses should also be assessed separately.
Which investigations are done when pregnancy does not occur?
In the first stage, ovulation, the uterus and ovaries and the partner's sperm characteristics are assessed. When necessary, methods such as the uterine X-ray can be planned to examine the patency of the tubes. The uterine X-ray, hysteroscopy and advanced genetic tests are not done routinely in every woman planning a pregnancy; which investigation is needed is decided according to the findings of the first assessment. It is important that the assessment is not limited to the woman alone; assessing the woman and the man together when pregnancy does not occur helps to identify the possible causes.
Frequently Asked Questions
My periods are regular; is a pre-pregnancy check-up still necessary?
Having regular periods is a favourable finding, but it does not take the place of assessing preparation subjects such as chronic illnesses, medicines, vaccines and folic acid.
What should I bring to the first consultation?
You can bring your earlier test and ultrasound results, any operation reports and the list of medicines you use. Noting down the date of your last period and the pattern of your periods is also useful.
Does a pre-pregnancy check-up mean that IVF treatment will be started?
No. The purpose of a pre-pregnancy check-up is to assess your health and plan the necessary preparations. Whether treatment is needed is determined only by the investigations done when the need arises.
I used the contraceptive pill for years; will it be harder for me to conceive?
Long-term use of the contraceptive pill does not cause permanent infertility. Ovulation generally begins again after stopping. However, menstrual irregularities that went unnoticed while on the pill may appear after stopping.
I conceived my first child easily. Is the same true for a second pregnancy?
Your earlier pregnancy is favourable information, but it does not show that the next pregnancy will occur in the same time. The time that has passed, age and changes in the health of both partners can affect the chance of pregnancy.
My mother went through early menopause. Do I need to be assessed early too?
A history of early menopause in the family, particularly in the mother or a sister, is taken into account in planning a pregnancy. This does not mean that you will definitely go through early menopause too; but it would be useful to share your plans with your doctor early.
Is it enough to have intercourse on the days an ovulation app shows?
Phone apps estimate the day of ovulation; they cannot determine it for certain. Predictions can be misleading, particularly if your periods are irregular. Instead of focusing on a single day, regular intercourse may make it easier to catch the fertile window.
Is it necessary to have intercourse every day to conceive?
No. Regular intercourse is generally a suitable approach; intercourse a few days apart during the ovulation period can also support the chance of pregnancy.
Does lying down or raising the legs after intercourse increase the chance of pregnancy?
These practices have not been shown to increase the chance of pregnancy. It is normal for some fluid to come out after intercourse, and this does not mean that all the sperm have come out.
Am I unable to conceive because I am very stressed?
It is not right to attribute a failure to conceive to stress alone. Stress can affect quality of life and the frequency of intercourse; but the approach "if you relax it will happen" does not take the place of medical assessment.
Should I use the "egg-quality-boosting" supplements recommended on the internet?
The benefit of every product has not been scientifically shown. Being "natural" does not mean it is safe either. Supplements should be assessed taking into account any deficiencies you have and the medicines you use.
If I have no complaints, can a chocolate cyst or a fibroid affect my pregnancy?
In some situations it can; but not every fibroid or chocolate cyst prevents pregnancy, and not all always need surgery. The location and size of the lesion, ovarian reserve and the plan for pregnancy are assessed together.
I had one miscarriage. Should I have comprehensive tests before trying again?
After a single miscarriage, extensive genetic or clotting tests do not need to be done in everyone. Whether investigation is needed is decided by assessing the week of pregnancy at which the loss occurred, your earlier history and the other findings.
Get Your Free Consultation
Fill out the form below and our team will contact you
