By Dr Sascha Edelstein
When you are thinking about starting a family, it can sometimes feel as though there is an endless list of things you should be doing first: eat perfectly, exercise more, sleep eight hours, take the right supplements, drink less, stress less, and somehow get everything in order before you even begin.
But good preconception health does not require perfection.
This year’s Jean Hailes Women’s Health Week is built around the theme “Do it anyway”, encouraging people to take small, manageable steps towards better health even when life is busy and circumstances are not perfect. It is an idea that translates particularly well to preconception care.
For me, good preconception health means taking the ordinary foundations of health and pointing them towards a particular goal. Eating reasonably well, moving regularly, sleeping enough, keeping alcohol modest, not smoking, and making sure the basics are covered with your GP, such as reviewing medications, checking vaccinations, keeping cervical screening current and managing any ongoing health conditions.
What it is not is a test you must pass before you are allowed to start trying. Many patients arrive feeling they need to get everything right first, and I spend a good part of that first conversation letting them off that hook. A handful of sensible changes, made consistently, is worthwhile. You do not need a perfect routine to start looking after your health. You just need to start.
Importantly, those changes are not only for women. Conception takes two people, and preconception health should involve both partners from the beginning.
How early should you start thinking about preconception health?
About three months before conception is a useful horizon to keep in mind. Sperm take roughly three months to develop, while an egg also spends its final months maturing before ovulation, so the health and habits of both partners in the months before conception are relevant.
Some recommendations have their own timing. Folate, for example, is recommended from at least one month before conception. But I would hate for anyone to read “three months” as a deadline. It is never too early to build healthier habits, and never too late for them to be worth doing.
With that in mind, the five themes of Women’s Health Week offer a useful way to think about preconception health: to fuel, to move, to rest, to breathe and to connect.
To fuel: forget the perfect “fertility diet”
There is no special fertility diet, and I would be sceptical of anyone selling one. The best-supported approach is much less exciting and much more achievable: a balanced, largely home-cooked way of eating.
That means plenty of vegetables and wholegrains, some fruit, lean proteins including fish, and less food from the highly processed and sugary end of the supermarket. If I had to choose the changes with the biggest practical return, I would suggest swapping most sugary drinks for water, cooking at home more often than not, and keeping alcohol modest for both partners.
The same broad pattern applies to men and women. The eating pattern that supports egg and sperm health is also one that supports general health, which is no coincidence.
What about fertility supplements?
This is an area where the marketing can run well ahead of the evidence.
For women, folate is clearly established. It reduces the risk of neural tube defects and is recommended from at least one month before conception. In Australia, iodine is also routinely recommended when planning pregnancy.
Beyond those, things become less straightforward. Fertility-branded multivitamins and supplement combinations are heavily advertised and can be expensive, and for many people they add relatively little to a reasonable diet. More is not necessarily better either. High doses of some vitamins can be unhelpful, and I have seen patients spending real money on shelves of bottles while the fundamentals go unaddressed.
In my own practice, I also look at vitamin D. Deficiency is common in Australia, and observational studies have found better assisted reproduction outcomes among women who are vitamin D replete compared with those who are deficient. However, that association has not yet translated into trial evidence showing that vitamin D supplementation improves fertility outcomes.
Correcting a deficiency is important for general and pregnancy health, but it should not be presented as a proven fertility treatment. It is worth knowing your level, and that means a blood test through your GP rather than guessing at the chemist.
My rule of thumb is folate, iodine and food. Anything further should earn its place through a conversation with your GP, dietitian, naturopath or fertility specialist, not an advertisement.
To move: regular beats heroic
When it comes to exercise, I encourage patients to think in terms of moderate, regular and sustainable activity, ideally the kind of exercise they will still be doing in three months.
Walking, swimming, cycling and some strength work can all qualify. The best exercise is the one you will actually keep up. For someone starting from very little activity, a daily walk is a perfectly respectable beginning.
It is often a mistake to launch into a punishing new program at the same time you start trying to conceive. Those programs have a tendency to collapse and take morale with them. For women with an uncomplicated pregnancy, Australian guidelines and the Royal Women’s Hospital also continue to encourage regular moderate physical activity during pregnancy, so a sustainable habit built now can carry straight through.
Regular beats heroic.
At the other extreme, exercise can go too far. In women, very high training loads combined with inadequate fuelling can disturb the menstrual cycle. A period that becomes irregular or stops altogether is a signal worth taking seriously, not a badge of fitness.
In men, the picture is less consistent, but chronic overtraining without adequate recovery does general health no favours either. Persistent fatigue, declining performance, unintended weight loss and changing or absent periods are all signs that it may be worth reviewing the balance between training, nutrition and recovery.
None of this is an argument against exercise. The dose makes the difference, and the middle of the road is where the benefit lives.
To rest: the preconception factor we rarely talk about
Sleep is the part of preconception health that almost nobody asks me about, which is exactly why I wanted it included in this discussion.
What we can say with confidence is that sleep matters for hormonal regulation and general health, and that poor sleep affects almost everything else we are talking about. It influences mood, appetite, weight and the energy needed to sustain healthier habits in the first place.
The direct evidence linking sleep to fertility outcomes is still developing, so I am careful not to overstate it. Sleep is part of the whole health picture rather than a proven lever for improving fertility outcomes. But you do not need a fertility-specific reason to take rest seriously. It is the foundation the other small steps stand on.
What if you work shifts?
This is particularly important because a significant proportion of our patients work shifts, including people in health care, emergency services, logistics and manufacturing. Telling them simply to get eight hours of sleep a night is not useful advice.
Shift work makes consistent sleep difficult, and that is a constraint to work within rather than a personal failing. The practical steps I suggest are to treat your available sleep window as a fixed appointment and protect it, keep your routine as consistent as the roster allows, make the bedroom properly dark, cool and quiet, keep the phone out of reach, and be mindful of caffeine during the latter part of a shift because it may still be in your system at bedtime.
Perfect sleep is not available to everyone.
Protecting the sleep that is available to you is a meaningful step in exactly the spirit of Women’s Health Week.
To breathe: support your wellbeing without blaming yourself
Trying to conceive can carry a substantial emotional load, often long before someone enters a fertility clinic. There is the monthly cycle of hope and disappointment, friends announcing pregnancies, intimacy beginning to feel scheduled, and questions from relatives that are kindly meant but land hard.
Many people carry all of this silently while continuing to work, attend appointments and manage everyday life. Fertility treatment, when it comes, can then add another layer of emotional and practical demands. Naming this matters, because people can start to believe they are coping badly with something that is, quite simply, hard.
It is also important to be very careful about how we talk about stress and fertility. There is a persistent idea that stress causes infertility, and I think it can do real harm.
Just relax’ may be the least helpful sentence in fertility.
That phrase quietly suggests that if someone could only calm down, they might become pregnant. In my experience, distress is far more often the consequence of fertility difficulty than its cause.
I prefer to turn that framing around entirely: your emotional wellbeing is worth supporting in its own right because these months are hard and you matter, not because feeling calm is another task you must perform to conceive.
Counselling can be useful much earlier than many patients assume. It does not need to be reserved for the point where somebody feels they are no longer coping. At Thrive, counselling support is part of how we look after patients, not an add-on kept aside for emergencies.
There are also smaller things couples can do themselves. Agree on times when you will talk about fertility and times when you will deliberately take a night off from it. Be cautious about late-night searching, which rarely comforts anyone, and try to keep at least one part of your week that has nothing to do with trying to conceive. None of those things removes the uncertainty, but they can make the uncertainty more manageable.
Where to find support
If any of this feels heavy, you don’t need to wait until it feels unmanageable:
Fertility counselling at Thrive — counselling support is part of ordinary care for our patients, not an add-on for emergencies.
VARTA — independent Victorian information and emotional support for people navigating fertility and fertility treatment.
Pink Elephants Support Network — peer support for miscarriage and early pregnancy loss, in partnership with PANDA (1300 726 306).
To connect: fertility should never be one partner’s homework
Fertility difficulty can be one of the most isolating experiences in medicine. Couples can be surrounded by people and still feel completely alone with what they are going through.
Between partners, honest conversations matter more than any single appointment. How are you each travelling? What would you both like to say to family? What happens next? It is also worth noticing who is carrying the practical and emotional load.
It is very common for one partner to manage the appointments, forms, tracking, decisions and much of the emotional weight as well. Sharing those responsibilities is not simply sharing the admin. It is a concrete act of connection.
The same principle applies to lifestyle changes. Shared meals, a walk after dinner or a more reasonable bedtime can be easier to maintain when both people are participating. Preconception advice has historically been directed overwhelmingly towards women, but conception takes two people and a man’s health in the months before conception matters too, as we discussed in our recent article on male factor infertility.
Fertility should never be one partner’s homework.
Your care team needs to connect as well
Connection matters on the clinical side too. When health care operates in silos, things can get missed and the patient can end up becoming the messenger, carrying test results and half-explanations between different practitioners.
Fertility sits within a person’s overall health and within the health of a couple. Ideally, the GP, fertility specialist, counsellor and any allied health practitioners involved should be working from one plan, with the patient at the centre rather than in the middle.
Our recent collaborative fertility care case study is a good example of what that looks like in practice. It does not necessarily mean having more practitioners involved. It means having the same practitioners on the same page.
One small step is still a step
Nobody eats perfectly, exercises every day, sleeps eight hours and feels serene all the time, their doctors included. Perfection was never the assignment; consistency is worth far more.
If you take one thing from this article, let it be one small step this week. My candidate would be to book an appointment with your GP for a preconception check, because one conversation can cover a remarkable amount of this ground for both partners.
And that is the message I would leave couples with: approach this together. You were a team before you were ever patients, and every step in this article is lighter when two people take it.
Small steps, taken anyway. That is the whole idea.