Your body mass index

Ideally, your body mass index (BMI) should be in the normal range 19-25. The National Institute for Health and Care Excellence (NICE) guidance states that being overweight (BMI 25-30) isn’t a problem but there is good evidence that being underweight (BMI <19) or “obese” (BMI>30) reduces the chance of achieving pregnancy.

In addition, women with a raised BMI have a risk of miscarriage, giving birth earlier, having a big baby or having a stillbirth. Women with a BMI above 30 are recommended to take vitamin D supplements and a high dose of folic acid (5mg) which has to be prescribed by a GP.

Please be aware that NHS funding is restricted and all Integrated Care Board (ICBs) have rules about BMI for the women and for some ICBs for the men too.

Folic acid

Folic acid reduces the chance of a baby developing spina bifida. This is a condition when a part of the baby’s spine doesn’t develop normally. Spina Bifida occurs very early in pregnancy, often before a woman realises that she is pregnant. Therefore, women are advised to take folic acid supplements for at least three months before they start trying for a baby and continue right up until 12 weeks of pregnancy.

While green vegetables do contain folic acid, in reality it’s quite difficult to get enough from diet alone so you are advised to buy folic acid 400mcg tablets from your local pharmacy. A small number of women will need a prescription for a higher dose folic acid (5mg), for example, women who are overweight, take anti-epileptic medication, have diabetes, or a family history of neural tube defect. Please discuss this with your GP if you are unsure.

Caffeine

It is recommended that women trying to get pregnant have no more than 1-2 caffeinated drinks per day.

Vitamin D

There is increasing evidence to support vitamin D supplementation during fertility treatment and pregnancy. The guidance from Public Health England recommends daily intake of 10 μg/d (400 IU/d). It is important to start taking the supplementation alongside folic acid whilst trying to conceive.

Alcohol

The National Institute for Health and Care Excellence (NICE) guideline recommends limiting to 1-2 units once or twice per week for women and 3-4 units per day for men.

Smoking

Smoking has a significant impact on chances of pregnancy. The effects of cigarette smoke for the woman are long lasting. The damage to the DNA of the woman’s eggs is the equivalent of an extra 5 years of aging. Cigarettes also damage sperm DNA and reduce male fertility.

Cigarette smoking, including passive smoking, is linked to an increased risk of miscarriage, having a small or growth restricted baby, stillbirth and cot death. There is compelling evidence that stopping smoking increases the chance of having a baby. There is increasing evidence that nicotine replacement is effective in helping people stopping smoking, doesn’t affect fertility and is safe in pregnancy. You should discuss with your GP, access the NHS Stop Smoking services, or consider getting an e-cigarette (vaping).

All ICBs restrict NHS funded treatments to non-smokers.

Medication

If either of you are having regular treatment with prescribed medication you should discuss this with your GP to ensure that your medical condition is well controlled and that the drugs you are taking are safe for pregnancy. You could arrange this when you are next due to collect a repeat prescription.

Stress and anxiety

It is very common to feel stressed or become anxious when you are trying to get pregnant and it isn’t happening. It may be worth discussing this with your GP or you can access patient support groups, through charities, such as Fertility Network UK and the Fertility Alliance. Some couples do have good support from their friends and family, but other couples prefer to keep their concerns confidential and private. What’s most important is for you to decide, as a couple, what works best for you.

All couples having IVF treatment are offered counselling from trained fertility counsellors. If you need support before you are seen at a fertility clinic, some counsellors do see patients on a self-funded basis.

The internet

It is empowering to find out information about getting pregnant and the possible investigations and treatments but it’s strongly recommended that you access recognised UK bodies for advice and information such as the HFEA Human Fertilisation and Embryology Authority or NHS Choices or NICE guidance. Information on the internet may not be evidence based, may represent someone’s personal views or may be relevant to a different country where the law and regulations are different from the UK.