Be proactive.  Here’s a list of what to do and what to avoid in the months prior to pregnancy. 

This list may seem obnoxiously long and obsessive.  It is simply the result of my effort to compile a "master list" for myself of things to keep in mind when trying to conceive.  If anything on this list – or any one recommendation of your doctor or midwife – triggers a fit of despair, hit the internet!  Do your own research and cost-benefit analysis.  I always advocate erring on the side of caution when it comes to pregnancy, and that is my bias with this list.   

• Take prenatal vitamins.  You can start these six months before you want to conceive, though most people generally start around three months prior to beginning to try for a baby.  Some brands are prescription-only, but there are several over-the-counter brands available.  Health-foods stores usually have a good selection, but consult with your doctor or midwife to see if she has a recommendation for you.  Be sure that the vitamins you choose do not have excessive amounts of synthetic Vitamin A, since too much can cause problems for the developing baby.  In my experience, prenatal vitamins make me nauseous if I take them without food, so I avoid taking them first thing in the morning.  My favorite brand, which is allergen-free and kosher, is Freeda One-a-Day. 
  
  
• Make sure to get enough folic acid in your vitamins and foods.  There are certain nutrients that your body needs more of during pregnancy - most notably, folic acid.  ACOG recommends 400 mcg prior to conception and 800 mcg daily thereafter.  You will want to have elevated levels of folic acid in your system from the first moments of conception.  This nutrient is especially critical during the first part of the first trimester, since several studies have shown that taking folic acid decreases the risk of neural tube defects.  Folic acid is an amazing substance that has been shown to increase fertility as well as help the body naturally reject embryos with severe defects.
  
  
• Consider supplements.  You may want or need extra calcium, since most one-a-day prenatal vitamins do not give you 100% RDA of calcium.  You’re expected to make up the difference with foods, but just make sure that you are actually doing this!  Other supplements to explore and discuss with your health care provider include Omega 3s (DHA and EPA in fish oil or EPA and ALA in flaxseed oil) and probiotics. I am just now learning more about using probiotics to infuse the intestinal tract with healthy flora. Based on my own research (googling Omega 3 fish oil), I chose to take fish oil during pregnancy.  If you do likewise, make sure to get oil that is ultra-purified/refined (pharmaceutical grade if possible) because of potential for heavy metals contamination in fish. DHA/EPA is critical for brain development; I have read that in the future, we will consider it almost as essential for pregnant mommies as folic acid. EPA and DHA have also been used as part of nutrient solutions for preemies with amazing results, and there is some evidence that they prevent depression and improve problem skin. Of course, it's generally best to get nutrients directly from foods instead of from supplement, but with the concerns about mercury and PCBs in fish, the fish oil supplements might actually be safer, provided that they are ultra-refined. Flax oil contains ALA, which the body converts to DHA and EPA but only at a rate of 5-10%.
  
  
• Stop any hormonal birth control.  You can try to get pregnant immediately after stopping the Pill (some doctors will say to wait, and others actually prescribe going on the Pill and then trying immediately after going off the Pill as a fertility treatment!).  If you are going to use Fertility Awareness to help with conception, give yourself extra time for your cycles to revert to their natural state (remember – this doesn't mean that they will be regular, since most of us aren't regular!).
  
  
• Have a pelvic exam, pre-pregnancy bloodwork, pap test, etc.  Have your iron levels checked, since anemia can sometimes be a problem for conception.  Thyroid levels can play a large role, too.
  
  
• Consider the option of pre-screening with your partner for genetic diseases (such as Cystic Fibrosis, Fragile X), as well as other viruses that can cause fetal harm if harbored during pregnancy (such as HIV, cytomegalovirus).
  
  
• Eat well.  And eat enough, since low body fat can inhibit conception.  Eat whole foods and organic foods whenever possible (Do you really want your fetus exposed to pesticide residue?).  Avoid artificial ingredients and processed foods. 
  
  
• Avoid caffeine.  You will want to wean yourself off of it gradually so that by the time you conceive, it's out of your system.  It interferes with calcium absorption and it is a drug that will pass into your baby’s system.  If you absolutely need it, there are studies that show that 1 cup of coffee a day is okay, but I would personally try to steer clear of it, at least during the first trimester.  Try herbal tea instead of coffee, decaffeinated organic/natural sodas or sparkling water instead of big-name soft drinks.
   
• Avoid alcohol whenever you’re at a time in your cycle when you could be pregnant, as well as during pregnancy.  For example, if you are bleeding from having your period and therefore know that you are not pregnant, it’s not the end of the world to have a glass of wine.  It will pass out of your system in a matter of hours.  As with anything else, use moderation.  (Caution:  Before drinking alcohol, it would be wise to make sure that any bleeding you experience during the trying-to-conceive phase is really your period and not bleeding from the implantation of the developing embryo.  If you use Fertility Awareness to chart your cycles, you will know.  Always err on the side of caution!)
  
  
• Male partners should also avoid alcohol and caffeine while trying to conceive and, I would argue, during the 3-month pre-trying phase, too.  Both of these depress sperm count.  (After you're pregnant, he’s off the hook!)
  
  
• Drink 8-10 8-oz. glasses of water or clear liquids each day.  We should all do this anyway!  Get in the habit, because you’ll need the hydration during pregnancy and for nursing.  This is especially important at the end of pregnancy for maintaining a healthy amniotic fluid volume and preventing preterm labor.
  
  
• Explore herbs if you are so inclined.  There are certain herbs said to promote fertility and be uterine tonics, such as Raspberry Leaf, but most doctors will not have experience with these and each midwife has a different perspective on using herbs.  The Wise Woman’s Herbal for the Childbearing Years by Susan Weed is an excellent resource if you want to make decisions on your own.  However, having a medical professional to guide you is always a good thing, as herbs are no less potent than conventional medicines.  If you are interested in alternative medicine approaches as a supplement to a more conventional approach, you could consider having a consultation with a midwife or holistic health practitioner (acupuncturist, naturopath, homeopath, etc.).
  
  
• Don't allow x-rays except during your period and make sure to always use a lead blanket. In that vein, have a dental exam and any repair work done before pregnancy, if possible, to avoid fetal exposue to local anesthesia.
  
  
• Don't take any medications, even OTC drugs, while actively trying to conceive, unless it's an emergency.  Of course, if you use Fertility Awareness, you will know what stage of your cycle you're in, and whether there is any chance you could be pregnant. Just as a rule, check with a doctor or midwife before taking any drug if you think you might be pregnant or during pregnancy. If you need information on taking a specific medication (over-the-counter or prescription) while pregnant, Perinatology.com and OBFocus have lists. Kellymom provides a summary of the drug classifications for pregnancy.
  
• Avoid the foods that pregnant women should avoid – in essence, treat yourself as if you are pregnant.  These include:  more than 1 serving of canned tuna per week, any high-mercury fish or shellfish (swordfish, shark, etc.), raw fish, canned or packaged deli meats and sausages containing nitrates or nitrites, raw eggs, rare red meat, MSG. 
  
• Limit your intake of anti-fertility foods, including peas, processed soy, high levels of sugar, peanuts and spinach while trying to conceive.  Peas contain a natural contraceptive.  Soy contains plant estrogens that can mimic human estrogen and cause a hormonal imbalance, so eat it in moderation.  It is difficult to remove all forms of soy from our diets, since it is so ubiquitous (some speculate that the pervasiveness of soy in our diets is to blame for lowering the age for girls getting their first periods).  Peanuts (including peanut butter) and spinach deplete calcium, so use them in moderation.  High levels of sugar can lead to a drop in blood sugar, which can affect reproductive hormones.
  
• Avoid artificial sweeteners.  The safety of saccharin and aspartame (NutraSweet or Equal) is unclear.  Xylitol and sorbitol are natural sweeteners (XyloSweet is made from Xylitol, which has the added advantage of fighting dental decay!).
  
  
• Monitor your exposure to solar radiation via airplane travel.  Most of us don’t need to worry about this, but flight attendants and heavy business travelers should take steps to ensure that their exposure is within recommended limits.  Those most at risk make several international or cross-country flight per year.  If you can’t avoid exceeding the recommended exposure, the National Oceanic and Atmospheric Administration's National Weather Service has a website for Space Weather Alerts; check the timeline and do not fly if there is a radiation storm warning in effect.
  
  
• Try to get at least 20 minutes of exercise 4-5 times a week.  Just do whatever you need to do to feel healthy and de-stressed.  It could be that your daily activities already provide enough physical activity, or it could be that you need to insert this into your life as a new priority.  Yoga might be a good fit for you if you don’t feel that you are the “athletic” type.
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  No hot tubs.  High temperatures can impact both egg and sperm – and for a man, this means a lower sperm count for a few weeks!  Not worth it.

• Check your workplace for fertility hazards, including exposure to radiation (including office equipment), low air quality, toxic chemicals, high temperatures, etc.  If you work around an older computer monitor that is not flat-panel, stay away from the back of the monitor, push the screen as far away from you as possible, and turn your monitor off when doing non-computer tasks.  Flat-panel monitors are preferable, since they offer a significantly reduced exposure to radiation. 

• Check your home for fertility hazards, including toxic cleaning products, electric blankets (they have low-voltage electric field emissions), and fumes from paint, construction or extermination.  If something has a strong chemical odor, it is probably toxic.  Whole Foods and other health-foods stores have a wide selection of non-toxic household products.  If you cannot avoid fumes, consider staying out of your home for a few days during and after painting, construction or extermination.  If you have a cat, you will need to avoid litterbox duty during preconception and pregnancy (cat feces can harbor toxoplasmosis). 

• Stay away from sick people, especially kids.  And wash your hands often!  This may seem obvious, but it bears mentioning.  Some childhood illnesses – Fifth Disease is a prime example – can have mild symptoms for the child, but serious and even life-threatening results for a developing baby.  So if there is any chance you could be pregnant, be extra cautious.  Of course, if it’s your own child who’s sick, it’s very hard to stay away, so simply be proactive in getting a diagnosis from your child’s doctor to rule out Fifth Disease and other diseases in this category.  If you fear that you were exposed (the virus is contagious before symptoms appear), you can be tested to see if you already possess immunity.  Talk with your doctor or midwife immediately.

• Watch your stress level and start making lifestyle changes to lower it.  Remember to breathe.  Treat yourself to periodic relaxation breaks - a cup of tea, a warm bath, a good book, acupuncture or massage, whatever it is that makes you feel nurtured.  Be conscious that you are taking this time to nuture yourself and your body for the purpose of preparing to conceive.  This is your introduction to the transformative experience of motherhood! 

And here's the rationale for all of this, as I see it:  You want to ensure that from the moment of conception, your body is READY.  You will have spent at least 3 months on a sort of detox/spa program…so that you know that the minute his sperm hits your egg, it's all happening in the ideal environment. 

Highly Recommended Reading (since what I have here really is only the tip of the iceberg):  Getting Pregnant by Niels Lauersen, MD PhD, and Colette Bouchez. This provides cutting-edge fertility medicine information (which you will hopefully not need!), background for several of the recommendations listed here, and additional resources.

And if you haven't already guessed, I strongly encourage the practice of Fertility Awareness [LINK to FA page].