Answer:

"It's positive!" If you're like many people, the first time you'll call your doctor is right after a positive pregnancy test. Instead, let me suggest you move visiting the doctor to the top of your to-do list before you do that baby dance.

After all, getting pregnant is not as easy as most people imagine. On average, a couple having regular, unprotected intercourse has only a 20% to 25% chance each month of getting pregnant. It takes half of all couples more than six months to conceive!

Yet most people prepare their cars for a weekend trip better than they prepare their bodies for a pregnancy. It makes sense to stack these odds in your favor by making sure you have the best chance to make a baby before you begin trying. That means the first questions you may want to answer are: "What needs to happen for us to get pregnant and how can I check each part to make sure it's working?"

Preconception care is a growing field, and research is finding that when put to use, it can have a significant impact on your and your baby's health. Preconception counseling usually involves meeting with a doctor or another health-care provider who is experienced in this specialty before pregnancy. It usually consists of an assessment of the health of both potential parents, although a greater emphasis is usually placed on that of the mother. And it may also involve doing some tests.

Among the items covered in preconception counseling will be:

• A thorough personal, medical, and family history of the potential mother and father. This should include:
  • Information about your reproductive history and sexual health, such as previous pregnancies, any STDs you have had, and former birth control methods
  • Information about family members with hypertension, diabetes, mental retardation, blindness, and deafness
  • Family history of multiple births or congenital birth defects
  • A list of any current medications you and your partner are taking
• A genetic evaluation
• A review of prior pregnancy problems
• A physical exam of the mother including a Pap and other tests
• A physical exam of the father, if indicated
• Blood samples and other tests of both parents if indicated (for example, HIV, infectious diseases, genetic predisposition)

Additional items to discuss in any preconception doctor visit include:

• Your weight. The time to reach your ideal weight is before you conceive. Weight loss is not recommended while pregnant.
  • Obesity puts your pregnancy in a high-risk category, increasing your chances for gestational diabetes.
  • Underweight women sometimes have irregular or no ovulation, making it extremely difficult to get pregnant, and during pregnancy they have a higher risk of delivery a low birth-weight baby.
• Your diet. It may be a cliché that you eat for two while pregnant, but it's the truth! You'll need to be at your dietary best to provide the nutrients both of you will need.
  • Try not to have more than 300 mg of caffeine per day. That's equal to two 5-ounce cups of coffee, three 5-ounce cups of tea, or two 12-ounce glasses of caffeinated soda.
  • Be sure you add a folic acid supplement of at least 400 micrograms a day as soon as you think about the possibility of getting pregnant. Folic acid is essential in preventing fetal malformations such as neural tube defects, such as spina bifida, and fetal cardiac problems. This protection applies to the very early stages of pregnancy, so it's vital to start the folic acid supplement at least one to two months before you conceive.
• Your exercise routine. Be sure to review or make any revisions to your current physical activity, or discuss activities to add to your day that are both safe and helpful in preparing you for the big workout called labor and delivery.
• Your home and workspaces. Now is the time to remove or abate hazards to you and your future child, such a cat litter boxes (see toxoplasmosis), lead paint, asbestos, and harmful chemicals.
• Your lifestyle. If you smoke, quit immediately. There are few changes you can make that so dramatically increase your and your family's health outlook than stopping smoking. Don't hesitate to ask your doctor for help quitting. This goes for your partner, too. Illegal drug use (yes, even marijuana) should cease, too. It's also safest to stop alcohol consumption as soon as you start trying to conceive.

I also recommend a spermanalysis before you begin trying to conceive. Knowing ahead of time that his sperm is OK -- enough healthy sperms that are able to move well through your cervix -- gives you peace of mind, or if there is a problem you can address it before spending a long time trying to conceive in vain. If he is reluctant to do the test, just let him know it's the only test that guarantees him an orgasm. How can he refuse?

It's perfectly safe to start trying to conceive as soon as you stop the pill. No adverse pregnancy outcome is expected even if you happen to get pregnant the day after stopping the pill. However, after you stop the pill, it's not unusual for ovulation, and therefore your period, to take some time to return. If your menstrual period doesn't return, or if it continues to remain very irregular for several months, that may be a sign that you haven't started ovulating regularly yet. Post-pill amenorrhea, the absence of a menstrual period after you stop the pill, is seen in about one in 30 women who stop taking the pill. It's usually suggested that you see your doctor if your period hasn't come about three to four months after stopping the pill.

Your chances of getting pregnant each month depend on many factors such as your age and how long you have been trying. But in general:

• There is a 15%-25% chance of becoming pregnant in each ovulatory cycle. But you need to do everything right.
• About 40% of couples starting out will conceive during the first three months of trying.
• About 70% of couples will conceive during the first six months.
• Up to 85% of couples will conceive within the first year.
• About 50% of couples who have not been able to conceive within one year will still be able to get pregnant on their own in the second year.

In other words, these numbers tell us that 60% of couples do not conceive in the first three months. There is nothing wrong with seeing your doctor as soon as you decide to try to get pregnant. But if you and your partner are young, healthy, and aren't pregnant after a few months of trying, it may not be time to hit the panic button right away. Generally, women under 35 with no other problems should try for a year before talking with their doctors about their options. If you're over 35, the time to seek help is after six months. Those over 40 may begin fertility tests immediately.

Of course, there can be clear signs that difficulties may lie ahead even before you begin. Irregular periods often mean you are not ovulating, and diagnosed conditions such as endometriosis and PCOS (polycystic ovarian syndrome) for her, and varicocele for him are indications that you may need help from the start. Don't despair. Treatments exist for these and other problems. Infertility does not mean you will never get pregnant.