Before you start trying
- Start folic acid at 400–800 mcg daily, ideally three months ahead
- Get blood pressure and blood sugar under control
- Review every medication and supplement for pregnancy safety
- Confirm rubella, varicella, and Tdap immunity
- Check thyroid, iron, and vitamin D
What a preconception visit covers
We review your cycle history, medical and surgical history, family and genetic history, medications, and vaccinations. Our on-site labs at both Fresno locations handle the bloodwork in the same appointment: CBC, ferritin, thyroid panel, A1c, vitamin D, rubella and varicella immunity, and STI screening.
Chronic conditions matter most here. Uncontrolled hypertension, diabetes, or thyroid disease meaningfully raise pregnancy risk, and all three are far easier to bring into range before conception than during it. We manage these through our primary care service and keep the recheck cadence tight.
Timing and tracking
Conception is most likely in the five days leading up to and including ovulation. Cycle tracking apps, ovulation predictor kits, and basic temperature charting all help identify that window. Very irregular cycles often mean irregular ovulation, which is worth investigating rather than waiting out.
When trying isn't working
The standard threshold for a fertility evaluation is twelve months of trying under age 35, and six months at 35 or older. Come sooner if your cycles are irregular or absent, if you have known PCOS or endometriosis, or if you've had two or more miscarriages.
We start the first-line workup — thyroid, prolactin, androgens, A1c, and ovulation confirmation — and refer to reproductive endocrinology with those results already in hand, which saves weeks.
Preconception and fertility visits are part of our women’s health services, and chronic conditions are managed alongside them through primary care.
Come to urgent care for:
- You're planning pregnancy and want baseline labs and vitamins sorted
- Irregular or absent cycles while trying to conceive
- Twelve months of trying under 35, or six months at 35+
- A chronic condition or medication that needs a pregnancy-safe review
Go to the ER (or call 911) for:
- Severe one-sided pelvic pain with a positive pregnancy test
- Heavy bleeding with dizziness or fainting in early pregnancy
- Shoulder-tip pain with pelvic pain and a positive test
Frequently asked
How early should I start folic acid?
Ideally three months before conception. The neural tube closes in the first few weeks, often before a pregnancy is confirmed.
Which of my medications need review?
Bring the full list, including supplements. Some blood pressure, acne, mood, and autoimmune medications need substituting before conception.
Can you tell me if I'm ovulating?
We can confirm ovulation with a mid-luteal progesterone level and evaluate cycle irregularity with thyroid, prolactin, and androgen testing on site.
Does age change the plan?
Yes. At 35 and older we shorten the trying window to six months before starting an evaluation, and we get labs moving sooner.
What if I've had a miscarriage?
One early loss is common and doesn't usually change the plan. Two or more warrants a recurrent-loss workup, which we start here.
Do you confirm pregnancy?
Yes — we confirm with testing, start prenatal vitamins, and refer you to obstetric care with your labs already complete.