Anything to do with pregnancy can sometimes feel like a crash course in withstanding uncertainty. From getting pregnant in the first place to avoiding complications later on, any parent-to-be is forced to reckon with the limits of their own control.<\/p>\n
The stats around this are worth emphasising: about one in seven<\/a> couples in the UK will have difficulty conceiving. About one in eight<\/a> known pregnancies will end in a loss. And as many as 29%<\/a> of low-risk pregnancies will experience some kind of unforeseen complication. Often there\u2019s no rhyme or reason to any of this. \u201cYou can do everything \u2018right\u2019 and still face delays. That\u2019s biology, not failure,\u201d says Dr Linda Farahani, a consultant gynaecologist and specialist in reproductive medicine at the Lister Fertility Clinic<\/a> in Chelsea, London.<\/p>\n All this said, leaving your fertility to the whims of chance may feel unnecessarily fatalistic. If you\u2019ve spent any time in the wilds of the \u201ctrying to conceive\u201d (TTC) community, you\u2019ve probably heard of something called \u201ctrimester zero\u201d. Simply put, this is the period before you get pregnant, when you try to prepare your body for a healthy outcome. There are no guarantees. But according to an army of \u201cpregnancy prep\u201d influencers, there\u2019s plenty you can do to maximise your odds of success.<\/p>\n What exactly is trimester zero?<\/p>\n Pregnancy is divided into three trimesters, each with its own signature characteristics (for example, morning sickness in the first trimester; a short-lived burst of energy in the second; feeling like you\u2019ve swallowed a bowling ball in the third). Some people talk about the fourth trimester<\/a>, too: the initial postpartum period in which parents and babies adjust to this disorienting new stage of life.<\/p>\n Current advice suggests that you should avoid alcohol consumption if you\u2019re trying to conceive. Photograph: Posed by models; ferrantraite\/Getty Images<\/p>\n Trimester zero, then, is the stage of pregnancy that occurs before you actually conceive. If this sounds odd, then tell that to public health agencies in the US, who have historically advised<\/a> women of reproductive age to behave as if they were already expecting. In fact, the term Zero Trimester was coined by sociology professor Miranda Waggoner, whose 2017 book of the same name<\/a> explored the rights and wrongs of this kind of pre-pregnancy healthcare. \u201cWomen are thought of as reproductive vessels by default,\u201d she wrote.<\/p>\n These days, however, trimester zero has a different connotation. It refers to the window of time in which a person is actively trying to conceive \u2013 maybe three months to a year \u2013 as opposed to being some natural state of womanhood. And according to Farahani, it\u2019s not an entirely ridiculous idea. \u201cThe idea of a trimester zero \u2013 a period before conception where you focus on optimising your health \u2013 can be genuinely helpful when framed sensibly,\u201d she says.<\/p>\n One study found that fewer than 8%<\/a> of women in the UK receive specific preconception care, such as being encouraged to take folic acid supplements. Many doctors think that figure is too low. \u201cWe know that optimising health before pregnancy can reduce the risk of complications such as pre-term labour and pre-eclampsia,\u201d says Dr Lucy Hooper, a GP and co-founder of Coyne Medical<\/a>, a private London clinic.<\/p>\n \u2018Supporting women to quit smoking can have a profound positive impact,\u2019 says Dr Lucy Hooper. Photograph: Supplied imageWhy is it suddenly popular?<\/p>\n Pregnancy preparation is a very old idea, with many ancient cultures practising fertility rituals of some description. Recently, though, preconception has become an industry. Social media is bursting with naturopaths, life coaches, holistic health practitioners, influencers, doctors and self-proclaimed experts of every stripe, who purportedly know the secrets to trimester zero.<\/p>\n Their advice runs the gamut from the sensible (Eat well! Minimise stress!) to the questionable. One pregnancy prep doctor advises her 75,000 Instagram followers<\/a> to avoid scented candles, polyester clothing and \u2013 perplexingly \u2013 \u201csecular music\u201d. Another recommends that women should focus on<\/a> \u201chigh-quality skincare\u201d and \u201csimple drainage and circulation rituals\u201d, while reading books \u201cthat expand inner authority and soften rigid self-pressure\u201d.<\/p>\n Many of them are selling something, too. Take naturopathic doctor<\/a> Dr Afrouz Demeri, who has established<\/a> \u201cthe world\u2019s most scientific seven-week online course to get you pregnant now\u201d, and has trademarked the term \u201ctrimester zero\u201d. She maintains that the preconception period is more critical than you can \u201cpossibly imagine\u201d, not least because it\u2019s \u201cwhen your child\u2019s DNA is being set up for success\u201d. There\u2019s also a thriving market for private blood tests<\/a> that will assess your hormonal profile or nutritional deficiencies.<\/p>\n It\u2019s easy to understand the appetite for solutions. More people than ever are experiencing fertility struggles, with a sharp increase<\/a> in the number of babies born via IVF. Part of this is down to age \u2013 more of us are waiting longer to have children \u2013 although there have also been concerns about lifestyle factors and environmental toxins. (Cut to many an influencer telling us not to use<\/a> non-stick pans.)<\/p>\n \u201cSubfertility is far more complex than many people realise,\u201d notes Farahani. \u201cAge is a major factor, but ovulatory disorders such as polycystic ovarian syndrome, endometriosis, fibroids, and hormonal disorders such as thyroid disease are very common. On the male side, sperm quality can be affected by genetics, infections, heat exposure and lifestyle factors. Lifestyle absolutely plays a role, but it is one piece of a much larger puzzle.\u201d<\/p>\n Of course, for every person who\u2019s stuck in the trenches of #TTC, there are others who haven\u2019t even started the process yet. A 2023 UK study found that almost half<\/a> of 16- to 24-year-olds were worried about their future fertility, while a 2022 US study<\/a> (admittedly conducted by a women\u2019s health clinic) found that \u201cat least four in five women experience some level of anxiety when thinking about their ability to get pregnant\u201d. That\u2019s a lot of people who might be in the market for hormonal health mentorship programmes or expensive beef liver supplements.<\/p>\n What does the evidence say?<\/p>\n Medics are in broad agreement here. There are certain things you can do to maximise the chances of a healthy pregnancy \u2013 but you\u2019re not going to find the magic bullet scrolling on TikTok. In fact, the lifestyle factors with the strongest evidence base are relatively simple (read, boring). \u201cThey include maintaining an optimum weight, not smoking, reducing alcohol intake, managing stress, sleeping well and eating a varied, nutrient-dense diet. These behaviours support hormonal balance, ovulation and sperm development,\u201d says Farahani.<\/p>\n Dr John Spicer, an NHS GP in south London, notes that the best overall advice is on the NHS website<\/a>. \u201cThis includes taking folic acid \u2013 two different doses depending on any history of neural tube defects,\u201d he says. \u201cAnything more complicated, such as withdrawing medicines or not, and adverse medical histories, should be discussed with one\u2019s GP or specialist.\u201d<\/p>\n Women are advised to take folic acid for the first 12 weeks of pregnancy. Photograph: Posed by model; Tashi-Delek\/Getty Images<\/p>\n Current advice<\/a> suggests that, if you\u2019re trying to conceive, you should avoid alcohol consumption altogether. That\u2019s partly due to the risks to a potential foetus, but also partly because it reduces the odds of conception \u2013 it interferes with ovulation in women and sperm count in men. And you don\u2019t even need to be knocking back the tequilas: one study found that as few as three<\/a> alcoholic drinks a week could make it harder to become pregnant.<\/p>\n Then there\u2019s smoking, which is strongly linked<\/a> with fertility problems. Continue to smoke once you\u2019ve conceived, and your risk of complications rockets, including premature delivery and low birth weight<\/a>. \u201cIt increases the risk of stillbirth by up to 47%<\/a>. Supporting women to quit smoking can therefore have a profound positive impact,\u201d says Hooper.<\/p>\n But other than staying generally healthy, and keeping on top of your medical appointments, there\u2019s no need to micromanage your lifestyle too much. After all, chronic stress can affect fertility.<\/p>\n \u201cStress destroys hormonal balance and, as a consequence, is a reason for delayed ovulation or suboptimal sperm quality,\u201d says Dr Gergana Peeva, an NHS consultant obstetrician and a medical expert for pregnancy and postnatal wellbeing platform Carea<\/a>. \u201cI have seen in my practice a lot of cases where lifestyle improvement and stress reduction have resulted in successful pregnancies.\u201d<\/p>\n What should you be eating?<\/p>\n Nutrition is important, says Farahani, but not in the overprescriptive way social media often claims. For instance, there\u2019s nothing to say that cutting out dairy or gluten will increase your chances of getting pregnant, unless you have an intolerance. \u201cWhat research shows is that dietary patterns rich in whole foods, fibre, antioxidants and healthy fats are associated with better reproductive outcomes,\u201d she says. \u201cThat doesn\u2019t mean individual food rules or restriction. It\u2019s about overall balance, not perfection.\u201d<\/p>\n Brazil nuts are a good source of selenium. Photograph: MirageC\/Getty Images<\/p>\n Jenna Hope<\/a>, a registered nutritionist, suggests focusing on protein-rich foods to boost egg quality, and healthy fats such as salmon and avocado to support hormone function. \u201cKey nutrients such as iron, folate, magnesium and selenium are also vital for promoting egg health,\u201d she says. \u201cSelenium is essential for the male partner too as it encourages movement from the sperm. Nuts, specifically Brazil nuts, are great sources. Green leafy vegetables should also feature heavily in the diet as they\u2019re nutrient dense and rich in fibre.\u201d<\/p>\n One 2018 study<\/a> found that following a Mediterranean diet (rich in fruit, veg, legumes, whole grains, nuts and olive oil) improved success rates in younger women going through IVF. There is also evidence to suggest that processed red meat<\/a>, caffeinated fizzy drinks<\/a> and refined carbohydrates<\/a> are bad for fertility when consumed in excess.<\/p>\n However, contrary to some sources, eating offal <\/a> isn\u2019t a preconception panacea. Calf\u2019s liver contains extremely high levels of vitamin A, which can actually be harmful to an unborn baby<\/a>.<\/p>\n Are there any supplements that work?<\/p>\n You should start taking folic acid as soon as you start trying to conceive, says Hooper, and keep going for the first 12 weeks of pregnancy. There\u2019s good reason for doing so: folic acid supplementation reduces the risk of neural tube defects like spina bifida by up to 72%<\/a>. \u201cOther deficiencies that should be corrected include iron, vitamin D, iodine and B vitamins,\u201d she adds. \u201cOmega-3 supplements are associated with a lower risk of pre-term delivery and may be worth considering if dietary intake is low.\u201d<\/p>\n But apply a note of caution before you splash out for an influencer\u2019s proprietary baby-making blend. \u201cThe supplement market is full of bold claims that simply don\u2019t align with the evidence,\u201d says Farahani. \u201cA fertility specialist or GP can help you interpret what\u2019s genuinely useful and what\u2019s simply marketing.\u201d<\/p>\n Is there anything else I need to think about?<\/p>\n You won\u2019t see many TikTok reels lauding the benefits of booking an appointment with your GP. But in truth, trimester zero is a good time to do a health audit and tackle any medical admin you\u2019ve been putting off.<\/p>\n \u201cMidwives encourage anyone thinking about having a baby to start considering their health early on,\u201d says Clare Livingstone, head of professional policy and practice at the Royal College of Midwives. \u201cSmall things like making sure your cervical screening and vaccinations are up to date, checking any medications with a healthcare professional and getting support to manage conditions like diabetes can make a real difference.\u201d<\/p>\n This is particularly important if you\u2019re older, notes Peeva, since the risk of certain pregnancy complications rises with age. \u201cFor more mature mums, blood pressure, diabetes screening and medication checks are key,\u201d she says.<\/p>\n I want to get pregnant. Should I worry about any of this at all?<\/p>\n It depends on your psychological makeup. For every person who thrives on the element of control, there will be another who winds up feeling worse than ever \u2013 full of self-recrimination in the event that something goes wrong.<\/p>\n Fertility problems can affect anyone, including those with optimal lifestyles. That means, if conception is taking longer than expected, it\u2019s important to seek support. \u201cThis isn\u2019t because you\u2019ve done something wrong, but because fertility is a medical issue like any other, and you deserve accurate information and compassionate care,\u201d says Farahani.<\/p>\n You can knock back all the black sesame lattes<\/a> you want, minimise blue light after dark<\/a>, deal with your repressed emotions<\/a> and replace your toxic kitchenware. But ultimately, getting pregnant is always going to involve a strong element of the unpredictable, however warm you keep your feet<\/a>.<\/p>\n \u201cFor many patients, particularly those already feeling vulnerable, the notion that they must \u2018perfect\u2019 their lifestyle before trying to conceive can introduce unnecessary pressure,\u201d says Farahani. \u201cMy concern would be that it can shift the focus from support to self-blame, and that\u2019s the last thing anyone on a fertility journey needs.\u201d<\/p>\n