Fertility
The 0th trimester: Reshaping the start of your pregnancy
Article produced in association with London Pregnancy Clinic and Jeen Health
For many years, formal clinical involvement in a pregnancy began at the point of confirmation, typically around eight to ten weeks.
The concept of the ‘0th trimester’ represents a shift in thinking: that the period before conception is itself a clinically significant window, during which health optimisation, risk identification and informed planning can meaningfully improve pregnancy outcomes.
Guidance from Tommy’s and the NHS both recommend pre-conception care as part of responsible reproductive health management.
What Pre-Conception Care Involves
Pre-conception care is not a single test or appointment. It is a structured approach to assessing and optimising a woman’s health before she attempts to conceive.
The NHS guidance on planning a pregnancy recommends a range of measures including taking folic acid, reviewing medications for safety in pregnancy, ensuring immunity to rubella and chickenpox, and addressing pre-existing conditions such as thyroid disorders, diabetes or high blood pressure before conception occurs.
General pre-conception assessments typically include blood pressure and BMI review, full blood count and iron levels, thyroid function, immunity screening (rubella, varicella), vitamin D status and cervical screening if overdue.
For women with existing conditions, specialist review before pregnancy is often more valuable than specialist referral during it.
Fertility Investigations as Part of the 0th Trimester
For women who are planning a pregnancy but have concerns about fertility, pre-conception investigations provide information that informs planning rather than leaving uncertainty unaddressed.
Clinics offering 0th trimester services, including London Pregnancy Clinic, provide investigations including hysterosalpingo-contrast-sonography (HyCoSy) to assess tubal patency, follicle tracking scans, anti-Mullerian hormone (AMH) testing to estimate ovarian reserve, and endometrial assessment.
These tests do not guarantee conception but they provide a clinical foundation from which fertility decisions can be made with better information.
Genetic Assessment in Pre-Conception Care
The genetic dimension of pre-conception care is increasingly central to a thorough 0th trimester assessment.
Genetic carrier screening before pregnancy allows couples to identify their carrier status for conditions such as cystic fibrosis, SMA and a range of other inherited disorders before conception, giving them time to consider their options with appropriate clinical support.
At-home carrier testing offered by Jeen Health provides access to comprehensive carrier screening without the need for a clinical referral.
Couples collect their sample at home and receive results within a defined timeframe.
When both partners carry a variant in the same gene, the result can be followed up with genetic counselling via clinics such as London Pregnancy Clinic, where clinical specialists can contextualise the findings and explain the available options.
Lifestyle and Nutritional Factors
Pre-conception health is not limited to clinical testing.
Lifestyle factors including physical activity levels, nutritional status, alcohol consumption and smoking all influence fertility and early fetal development.
Pre-conception care provides an opportunity to address these factors proactively rather than as an afterthought following a positive test.
Folic acid supplementation, recommended at 400 micrograms per day in the pre-conception period and the first trimester, is one of the most evidence-supported interventions available.
Why Timing Matters
Many of the interventions that benefit pregnancy are most effective when started before conception rather than after.
Addressing thyroid dysfunction, normalising blood pressure, treating iron deficiency anaemia, and identifying genetic risks all have a higher potential impact when managed from the outset rather than detected at the first antenatal appointment.
The 0th trimester framework provides a way of thinking about pre-conception care as a structured medical period with its own clinical agenda, rather than simply a waiting room for the first trimester.
What a Pre-Conception Appointment Might Look Like
A comprehensive pre-conception assessment with a specialist provider would typically cover a clinical consultation reviewing medical and family history, a pelvic ultrasound scan, blood tests for general health markers and fertility hormones, cervical health review if indicated, and a discussion of genetic risk including a recommendation for carrier screening if appropriate.
For couples with specific concerns about fertility or genetic history, specialist investigations can be added to this baseline assessment.
Disclaimer: This article is produced for informational purposes only and does not constitute medical advice, diagnosis or treatment.
Clinical guidance referenced reflects published NHS, NICE and RCOG standards as at March 2026. Individual circumstances vary; readers are advised to consult a qualified healthcare professional before acting on any information in this article.
This piece was produced in association with London Pregnancy Clinic and Jeen Health, which provided background clinical information for editorial purposes.
Hyperlinks to external sources are included for reference only and do not represent an endorsement of any product, service or organisation.
Onto Health has acquired Levy Health, a fertility software company providing precision diagnostics and patient intake for reproductive medicine.
The acquisition, fuelled by Onto Health’s US$20m Series A fundraise in April, supports its plan to build scalable, tech-enabled infrastructure for reproductive medicine.
Onto founder Roohi Jeelani, MD, called it the first of several moves in the company’s expansion strategy in a LinkedIn post, adding that there was “more coming soon”.
She said: “This isn’t just an acquisition, it’s proof of how we’re building Onto: physician-led, tech-enabled, and built to scale without losing the personal touch fertility patients deserve.”
Headquartered in Chicago, Onto Health combines evidence-based fertility care with artificial intelligence-driven diagnostics, clinical automation and longevity science.
AI-driven diagnostics use software to analyse patient information and support clinical decision-making, rather than replace clinicians.
Levy Health, founded in Berlin with US offices in San Francisco, helps medical providers identify endocrine disorders more quickly and helps clinics streamline fertility workups.
Endocrine disorders affect the body’s hormone system, which can influence ovulation, menstrual cycles and fertility.
Co-founder Caroline Mitterdorfer said joining Onto would expand Levy Health’s fertility care tools to more clinics and patients, helping physicians focus on patient care.
Onto opened its first clinic in Chicago in February, with plans for three more in the greater Chicago area.
The company said in April that it would use its new funding, led by Artis and Humania, to support additional operations in the US and expand into the Gulf Cooperation Council.
The Gulf Cooperation Council includes six Arab states bordering the Persian Gulf.
Softening ageing ovaries could help women remain fertile for longer, early animal research suggests.
Fertility declines with age for several reasons, including poorer egg quality, fewer ovarian follicles and the gradual stiffening of ovarian tissue.
Existing fertility treatments, including hormone therapy and in vitro fertilisation, mainly address hormonal imbalances or help eggs mature or become fertilised.
Scientists are now examining whether changing the physical structure of the ovaries could provide another route for future fertility treatments.
Stuart A. Cook, of the Cardiovascular and Metabolic Disorders Programme at Duke-National University of Singapore Medical School, published an accompanying commentary on the research.
Researchers led by Shixuan Wang at Huazhong University of Science and Technology in Wuhan, China, collected healthy ovarian tissue from younger, middle-aged and older women.
They also examined samples from patients with polycystic ovary syndrome, known as PCOS, premature ovarian insufficiency, or POI, and endometriosis.
PCOS is a hormonal condition that can disrupt ovulation. POI occurs when the ovaries stop working normally before the age of 40, while endometriosis causes tissue similar to the womb lining to grow elsewhere in the body.
Tests of protein levels and gene activity found higher levels of the inflammatory protein interleukin-11, or IL-11, in ageing and diseased ovaries.
In laboratory experiments, the researchers exposed ovarian fibroblasts to IL-11. Fibroblasts are cells that produce connective tissue.
The protein caused the cells to produce excess collagen, a structural material that can build up during scarring and make tissue stiffer.
The researchers then genetically modified mice so they could not respond to IL-11. The animals developed less ovarian stiffening and maintained better ovarian function as they aged.
Similar results were seen in mouse models of PCOS and POI caused by chemotherapy.
In the final part of the experiment, older mice and rats were injected with a nanoparticle treatment containing small interfering RNA, or siRNA, designed to switch off IL-11.
The treatment made the animals’ ovaries less stiff and improved fertility.
Pregnancy rates among older mice rose from 25 per cent to 50 per cent, while average litter sizes also increased.
More rats treated with the therapy became pregnant and produced larger litters.
The approach remains highly speculative and will require considerably more research before its safety or effectiveness in women can be established.
However, the researchers said blocking the inflammatory pathway could eventually form the basis of new fertility treatments.
They said: “We propose that anti-IL-11 therapy represents a promising translational strategy for delaying ovarian ageing.”
W Group has opened applications for W Accelerate with Merck KGaA and M Ventures, inviting reproductive and maternal health startups, scaleups and spinouts to pitch for direct access to global pharma partnership and strategic investment.
Selected companies will pitch on 5th October, competing for the chance to accelerate their growth through commercial partnerships, investment, or both.
This is the third time Merck KGaA, a global leader in reproductive health, has partnered with W Group on the programme, which exists to close the innovation and investment gap in women’s health by connecting the sector’s most promising startups directly with the corporates and investors positioned to scale them.
What Merck KGaA and M Ventures are looking for
This year’s call is focused on breakthrough solutions in female infertility, fertility preservation, adenomyosis, endometriosis, polyendocrine metabolic ovarian syndrome (PMOS), ovarian insufficiency, preeclampsia and pregnancy comorbidities.
New for this round, applicants choose between three pathways depending on what they need from the programme:
- The Partnership Lane, for companies seeking commercial collaborations and strategic relationships
- The Investment Lane, for founders looking to connect with investors and secure funding to scale
- The Dual Lane, for innovators pursuing both partnership and investment opportunities
How the Accelerate event works
Selected companies get a 1:1 pitch practice session ahead of time, then a private 30-minute session with Merck KGaA and M Ventures leadership on the day itself, small-group sessions with regulatory and investment strategy experts, an “Ask Merck Anything” roundtable, and a VIP networking reception.
Key dates
- Open call launches: 8th July
- Open call closes: 2nd September
- Notification of successful companies: 11th September
- Pitch day: 5th October
Applications are open now at wplatform.typeform.com/to/KGzviBQM.
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