Preconception & Fertility

Preparing for pregnancy is usually thought of in terms of ovulation windows, bloodwork, and appointments with a fertility specialist. Less often discussed is the body that will actually carry the pregnancy — the pelvic floor, deep abdominal muscles, hips, and connective tissue that stretch, adapt, and bear load throughout the nine months ahead. At SOMOM in High Park, our fertility and preconception care is physiotherapy and massage therapy aimed at helping this system feel strong, mobile, and comfortable before conception, whether pregnancy is achieved naturally, through fertility treatment, or via a fertility clinic’s care. It is not a fertility treatment itself, and it does not replace the medical investigations, bloodwork, or reproductive care provided by a family doctor, OB/GYN, or fertility clinic — it works alongside that care.

What We’re Preparing in the Body

The pelvic floor is a sling of muscle and connective tissue spanning the base of the pelvis, working in coordination with the deep abdominal muscles and diaphragm to manage pressure with every breath, cough, and lift. Heading into pregnancy, this system doesn’t need to be perfect, but it benefits from being responsive — able to both contract and fully release, rather than being chronically gripped or chronically weak. We also look at hip and lumbar spine mobility, since the pelvis will be asked to shift and widen as a pregnancy progresses, and at posture and breathing mechanics, which influence how load travels through the trunk. For some people, preconception physiotherapy also means addressing scar tissue from a previous surgery, a history of pelvic or abdominal pain, or muscle patterns left over from a prior pregnancy.

Concerns That Commonly Bring People In

People come to this stage of care for a range of reasons, including:

• Pain with intercourse or difficulty tolerating an internal gynecological exam
• A history of endometriosis, pelvic inflammatory disease, or pelvic or abdominal surgery
• Ongoing low back, hip, sacroiliac, or tailbone discomfort
• Bladder or bowel symptoms, such as urgency or straining, that have been present for years but never addressed
• General uncertainty about how a body with a known pelvic floor issue will manage pregnancy and birth

None of these need to be resolved before pregnancy can happen, and physiotherapy is not a prerequisite for conceiving. But many people find that addressing longstanding tension, weakness, or pain gives them a more comfortable, confident starting point heading into a physically demanding chapter.

How Physiotherapy and Massage Therapy May Help

A pelvic health physiotherapist can assess how the pelvic floor, deep core, hips, and spine are working together, and build a plan specific to what is found. For an overactive or tender pelvic floor, this often involves manual therapy, breathing and relaxation strategies, and graded exposure to touch and pressure. For an underactive or poorly coordinated pelvic floor, the focus shifts toward strength, coordination, and load tolerance. Any internal assessment is entirely optional, explained in advance, and performed only with ongoing consent — a great deal can be learned externally, through observation of breathing and movement patterns, hands-on assessment of the hips and low back, and a detailed conversation about symptoms and history. Massage therapy can complement this work, addressing generalized tension, supporting circulation, and helping the nervous system settle — something that matters for pelvic floor tissue as much as for the shoulders or back.

What Preconception Care Looks Like

A first visit typically includes a detailed history, a movement and postural assessment, and a conversation about goals — whether that’s resolving pain, addressing a specific symptom, or simply feeling more prepared. From there, care is individualized: some people attend a handful of sessions to address a specific issue, while others prefer ongoing visits through the preconception window and into pregnancy itself. Our pelvic health physiotherapy service is the foundation of this care, and many people pair it with periodic massage therapy for broader tension relief.

Working Alongside Your Fertility and Medical Care Team

Physiotherapy at this stage complements, rather than replaces, the medical side of fertility care. We do not diagnose or treat infertility, and we encourage anyone trying to conceive to stay closely connected with their family doctor, OB/GYN, or fertility clinic for investigations, monitoring, and treatment decisions. What we offer sits alongside that care: a chance to address the physical, mechanical, and comfort-related side of preparing a body for pregnancy. If you’re unsure whether preconception physiotherapy is right for you, our team is happy to talk through what an assessment would involve. Learn more about our broader approach on our pelvic health page, or book an assessment when you’re ready to begin.