Objective: Pre-conception counselling is important, as most pregnancies are unplanned. There are few published studies examining women's attitudes and knowledge in this area. As part of our ongoing education quality improvement program we evaluated the pre-conception knowledge and attitudes of women at an infertility clinic. Methods: Women who presented for initial assessment to a university-affiliated infertility clinic completed a knowledge survey prior to the first physician consultation. Results: Four hundred surveys were appropriately completed for data analysis. Patients were well informed about health optimization, folic acid consumption, infectious disease exposure, medication use, partner abuse, smoking, and recreational drug use. Patients were not well informed about the risks of daily alcohol consumption, advanced maternal age, exercise, cat litter exposure, and consumption of fish and certain other foods. They were uncertain about the importance of rubella immunization and family history. Nulliparous women were less knowledgeable about the significance of rubella immunization, exercise, recreational drug use, cat litter exposure, and fish consumption. Women who were more educated had more knowledge about the effects of the mother's age, exercise, alcohol exposure, and smoking on pregnancy. Conclusions: There are gaps in knowledge, even in the highly motivated population of infertile women who are planning to be pregnant. The results of this survey suggest that women need and want their physicians to educate them about optimal pre-pregnancy lifestyle. We will revise our education programs to account for these gaps. Larger population-based studies are needed to assess knowledge in the general population, so that appropriate health promotion and education programs can be implemented.