Objective: To assess the activity of a pre-pregnancy counseling clinic in terms of investigations, counseling, treatment, and subsequent pregnancy outcome. Materials and Methods: Prenatal diagnosis and therapy were given in a tertiary university hospital in Lagos offering referral services for fetal medicine. Design: Review of the first 1,000 couples who referred to the centre from various centres attended from 1992 to 2007. Main outcome measures were assessed through types of referrals, value of diagnostic tests, and subsequent pregnancy outcomes. Results: The main types of referral were previous miscarriage (48.2%), previous fetal abnormality (10.8%), chronic maternal illness (25.1%), and others (15.9%). Routine investigation showed high serological toxoplasmosis, rubella, cytomegalovirus, herpes simplex I, herpes simplex II (TORCH) positive antibodies carrier rate. Subsequent pregnancy outcome did improve in the chronic maternal diseases and previous miscarriage group. Conclusions: This study illustrates the importance of making an accurate assessment of previous problem and current health as a means of determining both maternal and fetal risks in a subsequent pregnancy.