Can pre-ejaculatory fluid impregnate a female? I am sexually

Patient: Can pre-ejaculatory fluid impregnate a female? I am sexually active and I do not use condoms with my boyfriend. Nor am I on any birth control pills. He never ejaculates inside of my vagina, he always pulls out and releases himself somewhere else. But I am nervous about the pre-ejaculatory fluid. Can this impregnate me?

Doctor: