Preconception Guidelines

 

 

Preconception Guidelines

 Whenever a couple commits to medical treatment for infertility, it is a substantial emotional and financial investment. As conscientious health care providers, it important for us to recommend certain preconception testing and precautions.

couple

 

Alcohol and Drug Use

Fetal alcohol syndrome is characterized by mental retardation and cranial facial deformities. It has been known to occur in infants where the mothers drank even lightly during their pregnancies. For this reason, we advise abstaining from alcohol use while you are trying to conceive and during pregnancy. New evidence also suggests that men who consume alcoholic beverages may have reduced sperm function and that their children may have a greater risk of fetal alcohol syndrome. A recent study showed that if either partner consumed four or more alcoholic drinks per week, fertility may be affected.

Prescription and recreational drug use can have far-reaching consequences for fetal development. Drug interactions with individual genetic vulnerabilities are never completely predictable, and any drug’s potential benefit must be weighed against its concomitant risks. Marijuana (THC) use in particular can have dramatic effect on sperm counts and/or functioning. Please inform us if you have a drug use or dependency problem. 

A study published in The New England Journal of Medicine conducted by researchers at the State University of New York at Buffalo, and presented at the annual meeting of the American Society for Cell Biology, showed that chemicals in marijuana cannabinoids, which mimic our bodies’ endocannabinoid compounds may interfere with the sperm’s ability to fertilize the woman’s egg.

We advise avoidance of any drugs or medications while attempting pregnancy and during pregnancy.

 

Smoking

Smoking has been proven to be a powerful vasoconstrictor, which can impair blood flow across the placental/fetal unit. This frequently results in low-birth weight infants. Smoking also changes cervical mucus in the female and possibly reduces sperm motility in the male, which may contribute to infertility. We advise that both partners discontinue smoking prior to attempting pregnancy. Smoking and the toxins in cigarettes have adverse effects on sperm quality.

In October 2000, British researchers concluded, based on data from nearly 15,000 pregnancies, that smoking can significantly delay time to conception. Active smoking was associated with failure to conceive within six to 12 months. Exposure to passive smoke further increased the odds against a woman conceiving within six months.

 

Environmental Exposures

Living and working in a complex urban society may present certain risks of exposure to toxic substances. Research into the reproductive effects of exposure to pesticides, radioactive materials and industrial solvents is just now being conducted. We recommend minimizing these exposures until definitive research is completed.

The role of video display terminals (VDT) in affecting pregnancy is controversial and unknown.

Another risk to be concerned about is toxoplasmosis, a parasite infection transmitted through cat feces. If you have a cat, avoid changing the litter box.

 

Exercise and Weight Management

For optimal fertility, try to maintain your ideal weight. Multiple studies have linked excessive weight to reproductive problems. Exercise regularly — staying fit will help control your weight and will keep your body strong enough to carry a pregnancy more easily. Excessive exercise, which burns more than 2,000 to 4,000 calories per week, may impair ovulation in some women.

 

Herbal Remedies

Many of these remedies have unknown effects and may interfere with your treatment. We suggest that they not be used. A recent study has shown that sperm have difficulty attempting to penetrate an egg with the use of some herbal medications.

 

Medication Use

Teratogen Registry: (800) 532-3749 - www.otispregnancy.org

“A community program for the elimination of preventable birth defects.” The California Teratogen Information Service (CTIS) is a statewide program operated by the Department of Pediatrics at the UCSD Medical Center, with satellite offices at UCLA and Stanford. They are part of a nationwide community of Teratogen Information Services (TIS) known as the Organization of Teratology Information Services (OTIS).

The service provides information about prescriptive and non-prescriptive drugs, street drugs, alcohol, chemicals, infectious diseases and any other physical agents, which may be harmful to an unborn child.

 

Diet and Vitamin Supplementation

A healthy balanced diet composed of fresh foods that are not processed or overcooked is one of the best things you can do for yourselves and your future offspring. Children who start life well nourished have a distinct advantage in their intellectual capacity and ability to fight disease.

A multi-vitamin containing folic acid (0.8 mg or higher/day) is a good adjunct to dietary nutrition. Vitamin use should be started at least three months prior to attempting pregnancy.

A study (N EngL J Med 2000; 343:1839-45) has found that the ingestion of caffeine may increase the risk of an early spontaneous miscarriage among non-smoking women carrying fetuses with normal karyotypes (chromosomes). Reducing caffeine intake during early pregnancy may be prudent. The study suggests that pregnant women curtail their consumption of coffee to two cups of American coffee per day.

 

Folate (Folic Acid) Sources

Fruits and dark green leafy vegetables are top sources of folic acid. One serving provides up to 25% of the recommended daily allowance (RDA).

It is impossible to be aware of all possible factors that may cause pregnancy or fetal complications. Nevertheless, common sense avoidance of known toxins and a healthy life-style represent a reasonable approach while attempting pregnancy and being pregnant.

 

Rubella/Varicella Titre and Vaccine

Rubella (German measles or Three-day measles) is a communicable virus, which typically causes low-grade fever, upper respiratory symptoms and a diffuse red rash. In childhood, this infection is usually mild. However, if contracted during pregnancy, this disease can have severe effects on the developing fetus, including blindness, heart defects, hearing defects, musculoskeletal defects, and mental retardation. Varicella (Chickenpox) is also a communicable disease and is dangerous if contracted near delivery.

If you have not been tested for rubella/varicella immunity, we advise that this be done. If there is no immunity, we recommend that you be vaccinated for both. For Rubella, wait one month before beginning IVF treatment as it is a live vaccine. (Contraception should be used during this time).

 

Blood Type and Rh

You should know your blood type and Rh status. If you already know this information, please bring documentation to your first appointment. If unknown, we will do a blood type and Rh test.

 

Genetic Disease Prenatal Screening

It is not possible to screen patients for every known genetic disease, nor is it possible to guarantee a healthy baby. However, it is recommended that couples consider preconception testing for the following ethnically appropriate genetic diseases after consultation with their physician. Some couples may decline testing while others may choose to proceed. Referral to a genetic counselor for more in depth information is available if so desired. More information is available at www.acmg.net or www.genetics.org.

Cystic Fibrosis affects the mucus secretions from the exocrine glands such that abnormally thick mucus secretions are produced, blocking ducts and body passages. Particularly involved are the lungs and the intestines, which affect breathing and digestion. The disease is inherited in an autosomal recessive manner and either sex is equally affected. Because the condition is autosomal recessive, both parents of an affected child are asymptomatic carriers, and therefore have a one in four (or 25%) risk of recurrence in any future pregnancies.

Cystic Fibrosis occurs in about one in 3,300 Caucasian births. To be a carrier of the condition without a family history of Cystic Fibrosis carries a population risk of about one in 25.

Sickle Cell Anemia is a hereditary chronic form of anemia in which abnormal sickle or crescent-shaped red blood cells are present. The frequency of the gene that causes this disease occurs almost exclusively in the African-American population.

Tay Sachs/Canavans, Gaucher (Jewish) and Tay Sachs (French Canadian/Cajun) is an inherited disease, most common in families of Eastern European Jewish origin and in French Canadian ancestry. No specific therapy is known. Symptoms are very early onset with progression and death usually occurring by age three or four.

a Thalassemia and ß- Thalassemia is a group of chronic, hereditary anemias, particularly common in persons of Mediterranean, African and Southeast Asian ancestry. Clinical features are similar but vary in severity. The younger the child when the disease appears, the more unfavorable the outcome.

Fragile X Syndrome is a genetic condition that causes intellectual disability, behavioral and learning challenges and various physical characteristics. Though Fragile X occurs in both genders, males are more frequently affected than females, and generally with greater severity.