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Pre-conception advice
Whatever the outcome of fertility investigation and treatment, a number of circumstances have an impact not only on your general health but also on your reproductive health. The degree of influence these factors have on your ability to conceive and carry a child is often not quantifiable but extensive research has shown their role to be significant.
Folic Acid
Spinabifida is one of the commonest serious abnormalities that can affect a new born baby. The incidence of Spinabifida can be markedly reduced by giving Folic Acid supplements over the time of conception and through the early stages of pregnancy.
Smoking
Smoking is associated with a decreased likelihood of a pregnancy arising naturally, significantly decreases the likelihood of Assisted Conception methods such as IVF working and is associated with a slight increased risk of miscarriage. Male smokers have a 13 - 17 % reduction in sperm counts compared to non smokers although fertility may not be reduced. This reduction in count is most significant in men who already have reduced sperm test results.
Weight
Obesity is associated with irregular or decreased ovulation. Obesity is also associated with reduced spontaneous pregnancy and reduced pregnancy rates following ovulation induction and assisted conception methods such as IVF. Obesity also increases the risks of pregnancy by making scans technically more difficult and increasing the likelihood of complications such as diabetes, thrombosis and haemorrhage. One of the most reproducible measures of obesity is the Body Mass Index (BMI). The ideal BMI is between 18 and 25. The BMI can be calculated in the following way:
BMI = weight in kg x height in metres
Women whose body mass index is over 30 should endeavor to lose weight as this will help increase their fertility and improve their fitness for the stress of pregnancy.
Obesity in men alters hormone levels with a decrease in testosterone, but there is no evidence that obesity in men reduces fertility. Nevertheless obesity does increase the risk of death from heart disease and stroke.
Alcohol
There is no strong correlation between alcohol consumption and infertility. However high alcohol intake in pregnancy has a proven adverse affects on fetal development. Moderate alcohol intake in men does not appear to be detrimental to fertility. High alcohol intake can lead to decreased fertility due to both poor sperm production and impotence.
Rubella (German Measles)
Rubella infection in early pregnancy can lead to serious abnormalities in the new born baby. Rubella is a common viral infection which is characterised by mild flu like symptoms and a faint generalised rash. Vaccination in adolescence does not guarantee immunity in later life. Immunity is tested by a simple blood test to detect antibody to Rubella in your blood stream.
Exercise
Exercise is good for your general health. While not likely to improve your fertility, regular exercise will improve your energy levels, your fitness and stamina for a pregnancy and will help maintain your weight within the desired range. Exercise should not be in fits and starts but should be regular and steady. Aerobic exercise is best - jogging, swimming, cycling, brisk walking, rowing - and should be strenuous enough to make your pulse rate rise to your aerobic range for your weight and age and make you slightly breathless. Aerobic exercise should be carried out - as a minimum - for 20 minutes three times a week. Exercise is not contraindicated in early pregnancy - but if you are in doubt consult your GP, Midwife or Obstetrician.
Medical History
If you have any continuing medical problems such as Diabetes, Hypertension, Kidney disease, Heart disease, Epilepsy, Severe Asthma, it is important that the care of these conditions is optimised and the drug regimes reviewed before infertility treatment and hopefully a pregnancy begins. In such cases close collaboration between your regular doctors and the infertility team is important.
Travel
Overseas travel is now commonplace and exotic destinations are becoming more accessible. Such destinations often require extensive vaccinations such as Yellow Fever, Polio, Hepatitis and Typhoid. In addition Malaria prophylaxis may be required. Remember also that HIV is prevalent in Sub-Saharan Africa and Thailand.
Diet
For your general health, you should have a well balanced diet with appropriate intake of vitamins, fibre and protein. There are no particular foods that are detrimental to fertility;however, certain foods should be avoided in pregnancy, namely soft cheese, pate and liver.
Genetic Diseases
Downs Syndrome is the commonest chromosomal abnormality affecting babies in the UK. Older women over the age of 36 at the time of conception are at increased risk. You should discuss the implications of this with your doctor or fertility specialist who will advise on the possible tests available in the early stages of pregnancy. Thalassaemia and Sickle Cell disease are conditions which are more common in certain ethnic groups and geographical origin. Thalassaemia is prevalent in people from Asia those from Mediterranean countries. Sickle cell disease is prevalent in those of Afro-Carribean origin.
Cervical smear
Regular cervical smears lowers the incidence of cervical cancer. In the United Kingdom women routinely have smears performed every 3 years, if you are close to requiring a repeat smear it is advisable to have this performed before you start on treatment.
