Pre-conception advice

Whatever the outcome of fertility investigation and treatment, a number of lifestyle factors 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 indicated 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 treatment such as IVF to be successful and is associated with a slight increased risk of miscarriage. Male smokers have a 13 - 17 % reduction in sperm counts compared with non smokers although fertility may not be reduced. This reduction in count is most significant in men who already have reduced sperm test results. Women who smoke have their egg numbers fall rapidly compared with women who do not smoke.

We provide a free Stop Smoking Service please call 024 7696 4760 to speak to an advisor and receive advice to support you.

Weight

Obesity is associated with irregular or decreased ovulation. Obesity is known to increase miscarriage rates with reduced pregnancy chances following treatment such as ovulation induction, IUI and IVF/ ICSI treatment. Obesity also increases the risks during pregnancy by increasing the likelihood of complications such as diabetes, thrombosis and hemorrhage. One of the most reproducible measures of obesity is the Body Mass Index (BMI). The ideal BMI is between 19 and 25 kg/m2. The BMI can be calculated in the following way:

BMI = weight in kg x height in metres2

Women whose body mass index is over 30kg/m2 should endeavor to lose weight as this will help increase their changes of pregnancy fertility and improve their fitness during pregnancy.

Obesity in men alters hormone levels with a decrease in testosterone. Obesity also increases 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 (less than 6 units per week) in men and women 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 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 virus in your blood stream.

Exercise

Exercise is good for your general health. Whilst exercise is 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. It is recommended that exercise be regular and steady. If you wish to attain weight loss, aerobic exercise helps, such as 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 may 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 regimens reviewed before infertility treatment. Close collaboration between your regular doctors and the Fertility 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. It is important you consult your doctor if you have travelled or are planning to travel whilst having fertility treatment.

Zika Virus

Zika virus disease is mainly spread by mosquitoes. For most people it is a very mild infection and isn't harmful.

However, it may be more serious for pregnant women, as it's been linked to birth defects – in particular, abnormally small heads (microcephaly). People travelling to affected areas should seek travel health advice before their trip.

Symptoms of Zika virus infection

Most people don't have any symptoms. If symptoms do occur, they are usually mild and last around two to seven days.

Commonly reported symptoms include:

  • Fever
  • Rash
  • Joint pain (with possible swelling, mainly in the smaller joints of the hands and feet)
  • Conjunctivitis (red eyes)
  • Muscle pain
  • Headache
  • Pain behind the eyes
  • Itching all over the body

HFEA Guidance for Fertility Treatment and Gamete Donation

Recent concerns about the Zika virus means fertility clinics should be extra vigilant when considering people for fertility treatment or gamete donation.

The virus is principally transmitted by mosquitoes but there also appears to be a risk of sexual transmission.

Whilst the situation is still evolving, and given the potentially significant consequences for a pregnancy if Zika is transmitted via the sperm, patients should be asked about recent travel. Additionally, if you are embarking on fertility treatment you should ensure clinic staff are informed about your own travel history.

Relevant issues

  1. There is evidence that the Zika virus can be found in semen and that it may persist in semen after the acute infection has resolved
  2. There have been recorded incidences of sexually transmitted infection
  3. The Zika virus is likely to survive the freeze and thaw of donated gametes

Recommended actions

It is recommended that any person who has travelled to an area where the Zika virus is present should not try to conceive naturally, donate gametes or proceed with fertility treatment for 28 days for female patients and six months for male partners. This is consistent with the advice being given to potential blood, organ and tissue donors by Public Health England to travellers from affected areas.
 

Diet

For your general health, you should have a well balanced diet with appropriate intake of vitamins, fibre and protein. 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 years 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-Carribbean origin.

Cervical smear

Regular cervical smears lower 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.