Preconception Counseling benefits for a safe and healthy pregnancy

Is there a need for Preconception counseling in India?

• Infertility is on rising in India. Current Statistics have revealed that 27.5 million couples actively seeking children suffer from infertility; affecting both men and women equally.
• At least 10-15 percent of married couples are experiencing fertility issues at some point.
• One in 2 millennials is delaying having family and think they can conceive later. 54% of those delaying pregnancy face issues in conception in their 30’s

I had a couple who came to me, about 4 years after love marriage, unable to conceive. While going through investigations we realized that they both had Thalassemia minor. They had a child through IVF and the child escaped with minor thalassemia but it could have been catastrophic for the child if a natural conception had indeed happened.

Another couple who decided to postpone having babies till 4 years after marriage came in one day only to realize that the husband had no sperms and they wished they had found out earlier and hadn’t wasted that much time.

Yet another lady conceived normally without any treatment but then realized she had grossly abnormal thyroid gland function and diabetes as well.

It’s not that for any of these couples, the ending was bad…they did live happily ever after. But the same situation could have been dealt with much better, without wasting time and without the anxiety that they had to suffer, if only they know about the preconception counseling benefits and had had the vision to seek Pre Conception Counseling in time.

Who are the couples who should be availing of preconception counseling benefits?

Fertility Counselling is recommended for all couples who are yet to start a family. They may fall under the following categories:

1. Couples who are planning to get married.
2. Newly married couples.
3. Couples married for some time and are ready to start a family….and
4. Also, couples who are married and are thinking of delaying for a few years before starting a family

Let’s understand what are the Preconception counseling benefits:

Going in for Preconception fertility counseling will help couples understand the following:

1. There are 4 basic requirements for fertility. Good eggs, good sperms, open fallopian tubes, and normal hormone levels – are these criteria satisfied?
2. Is there any existing medical condition that needs evaluation and correction before having babies?
3. Are there any lifestyle changes that are required?
4. What are the fertility score and their reproductive window?
5. What are the peak fertility years for natural conception?
6. Whether they can delay starting the family or not and for how long can they safely delay. This is where preconception counseling is helpful to this group of couples also who are not immediately thinking of having babies.
7. By which age should the couple have their first and second child respectively
8. What steps they must take to maintain optimal reproductive health and avoid future conception issues.
9. How to prepare for a healthy and smooth pregnancy naturally.
10. Fertility preservation options in case the couple is planning to delay motherhood for a long time.

So how does preconception counseling happen?

We normally start with a basic question…do you wish to have babies right now?

If the answer is yes, then, do you wish to go down that route immediately or in the next 3 months or 6 months? Why is that important…. my plan for your evaluation and vitamin supplementation and other aspects will be designed accordingly?

If you do not wish to go down that route, then we discuss and document the various reasons why you wish to delay, and we then proceed to evaluate basic fertility for both partners. In the 2nd meeting, once the reports are ready, we discuss the pros and cons of delaying and what options are available to save guard future fertility.

Next, I take a detailed history to understand if there is anything in your family history or personal history which could cause problems with future fertility or the health of the mother or the baby. Thus, I ask several detailed questions such as :

Your family’s genetic history, or any history of thyroid disease, epilepsy, diabetes, asthma, blood pressure, depression, heart or kidney disease, and finally if any previous surgeries or any other relevant treatment has been done.

Steps in Pre-conception Counselling:

The 5 pillars around which I design the pre-conception counseling sessions are :

Change, Investigate, Correct, Add and Counsel

Let’s take them one by one:

What are the things we need to Change to improve natural conception?

1. Broadly speaking Lifestyle changes like sleeping well and avoiding late nights…….. While some of the focus areas include
2. Weight management
3. Diet
4. Exercise
5. Smoking
6. Alcohol
7. Stress
8. Avoiding steam, sauna, and hot baths

We spoke about the 5 pillars. The next pillar is Investigation.

1. The Fertility quotient of the couple. The AMH is done via a blood test and antral follicle count is done via a vaginal ultrasound on the 2nd or 3rd day of periods for the woman and sperm analysis for the man needs to be done.
2. Hormonal levels need to be tested such as Thyroid and prolactin levels. Some others may be needed depending on the individual case.
3. Follicular monitoring or serial ultrasounds are done to ascertain how the follicle or the fluid-filled balloon containing the egg is growing inside the ovary and finally when in the cycle does the egg get released. This is the most fertile period for the woman.
4. Genetic disorders like Thalassaemia and
5. The test needs to be done for Medical problems like Diabetes and anemia.
6. Immunity status against viral infections like Rubella and Varicella and some others which I will mention shortly needs to be ascertained and finally
7. Smears from the mouth of the womb for Chlamydia infection need to be taken as such infections, if present, can cause fallopian tube damage.

Then comes the aspect of Correction.

One of the preconception counseling benefits is the opportunity to correct a problem even before it occurs. During this phase, my team and I work towards the correction of all that is abnormal but correctable. We bring together a team of specialists such as a Chest specialist for asthma, an endocrinologist for diabetes, a neurologist for epilepsy, a psychologist or psychiatrist for depression or nutritionist for weight loss, and so on.

To know more about gestational diabetes and what can be done at the preconception counseling stage to prevent and/or better manage this condition read my article on this topic here

The 4th pillar is Addition and here I look at all those additions that will make future fertility and pregnancy safe:

Another preconception counseling benefit that couples can harness is having a diet that is optimal for the formation of healthy oocytes and sperms and also provides the optimal environment for fertilization, implantation, and growing fetus.

Additions are of two types.

1. One of the preconception vitamins like folic acid, vitamin D, and B 12 esp. for vegetarians. This should be ideally started 3 months before conception
2. Secondly, additions are in the form of vaccinations. These include vaccinations against diphtheria, whooping cough, tetanus, measles, mumps, rubella, chickenpox, and hepatitis B. of course many or most of these vaccines would have been given to you as a child but in case the immunity wasn’t built or if the vaccine was missed, this preconception period is a good time to boost up your immunity against these. Another vaccine that is vital and should be taken by all is the Influenza vaccine. This is to be taken yearly and protects against the 3 commonest virus strains causing flu as well as the swine flu.

Last but not least is the 5 th pillar of Pre-conception Counseling:

One of the major preconception counseling benefits is the knowledge encompassed during the entire process and sing it to make informed and planned decisions for better pregnancy management

This is where we collate all the information that we have gathered over the last few days or weeks and we work towards answering every question or doubt that you have and also making suggestions from our end based on what we have discovered. This encompasses

1. General counseling and reinforcing the importance of correct BMI, quitting smoking, reducing alcohol intake, taking a proper diet, getting a dental check-up done, reducing stress and exercising, etc.
2. Next, we talk about the most fertile period for the couple based on our tests
3. Next, we discuss the timing and frequency of intercourse as there are innumerable myths about this. To put it in a nutshell, sperms survive longer than eggs thus even if intercourse happens days before ovulation, it still works but eggs don’t survive more than 12 to 24 hours. Intercourse thus needs to be on alternate days and should happen before ovulation or maximum on the day of ovulation. If it happens a day or two after ovulation it may not be successful. Again, intercourse need not start before the 11th or 12th day of periods because ovulation is unlikely before that. Remember that repeated ejaculation will reduce the quality and number of sperms even in the most fertile of men.
4. Based on the reports of ovarian reserve testing and sperm counts we discuss the possibilities of natural conception and timelines for going ahead and trying naturally.
5. Another important aspect to discuss is the importance of age both in terms of fertility as well as Down’s syndrome. This is the most common cause of mental retardation in children. Happens because of a defect in chromosome 21 in the fetus while the baby is still in the mother’s womb. It is more common if the mother is above the age of 35 although it can happen if she is younger too.
6. If the couple has any genetic reports which are abnormal like e.g. Thalassaemia, then we use this opportunity to discuss how we can give them a healthy baby without any complications.
7. I also discuss social egg freezing, sperm freezing, and contraception with those that wish to delay conception for a few years.

The history and treatment sheet that we use in the clinic to do preconception counseling runs into 11 pages. So, as you can understand, it’s quite exhaustive. I may not have been able to cover everything, but I hope I have been able to impress upon you the need for preconception counseling at least. Even if I managed to light a spark of curiosity, I guess the fire will burn sooner or later.