- Infertility is on rise 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 are 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 a 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 thalassaemia 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.
Its 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 had the vision to seek Pre Conception Counseling.
What is this preconception counseling?
- Pre conceptional counselling is basically an advisory session provided to a couple before they start to try and have children.
- Preconception health means taking care of your own health to ensure that if you choose to start a family; you’ll be healthy enough to do so. Whether you’re thinking about now, the near future or not at all, the key is setting goals, making a plan, and most importantly, taking care of yourself during the preconception period since your health before pregnancy can affect the health of your baby.
Who are the couples who should be availing of preconception counselling?
Fertility Counselling is recommended for all couples who are yet to start a family. They may fall under the following categories:
- Couples who are planning to get married.
- Newly married couples.
- Couples married for some time and are ready to start a family….and
- Also, couples who are married and are thinking of delaying for a few years before starting a family
Going in for fertility counselling will help couples understand the following:
- There are 4 basic requirements for fertility. Good eggs, good sperms, open fallopian tubes and normal hormone levels – are these criteria satisfied?
- Is there any existing medical condition which needs evaluation and correction before having babies?
- Are there any lifestyle changes that are required?
- What is the fertility score and their reproductive window?
- What are the peak fertility years for natural conception?
- Whether they can delay starting the family or not and for how long can they safely delay. This is where preconception counselling is helpful to this group of couples also who are not immediately thinking of having babies.
- By which age should the couple have their first and second child respectively
- What steps they must take to maintain optimum reproductive health and avoid future conception issues.
- How to prepare for a healthy and smooth pregnancy naturally.
- Fertility preservation options incase the couple is planning to delay motherhood for a long time.
So how does preconception counselling 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…. because 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 the 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.
The 5 pillars around which I design the pre conception counselling 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?
- Broadly speaking Lifestyle changes like sleeping well and avoiding late nights…….. While some of the focus areas include
- Weight management
- Avoiding steam, sauna and hot baths
We spoke about 5 pillars. The next pillar is Investigation.
- The Fertility quotient of the couple. The AMH done via a blood test and antral follicle count done via a vaginal ultrasound on the 2nd or 3rd day of periods for the woman and sperm analysis for the man need to be done.
- Hormonal levels need to be tested such as Thyroid and prolactin levels. Some others may be needed depending on the individual case.
- 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.
- Genetic disorders like Thalassaemia and
- Medical problems like Diabetes and anaemia need to be tested for
- Immunity status against viral infections like Rubella and Varicella and some others which I will mention shortly needs to be ascertained and finally
- Smears from the mouth of the womb for Chlamydia infection needs to be taken as such infections , if present , can cause fallopian tube damage.
Then comes the aspect of Correction.
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, endocrinologist for diabetes, neurologist for epilepsy, psychologist or psychiatrist for depression or nutritionist for weight loss and so on. .
The 4th pillar is Addition and here I look at all those additions that will make future fertility and pregnancy safe:
Additions are of two types.
- One of preconception vitamins like folic acid, vitamin D and B 12 esp. for vegetarians. This should be ideally started 3 months before conception
- Secondly additions are in the form of vaccinations. These include vaccinations against diphtheria, whooping cough, tetanus, measles, mumps, rubella, chicken pox 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 pre conception period is a good time to boost up your immunity against these. Another vaccine which 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 the least is the pillar of Counselling:
This is where we collate all the information that we have gathered over the last few days or weeks and we work towards answering each and every question or doubt that you have and also making suggestions from our end based on what we have discovered. This encompasses
- General counselling and reinforcing the importance of correct BMI, quitting smoking, reducing alcohol intake, taking a balanced diet, getting a dental check-up done, reducing stress and exercising etc.
- Next we talk about the most fertile period for the couple based on our tests
- Next we discuss the timing and frequency of intercourse as there are innumerable myths pertaining to this. Basically, to put 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 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.
- 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.
- 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 foetus 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.
- If the couple has any genetic reports which are abnormal like for e.g. Thalassaemia, then we use this opportunity to discuss how we can give them a healthy baby without any complications.
- I also discuss social egg freezing, sperm freezing and contraception with those that wish to delay conception for few years.
What I have shared today is just a small gist of all that is done because it would be impossible to discuss everything through one podcast. The history and treatment sheet that we use in clinic to do preconception counselling runs into 11 pages. So, as you can understand, its 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 counselling at least. Even if I managed to light a spark of curiosity, I guess the fire will burn sooner or later.
This brings me to the end of yet another discussion. This discussion is also available as a podcast – check out here.
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