Health Care Maintenance/Preconceptional Care

Health Care Maintenance and Preconceptional Care are important for you in general and can improve your chances of conception and of carrying a healthy pregnancy to term. At the Center for Advanced Reproductive Medicine,we want to ensure that as you go through infertility or menopause or any other reproductive endocrine therapy, we assist in your healthy well being.

The American College of Obstetricians & Gynecologists (ACOG) has set health-care-maintenance guidelines for annual well-women visits that vary by age. During the reproductive years, these guidelines include preconceptional care for all women planning on conceiving within the next year. Women age 19-39 years should have the opportunity, once a year, to review all of the following with their primary care provider:

Any new surgeries, hospitalizations or emergency room visits since last-year's annual exam. Any new medical illnesses (like diabetes or high blood pressure), how well all current therapy is working, any side effects, if new therapies are available and how they may affect or be affected by a pregnancy. For some illnesses, you need to be referred to a specialist in high-risk pregnancies (Maternal Fetal Medicine specialist or Perinatologist) to receive counseling and change therapy even before you conceive.

Any new allergic reactions, any new medications (prescription, over-the-counter or herbal therapies) and any alternative medicine therapies (acupuncture, chiropractic, holistic, homeopathy, naturopathic) to be sure they have been proven safe to use during pregnancy.

Nutrition: the closer you are to ideal body weight for your height, the more fertile you will be and the healthier your pregnancy will be. It is not usually a good idea to start a new weight-loss diet or exercise program during pregnancy; but a well-balanced, high-fiber, low-fat diet and a regular exercise program begun prior to pregnancy are safe to continue. Caffeine (coffee, tea, sodas) needs to be stopped or limited before & during a pregnancy. Multivitamins should be changed to prenatal vitamins at least 2 months before stopping contraception (because calcium, iron and folate/folic acid needs increase dramatically while vitamin A supplements should be avoided).

Habits: smoking (for either the female partner, the male partner or both) decreases your fertility by half, speeds up the onset of menopause by 2 years, increases miscarriages and increases sudden infant death syndrome. Over 85% of smokers want to quit, but less than 10% can do so on their own. Modern smoking-cessation programs are highly effective; they include education, behavior modification, nicotine replacement and bupropion/ Zyban® therapy to prevent cravings and irritability/moodiness. Their key is preventing you from returning to smoking later on. There is no safe level of tobacco, alcohol or street-drug use during pregnancy; we recommend stopping at least 2 months before going off contraception.

Sexuality: This is a time to review any questions or concerns about your current sexual functioning or practices, homosexuality, gender identity or high-risk sexual behaviors. You should receive any counseling/testing needed for HIV/AIDS, hepatitis or other sexually transmitted diseases which ones can be cured, which can only be suppressed and which ones cannot, how to protect yourself, your partner and how to prevent passing them on to your newborn during childbirth.

Diagnostic tests: A mammogram should be ordered before age 40 if you have a family history of premenopausal breast cancer or have an abnormal breast exam. A hemoglobin should be ordered if there is a history of anemia or excessive bleeding. A urinalysis should be ordered for burning with urination or increased frequency of urination. A blood sugar should be ordered for excessive thirst, large volumes of urine or if you have certain hormone imbalances like polycystic ovarian syndrome. A tuberculosis skin test should be ordered for a chronic cough or exposure to anyone with tuberculosis. Thyroid-stimulating hormone should be ordered if you feel run down or jittery and for recent changes in weight or menstrual cycles.

Vaccines/ boosters are best given before pregnancy

• A rubella IgG titer should be ordered for all women at least one month before stopping contraception (5 - 10% of people who were vaccinated as children, need an adult MMR to prevent congenital rubella syndrome—deafness, mental retardation and facial deformities).
• An adult tetanus-diphtheria (Td) booster is needed every 10 years (5 years if there is a dirty cut or animal bite); this not only protects you, but your immunity crosses the placenta to protect your newborn until they are old enough to be vaccinated.
• If you do not remember having chicken pox (actual blisters all over your body), a Varicella-zoster IgG should be ordered; and you should be vaccinated if not immune (series of 2—once in a lifetime) because adult chicken pox can be lethal for you and your fetus.
• If you have chronic lung disease (smoking, COPD, asthma, chronic bronchitis) or a history of pneumonia, splenectomy or sickle cell, you should receive the adult unconjugated 23-valent pneumococcal polysaccharide vaccine once every 7 years.
• If you are planning to be pregnant within the next year, a ‘flu shot should be ordered before you get pregnant.
• Hepatitis B vaccine (a series of 3—given once in a lifetime) is for all medical/dental personnel, child-care, police, family members of people with hepatitis B and anyone who is not in a stable, longstanding, monogamous sexual relationship.

Family history: Get as much information as possible on any blood-relatives with recurrent miscarriages or babies born with birth defects, mental retardation, physical deformities, chromosomal abnormalities or genetic defects. Some couples need genetic counseling/testing to see if they are also at risk. Patients with family histories of high blood pressure, diabetes, cardiovascular disease and some cancers (breast, ovarian, uterine, colorectal or prostate) need earlier/more intensive screening.

Health risks/injury prevention: Know about safety belts, helmets, ear plugs (to prevent hearing loss), Sunscreen/hats/long sleeves (to prevent sun-damage) and training on occupational or recreational hazards. All firearms need to be kept locked and unloaded with keys only to those successfully completing a formal firearm safety course.

Verbal abuse, psychological abuse, physical or sexual abuse, domestic violence or family dysfunction. Stress from interpersonal or family relationships, lifestyle- or job-related stress, sleep disorders, depression or thoughts of suicide can be treated. If left untreated, it can decrease your fertility.

Physical exam: A yearly check of height, weight, blood pressure, neck (for swollen lymph nodes or goiter), breasts (reviewing the correct technique for self-breast exam), abdomen, pelvis (with Pap smear) and skin (for moles that have changed, sores that do not heal or new bumps) is important. Your annual dental exam with teeth-cleaning and any necessary repairs should be done before you conceive because X-rays, nitrous gas and many types of antibiotics cannot be given during pregnancy. Good physical and dental health have both been shown to improve the outcome of your pregnancy. Women over 40 should also have screening for cholesterol, urinary incontinence, a mammogram every 2 years and counseling about retirement planning. They should have an evaluation for menopause and education on hormone replacement therapy. Their physical exam should also include an exam of their mouth and teeth. Women over 50 should also have a mammogram every year, a sigmoidoscopy every 3-5 years, increase to 1,500 mg/day of calcium and (beginning at age 55) annual ‘flu shots. Their physical exam should also include a rectal exam and a test for blood in their stool.