Preconception Counseling

by Alan Copperman, MD

There are many important steps that a couple needs to take when getting ready to conceive a child. It is very important that both partners are prepared both physically and emotionally for this life-enhancing event.

The first step is to inform your regular Obstetrician/Gynecologist that you are ready to talk about getting pregnant and you would like to schedule an appointment. At the appointment, your doctor will probably have a routine set of questions and tests that they give to a couple preparing for pregnancy.

This article lists the routine questions and tests that I recommend to my patients, and offers you some background information for that first visit to the Ob/Gyn.

The Doctor Visit

The visit to your doctor should occur at least three months before you want to begin trying to get pregnant. This visit should include a full physical examination including a Pap smear and cervical cultures, as well as blood tests. These blood tests will test you for anemia, and your immunity to rubella and chicken pox. If you are not immune to one or both of these viral infections, you may need to be vaccinated. In this case, it is best to wait three months before trying to conceive.

Genetic disorders
You and your partner should also undergo genetic counseling and testing prior to becoming pregnant. Based on each partner's family history, targeted tests can be performed to find out whether a couple is at risk for having a child with certain diseases. Some examples include Tay Sach's disease, most commonly seen in those of Ashkenazi Jewish decent, sickle cell anemia, most common in African Americans, and cystic fibrosis, which is most common in Caucasians. If both husband and wife are carriers of a certain disease, there is a technique available to prevent passing on any disease to the child. The technique requires, however, that a couple go through in vitro fertilization, often a very expensive procedure. If you and your partner are both carriers of a genetic disease, it is best to discuss your pregnancy options with a genetic counselor.

Sexually transmitted diseases
Sexually transmitted diseases (STD's) can also have an effect on a woman's fertility. Your doctor should discuss your medical history with you and may decide to perform cervical cultures or blood tests to prove that there are no infections that would hinder your ability to conceive. STD's, like chlamydia, gonorrhea and genital herpes, can effect your ability to conceive by causing scarring of the fallopian tubes. Recently, mycoplasma (a type of bacteria) has been identified as an agent that may be capable of preventing couples from getting pregnant. If any of the tests are positive, antibiotics can be prescribed to kill the bacteria in both partners. It is usually recommended that a couple abstain from intercourse until the infection is completely cured.

Lifestyle

Prenatal Vitamins and Good Diet
In addition to visiting your doctor, another important step a woman should take before trying to conceive is to begin taking prenatal vitamins that provide between 400 and 800 micrograms of folic acid (most prenatal vitamins have at least this much). Studies have shown that taking prenatal vitamins, especially those with at least 400 micrograms of folic acid, can reduce the chance of having a baby with brain and spinal cord malformations called neural tube defects.

The prenatal vitamins should, of course, be supplemented with a well balanced diet. If you are anemic, vegetarian, or eat very lightly, you may need to change your eating habits as you are trying to conceive. Not having enough nutrients in your body can cause many problems as your baby develops. A woman who is anemic, for instance, may not have enough iron stores for normal red blood cell production in the fetus. Most importantly, deficient caloric intake can lead to growth retardation and a smaller fetus.

Good Fitness
/HoldingSquat.jpg" style="float:right; padding-left:4px; />Along with eating well and taking prenatal vitamins, being physically fit is also a plus during the pre-pregnant and pregnant stages. Studies have shown that good fitness during conception and pregnancy make for a much easier labor and delivery. Maintaining a body weight of no more than 15% above or below ideal body weight will provide an optimal environment for the fetal growth period. If a woman is less than 15% below ideal body weight, she is not just slight, she is skinny. In fact, many women this underweight won't ovulate normally, and this may make it hard to conceive. Finally, in the first trimester, many women have such extreme nausea and vomiting that they lose a significant amount of weight. For these reasons, I always encourage women to optimize their health before conceiving.

I recommend that women who exercise prior to becoming pregnant continue to exercise throughout much of pregnancy, however, some modifications may be necessary. Talk with your doctor once you become pregnant, and determine together the level of exercise that you both feel is safe. These guidelines should be applied to the time just prior to conception as well, as the fetus is nearly 2-3 weeks old before most women even know that they are pregnant.

Adequate nutrition and hydration must be maintained and overheating avoided. The core body temperature, and thus the uterine temperature, can exceed 102° during "spinning" or other vigorous exercise in a hot, crowded gym. Attempts to lose weight should occur before, not during pregnancy.

Controlling Habits and Environment During Pregnancy

It is also important for a couple to evaluate their daily surroundings and habits as they are trying to get pregnant.

Controlling your environmental exposure
Asbestos, lead, and radiation exposures should be avoided. If you have a cat, speak with your doctor about taking blood tests to see if you have antibodies to toxoplasma (parasite that can cause birth defects). If you do not have antibodies, you should use gloves and a mask to change litter boxes during pregnancy.

Controlling your habits
If you drink alcohol, smoke cigarettes or use illegal drugs, these habits need to be modified, preferably stopped, once you begin trying to conceive. They all can have terrible, lasting effects on your baby as its organs are developing, even before you know for sure if you are pregnant. For your own health as well as your future children, quitting, or at least cutting down on these habits, will help everyone. Your doctor can give you information about support groups, treatment centers and other sources of help.

What is the Best Time to Conceive?

Now that you have taken all of the proper steps to get ready for pregnancy, what is the best way to get pregnant? If you are a woman and have a twenty-eight day menstrual cycle, you should start having intercourse at least five days before you expect to ovulate. This is usually about nine days after you begin your period. You should continue to have sex at least every other day until day nineteen.

There does not appear to be any advantageous sexual position, but it is best for ejaculation to occur deep within the vagina. There also does not appear to be any benefit to bed rest following intercourse (most sperm swim up the reproductive tract rather quickly).

Many people believe that stress affects a couple's ability to conceive. This is a myth. It is important, however, to keep the romance alive in your marriage, and try not to let the process of trying to get pregnant create friction or stress. Trying to conceive should be enjoyable for both partners.

Conclusion

Remember, be patient when you are trying to get pregnant. Many patients tell me they want to get pregnant in a certain month so they can deliver at a time that fits in their schedule. One of the couples I visited with wanted to conceive on a certain day so that they could deliver before the end of the year and sneak in another tax deduction. The reality is that getting pregnant can sometimes take six months to a year because the chance of conception each month is only one in five or six. If success does not come within six months to a year of trying, it is reasonable for the couple to talk with their physician to find out whether any tests or treatments are indicated.

Finally, getting pregnant is just the beginning of a wonderful experience of being a parent and raising a child. As the father of two-year-old twin boys and another baby on the way, I highly recommend it. Good luck to you.

Dr. Alan Copperman is an Assistant Professor of Obstetrics, Gynecology, and Reproductive Medicine at the Mount Sinai Medical Center, and is Director of the Division of Reproductive Endocrinology.
Dr. Copperman is Board Certified in both Obstetrics & Gynecology and Reproductive Endocrinology. He has authored numerous articles and chapters on infertility, endometriosis, polycystic ovarian syndrome, and pelvic surgery. Dr. Copperman is frequently quoted in the media, including The New York Times, The Daiy News, and Parenting Magazine. He has appeared on "20/20," and numerous other local and national news shows. He is a Fellow of the American College of Obstetricians and Gynecologists, and of the American Society of Reproductive Medicine.

Copyright © Alan Copperman. Permission to republish granted to Pregnancy.org, LLC.