Preconceptual Advice
1. All women planning a pregnancy should be advised to start folic acid supplementation (0.4mg daily) from the time contraception is discontinued to reduce the risks of neural tube defects in the foetus. A large Medical Research Council study found that such supplementation with folic acid reduced the incidence of neural tube defects by 72%.
2. An Omega 3 sup tplement should be taken. It has extensive advantages for general health and it has been shown to improve the cognitive function of babies born to mothers with high levels of Omega 3.
3. Women who are overweight or obese should be advised to lose weight prior to pregnancy. Obesity [body mass index] (BMI)>30 kgm2 is associated with an increased risk of infertility, miscarriage, hypertension and preeclampsia, gestational diabetes, thrombo-embolism, post-partum haemorrhage, shoulder dystocia and operative delivery. Encouraging weight loss is important for the woman’s general health, but may also improve the chances of conception, thus providing a timely incentive.
4. All women who smoke should be advised to stop. Smoking reduces male and female fertility. The particular risks associated with smoking during pregnancy include an increased risk of ante partum haemorrhage from placenta praevia and placental abruption, small-for-gestational-age babies, and prematurity due to pre-term rupture of membranes and pre-term labour. Carbon monoxide freely crosses the placenta and decreases the oxygen-carrying capacity of haemoglobin. Nicotine stimulates adrenergic release causing generalised vasoconstriction and decreased uterine perfusion. The effects on birth weight are also relevant to passive smoking, and women find it harder to stop smoking if their partner smokes, providing a rationale for women planning a pregnancy to encourage their partners and family to stop smoking as well. Smoking also increases the risk of ear and respiratory infections in the infant within the first year of life, and increases the risk of the child developing asthma. In addition, there is a greater than two-fold increase in the risk of sudden infant death syndrome. Carcinogens and poisonous compounds present in cigarette smoke also pass to the foetus. Research has shown that early pregnancy is a time when women are more likely to give up smoking, and every effort should be made to encourage and support women to stop smoking.
5. Alcohol reduces both male and female fertility. It is a teratogen associated with a specific syndrome in babies exposed to very high doses from mothers with chronic and continued alcohol abuse and dependence throughout pregnancy.
Infertility is without a doubt a life altering experience. From your self-esteem, to your plans and dreams for the future, relationships with your friends, family and even your spouse can all be affected. Attention is primarily focused on the physical aspects of infertility, while the emotional aspects often go ignored and untreated. People aren’t aware of how emotionally challenging and overwhelming infertility can be.
As time goes by and your baby plans don’t unfold as expected, even the most harmless questions can seem overwhelming. Suddenly you feel overcome and the only thing everyone wants to know is, “Are you pregnant yet?” Give some thought as to how much of your personal life you are comfortable sharing, and with whom.
Anger or disappointment at your own body or your partner’s is also a prevalent feeling among women. The stress, sadness and other feelings you might be experiencing are common.
At Dawie Slabbert Fertility Practice, a clinical psychologist with extensive experience in fertility issues will guide and advise you. These support groups, in addition to other wellness programmes including nutrition and personalised counselling, can also help you learn how to cope with the physical and emotional impacts of infertility. We have found that many of our patients not only benefit from regular exercise including aerobic, yoga, and pilates, but sharing the experience with others who understand is equally, if not, more important.
Don’t be afraid to call upon all your support systems whether they’re family members, friends, social group friends, or professional support groups.
Author Dr Dawie Slabbert
