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The Preconception Checkup
Author: Dr. Anna Kaplan
Many women wanting to get pregnant start by seeing if nature will take its course. Others, however, chose to maximize their chances of a healthy pregnancy by visiting a doctor to get advice before trying to conceive. This is especially important for anyone with medical problems. While it will not necessarily prevent infertility, it may give you an edge by removing some potential problems.
First of all, a doctor seeing you for a preconception checkup will ask you about your medical history. Do you have any medical problems, and are you taking any medication? One of the most important conditions is diabetes. Women with diabetes can have trouble getting pregnant as well as have a complicated pregnancy, labor, and delivery. Your diabetes needs to be under good control before you get pregnant.
Closely related to this is weight. If you are very overweight, it may make getting pregnant more difficult. You cannot diet during pregnancy. You have to eat enough for the baby. Your doctor might suggest that you try to lose weight first. You can also have problems if you are underweight, either because of an eating disorder or if you are an athlete who engages in large amounts of calorie-burning exercise. In these cases, you may not be ovulating.
The doctor will ask you about your periods. Are they regular? If they are regular and every 28 to 32 days (sometimes longer), you are probably ovulating. You may have already checked this with a urine fertility test. Or the doctor might want to check a progesterone level during the second half of your cycle. If you are ovulating regularly, you do not have one of the main causes of infertility.
Do you have any symptoms of a sexually transmitted disease, or have you had one in the past? Doctors are especially encouraged to screen women for infection with Chlamydia, which is very common. Both detection of any infection and treatment are extremely important.
If your periods are not regular and you have any medical problems that might be the cause, the doctor will want to try and improve your health and hopefully help your body ovulate regularly. This could include trying to get you to your ideal weight, treating diabetes, and evaluating you for any other disorder that can be treated, for example, abnormal thyroid hormone levels or polycystic ovary disease. Thyroid disease can be treated and thyroid levels maintained at a normal level. There are a number of medical treatments for polycystic ovary disease, some of which facilitate normal ovulation.
If you are taking medications, are they absolutely necessary? This is the time you should be asking this question. If they are necessary, are you taking the safest medication of its type, or would you be better off changing medication? Are your other medical problems under control? An example would be asthma. You must continue a medical regimen if you have bad asthma. You should not stop prescription inhalers or any other asthma medicine without discussing it with a doctor. While you may need your asthma medicine, there might be hay fever medication you want to stop using during this time.
If you are taking birth control pills, you obviously must stop them. Some say that you need to wait a number of months before trying to get pregnant, using an alternative form of birth control, like a diaphragm or condoms. That may not be necessary.
This checkup would also be a good time for your doctor to make sure you are having intercourse in the best way to maximize your chances of getting pregnant. He or she will also tell you to stop drinking coffee and caffeinated drinks. Caffeine has been shown to lower fertility in both men and women, so you should also have your partner give up the caffeine. Cigarette smoke may decrease your fertility as well, so you should stop smoking. You should try not to drink alcohol, which also is dangerous to a fetus, and you should not use street drugs.
You do want to start folic acid immediately, 400 mg a day. This protects against something called neural tube defects in fetuses. These are potentially catastrophic problems with a baby’s spinal cord and/or brain. You need to have sufficient folic acid in your system from day one of your pregnancy, which you can only achieve by taking it as soon as you start trying to get pregnant.
If you need any vaccines, from the Tdap shot (tetanus, pertussis, and diphtheria) and MMR (measles, mumps, and German measles) to seasonal influenza protection, you should get them as soon as possible. They will help protect you and the baby. German measles can cause serious problems for a fetus. Influenza can be dangerous for you when you are pregnant, as well as to an infant. Getting vaccinated will help avoid those problems.
Your doctor might also suggest you stay away from areas where you might catch illnesses that can be passed through the placenta should you become pregnant. This would include your cat’s litter box, if you have a cat. Cats carry toxoplasmosis, which you can get. It isn’t a serious illness, but can cause serious problems for the fetus if you are pregnant.
Visiting the doctor, getting advice, and then following it may help you get pregnant more quickly, as well as help ensure a healthy pregnancy and baby. You might want to ask your partner to see his doctor too. There are a few things he can do as well, like giving up caffeine.
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