As part of our continuing effort at Fertility Centers of Illinois to keep you up-to-date on important topics and advances in reproductive medicine, the following letter will provide a pre-conception checklist to help your patients prepare for growing their families in the New Year.
While your patients may complete a physical and routine screening with you prior to trying to conceive, we’d like to provide a list of other considerations to take into account.
Review updated insurance coverage:
The new year often comes with updates and changes to individual insurance coverage. As many as 20% of patients will have coverage for infertility services designated as diagnostic only. This means that only testing will be covered, but not treatment. In these patients, it is very important to do all testing first before any treatment is started, such as ovulation induction with clomiphene citrate. After treatment has started, no further testing will be covered. With diagnostic only coverage, the patient is considered self-pay for all infertility treatment.
Assess the reproductive health of both partners:
Fertility diagnoses are split with approximately one-third being attributed to the woman, one-third with the man, and another third due to combined factors, or unexplained. Completing a Fertility Awareness Checkup for only $90 is an affordable way to assess the reproductive potential of both partners. The checkup includes a blood test and ultrasound for women to evaluate ovarian reserve and a semen analysis for men to assess sperm count, morphology, and motility.
Review existing medication:
Many medications may interfere with conception or pregnancy. We recommend that you review your patient’s current medications and supplements and identify any that could be deleterious during pregnancy. When possible, the medication may be discontinued, or a safe alternative can be chosen.
Offer genetic carrier screening:
The American College of Obstetricians and Gynecologists recommends genetic counseling and offering preconception carrier screening for all women contemplating pregnancy. This includes screening for cystic fibrosis, spinal muscular atrophy and other conditions as indicated by family history and ethnic background.
Assess Body Mass Index and encourage a weight goal:
An elevated BMI can impact fertility in both women and men and lead to hormonal imbalances. A very low BMI (<20) may be associated with cessation of ovulation. It’s recommended to encourage a healthy lifestyle and achieve realistic weight gain or loss prior to attempting pregnancy.
Boost Vitamin D levels:
Normal Vitamin D levels may help optimize fertility and decrease complications during pregnancy. Midwesterners are at particularly high risk of having low Vitamin D levels and should undergo screening with recommended supplementation or dietary changes if found to be deficient.
Complete all necessary vaccinations:
This includes screening for immunity to Rubella and Varicella and having a flu shot during influenza season.
Start folic acid supplementation prior to conception:
400 micrograms of folic acid per day are recommended for those at average risk of having a child with a neural tube defect (NTD). High-risk individuals with a history of having a child with an NTD, or who have a seizure disorder, should take 4mg of folic acid daily.
Manage chronic conditions:
To optimize pregnancy outcomes and reduce the risk of complications, control of chronic medical conditions such as diabetes, hypertension and thyroid disorders should be achieved prior to pregnancy.
Counsel about travel:
Certain destinations increase the risk of exposure to infectious diseases which may impact a subsequent pregnancy. Patients should be counseled about Zika virus exposure and the appropriate interval to postpone pregnancy following travel to affected regions.