Before starting your family, it is important to first talk with a member of our healthcare team. At the Center for Fertility and Reproductive Endocrinology (CFRE), we take every opportunity to appropriately counsel patients about this critical time, in order to optimize pregnancy outcomes.
We have adopted the American College of Obstetrics and Gynecology approach to preconceptional care by thoroughly reviewing 6 categories which may impact pregnancy:
From a behavioral standpoint, it is important to begin taking prenatal vitamins, which contain folic acid, at least 1 month prior to conception, and continue them until 2-3 months into pregnancy. The American College of Obstetrics and Gynecology, the American Academy of Family Physicians, and the US Preventive Services Task Force all recommend that women take between 400-800mcg of folic acid daily. Folic acid is critical for normal fetal brain and spinal cord development, and helps to prevent neural tube defects. If you have a history of having a pregnancy affected by a neural tube defect, you should take at least 4mg of folic acid per day.
There are several chronic diseases, such as diabetes, asthma, heart disease, hypothyroidism, and even obesity, which require special attention, as they may have significant impacts on the pregnancy. Women whose medical history is significant for these chronic diseases will require additional counseling both before and throughout their pregnancy regarding the associated risks.
From a genetic standpoint, we take a thorough family history on both the patient and her partner, in order to determine their offspring’s risk for inherited disorders. Currently, we recommend Cystic Fibrosis screening for all of our patients, and we offer targeted screening for at risk couples based on their ethnicity and family history. A thorough review of medications is also critical, as certain medications can have a detrimental effect on the development of the fetus. We carefully review all medications listed and determine their safety by assigning each medication a US Food and Drug Administration risk category.
Typically, Category A and B drugs are considered safe in pregnancy. If another provider has placed you on a Category C or D drug, you must weigh the risks of continuation with the benefits of discontinuation.
In regards to screening for sexually transmitted disease, we follow the Centers for Disease control recommendations, and screen all of our patients prior to IVF for gonorrhea, Chlamydia, hepatitis B and C, HIV, and Syphilis.
We also follow the American Society of Reproductive Medicine’s 2013 vaccination guidelines for female infertility patients, which is based on age. We first ensure ongoing immunity for Rubella and Varicella by obtaining rubella and varicella titers pre-conceptionally, if you are not adequately immunized, we will offer vaccination.
For most women, we additionally recommend an influenza vaccine, Tdap, and HPV vaccine prior to conception. For at risk populations, we may also recommend Hepatitis A, B, pneumococcus, and meningococcus vaccines.