Say hello to pre-conception counselling
They say, success as a counsellor is not found in ‘doing something’ for a client, but rather in ‘being someone’ for the client.
Well, I couldn’t agree more! My profession allows me to witness a paradigm of human emotions. I vividly recollect that it was a bright Monday morning of 2012, a couple walked into my chamber. They had been trying hard to experience the joys of parenting through natural methods, but fate had other plans.
It’s only when we started running tests that we discovered that both of them had thalassaemia minor. We did an IVF and the couple was gifted with a beautiful child. The child escaped with minor thalassaemia. Being a gynaecologist, I would not be overemphasising when I say that it could have been catastrophic for the child if a natural conception had indeed happened.
It would only be right of me to share yet another of my experiences. A couple had taken a conscious call to postpone having babies till four years after marriage. However, when they walked in for a consultation, they were in for a rude shock. We realised that the husband had no sperms.
The examples are real life and endless. Imagine the plight of a mother who conceived normally (without any treatment) and subsequently realised she had abnormal thyroid gland function and diabetes. Not much needs to be said about the plight of her baby.
As a doctor with an experience spanning two decades, I sincerely feel that the importance of pre-conception counselling cannot be undermined. Scores of couples would only benefit from seeking counselling to help them deal better with adverse situations.
What IS pre-conception counselling?
Pre-conceptional counselling is basically an advisory session provided to a couple before they start to try and have children.
Pre-conception health means taking care of your own health to ensure that if you choose to start a family you’ll be healthy enough to do so. Whether you’re thinking about now, the near future or not at all, the key is setting goals, making a plan, and most importantly, taking care of yourself during the pre-conception period since your health before pregnancy can affect the health of your baby.
Who should avail of pre-conception counselling?
Fertility counselling is recommended for all couples who are yet to start a family. They may fall under the following categories:
• Couples who are planning to get married.
• Newly-married couples.
• Couples married for some time and ready to start a family.
• Couples who are married and are thinking of delaying for a few years before starting a family
Going in for fertility counselling will help couples understand the following:
• There are four basic requirements for fertility — good eggs, good sperms, open fallopian tubes and normal hormone levels. Are these criteria satisfied?
• Is there any existing medical condition which needs evaluation and correction before having babies?
• Are there any lifestyle changes that are required?
• What is the fertility score and their reproductive window?
• What are the peak fertility years for natural conception?
• Whether they can delay starting the family or not and for how long can they safely delay. This is where pre-conception counselling is helpful to this group of couples also who are not thinking of having babies immediately.
• By which age should the couple have their first and second children, respectively?
• What steps must they take to maintain optimum reproductive health and avoid future conception issues.
• How to prepare for a healthy and smooth pregnancy naturally.
• Fertility preservation options in case the couple is planning to delay motherhood for a long time.
How does pre-conception counselling happen?
We normally start with a basic question: Do you wish to have babies right now?
If the answer is yes, then do you wish to go down that route immediately or in the next three months or six months? Why is that important? Because my plan for your evaluation and vitamin supplementation and other aspects will be designed accordingly.
If you do not wish to go down that route, then we discuss and document the various reasons why you wish to delay, and we then proceed to evaluate basic fertility for both partners. In the second meeting, once the reports are ready, we discuss the pros and cons of delaying and what options are available to safeguard future fertility.
Next, I take a detailed history to understand if there is anything in your family history or the personal history which could cause problems with future fertility or the health of the mother or the baby. Thus, I ask several detailed questions such as your family’s genetic history, or any history of thyroid disease, epilepsy, diabetes, asthma, blood pressure, depression, heart or kidney disease and, finally, if any previous surgeries or any other relevant treatment has been done.
THE FIVE PILLARS OF COUNSELLING
I design the pre-conception counselling sessions around five things. They are Change, Investigate, Correct, Add and Counsel. Let’s take them one by one.
Change: The factors which need change are lifestyle, weight, diet, exercise, smoking, alcohol and stress.
Investigation: We need to evaluate the fertility quotient of the couple, hormones like thyroid and prolactin need to be tested. Genetic issues like thalassaemia need to be identified. Immunity against rubella and chicken pox needs testing.
Correction: During this phase my team and I work towards correction of all that is abnormal but correctable. We bring together a team of specialists such as a chest specialist for asthma, endocrinologist for diabetes, neurologist for epilepsy, psychologist or psychiatrist for depression, and nutritionist for weight loss, and so on.
Addition: Folic acid, vitamin D and in vegetarians, Vit B 12 needs addition. All vaccinations need to be completed.
Counselling: This is where we collate all the information that we have gathered over the last few days or weeks, and we work towards answering each and every question or doubt that you have and also making suggestions from our end based on what we have discovered. The last encompasses a few things.
• General counselling and reinforcing the importance of correct BMI, quitting smoking, reducing alcohol intake, taking a balanced diet, getting a dental check-up done, reducing stress and exercising etc.
• Discussions about the most fertile period, frequency of intercourse and other myths and queries.
• Based on the reports of ovarian reserve testing and sperm counts we discuss the possibilities of natural conception and timelines for going ahead and trying naturally.
• If the couple has any genetic reports which are abnormal, for example, thalassaemia, then we use this opportunity to discuss how we can give them a healthy baby without any complications.
• I also discuss social egg freezing, sperm freezing and contraception with those that wish to delay conception for a few years.
Four out of 10 women report that their pregnancies are unplanned. Up to 10 per cent of pregnancies among women with untreated infections result in prenatal death. Pre-conception care is the provision of medical, behavioural and social health intervention to women and couples before conception occurs. It helps in improved maternal and child health outcomes in both short term and long term.
As someone rightly said, having a baby is like falling in love again! Might as well do it the right way!
Dr Rajeev Agarwal is the director of Care IVF, Calcutta