Fertility

April 12, 2017


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Planning for pregnancy? What is in the way in stopping you from getting pregnant? Does the food affect your chances in getting pregnant? Here is some advice from the experts in helping you to embark on the journey of pregnancy.

When planning to start a family, what steps would you advise a woman to take?

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A) Risk assessment
Women are encouraged to visit doctors prior to planning for pregnancy so that the level of risks during pregnancy can be assessed. The aim is to assess risk of harm of mother and baby. At risk, pregnancy should be identified and steps taken to reduce the complications

B) Counselling
Advise on the nature and optimal health status prior to pregnancy in order to achieve best outcomes for both mother and baby.
 

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C) Education
Knowledge and information regarding planning to start family is as important as personal health status. Appropriate exercise, food, medications to avoid, hazardous environment and lifestyle factors all play a crucial role in ensuring successful pregnancy. This will also ensure they have adequate resources and guidance on pregnancy problems and possible interventions.

D) Medical Treatment
Pre-existing medical conditions such as diabetes, thyroid problems or heart diseases should be attended to by proper medical care prior to pregnancy to minimise adverse pregnancy outcomes.
 
Do you believe natural methods such as changing your diet plans and lifestyle could help to increase a couple’s chances of conceiving? Why?

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Healthy diet intake (low fat, low sugar and high fibre diet) is important to ensure good pregnancy outcomes apart from reducing the risks of obesity, high blood pressure and diabetes. Eating potassium rich food such as banana, spinach, tomatoes have been shown to be able to reduce high blood pressure.
 
In addition, losing weight will not only reduce complications during pregnancy but also reduce risks of operative deliveries. However, various factors will limit the nutritional intake of women such as economic, educational, social, the need for physical labour, inadequate housing or family disruption. Therefore, sufficient education and financial aids play a crucial role in achieving the goals.

Overall, dietary modification and supplementation are important in achieving healthy pregnancy and good outcomes. However, it needs to be stressed that although various studies on dietary supplementations have been published in the literatures, no robust evidence so far to recommend other dietary supplementation in reducing congenital abnormalities.

Lately, obesity has become apparent in our community including women of childbearing age. Findings have shown that obesity has had adverse effects on pregnancy with associated increase in maternal morbidity and mortality. Weight reduction should ideally be started prior to pregnancy as trying to lose weight during pregnancy is not advisable. Healthy diet and regular exercise play an important role in achieving the goal in addition to readily accessible health care facilities and interventions.

Will eating certain food increase the chances of fertility?
Published literatures so far have not advocate any particular food or categories of food to increase the chances of fertility. However, healthy diet still remains important not only for overall health but also to boost the immune system. There is no robust evidence to suggest certain food/diet will render a woman infertile either.

Should women start eating supplements to improve their overall wellbeing before pregnancy or during pregnancy?

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The protective effect of folic acid supplementation against neural tube defect (NTD) (spina bifida) has been confirmed. The usual dose in Malaysia is 5mg although recommendation dose globally is 600microgram. It should be started before and continue 3 months into pregnancy. It can reduce the risk of neural tube defect by more than two thirds, both for normal and high risk women.
 
High risks groups include women with previously affected fetus and those taking antiepileptic medication. Multivitamin without folic acid have not been shown to prevent neural tube defect. Women with thalassaemia trait has increased incidences of neural tube defect in addition to their low haemoglobin status. It is recommended to advise 5mg folic acid and iron supplement for them. Fortification of food (such as flour) has been found to be effective in reducing the incidence of NTD. Nevertheless, folic acid has not been shown to be protective against other congenital abnormalities.

Women on high dose of vitamin A as either diet supplements or acne treatment should be informed about its teratogenic effects. Adequate contraception covered is important in counselling prior to prescribe vitamin A to women in childbearing age. Overall, dietary modification and supplementation are important in achieving healthy pregnancy and good outcomes.

However, it needs to be stressed that although various studies on dietary supplementations have been published in literatures, no robust evidence so far to recommend other dietary supplementation in reducing congenital abnormalities.

Is there anything that women should avoid eating or drinking while trying to get pregnant?

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Majority of women in the reproductive age group should be counselled about the usage of medications especially over the counter medications. Although most drug are relatively harmless during pregnancy, but the safety level of most drugs during pregnancy have never been studied. The recommendations from recognise drug and food authority (e.g USA-FDA) around the world are mainly based on anecdotal studies or animal studies. When women are already on medication for certain illnesses such as epilepsy, stopping the medication is not advisable as it may result in recurrence epileptic attack with subsequent detrimental effects to both mother and developing fetus.
 
Special precaution must be taken for patients who suffer from diabetes or high blood pressure. Medications in the treatment of both conditions need to be either stopped or monitored closely during pregnancy.

Alcohol consumption and cigarette smoking both increase the risk of miscarriages and small babies. Women who are planning to start a family should receive counselling to stop or abstain themselves from smoking cigarettes and consuming alcohol. Preventative interventions in this respect are more important through community health talks and exhibitions as well as the banning of cigarette-smoking.

Previous research has shown that recreational drugs are associated with fetal abnormalities. For example, cocaine use is associated with sudden separation of placenta during pregnancy (placenta abruption) and potentially small babies. In addition, they are prone to have blood borne infections such as hepatitis B & C and HIV.

In our community, recreational drug usage among women is believed to be underestimated due to a lack of specialised substance abuse clinics. Therefore, it is crucial that women themselves come forward to be screened whenever they plan to start a family.

What are the certain types of health conditions that women are not aware of that can decrease the chances of women getting pregnant?
It has increasingly been shown that women in the reproductive age group contract chlamyida infection. It is a form of sexually transmitted disease. Those who contract it may be asymptomatic. However, if it is not treated promptly, it will affect fertility resulting from the internal scarring and damage to the fallopian tubes. Screening for Chlamydia in women is easy as either urine or endocervical sample can be used for the test. The result will be available immediately. Counselling or treatment can executed promptly.

Women with polycystic ovarian syndrome (PCOS) condition will occasionally become subfertile due to the hormonal imbalance. The majority of women with PCOS present irregular menstruation, obesity and hirsutism (excessive hair growth). Ultrasound of the pelvis and hormonal profile test will allow the doctor to make the diagnosis. Early treatment and assistance from gynaecology is advisable. In addition, another gynaecological condition named endometriosis (retrograde flow of menstruation) may also affect women’s fertility due to internal scarring and formation of ovarian cyst (endometrioma). Painful menstruation and painful sexual intercourse are signs of endometriosis.

Maternal infections are potentially harmful not only to women themselves but to their partner and newborn baby. Infections can be transmitted to the baby during pregnancy and/or delivery causing grave consequences to the baby.

Vaccination against rubella and hepatitis B has long been established in our health care system. However it is advisable to screen for immunity for both the diseases prior to pregnancy. Rubella infection during pregnancy will have dire consequences to the developing baby. Hepatitis B carrier should also be identified, as appropriate treatment can be given promptly after delivery to prevent perinatal transmission. Varicella-zoster (chickenpox) vaccination has not been widely available in our community but the majority of reproductive-aged women have previous history of the disease and immunity.

During pregnancy, it is potentially harmful and may cause deformity to the baby especially with contractions before 20 weeks gestations. Therefore vaccination in the susceptible group before pregnancy is desirable.


Dr. Haw Wan Lye
Consultant Obstetrics & Gynecologist
Columbia Asia Hospital - Cheras