Preconception Recommendations Flashcards
optimize health - women - how many months in advance? and when do eggs begin to awaken?
3-6 months ahead. eggs begin to awaken 6-12 months before ovulation
when does the active follicular phase development start before ovulation?
active follicular phase starts 14 weeks before ovulation
sperm provider - how many months in advance?
3 months ahead - final sperm maturation in the epoididymis 10-15 days
lifestyle - egg provider
smoking, drugs, BMI, shift work, alcohol >4/week, caffeine ove4r 200 mg/day
lifestyle - men
smoking, drugs, vaping, high BMI, exercise heat, cell phones, computers, alcohol >4/week, anabolic steroids/supplements
what equals 1 drink?
(12, 8, 5, 1)
12 oz beer, 8-9 oz of malt, f5 oz of wine, 1.5 fl oz of shot
THC - how long in system? can it reach the fetus? is it in breast milk?
in system for 2-4 weeks, can reach fetus in placenta, THC and CBD are in breast milk
THC - females - what problems?
period disturbances, reduced oocytes, premature birth low birth weight
THC - males
low testosterone, decreased sperm, reduced motility, reduced sexual desire
body weight - egg provider
Optimal body mass index (BMI) of 18-25
Egg Provider:
BMI < 20 has higher risk of ovulation disorders and infertility
BMI > 30 Increase in ovulation disorder, miscarriage and poor obstetrical outcomes
sperm temp
1 degree or less than body temp
preg diet
The Mediterranean diet has been shown to be helpful
Most important to eat a well-balanced diet
if pt has high bmi, needs
an anesthesiolgist consult (airway obstruction)
BMI over 45
can’t treat them here
Preconception Workup - what blood tests
(RRCCV TAG)
Bloodtests (within 1 yr of initial consult):
ABO/Rh & Antibody Screen
CBC
TSH/Free T4/TPO
Rubella IgG
Varicella IgG
Anti-mullerian Hormone (AMH) (looks at ovarian reserve)
Pap/annual exam (AE)/mammogram (depending on age/history)
Vitamin D (25-hydroxy), per provider
Chlamydia/GC (gonohorrhea) Amplification, per provider
Genetic Carrier Screening (Horizon-Natera - this is the genetic testing)-both partners (optional)
required labs prior to treatment - women
(HHHR)
Hep B surface antigen, Hep C antibodies, HIV 1 & 2 antibody, RPAR (syphilis) (CA requires this)
labs - sperm only - memorize this
Hep B surface antigen, Hep C antibodies, HIV 1 & 2 antibody, RPAR (syphilis) (CA requires this), HTLV 1/11 antibody
labs - if pt using sperm donor - MEMORIZE THIS
(HHHR +2)
Hep B surface antigen, Hep C antibodies, HIV 1 & 2 antibody, RPAR (syphilis), HTLV, CMV Abx IgG/IgM (if using donor sperm) - IgM is current infection IgG is past infection
kaiser
can’t provide orders for kaiser
acupuncture
Lots of information and studies, no universal agreement in benefit
Studies consistently report positive patient experience and outlook
Likely most beneficial if started before active fertility treatment
It is safe, can reduce stress and improve relaxation
Possible benefits:
Hormonal-May cause hypothalamus to release GnRH= improved ovulation
Blood Flow-May increase blood flow to the uterus and ovaries by inhibiting uterine central sympathetic nervous system activity
Stress Mediation-Stim. Endogenous opioids (endorphins), lower cortisol (stress response)
Supplements
Supplements are not all created equal.
Natural does notequal safe.
These are weakly regulated and undergo little or nogovernment testing for safety or effectiveness.
Look for NSF or USP certification.
Importantprovider aware of all medications the patient is takingincluding supplements.
Important to note when/ifto discontinue depending on treatment type and ifpregnancy planned
common supplements - vitamin D - how much?
prenatal (these are good), vitamin D3 2000 IU daily (insufficiency may be associated w/ lower implantation and decreased ovarian stimulation response)
vitamin C - diminished ovarian reserve DOR
(vitamin C is a perfect 1000)
1000 mg 3x/day - antioxidant
vit E - DOR
(Selene E)
800 IU/day - antioxidant
melatonin - DOR
(Mel is my fav #)
3 mg night - antioxidant, oocyte maturity, improves egg quality and blast quality in animals, my improve fertilization rates, pts with hashimotos should avoid
Acai - DOR
liquid concentrat, 35,000 mg of fresh acai - internal CCRM, slight increase in oocytes, sligh increase in fertilization rates, increasee in normal blasocytes
coenzyme Q 200 mg, ubiqinol 200 mg new Q - DOR
1 tab 3x/daily with food
1 tab 2x/daily with food
1 tab 2x/day
energy source for oocyte, mitochondria, spindles, may improve oofcyte maturation and embryo grade
theralogix
company to order supplements - good one
supplements for PCOS
(PCOS needs COU)
conenzyme Q 200 mg, ubiqinol 200 mg, Ovocital (1 scoop for drink 2x/day - similiar to metformin)
male supplements
multivitamin and vitamin D, conception XR, 1 cap 1 tab 2x/day, coenzyme q 200 mg, ubiqinol 200 mg, neo-q
body weight - sperm provider
Sperm Provider:
BMI > 35 may have reduced sperm count and motility
prenatal vitamins - when to start? which ones?
Prenatal vitamins, start 3 months prior
Folic acid, vitamin D, Omega-3/DHA
Movement, sleep, self-care
common supplements - omega 3
(The Omega is 500)
omega 3 500 mg daily (improves oocyte and embryo quality, important in 1st trimesterd for neurodevelopment
