Preconception Recommendations

Question 1

optimize health - women - how many months in advance? and when do eggs begin to awaken?

Answer 1

3-6 months ahead. eggs begin to awaken 6-12 months before ovulation

Question 2

when does the active follicular phase development start before ovulation?

Answer 2

active follicular phase starts 14 weeks before ovulation

Question 3

sperm provider - how many months in advance?

Answer 3

3 months ahead - final sperm maturation in the epoididymis 10-15 days

Question 4

lifestyle - egg provider

Answer 4

smoking, drugs, BMI, shift work, alcohol >4/week, caffeine ove4r 200 mg/day

Question 5

lifestyle - men

Answer 5

smoking, drugs, vaping, high BMI, exercise heat, cell phones, computers, alcohol >4/week, anabolic steroids/supplements

Question 6

what equals 1 drink?

(12, 8, 5, 1)

Answer 6

12 oz beer, 8-9 oz of malt, f5 oz of wine, 1.5 fl oz of shot

Question 7

THC - how long in system? can it reach the fetus? is it in breast milk?

Answer 7

in system for 2-4 weeks, can reach fetus in placenta, THC and CBD are in breast milk

Question 8

THC - females - what problems?

Answer 8

period disturbances, reduced oocytes, premature birth low birth weight

Question 9

THC - males

Answer 9

low testosterone, decreased sperm, reduced motility, reduced sexual desire

Question 10

body weight - egg provider

Answer 10

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

Question 11

sperm temp

Answer 11

1 degree or less than body temp

Question 12

preg diet

Answer 12

The Mediterranean diet has been shown to be helpful
Most important to eat a well-balanced diet

Question 13

if pt has high bmi, needs

Answer 13

an anesthesiolgist consult (airway obstruction)

Question 14

BMI over 45

Answer 14

can’t treat them here

Question 15

Preconception Workup - what blood tests

(RRCCV TAG)

Answer 15

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)

Question 16

required labs prior to treatment - women

(HHHR)

Answer 16

Hep B surface antigen, Hep C antibodies, HIV 1 & 2 antibody, RPAR (syphilis) (CA requires this)

Question 17

labs - sperm only - memorize this

Answer 17

Hep B surface antigen, Hep C antibodies, HIV 1 & 2 antibody, RPAR (syphilis) (CA requires this), HTLV 1/11 antibody

Question 18

labs - if pt using sperm donor - MEMORIZE THIS

(HHHR +2)

Answer 18

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

Question 19

kaiser

Answer 19

can’t provide orders for kaiser

Question 20

acupuncture

Answer 20

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)

Question 21

Supplements

Answer 21

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

Question 22

common supplements - vitamin D - how much?

Answer 22

prenatal (these are good), vitamin D3 2000 IU daily (insufficiency may be associated w/ lower implantation and decreased ovarian stimulation response)

Question 23

vitamin C - diminished ovarian reserve DOR

(vitamin C is a perfect 1000)

Answer 23

1000 mg 3x/day - antioxidant

Question 24

vit E - DOR

(Selene E)

Answer 24

800 IU/day - antioxidant

Question 25

melatonin - DOR

(Mel is my fav #)

Answer 25

3 mg night - antioxidant, oocyte maturity, improves egg quality and blast quality in animals, my improve fertilization rates, pts with hashimotos should avoid

Question 26

Acai - DOR

Answer 26

liquid concentrat, 35,000 mg of fresh acai - internal CCRM, slight increase in oocytes, sligh increase in fertilization rates, increasee in normal blasocytes

Question 27

coenzyme Q 200 mg, ubiqinol 200 mg new Q - DOR

Answer 27

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

Question 28

theralogix

Answer 28

company to order supplements - good one

Question 29

supplements for PCOS

(PCOS needs COU)

Answer 29

conenzyme Q 200 mg, ubiqinol 200 mg, Ovocital (1 scoop for drink 2x/day - similiar to metformin)

Question 30

male supplements

Answer 30

multivitamin and vitamin D, conception XR, 1 cap 1 tab 2x/day, coenzyme q 200 mg, ubiqinol 200 mg, neo-q

Question 31

body weight - sperm provider

Answer 31

Sperm Provider:
BMI > 35 may have reduced sperm count and motility

Question 32

prenatal vitamins - when to start? which ones?

Answer 32

Prenatal vitamins, start 3 months prior
Folic acid, vitamin D, Omega-3/DHA

Movement, sleep, self-care

Question 33

common supplements - omega 3

(The Omega is 500)

Answer 33

omega 3 500 mg daily (improves oocyte and embryo quality, important in 1st trimesterd for neurodevelopment