Fertility Week 2018 starts on October 15. This year’s message, Healthy You, Healthy Baby encourages men and women to consider their health before conception to improve their chance of conceiving, and to do their best for their baby’s future health. It has been known for some time that the general environment of a uterus can cause epigenetic changes to a fetus, but there is now growing evidence that the health of both parents before and at the time of conception influences their chance of conceiving and the short and long-term health of their child. The environment where eggs and sperm mature and the composition of the fluid in the fallopian tube when fertilisation takes place are affected by parents’ general health. So, in addition to the genetic material parents contribute to their children, the health of their eggs and sperm health at the time of maturation and conception has lasting effects on the expression of the genes and the health of the future child. Obesity, smoking, environmental toxins, alcohol, drugs, lack of physical activity and poor nutrition all pose risks to the health of egg and sperm and consequently to the health of a future child. Chronic health conditions such as diabetes and hypertension can also adversely affect gamete health.

Why promoting preconception health in primary health care is important

Whether they are actively trying for a baby or not, people of reproductive age can potentially conceive any time. This is why preconception health messages need to be integrated into primary health care and discussed opportunistically with women and men of reproductive age whenever possible.

Screening for pregnancy intention

A condition for preconception health optimisation is that the pregnancy is planned. To reduce the risk of unintended pregnancy, the ‘Guidelines for preventive activities in general practice’ recommend screening for pregnancy intention in primary health care settings. A promising method for assessing the risk of unintended pregnancy and giving prospective parents the opportunity to optimise their preconception health is the One Key Question® (OKQ) initiative developed by the Oregon Foundation for Reproductive Health. It proposes that women are asked ‘Would you like to become pregnant in the next year?’ as a routine part of primary health care to identify the reproductive health services they need to either avoid pregnancy or increase the chances of a successful one. This non-judgemental approach allows practitioners to provide advice about reliable contraception if the answer is ‘no’ and information about preconception health if the answer is ‘yes’ or ‘maybe’.

Providing preconception health information and care

While a 15-minute consultation will not allow in depth discussions about contraception or preconception health, directing women to reliable sources of information and inviting them to make a time to come back to discuss their reproductive health needs in light of their pregnancy intentions might increase awareness of the importance of preconception health optimisation. Considering the mounting evidence about the role of paternal preconception health for fertility and the health of offspring, men also need to be made aware of the importance of being in the best possible shape in preparation for fatherhood. Directing men to accessible and reliable sources of information about male reproductive health can improve awareness about how they can contribute to the long-term health of their children.

Quality resources

Your Fertility is the Commonwealth Government funded national fertility health promotion program that improves awareness among people of reproductive age and health and education professionals about potentially modifiable factors that affect fertility and reproductive outcomes. A media campaign planned for Fertility Week will encourage men and women to seek the information they need from their GP. The Your Fertility website, www.yourfertility.org.au is designed to assist time-poor practitioners to direct their patients through evidence-based, up-to-date, accessible information about all aspects of female and male reproductive health. Resources on the Fertility Week page include videos from fertility experts, facts sheets and messages tailored for both men and women. Short videos produced for health professionals feature Dr Magdalena Simonis, GP, and Associate Professor Kate Stern, fertility specialist, who both describe their approaches to raising lifestyle issues and fertility with male and female patients of reproductive age. The RACGP’s preconception care checklist for practitioners is available from www.racgp.org.au/AJGP/2018/July/Preconception-care Visit the Your Fertility website content, fact sheets for health professionals and patients help promote the important messages about how healthy parents make heathy babies.   Visit the Your Fertility Website View the Preconception Care Checklist