Preconception health: what every rural GP should know

Most Australians want and expect to have children. But many are not aware of the range of factors that can affect their fertility, let alone the health of their potential child.

We also know that it can be difficult for GPs to discuss fertility with patients, particularly their male patients. A recent yet to be published survey of 304 GPs by Healthy Male (formerly Andrology Australia) found some of the perceived barriers to discussing the subject with men include: a lack of knowledge; not feeling able to start the conversation unless asked; and a general perception that fertility issues are a female problem.

A recent webinar presented by Your Fertility and Healthy Male details how primary health professionals can use evidence-based information to maximise their patients’ chance of a healthy pregnancy and baby. The presentation, available online, includes expert advice for health professionals who may not be able to attend conferences.

Gynaecologist and fertility specialist Dr Shannon Zawada told the webinar that women should be advised to optimise their diet and strive for a healthy weight. While age is a major factor for women, she said a low body mass index (BMI) can increase the risk of ovulation disorders and premature birth and a high BMI can decrease the quality of eggs, lengthen time to conception, and cause complications during pregnancy such as gestational diabetes and still birth.

The good news is, women who lose 5-10 per cent of their body weight can significantly improve ovulation, time to conception and decrease their risk of pregnancy complications. A 10 per cent decrease in weight is so powerful it drops the risk of still birth by 10 per cent.

Nutrition is important, too. A 2018 study published in the Lancet found that at least 90 per cent of young women trying to conceive in high income countries do not eat the recommended five serves of vegetables and two serves of fruit a day. Given protein deficiency has been associated with placental insufficiency, it is worth paying attention to your female patient’s diet before she conceives.

Medical Director of Healthy Male, Professor Rob McLachlan, said modifiable factors for men’s fertility include: age; smoking; alcohol; obesity; poor diet; environmental/occupational chemical exposure; heat infections; and medication, drugs and steroids.

While the impact of age is not as pronounced in men, Professor McLachlan said older men experience a lower conception rate, reduced sperm DNA quality, poorer outcomes from assisted reproductive treatment, and a higher rate of autosomal dominant disease in offspring, such as polycystic kidney disease.

He said if a male patient discusses fertility concerns with their GP, it is appropriate to for the GP do a semen analysis and sex hormone test at the first presentation because it may uncover a serious diagnosable condition.

Dr Magdalena Simonis, a general practitioner with a special interest in women’s health, said
there were many opportunities for GPs to broach the subject of fertility. These moments include: cervical screening for women; general health checks for men; vaccinations; and checks for sexually transmitted infections (STIs).

The webinar and other evidence-based resources to help patients understand their fertility, including an ovulation calculator, are available on the Your Fertility and Healthy Male websites.