Pre-conception counselling becomes the norm (Health Feature)

When 32-year-old Amita (name changed) and her husband went to see a gynaecologist after she suffered a miscarriage, they were shocked to know that the anti-pimple cream she uses regularly could be the reason for causing difficulties in her pregnancy. Lack of awareness, stress and late pregnancy are all factors that can cause difficulties while trying to conceive, making pre-conception counselling crucial, doctors say.

"Amita had no idea that the cream she was using had Isotretinoin, which is an X-category element that can cause anomalies in the child. Such creams must be stopped at least three months before one is trying to conceive. But because of lack of awareness, she was here after she had a miscarriage," Shivani Sachdev Gour, gynaecologist at Delhi-based Isis healthcare institute told IANS.

Pre-conception counselling, during which experts guide you towards planning a healthy pregnancy and offer treatment, if required, is slowly becoming the norm among couples in urban India. Doctors, however, say that most couples still come after they have hit a roadblock, adding that nearly 15-20 percent of their patients have pregnancy-related complications that are mostly lifestyle-related.

"Most couples come to us after six months to one year of trying to get pregnant and not succeeding," said Richa Jagtap, doctor and clinical director of Nova IVF Fertility in Mumbai. "In today's times, when everything is getting delayed - late marriage, late pregnancy - and there is so much stress to add to it, getting pregnant can sometimes become difficult or complicated. But not in all cases do you need treatment. With just the right guidance you can avoid complications if you seek advice earlier than later," Jagtap added.

One of the first things a couple is advised when they come for such counselling is a health check-up. "Pre-conception counselling should ideally be done three-six months before planning pregnancy. When a couple comes to us, we put the woman on a folic acid supplement and determine any risk factor that she may have, like diabetes or heart disease, and guide accordingly," Chetna Joshi, gynaecologist at Gurgaon's Columbia Asia Hospital, told IANS.

Medical tests such as for thyroid disorder, thalessemia, blood sugar, haemoglobin, and rubella are prescribed and a hormonal profile is drawn up. If the couple agrees, tests for HIV status and hepatitis B and C are also advised.

"A test for thalessemia, for instance, is very important because if the woman is thalessemia minor and so is the man, then it is a catastrophic situation for the baby. There is one in four chances of the baby inheriting the disorder and there could be multiple abortions," said gynaecologist Madhu Ahuja at New Delhi's Max Hospital.

In addition, if conceiving is difficult and the woman is obese, she is also tested for polycystic ovary. Doctors say that polycystic ovary and endometriosis tests are becoming common these days. In some cases husbands may also be asked to take a semen analysis.

"We also see if any drug that the patient may be using needs to be changed," Joshi said. "Acne treatment, for instance, must be stopped three months before planning pregnancy even if it's a local application and so should vitamin A applications".

But all said and done, doctors say that if a woman is below 30 years of age, the couple can take two years before seeking help, if the woman is 30 they should take a year, and if she is above 30, they should seek help after trying for six months because there is a "sharp decline in fertility between 35 to 37 years of age".

"We also advise couples on the best time for conception. Good guidance is sometimes all that is needed. And if treatment is required, early detection helps you do something instead of spending days in confusion and helplessness," Ahuja noted.

(Azera Parveen Rahman can be contacted at azera.rahman@gmail.com)