Clinical summary guide

Preconception care for males

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The GP’s role

Overview

Preconception care is aimed at identifying and mitigating any biomedical, behavioural and social conditions that may compromise a pregnancy and its short- or long-term outcomes. It involves complementing usual best practice with reproductive health care, and helps prepare people for conception, pregnancy and parenthood.

Despite men’s obvious influence over couples’ reproductive decisions, responsibility for reproduction is borne largely by women. Healthcare related to childbearing is primarily focused on women, with men feeling excluded or marginalised as a result.

Preconception care for men may improve participation of men in managing fertility and planning for parenthood, with potential benefits to a man’s health and that of his family.

The existing evidence base is sufficient to inform preconception care for males, even though this aspect of preventive care has been traditionally overlooked. Our knowledge that male health prior to conception influences fertility and pregnancy outcomes obligates action to improve male preconception health. Future high-quality studies of preconception care for males will further inform care.

There are common-sense reasons for providing preconception care for males:

  1. Benefit to reproductive outcomes and coincident benefit to male health in general
  2. Benefit to the health of partners and children
  3. Enhancement of men’s capacity as fathers
  4. There is low risk of harm

Most people of reproductive age are accepting of routine discussions with general practitioners about their reproductive intentions.

Paternal factors associated with fertility, and perinatal or offspring health

Paternal factorOutcome
Advanced ageReduced fertility

Increased risk of preterm birth, miscarriage, stillbirth, offspring congenital abnormalities, trisomy 21 and psychiatric disorders
AlcoholAdverse effects on offspring health
CryptorchidismInfertility
DepressionParental stress and disengagement with child; child neglect; impaired language, reading, social and behavioural development and mental illness in offspring
DiabetesInfertility
Metabolic syndromeIncreased risk of pregnancy loss
ObesityReduced fertility, preterm birth

Adverse effects on offspring health (mostly animal studies)
Occupational and environmental radiation and chemical exposureInfertility
Physical inactivityReduced fertility
Poor dietLower sperm quality

Adverse effects on offspring health
Sexually transmitted diseasesInfertility, congenital infection of offspring
SmokingReduced fertility, congenital abnormalities, small for gestation age offspring

Adverse effects on offspring health
Unhealthy behaviours shared with partnerInfertility, adverse pregnancy outcomes, poor parental and child wellbeing

Preconception healthcare for males of reproductive age

Investigations and interventionsComponents
Reproductive life planAsking about male’s future reproductive intentions, and helping to institute a suitable plan, provides opportunity for timely delivery of information and can provide context for preventive health practices

Provide education about the effects on reproduction of paternal aging
Medical historyPrevious and existing medical conditions
Surgical history
Mental health history
Family history
Social history
Occupational history (radiation, chemical exposures)
Abuse (physical, emotional, sexual)
Alcohol and other drug use
Smoking
Physical activity
Diet
Immunisations
Medication review
Sexual and reproductive historyExisting children
Previous conceptions/pregnancies
Trouble conceiving
Puberty
Sexuality
Sexual behaviour
Previous and existing relationships
Contraception
Sexual function
Physical examinationSexual maturity
Gynecomastia
Genital exam (including testicular palpation and volume measurement, instruction for self-examination)
Height, weight, abdominal circumference/BMI
Blood pressure
Laboratory testsAs indicated by history and examination (e.g. infertility; diabetes; adrenal, thyroid, testicular function; chlamydia, gonorrhea, syphilis, HIV)
Genetic carrier screening (spinal muscular atrophy, cystic fibrosis, fragile X)
Mental health assessmentThere are several mental health assessment tools useful for the assessment of paternal perinatal healt
Sources: 1, 2

Barriers and facilitators to provision of male preconception care*

PCC = preconception care, HP = healthcare professional

Provider factors

BarriersFacilitators
Lack of knowledge of fertility and preconception health or benefits of preconception care; lack of training; lack of knowledge of guidelines
Negative attitude towards or not convinced of benefits or efficacy of preconception care interventions
Sensitivity of topic, perceived female focus
Not working in obstetrics and gynaecology
Lack of clarity on whose responsibility it is to deliver PCC (e.g. GP, nurse, other health professional)
Competing medical or preventive priorities
No opportunity to deliver PCC
Discussion of various aspects of PCC dependant on speciality of HP
Having good knowledge about factors that affect fertility
Having designated responsibility for providing PCC
Having confidence in delivering PCC
Having more experience in delivering PCC
Seeing more patients from higher risk groups, as they are perceived to be more in need
Sources: 1, 2, 3, 4

BarriersFacilitators
Patients not coming in at preconception stage
Perception that patient is not thinking about having children
Perceived negative attitude of patient to PCC
Patient lacking awareness of PCC and its importance
Perception that it might raise anxiety in the patient
Request from patient for PCC
Mentioning desire to become pregnant
Having a health condition perceived to be relevant to PCC (e.g. obesity)
Sources: 1, 2, 3, 4

Organisation/system factors

BarriersFacilitators
Lack of guidelines and tools
Lack of time to dedicate to PCC
Lack of reimbursement for PCC service/no costing structure
No clear division of responsibility
Availability of PCC resources (e.g. checklists, pamphlets, patient education)
Access to trained/qualified health professionals
Sources: 1, 2, 3, 4

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Preconception care for males

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