Tristan Carter is completing a PhD in public health at the University of Technology Sydney, where his research looks at preconception health among Australian men. We talked to him about what men need to know about their preconception health.
1. What does preconception health mean and why is it so important?
Being in optimal health is particularly important when planning or attempting a pregnancy. The preconception period (the time before becoming pregnant) provides opportunities for future parents to improve aspects of their health and reduce exposure to risk factors that could contribute to poor outcomes for themselves, or their future baby (1). These risk factors can include the parent’s health, diet, lifestyle, and environment (2, 3). Positive health and behaviour changes can have ramifications across multiple generations.
Consulting with a health professional for advice and support to improve preconception health is known as ‘preconception care’. Through preconception care, a health professional may recommend medicines or therapies, as well as changes to behaviours and social supports with the overall aim of improving the current and future health of couples (1).
2. Why is preconception health care, specifically for men, important?
Most preconception health care and research has focused heavily on the role of the mother’s health, but both men and women contribute to the genetic inheritance and expression of their children (4).
A future father’s responsibilities and influence also begins in the preconception period (5), so male partners need to be included in activities that prepare couples for pregnancy and parenthood (6). Becoming a parent is a major milestone and planning to become a father may be accompanied by stress (7) and fathers may also feel underprepared (8). Research shows that men want to be involved in the preparing for the pregnancy, but often feel like outsiders (5). We must refocus our understanding of preconception health care to include men (9).
3. What factors should men be aware of if they are trying to have a baby?
All aspects of health must be considered when attempting pregnancy (10); however, there are some that growing evidence suggests may be particularly relevant for men in the preconception period. While some of these health factors can be changed (modifiable) others are more fixed (non-modifiable). Ideally, any changes should be in place for a minimum of 3 months before attempting pregnancy to allow for the benefits to be reflected in the sperm, which has a 90-day cycle of production. However, some changes would need to be made for much longer for there to be a real benefit.
Non-modifiable risk factors
Age: Aging impairs semen characteristics including sperm volume, counts and motility (11). Men aged under 40 have decreased risk of having children with cancers such as leukemia, congenital anomalies and birth defects, psychiatric disorders, neurodevelopmental outcomes, and other adverse reproductive outcomes (12).
Family history: A family history can be considered a risk factor for offspring ailments such as venous thrombosis (13) and gastric cancer (14).
Environmental: Men must also consider their current environments. “Many of the key drivers of health reside in our everyday living and working conditions…” (10). Take heed of chemical exposures in the workplace (15) and in your home.
Modifiable risk factors
There are also a range of modifiable, or changeable, preconception risk factors for men which have adverse outcomes for the pregnancy and the child (16).
Alcohol consumption: Men are prone to exceed alcohol guidelines (17). Consuming less than 4 standards drinks on any one day or less than 10 standard drinks per week can reduce your offspring’s risk of alcohol related birth defects or behavioural abnormalities (18).
Body composition: A waist measurement < 94cm reduces the risk of chronic disease (19). Maintaining a healthy weight and composition can reduce the risk of offspring congenital malformations (20) and preterm birth (21).
Drug use: Children of parents who are not drug-dependent have reduced chances of developing mental disorders and maladaptive behaviours by late adolescence (22).
Nutrition/Diet: Men who do not frequently consume fast-food less often have infants born earlier, compared with men who do not frequently consume fast-food (23).
Physical activity: Moderate exercise may promote beneficial health outcomes and general wellbeing, whereas high-intensity exercise appears to reduce male fertility (24).
Smoking: Smoking abstinence during preconception may reduce chances of children developing asthma (25) and reduce the risks of offspring heart defects (26).
4. What part about getting healthy before trying for a baby do you wish more men knew?
Men’s health before their partner becomes pregnant can have far-reaching consequences for their future child. Making simple changes like reducing alcohol intake, quitting smoking, and eating better before conception is the least you can do for the health of your baby.
5. What advice would you give health professionals to help them
incorporate preconception care for men into their practice?
- Include men of reproductive age in your preconception screening by simply asking
“are you currently attempting a pregnancy or planning for a pregnancy”?
- Plant the seed about preconception care…. Consider discussing modifiable preconception risk factors which may
affect male fertility and child health outcomes, even if you are not specifically asked.
- Be inclusive. Make sure both reproductive partners are included and feel part of the process.
- Use resources including the preconception checklist for men (27) and the emerging paternal preconception research.
- Identify any industry relevant information relating to preconception and consider
participation in any preconception special interest groups within your profession.
6. Why is language so important when talking about fertility and preconception health with men?
Many men think that preconception and fertility are maternal health issues, which makes them difficult for males to discuss (28). It’s important that preconception health messages foster inclusivity and acknowledge reproductive autonomy (29). Language must be framed to represent all men and all reproductive decisions, not just those from a traditional nuclear family (29). Communications to men about preconception health and care should avoid any blame and stigma that may be associated with fertility and reproduction; language should be phrased to address the benefits of positive health behaviours, not focus on the associated threats (29).
Your Fertility recognises that not all people who need to access men’s health care identify as men and that this language may not reflect terminology that is inclusive of the trans and gender-diverse community.
More like this on Your Fertility
- World Health Organization [WHO], editor Meeting to develop a global consensus on preconception care to reduce maternal and childhood mortality and morbidity Meeting to develop a global consensus on preconception care to reduce maternal and childhood mortality and morbidity 2012; Geneva: World Health Organization [WHO].
- Stephenson J, Heslehurst N, Hall J, Schoenaker DAJM, Hutchinson J, Cade JE, et al. Before the beginning: nutrition and lifestyle in the preconception period and its importance for future health. The Lancet. 2018;391(10132):1830-41.
- St Fleur M, Damus K, Jack B. The future of preconception care in the United States: multigenerational impact on reproductive outcomes. Upsala Journal of Medical Sciences. 2016;121(4):211-5.
- Dunford AR, Sangster JM. Maternal and paternal periconceptional nutrition as an indicator of offspring metabolic syndrome risk in later life through epigenetic imprinting: A systematic review. Diabetes and Metabolic Syndrome: Clinical Research and Reviews. 2017;11(Supplement 2):S655-S62.
- Kotelchuck M, Lu M. Father’s role in preconception health. Maternal and child health journal. 2017;21(11):2025-39.
- Entsieh AA, Hallström IK. First-time parents’ prenatal needs for early parenthood preparation-A systematic review and meta-synthesis of qualitative literature. Midwifery. 2016;39:1-11.
- Carlson J, Edleson JL, Kimball E. First-time fathers’ experiences of and desires for formal support: A multiple lens perspective. Fathering. 2014;12(3):242-61.
- van Vulpen M, Heideveld-Gerritsen M, van Dillen J, Oude Maatman S, Ockhuijsen H, van den Hoogen A. First-time fathers' experiences and needs during childbirth: A systematic review. Midwifery. 2021;94:102921.
- Steel A, Carter T. Balancing our gaze on preconception health and care to include men. Advances in Integrative Medicine. 2021;8(2):79-80.
- Australian Government: Australian Institute of Health and Welfare [AIHW]. Chapter 4 Determinants of health 2016 [Available from: https://www.aihw.gov.au/reports/australias-health/australias-health-2016/contents/chapter-4-determinants-of-health.
- Halvaei I, Litzky J, Esfandiari N. Advanced paternal age: effects on sperm parameters, assisted reproduction outcomes and offspring health. Reproductive Biology and Endocrinology. 2020;18(1):1-12.
- Brandt JS, Cruz Ithier MA, Rosen T, Ashkinadze E. Advanced paternal age, infertility, and reproductive risks: a review of the literature. Prenatal diagnosis. 2019;39(2):81-7.
- Bezemer ID, van der Meer FJM, Eikenboom JCJ, Rosendaal FR, Doggen CJM. The value of family history as a risk indicator for venous thrombosis. Archives of internal medicine. 2009;169(6):610-5.
- Yaghoobi M, Bijarchi R, Narod SA. Family history and the risk of gastric cancer. British journal of cancer. 2010;102(2):237-42.
- Fazekas-Pongor V, Fekete M, Csaky-Szunyogh M, Cseh K, Penzes M. Parental occupational exposure and congenital heart diseases in a Hungarian case-control study. International archives of occupational and environmental health. 2021;94(3):515-27.
- Carter T, Schoenaker D, Adams J, Steel A. Paternal preconception modifiable risk factors for adverse pregnancy and offspring outcomes: a review of contemporary evidence from observational studies. BMC Public Health. 2023;23(1):509.
- Australian Bureau of Statistics [ABS]. Alcohol consumption 2022 [Available from: https://www.abs.gov.au/statistics/health/health-conditions-and-risks/alcohol-consumption/latest-release.
- Australian Government: Department of Health and Aged Care. Australian Alcohol Guidelines Revised 2020 [Available from: https://www.health.gov.au/news/australian-alcohol-guidelines-revised.
- Health VSGDo. Body mass index (BMI): Victoria State Government: Department of Health 2022 [Available from: https://www.betterhealth.vic.gov.au/health/healthyliving/body-mass-index-bmi.
- Chen R, Chen L, Liu Y, Wang F, Wang S, Huang Y, et al. Association of parental prepregnancy BMI with neonatal outcomes and birth defect in fresh embryo transfer cycles: a retrospective cohort study. BMC Pregnancy & Childbirth. 2021;21(1):1-11.
- Sun M, Zhang S, Chen L, Li Y, Diao J, Li J, et al. Association between paternal pre-pregnancy body mass index with preterm birth and low birth weight. Frontiers in Pediatrics. 2022;10:955544.
- Marmorstein NR, Iacono WG, McGue M. Alcohol and illicit drug dependence among parents: associations with offspring externalizing disorders. Psychological Medicine. 2009;39(1):149-55.
- Moss JL, Harris KM. Impact of maternal and paternal preconception health on birth outcomes using prospective couples' data in Add Health. Archives of Gynecology and Obstetrics. 2015;291(2):287-98.
- Australia TFSo. The role of exercise in improving fertility, quality of life, and emotional well-being. 2015 [Available from: https://www.fertilitysociety.com.au/wp-content/uploads/FSA-The-role-of-exercise-in-improving-fertility-2016.pdf#:~:text=Physical%20activity%20and%20male%20fertility%20High%20intensity%20exercise,in%20those%20in%20the%20moderate%20intensity%20exercise%20group.
- Accordini S, Calciano L, Johannessen A, Portas L, Benediktsdóttir B, Bertelsen RJ, et al. A three-generation study on the association of tobacco smoking with asthma. Int J Epidemiol. 2018;47(4):1106-17.
- Deng K, Liu Z, Lin Y, Mu D, Chen X, Li J, et al. Periconceptional paternal smoking and the risk of congenital heart defects: A case-control study. Birth Defects Research Part A - Clinical and Molecular Teratology. 2013;97(4):210-6.
- Your Fertility. Preconception Checklist for Men 2023 [Available from: https://www.yourfertility.org.au/sites/default/files/2020-10/Pre-conception%20Checklist%20for%20Men.pdf.
- Harlow AF, Zheng A, Nordberg J, Hatch EE, Ransbotham S, Wise LA. A qualitative study of factors influencing male participation in fertility research. Reproductive Health. 2020;17(1).
- Mertes H, Harper J, Boivin J, Ekstrand Ragnar M, Grace B, Moura-Ramos M, et al. Stimulating fertility awareness: the importance of getting the language right. Human Reproduction Open. 2023;2023(2):hoad009.