Key Takeaway: Care before building a family is critical
For most people, fertility care is not something that becomes a concern until you are about to start trying to get pregnant or you are already trying. While receiving care during the fertility process is important, the care you and your partner receive well before this phase may actually be even more crucial. Frame plays a critical role in ensuring that this happens for both patients and providers.
Why does care before building a family matter?
The ultimate goal of preconception care is to lower the risk of bad health outcomes by working with you to optimize your health, address any risk factors that can be changed, and provide education about healthy lifestyle choices now that could affect pregnancy risks in the future.
Preconception care is not only recommended by the American College of Obstetricians and Gynecologists (ACOG) but also by the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO). This recommendation includes anyone who thinks they may want to have children in the future.
Many studies have shown that improved preconception health can lead to better pregnancy outcomes for both parent and child as well as lower healthcare costs. Health care before pregnancy can improve diseases that are already present, lower a person’s risk for other diseases, and help prepare a family for pregnancy. If that wasn’t enough, there are also some interventions that are available before conception that are not possible once a person is pregnant.
The status of care before conception today
Unfortunately, in the US today, only about 14% of people receive preconception care. Of the care that is provided, there are several gaps that have yet to be filled.
First, there is a broad failure to include preconception counseling in routine annual and wellness checks. As an OB/GYN physician, questions about current and future pregnancy plans have become a routine part of my process with each person I see who has the capacity for pregnancy. Many chronic medical conditions like diabetes, high blood pressure, mental health illness, and thyroid disease can significantly affect pregnancy outcomes and should be managed as early before pregnancy as possible. All providers who see people of reproductive age who could become pregnant or wish to become pregnant at some point should be asking them about their family planning.
In particular, adolescents and people with testes are often kept out of conversations about preconception care. In the past, preconception care has been considered a “female” or maternal concern. We now know this is wrong. As research has shown, lifestyle choices that affect sperm health can have profound effects on fertility and pregnancy outcomes for a family. We also know that many conditions that worsen in adulthood could be prevented or improved with care in the younger, adolescent years.
Even when preconception care is given, there is no guarantee it is done completely and well. Adequate preconception counseling includes reviewing your medical, surgical, and psychiatric history, family and genetic history, medications, and immunizations. It should also include screening for infectious diseases like STIs as well as an assessment of substance use, intimate partner violence, nutritional status and healthy weight, and potential environmental exposures. For people who do not desire pregnancy in the near future, preconception counseling also includes a review of all effective birth control options and education on general reproductive care and sexual health.
Finally, your provider may have every intention to do full preconception counseling but limitations on time per visit in the office can make it nearly impossible to do the appropriate counseling and discuss any additional complaints. Most providers, myself included, recommend scheduling a separate preconception visit for this reason. The drawback to this approach is that insurance coverage for visits beyond the annual wellness check can vary. I have had countless situations like this arise where we have identified a health concern but do not have enough time in our visit to go through more than the most important, basic information that person needs. Many of these people don’t come back for a second visit due to insurance coverage issues as well as work, childcare, and transportation constraints.
To compound all the problems above, public awareness of the importance of preconception care is not as high as it should be. With the inconsistent nature of sexual education in US schools, it should come as no surprise that many people do not fully understand their current reproductive health, let alone how seriously their health decisions now could affect their (and their partner’s) reproductive health in the future.
How Frame is Helping to Bridge this Gap
Over the last few years, there has been an explosion of digital diagnostic startups that aim to plug the many holes in our healthcare system when it comes to reproductive health in particular. I have seen the need for these startups day after day in the office–whether it’s the young person with endometriosis who wants to freeze their eggs but is unsure where to start or the couple struggling emotionally, physically, and, all too often, financially with their infertility diagnosis and treatment process.
Inspired by the founders’ own difficult family-building path, Frame offers the first and only evidence-based, holistic platform for the early identification of fertility risk and care navigation. This allows for earlier intervention, which can mean avoiding costly and invasive fertility procedures in the future and improving the health of the parent(s) and child. No matter where people are in their family-building journey, Frame can help them be proactive about their general health and family planning while helping them understand and achieve better health outcomes.
The fact that Frame was developed alongside clinical experts and is rooted in research is reassuring for providers like myself. In providing the best possible care for our patients, we are always on the lookout for evidence-based tools that can engage people in a way that will help them optimize their health.
Additionally, the complementary nature of Frame’s offerings actually enhances and supports providers who want to give their patients a holistic treatment plan but are unable to do so effectively within the current constraints of our healthcare system. Many of the changes needed to make a lasting health impact are comprehensive by nature–things like diet, exercise, sleep, and stress and mental health management are easy to discuss in the office but not so easy to implement in everyday practice when your doctor isn’t in the kitchen or the gym with you. Lifestyle changes like these require time, consistency, and patience outside the typical office visit where providers are able to have a direct impact. Frame understands the importance of these often overlooked factors and incorporates them into the care navigation process.
It is my pleasure to serve as a Clinical Advisor to Frame. I hope you’ll explore their product and support them as they continue to improve access to crucial preventive care for those who need it.
