Premarital counseling

There are genetic diseases that are widespread in some societies. A person carrying the gene for a certain sickness can pass it to his children. Also With the wide spread of sexually transmitted disease there is a chance that these diseases can be spread to from one couple of the other. At the same time there is an increase in the levels of delayed fertility worldwide. All this strengthened the importance of requiring couples to  undergo pre-marital exams before marriage. Some countries have encouraged their citizens to go for such pre-medical exams while others have made doing so a legal requirement for marriage. The marriage contract is a serious commitment that is supposed to be permanent and stable.

Premarital counseling aims in checking the couple’s ability to produce children, detecting genetic problems in the couple that can be transmitted to their children, detecting any infectious disease in either of the couple which can harm either of them or their children and detecting any chronic illness that can affect the ability to produce or take care of children.

It also helps in educating couples on reproduction in terms of teaching them facts concerning the male and female reproductive parts, how menstruation, ovulation and pregnancy happens, family planning methods, the common preventable problems (e.g. Rh incompatibility and Down’s syndrome). It also helps couples to discuss their concerns freely.

For the couple

The doctor starts by checking the familial relation between both couples and checking if there are any hereditary diseases in their family. Then he asks for history of any medical diseases in the couple themselves or their families e.g. diabetes, tuberculosis, hypertension. After the history taking he starts his examination by a general examination and checking for symptoms of common diseases like kidney or liver or heart diseases then he look for symptoms of glands and hormone problems and he finished by a general abdominal examination. After the examination he writes out a set of laboratory investigations to be performed e.g. Complete blood picture, Blood Group and Rh factor, Blood Glucose, Rubella screening, Hepatitis Virus B and C, Urine analysis and Other investigations (if needed), such as:  syphilis, hepatitis or HIV.

Specific for men

The doctor takes history from the male partner about any previous operations done E.g. laparotomy, varicocele, hydrocele, hernia and mumps. Then he inspects the external reproductive parts and look for Genital ulcers, Urethral discharge, Varicocele, Hypospadias or undescended testicles. After finishing he writes some laboratory investigations to be done like Hormonal analysis of Testosterone, FSH, LH and Semen Analysis which is the first tests done to help determine whether a man has a problem producing children .Semen is checked for its volume, Liquefaction time which is a measure of time for the semen to liquefy from its original gel form, Sperm count, Sperm shape and Sperm motility. In addition to other tests like acidity measure, White blood cell count and Fructose level.

Specific For women

The doctor takes the menstrual history from the female partner by asking about age of first period, regularity, duration, heaviness of flow, Pain during period, vaginal discharge and date of last menstruation. After that he inspects the external reproductive parts and look for Genital ulcers, condition of the labia minora and clitoris, evidence of Female genital circumcision. Then he performs a pelvic ultrasound which uses sound waves to form a picture of the organs and structures in the lower belly (pelvis). A pelvic ultrasound looks at: The bladder, ovaries, uterus, cervix, and fallopian tubes of a woman. After finishing his examination he writes out some laboratory investigations e.g. hormonal analysis of ESTRADIOL (E2), F.S.H, L.H, PROGESTERONE, and PROLACTIN.

Author: DrAshrafSabry

Fertility, Obstetrics & Gynecology Consultant.