Ninety-six per cent of women who attended a preconception clinic before undergoing IVF had three or more lifestyle problems and risk factors, according to a study in the May issue of the Journal of Advanced Nursing.

Half of the obese women lost weight and nearly a third of the smokers decided to quit after receiving advice at the clinic. But the nurses were surprised that some women had no motivation to lead healthier lifestyles, even though they were prepared to go through IVF to get pregnant. For example 30% of the smokers refused to quit and 16% of the obese women weren't prepared to lose weight.

Researchers from the University Medical Center in Utrecht, The Netherlands, analysed the results of questionnaires completed by 101 women who had received preconception care before IVF, together with the seven nurses who advised them.

"Medical professionals are increasingly recognising that there are important links between preconception health and positive IVF outcomes, both in terms of the success of the procedure and the health of the baby" says nurse researcher Henrietta Ockhuijsen from the Department of Reproductive Medicine and Gynaecology at the Center. "Despite this, preconception care is rarely offered to couples undergoing IVF."

A total of 130 women, aged from 25 to 42 years, completed an internet-based preconception questionnaire developed by the Erasmus Medical Center in Rotterdam and 101 of those completed a further questionnaire after they had received lifestyle advice from one of the seven nurses. The obese patients and smokers were then followed up for a further year. The registered nurses ranged from 42 to 51 years-of-age and had all worked in the fertility clinic for more than five years.

Key findings of the study included:

    The vast majority of the 130 women who completed the lifestyle problems and risks questionnaire faced three or more risks (96%), with only 4% facing two. These lifestyle problems and risks included bacterial and parasitic infections, alcohol use, smoking, obesity and using medication without a prescription.

    All of the women were satisfied with the time spent with them by the nurse providing preconception advice and 96% were satisfied with the verbal information provided.

    The women were also asked for their views on the preconception site run by the Erasmus Medical Center. The overall written information scored a satisfaction rate of 94%, the information and advice about lifestyle problems scored 91% and 89% respectively and the strategies to improve lifestyles scored 75%.

    Women valued the personal contact and approach from their nurse and the time allocated for preconception advice. But women with lower risk factors felt the clinic was unnecessary and that a better selection procedure would increase the efficiency and value of the service.

    Half of the 30 women who were obese lost weight. They had an average BMI of 34.3, weighed an average of 101.3kg and lost an average of 6.1kg. Ten further women said they were motivated to lose weight, but declined to be followed up, and the remaining five said they didn't feel motivated to lose weight.

    Seven of the 23 patients counselled for smoking quit, six reduced the number of cigarettes they smoked, three wanted to quit but declined follow up and seven were not motivated to quit.

    The nurses were sceptical about the clinic to start with, but became more confident about the value of the programme and their role, scoring it an average of 4.3 out of ten at the start and 6.3 at the end. More than half (57%) were happy with the training they received, 86% with the coaching, 86% with the internet-based questionnaire used, 72% with the evidence-based manual and 57% with the organisation of the clinic.

    However only 42% were satisfied with the fact that all the women were referred to the preconception clinic, arguing that it was more important for women who were obese, smoked, lacked knowledge and had multiple lifestyle problems to attend.

    Less than half (42%) were satisfied with the knowledge and skills they had to counsel women with obesity. The nurses also felt awkward about talking about issues such as weight loss and smoking cessation with women who were already facing the stress of IVF.

"The results of our study show that preconception care was well received by the patients and that it motivated some women to lose weight and quit smoking" concludes Henrietta Ockhuijsen. "We feel that such care should be incorporate into IVF programmes and that nurses could play a key role in running special clinics, as long as they were provided with additional education and clear protocols."