Table 1.

Rationale for Including Preconception Health Services for Men

Service	Rationale
Reproductive life plan	Although not evidence-based in terms of its impact on reproductive and sexual risk behaviors among men, developing a reproductive life plan is a core recommendation in CDC’s preconception health recommendations.22 Asking about a client’s reproductive life plan is a necessary first step in assessing the need for other family planning services.
Medical history	Although not evidence-based in terms of its impact on reproductive and sexual risk behaviors among men, obtaining information from a medical history (e.g., about environmental hazards and toxins, medications, genetic conditions and family history, infectious diseases and vaccinations, mental health concerns) has been recommended by CDC and experts in men’s health.21,38 Obtaining a medical history is a necessary first step in assessing the need for other screening and treatment services.
Sexual health assessment	Although not evidence-based in terms of their direct impact on reduced sexual risk behaviors or STD incidence among men, conducting a sexual health assessment is a recommendation in the STD Treatment Guidelines,17 and a recommended first step in assessing the need for STD screening.
Alcohol and other drug use	Research has shown that heavy drinking (>2 drinks a day) is associated with lower levels of testosterone, semen volume, sperm count, and the number of sperm with normal morphology and motility.39 Other drugs have also been associated with male infertility, including marijuana and cocaine,40,41 and anabolic steroids.42,43 Both CDC and experts in men’s health included screening for alcohol and other drug use as a preconception health service.21,38
Tobacco use	Tobacco use has been associated with decreased sperm count, abnormal sperm morphology, motility, and fertilizing capacity; it may also induce oxidative damage to sperm DNA.44 Both CDC and experts in men’s health included screening for tobacco use as a preconception health service.21,38
Immunizations	There is some evidence of an association between mumps and male infertility.45,46 In addition, several vaccine-preventable diseases (flu, measles, etc.) if passed from a man to a pregnant woman could have an adverse impact on the woman and/or the infant.47,48 In addition, both CDC and experts in men’s health recommend reviewing men’s immunization status as a preconception health service.21,38
Depression	Depression of the father during the postnatal development of his child has been significantly associated with poor childhood emotional and behavioral outcomes.49 Further, depressed fathers can be associated with negative mother-child interactions.50 Conversely, fathers with good mental health have been shown to reduce the impact of a mother’s depression on the child.51 In addition, both CDC and experts in men’s health included depression screening as a preconception health service.21,38
Height, weight, and BMI	Obesity has been associated with lowered testosterone level, poorer semen quality, and reduced fertility.52,53 In addition, both CDC and experts in men’s health included BMI screening as a preconception health service.21,38
Chlamydia Gonorrhea Syphilis	STDs are considered a men’s preconception health issue because they can lead to infertility in the female partner and severe morbidity in the child (e.g., perinatal HIV, congenital syphilis).
HIV/AIDS	Both CDC and experts in men’s health included STD screening and treatment as a preconception health service.21,38
Diabetes	In men with diabetes mellitus type 1, semen volume, motility, and morphology are all significantly lowered compared to controls; diabetic men with unsatisfactory glycemic control had lower sperm count, motility, velocity, and viability than men with satisfactory glycemic control.54 Both CDC and experts in men’s health included screening for and managing diabetes as a preconception health service.21,38

STD, sexually transmitted disease.