臨床婦人科産科78巻3号

2024年04月発行

臨床経験

不妊治療施設による妊活前のプレコンセプションケア外来の試用から見えてきた課題と展望

著者： 勝又翔子¹ 太田邦明² 加茂尚永³ 筋野徒志雄¹ 小宮顕⁴ 伊藤真帆¹ 今井美和¹ 石川恵¹ 川井清考¹

所属機関： ¹亀田IVFクリニック幕張 ²東京労災病院産婦人科 ³さんむ医療センター産婦人科 ⁴亀田総合病院泌尿器科

ページ範囲：P.351 - P.358

▶要旨

　近年の晩婚化・晩産化に伴い，妊娠後の問題を予防するだけでなく妊娠すること自体に対するプレコンセプションケアの必要性が増大し，われわれは不妊クリニックでプレコンセプションケア外来を設立した．受診患者は，月経不順など不妊症の懸念を抱えたカップルやすでに妊活中で不妊治療も検討しているカップルが多かった．受診後に不妊治療や不妊検査のために通院を継続した患者は一定数おり，不妊クリニックにおけるプレコンセプションケア外来の運用により挙児を希望してから妊娠までの期間が短縮できる可能性がある．妊娠に対して積極的なカップルでさえも身体づくりや栄養管理についての知識は乏しく，その重要性やサプリメントの活用について，一般的なプレコンセプション期のカップルに対する啓発が急務であると考えられた．

参考文献

1）厚生労働省 : 令和3年（2021）人口動態統計（確定数）の概況．2022年9月16日　https://www.mhlw.go.jp/toukei/saikin/hw/jinkou/kakutei21/index.html

2）Dean SV, Lassi ZS, Imam AM, et al : Preconception care : nutritional risks and interventions. Reprod Health 11（Suppl 3） : S3, 2014

3）Stephenson J, Heslehurst N, Hall J, et al : Before the beginning : nutrition and lifestyle in the preconception period and its importance for future health. Lancet 391 : 1830-1841, 2018

4）World Health Organization，Maternal, Newborn, Child＆Adolescent Health＆Ageing : Preconception care : maximizing the gains for maternal and child health―policy brief．15 February，2013 https://www.who.int/publications/i/item/WHO-FWC-MCA-13.02

5）フェリング・ファーマ，不妊治療中のカップルを対象に不妊症・不妊治療に関する国際意識調査を実施―不妊症と診断された方が子どもを持つという決断から妊娠までの平均期間は約6.4年．プレスリリース，フェリング・ファーマ社，2022年10月18日　https://d2gohj824v350l.cloudfront.net/wp-content/uploads/sites/32/2022/10/25063216/20221018_pressrelease.pdf

6）厚生労働省 : 令和元年国民健康・栄養調査報告，結果の概要．2020年12月　https://www.mhlw.go.jp/content/000711005.pdf

7）World Health Organization : Physical activity．5 October，2022　https://www.who.int/news-room/fact-sheets/detail/physical-activity

8）Broughton DE, Moley KH : Obesity and female infertility : potential mediators of obesity's impact. Fertil Steril 107 : 840-847, 2017

9）McKinnon CJ, Hatch EE, Rothman KJ, et al : Body mass index, physical activity and fecundability in a North American preconception cohort study. Fertil Steril 106 : 451-459, 2016

10）Kirchengast S, Huber J : Body composition characteristics and fat distribution patterns in young infertile women. Fertil Steril 81 : 539-544, 2004

11）Ramlau-Hansen CH, Thulstrup AM, Nohr E, et al : Subfecundity in overweight and obese couples. Hum Reprod 22 : 1634-1637, 2007

12）Hammoud AO, Gibson M, Peterson CM, et al : Impact of male obesity on infertility : a critical review of the current literature. Fertil Steril 90 : 897-904, 2008

13）Foucaut AM, Faure C, Julia C, et al : Sedentary behavior, physical inactivity and body composition in relation to idiopathic infertility among men and women. PLoS One 14 : e0210770, 2019

14）Nishigori H, Obara T, Nishigori T, et al : Preconception folic acid supplementation use and the occurrence of neural tube defects in Japan : a nationwide birth cohort study of the Japan Environment and Children's Study. Congenit Anom（Kyoto） 59 : 110-117, 2019

15）Karolczak K, Watala C : Melatonin as a reducer of neuro-and vasculotoxic oxidative stress induced by homocysteine. Antioxidants（Basel） 10 : 1178, 2021

16）Ostrakhovitch EA, Tabibzadeh S : Homocysteine and age-associated disorders. Ageing Res Rev 49 : 144-164, 2019

17）Berker B, Kaya C, Aytac R, et al : Homocysteine concentrations in follicular fluid are associated with poor oocyte and embryo qualities in polycystic ovary syndrome patients undergoing assisted reproduction. Hum Reprod 24 : 2293-2302, 2009

18）Liu L, Lin Z, Lin P, et al : Association between serum homocysteine level and unexplained infertility in in vitro fertilization/intracytoplasmic sperm injection（IVF/ICSI）: a retrospective, hospital-based, case-control study. J Clin Lab Anal 34 : e23167, 2020

19）Wang H, Han A, Jiang S, et al : Homocysteine level related to age is associated with embryo quality in women who had IVF with diminished ovarian reserve. Front Reprod Health 4 : 886277, 2022

20）Dai C, Fei Y, Li J, et al : A novel review of homocysteine and pregnancy complications. Biomed Res Int 2021 : 6652231, 2021

21）Kaldygulova L, Ukybassova T, Aimagambetova G, et al : Biological role of folic acid in pregnancy and possible therapeutic application for the prevention of preeclampsia. Biomedicines 11 : 272, 2023

22）Kuroda K, Horikawa T, Gekka Y, et al : Effects of periconceptional multivitamin supplementation on folate and homocysteine levels depending on genetic variants of methyltetrahydrofolate reductase in infertile Japanese Women. Nutrients 13 : 1381, 2021

23）Schröder-Heurich B, Springer CJP, von Versen-Höynck F : Vitamin D effects on the immune system from periconception through pregnancy. Nutrients 12 : 1432, 2020

24）Mumford SL, Garbose RA, Kim K, et al : Association of preconception serum 25-hydroxyvitamin D concentrations with livebirth and pregnancy loss : a prospective cohort study. Lancet Diabetes Endocrinol 6 : 725-732, 2018

25）Chu J, Gallos I, Tobias A, et al : Vitamin D and assisted reproductive treatment outcome : a prospective cohort study. Reprod Health 16 : 106, 2019

26）Ekapatria C, Hartanto B, Wiryawan P, et al : The effects of follicular fluid 25（OH）D concentration on intrafollicular estradiol level, oocyte quality, and fertilization rate in women who underwent IVF program. J Obstet Gynaecol India 72（Suppl 1） : 313-318, 2022

27）Fichera M, Török P, Tesarik J, et al : Vitamin D, reproductive disorders and assisted reproduction : evidences and perspectives. Int J Food Sci Nutr 71 : 276-285, 2020

28）Si S, Mo M, Cheng H, et al : The association of vitamin D and its pathway genes' polymorphisms with hypertensive disorders of pregnancy : a prospective cohort study. Nutrients 14 : 2355, 2022

29）Amini S, Jafarirad S, Amani R : Postpartum depression and vitamin D : a systematic review. Crit Rev Food Sci Nutr 59 : 1514-1520, 2019

30）Fallah A, Mohammad-Hasani A, Colagar AH : Zinc is an essential element for male fertility : a review of Zn roles in men's health, germination, sperm quality, and fertilization. J Reprod Infertil 19 : 69-81, 2018

31）Irani M, Amirian M, Sadeghi R, et al : The effect of folate and folate plus zinc supplementation on endocrine parameters and sperm characteristics in sub-fertile men : a systematic review and meta-analysis. Urol J 14 : 4069-4078, 2017

32）Zhao J, Dong X, Hu X, et al : Zinc levels in seminal plasma and their correlation with male infertility : a systematic review and meta-analysis. Sci Rep 6 : 22386, 2016