Archive for the ‘Trying for a Baby’ Category

How will I know I’m pregnant? FAQs.

I think I might be pregnant -what is the best way for me to confirm this?

By far the most accurate way to confirm a pregnancy is to perform a home pregnancy test. If used correctly, these are extremely accurate. Your doctor can offer a pregnancy testing service if confirmation is required This may be the case if, for example, you test too early and get a false negative result (see below) and then lose faith in the home test Apart from a home pregnancy test, pregnancy can also be confirmed with a blood test, although this is usually only done if there are possible problems such as irregular bleeding. Occasionally, ultrasound scans are used to confirm a pregnancy particularly if there is a question mark about the dates, although an embryo cannot be seen on a scan until at least four weeks after conception.

I feel pregnant - how early can I do a test?

Pregnancy tests determine if you are pregnant by detecting a hormone called human chorionic gonadotrophin (hCC) in your urine. This pregnancy hormone is released when the fertilized egg is implanted in the lining of the womb and it rises significantly in the early stages of pregnancy.Most pregnancy tests can now detect hCG as early as the day you are due to have your period. If you have irregular cycles, use your longest recent cycle to determine when you should test

My period is late but the pregnancy test was negative. Could I be pregnant?

If your test was negative and you still think you may be pregnant, wait for three days and perform another test! there may not have been enough hCG in your urine when the first test was carried out. If you have had two or three negative tests and still feel you may be pregnant, or your period has not arrived, ask your doctor for advice as there may be a number of medical reasons apart from pregnancy why your period has not arrived.

Are home pregnancy tests reliable?

If you follow the instructions carefully, home pregnancy tests are around 97-99 per cent accurate. When you are carrying out a home pregnancy test, it is advisable to use the first urine sample of the day and to not drink too much fluid the night before This is to prevent the sample becoming too diluted, which could make it difficult to measure the levels of hCG. Certain fertility medications can interfere with the results of a pregnancy test, so if you have been undergoing any fertility treatment and think this may apply to you, you should ask your doctor or fertility clinic for more information and advice. Doing a pregnancy test too early in pregnancy can produce a false negative result, which means that the test reads negative but you are really pregnant. If you think this may be the case, repeat the test in three days’ time.

I’m on the Pill but my doctor has confirmed I’m pregnant.
How can this have happened?
The oral contraceptive Pill is around 92-99.7 per cent effective, depending on the brand and how reliably it is taken. Although figures indicate that approximately 8 out of 100 women do become pregnant during the first -year of using the Pill, other studies indicate that
when the Pill is taken properly as instructed this figure falls to less than I out of 100
Ideally, the Pill should be taken at the same time each day although some types can be taken up to 12 hours late. If you forget to take even one Pill, you increase your chances of getting pregnant. If two or more Pills from the same packet are missed, this can dramatically increase the risk of pregnancy if no other contraception is being used.
Certain drugs, such as antibiotics, some herbal remedies, and other medicines can interfere with the reliability of the Pill Also, sickness and diarrhoea can reduce the Pill’s effectiveness. Talk to your doctor, who will be able to help and advise you about what your options are next.
My girlfriend has told me she’s pregnant - how can I be sure it’s mine?
Unfortunately, the only way to be sure that you are the father of her baby is to take a DNA test, which can be carried out several weeks after the baby is born. To do this, you will need the consent of the
mother, as samples of DNA will need to be obtained from the child (and possibly from the mother too). DNA (deoxyribonucleic acid) is found in our body cells and is responsible for our genetic makeup and hence our characteristics. DNA is identified in a blood sample or from a scraping of cells inside the cheek. Samples from the child and partner need to be obtained in the same way,
I drank and smoked quite a lot before I realized I was pregnant. Will this affect the baby?
As you are probably aware, it is not advisable to drink and smoke during pregnancy. There are, however many women in your position who did not realize they were pregnant and continued to smoke and drink The important thing is to stop drinking and smoking now and take the best possible care of yourself and your baby As many young women ”binge drinks’, it is important for women of child-
bearing age to be aware that alcohol does cross the placenta and is a toxic substance to the baby. Most women, once they realize they are pregnant, stop drinking immediately and this is the best course of action for you to take.
If a mother continues to drink heavily, the alcohol can adversely affect the developing fetus, especially between weeks 4 and 10 of pregnancy, and serious complications, such as fetal alcohol syndrome and fetal alcohol spectrum disorder can develop. If one of these conditions develops, it can result in physical, behavioural, and learning disabilities that can have lifelong implications for the baby Drinking in pregnancy also increases the risk of miscarriage and premature labour.
The harmful chemicals in smoke can restrict the baby’s growth and cause dependency on nicotine even within the womb (see p 42) so give up now
I haven’t got any pregnancy symptoms yet - when are they likely to start?
Not everybody feels the full range of pregnancy symptoms as soon as they become pregnant, and it is not uncommon for some women to experience none at all. There are many factors that influence the range and intensity of pregnancy symptoms, such as your age, working environment, your state of health, diet, previous pregnancies, smoking, and how your body reacts to pregnancy hormones.
Nausea and vomiting are among the most common symptoms that women report, usually in the first three months and starting at around six weeks. These tend to improve by 12 weeks, but for some women can continue throughout the pregnancy.
Another early pregnancy symptom is breast tenderness, which is caused by changes in the levels of hormones that help to get your breasts ready for breastfeeding. The breasts may enlarge and become tender and heavier.

My partner doesn’t seem as enthusiastic as me about the pregnancy - should I be worried?
Men and women can react to the news of a pregnancy in different ways and for many men, coming to terms with a pregnancy can take far longer. It’s worth bearing in mind that during the early stages of pregnancy, men can find it hard to relate to the pregnancy as they have yet to see their baby on a scan or the changes in your body On the other hand, you may be very aware that your body is undergoing many physical and emotional changes.
It’s likely that your partner simply needs more time to adjust to the news. He may be concerned about the changes to your lifestyle and the financial implications of having a baby Talking openly to each other can help to ease anxieties for you both.

First signs of pregnancy
The most obvious initial sign that you are pregnant is a missed period. Other common early pregnancy symptoms include feeling extremely tired and bloated, having increasingly tender breasts, experiencing an increased need to pass urine, and finding that you have a greater or lesser sex drive, although all of these symptoms can occur premenstrually Some women also experience a small bleed around the time their period was due: which may be confused with a lighter period, that occurs when a fertilized egg implants in the wall of the uterus. There may also be a metallic taste in the mouth, nausea or vomiting - described as morning sickness, although this can occur at any time of day Some women don’t experience any symptoms.

A surprise pregnancy
dealing with unexpected
If your pregnancy was unplanned, you may have to work through feelings of shock and anxiety before coming to terms with this life-changing event.
* Be open with your partner about your feelings and reassure him that this is as much of a shock for you
* Rather than feel anxious about your lifestyle, make positive changes straight away! adopt a healthy diet, stop smoking and drinking, and take folic acid (see p.15). *You may feel overwhelmed, but rather than despair, just allow yourself time to adjust physically, mentally. and emotionally
These early symptoms may settle around the middle of the pregnancy A lack of symptoms is not indicative of how healthy your pregnancy is - you may just be one of the lucky few who sail through with no annoying side effects’.

Not Getting Pregnant FAQs.

We’re not getting pregnant what do we do now?
We’ve been trying to conceive for 12 months - can the doctor identify the problem?
There are many factors that can increase or decrease your chances of becoming pregnant, but if you have been trying for a year, it would be sensible to contact your doctor. After an initial assessment of your general health and lifestyle, your doctor will offer your partner a sperm test (see below) and you will be offered tests to see if you are producing eggs and check whether or not your Fallopian tubes are blocked. Blood tests will be carried out to check your iron levels, your red and white blood cell count, and to check how organs such as your liver and kidneys are functioning In addition, couples are asked to agree to a sexual health screening to check for previous or current STls, such as HIV and syphilis.

My wife has been tested and has the all clear - how can I tell if I’m causing our fertility problem?
You will be offered a semen analysis to determine your sperm quantity and quality — how sperm move (motility) and whether they are a normal form. A healthy sperm count should have a concentration of 20 million spermatozoa per millilitre of semen, with
75 per cent of these alive and 50 per cent of these ‘motile”, or moving as well as possible Differences can occur over time in both the quality and quantity of sperm, so if your first sample is poor, you will probably be tested again a couple of months later.
You are also likely to be advised to give up smoking, reduce alcohol intake to 1-2 units once or twice a week, and to wear loose-fitting underwear to avoid overheating the testes If a problem is found, you will be referred to a specialist for a consultation Try to avoid becoming stressed as this can also affect fertility Learning relaxation techniques with your partner and practising these regularly will help.

We can’t conceive naturally - what do we do now?
Assisted conception; or assisted reproduction, is the term used when women are helped to conceive without having intercourse There are five main procedures available, listed below. Your consultant will go through each one with you, and together you can make a decision about which is most suitable depending on your problem. You can also contact the National Institute for Health and Clinical Excellence (NICE) for more information (see p.310)
* Ovarian Stimulation (OS), or Super Ovulation (SO), involves injections of fertility hormones to boost egg production This is followed by intrauterine insemination (IUI) of sperm, whereby sperm are collected and sorted so that only the strongest remain and these are then artifically placed inside the uterus via a catheter. This is ideal for couples when the man’s sperm is “slow” or the woman has problems ovulating, or there is a combination of both. * Gamete Intra-Fallopian Transfer (GIFT). This is suitable for couples for whom no cause for infertility has been found. It involves stimulating the ovaries to produce eggs, which are removed, mixed withsperm and replaced directly into the Fallopian tubes, allowing conception to occur inside the body.
* In Vitro Fertilization (IVF). This is the most widely used treatment and involves a seven-step process (see below and p.30) This is ideal for most problems including blocked tubes
* Intra-Cytoplasmic Sperm Injection (ICSI). This is used if the man’s sperm count is low, the motility of the sperm is very poor, or the woman is allergic to her partner’s sperm. The treatment involves injecting just one viable sperm into an egg (see box right). * Artificial Insemination by Donor (AID). This is simply the injection of donated sperm into the cervix This is used when a man is unable to maintain an erection or is sterile Similarly, women may require an egg donation if they are unable to produce their own eggs, although this is more complicated.
Whatever treatment is provided, it is important that you and your partner are treated as a couple rather than separate patients. It is also essential that you are kept informed throughout the process and given information on any risks and benefits.

What does IVF involve?
IVF, or In Vitro Fertilization, involves the surgical removal of an egg which is then mixed with sperm in a laboratory dish to fertilize and produce an embryo outside of the womb (see p.30).
IVF treatment occurs in cycles, as there are various stages that must be completed for it to be successful. Initially, a drug is used in the form of a nasal spray or injection to switch off the woman’s natural cycle of egg production in the ovaries, known as ”clown-regulation”. Fertility drugs are then given to stimulate the ovaries to produce more than one egg (ovulation induction). Mature eggs are collected from the ovaries using a fine needle guided by ultrasound. The procedure is usually uncomfortable rather than painful. On the same day, the partner’s sperm is collected and then the eggs and sperm are mixed in a dish. Within a few days, one or sometimes two embryos are transferred into the womb. If an embryo successfully attaches to the inside of the womb and continues to grow, a pregnancy results.

ICSI

This procedure may be used when it is thought that the quality of the partner’s sperm may be responsible for fertility problems. If the sperm count is low or movement is poor, sperm may be ”assisted” in fertilizing the egg. An individual sperm is injected directly into the egg and, if fertilization takes place, the resulting embryo is placed in the uterus.
What are the success rates of fertility treatments?
Success rates for treatments vary, depending on the treatments used and the health of the couple If you want to know the success rates of individual clinics, you can ask for their ratio of “live-births-per-cyclestarted”. This information is available from each clinic, but there are currently no nationally held data
Overall, couples have a better success rate if the woman is aged 23-39 years, has been pregnant or has had a baby, and has a normal body weight (a body mass index between 19 and 24). The older a woman is, the less likely she is to get pregnant
Figures show that for every 100 women who are 23 to 35 years, more than 20 will get pregnant after one PVT cycle; from 36 to 38 years around 15 will get pregnant at 39, around 10 will get pregnant; and in women over 40, around 6 will get pregnant

IVF is so expensive - can we get help with funding?
Since April 2005, women between the ages of 23 and 39 are entitled to one free IVF cycle on the NHS. However, you must meet the eligibility criteria set by your local Primary Care Trust (PCT), which varies across the country and depends on factors such as your marital status, weight, and whether you or your partner smoke Couples who can afford to, or who may have had one unsuccessful cycle already, often opt for a private clinic Although these are regulated by the Human Fertilisation and Embryology Authority (HFEA), this cannot set costs, and a private course of IVF can cost from E4,000 to £10,000
My partner is worried about producing his sperm sample. How can I reassure him?
As fertility problems affect 1 in 7 couples in the UK reassuring your partner that this is not an unusual situation is always a good start. You could try leaving out a leaflet on fertility problems for him to read for more information Try to empathize with him as much as possible by sharing your experiences and the tests you have undergone.
Your partner may be worried about ejaculating at the required time when he is already feeling anxious and is in a clinical environment Some men require a sex toy, magazines, or video clips to help. For others, restraining from sexual intercourse for a few days can make ejaculation easier If you live fairly close to the clinic, your partner may be able to produce the sample at home and deliver it.
Sometimes a medical condition such as diabetes prevents a man ejaculating If this is the case, sperm can be obtained through ‘’sperm recovery”, whereby a small needle is passed through the skin of the scrotum into the testes and sperm is withdrawn.

The drugs I’m taking for IVF are giving me terrible mood swings. Is this normal?
The drugs used in IVF treatment are female hormones (see p.30) to stimulate your ovaries to mature more than one egg at a time, and progesterone, which helps to sustain a pregnancy. Different levels of hormones can result in mood swings, as any woman who suffers with premenstrual tension (PMT) can testify, and this is also a common side effect of IVF treatment It’s worth considering too that couples undergoing IVF are under incredible stress, which has been linked to an increased risk of developing depression, so it’s important to decide whether you are feeling ”hormonal” or are in fact depressed. Your doctor can advise you and refer you if necessary.
My partner has a low sperm count - can you tell us what help is available for us?
Usually, two or three semen samples are taken to work out the average sperm count and to see if there are abnormal sperm present. A healthy semen sample of 2-5ml contains more than 20 million sperm per ml; a count below this is considered low If your partner has abnormal sperm, further testing may be necessary Lifestyle changes can boost sperm (see below). There are also hormonal treatments to improve sperm count and surgery to remove blockages You may be reassured to know that even poor-quality semen can be used to fertilize an egg with IVF or with ICSI (see p.29).
Can lifestyle changes really improve sperm?
Poor quality sperm has been linked to excessive drinking (more than three or four units of alcohol per day), smoking, and to wearing tight-fitting underwear,
which overheats the testicles and can affect their efficiency Excessive stress and a poor diet are also thought to affect sperm So yes, it is worth reviewing your lifestyle to see if improvements can be made Jobs that may expose you to harmful agents, such as pesticides, may also affect sperm, so if you think your partner’s job may pose a risk, it’s worth investigating.
I’m pregnant using a donor -what happens if my child wants to trace her biological dad?
From April 2005, children who were conceived using donor sperm have had a right when they reach 18 years of age to find out their parent’s identity. This also applies to children conceived using donor eggs and embryos. This right applies only to children conceived after this date and not retrospectively. Prior to this date, children had the right to know at 18 years of age if they were conceived using donor sperm, eggs, or embryos and to find out if they were related to someone they wanted to marry. The reason for this change in the law is that children conceived in this way are being given the same rights as adopted children regarding information on their genetic parents. However, some fertility experts fear that this will deter potential donors.
Is surrogacy allowed in the UK?
Currently, surrogacy is legal in the UK, although it is illegal to advertise it as a service However, the law does not recognize surrogacy
as a fixed agreement, which means that a surrogate can change her mind about the arrangement during the pregnancy and up to six weeks after the birth. It is usual for a surrogate to receive ”reasonable expenses”, although there is no definition of what is deemed as reasonable. Usually, this includes costs incurred by the surrogate relating to her pregnancy, If the father of the child is named on the birth certificate, this gives him equal rights to the child. If this is not the case, then six weeks after the birth the new parents can apply for a parental order that gives them full parental status At this point, the surrogate gives up any parental rights to the child.

Conception problems

There are a range of reasons why a couple may have difficulty in conceiving. Investigations and tests may uncover specific conditions, which may be treatable, or you may be offered help to conceive.
What can affect a man’s fertility? A semen analysis may reveal various reasons why sperm have difficulty in fertilizing an egg The sperm count may be low (less than 20 million sperm per ml); the motility of the sperm (how they move) may be poor, and there may be a high percentage of abnormally formed sperm Some men experience a failure to ejaculate at orgasm There may also be damage to the tubes that connect the testicles to the seminal vesicles where sperm are produced, and this may have been present from birth or caused by a later infection
What can affect a woman’s fertility? Conditions such as polycystic ovary syndrome
(a hormonal imbalance that causes ovarian cysts) and endometriosis (see p 19) can disrupt fertility. Other hormonal imbalances, such as low levels of FSH and LH, can affect ovulation; or levels of progesterone may be too low to sustain a fertilized egg. Damaged Fallopian tubes, caused by an ectopic pregnancy (see p 25), surgery endometriosis, or pelvic inflammatory disease, which may be caused by an infection such as chlamydia, can prevent conception. Damage to the ovaries can occur from scarring as a result of surgery or infection, or the supply of eggs may be low Some women have an abnormally shaped uterus, or have uterine scarring, that can prevent the successful implantation of an egg.

IVF treatment

In vitro fertilization or IVF, is a complex procedure with several stages, from the stimulation and harvesting of your eggs to the successful fertilization of the eggs, development of embryos and transfer of the embryos into the womb for implantation. Undergoing IVF can be a stressful and time-consuming undertaking, but knowing in advance how the procedure works and what you can expect at each stage can reduce anxiety and help you and your partner to cope.
What happens first? To optimize the chances of success with IVF more than one egg at a time is removed for fertilization Normally, your body produces one egg each month. In rVF, you will inject yourself with drugs, such as clomiphene and hMG (human menopausal gonadotrophin) to stimulate your ovaries to produce several eggs. While you are undergoing this treatment, you will need to visit your clinic every one to two days over one or two weeks to monitor the development of the eggs. Once it is thought that the eggs are mature, you will be given a blood test to measure your levels of oestrogen, which is released around ovulation.

What happens next? Once your follicles are ripe and ready for ovulation, your eggs will be collected at the clinic using ultrasound or laparoscopy to guide a probe. Once the eggs have been collected, they will be mixed with your partner’s sperm in a Petri dish in a laboratory ready for fertilization Your partner needs to produce the sperm on the same day as the egg collection. He can either do this at home, or come into the clinic with you and produce the sperm while you are undergoing the egg collection procedure.What happens in the laboratory? Once the egg and the sperm have been mixed, they are placed in the laboratory and monitored closely for the next few days. They will first be inspected around 18 hours later to see how many of the eggs have been fertilized and the clinic will usually pass this information on to you the day after the procedure It’s quite common for not all of the eggs to be fertilized and for only two or three to develop into embryos. The fertilized eggs are incubated in the laboratory over the next couple of days and their progress measured. The laboratory technician watches cell division under a microscope, waiting for the eggs to divide into two or more cells on their journey to becoming a blastocyst (see p.21).
If one or more fertilized eggs develop in the laboratory, you will be called back in for the embryo transfer, This is done by injecting eggs through a catheter into the uterus. No more than two eggs will be transferred and you will have the option to freeze any remaining embryos.

Surrogacy
A surrogate mother is a woman who reaches an agreement to carry a baby on behalf of another woman. She can either conceive the baby with the partner’s sperm, in which case she is the maternal mother, or the infertile couple may fertilize their own egg through fertility treatment, which is then transferred into the uterus of the surrogate mother for her to carry the baby through pregnancy and deliver at birth. This process can be beset with problems: such as the conflicting emotions of both the surrogate mother and the receiving couple, or legal issues if, for example, the surrogate mother has a change of heart after the birth and wishes to keep the baby, For this reason, it is important that all parties entering into the agreement have carefully considered the implications and are confident and happy in their roles.

Miscarriage FAQs. I’ve had a miscarriage why did it happen to me?

What is a miscarriage?
A miscarriage is the spontaneous loss of a baby at any time up until the 24th week of pregnancy After 24 weeks the loss is referred to as a stillbirth. The signs of a miscarriage are vaginal bleeding and period-like cramps. As not all miscarriages follow the same pattern, there are various terms to describe what occurs:
* A threatened miscarriage occurs when there is bleeding and possibly pain, but the fetus survives. * An inevitable miscarriage occurs when there is bleeding and pain due to contractions in the uterus, the cervix opens, and the fetus is expelled.
* A missed miscarriage occurs when the fetus dies but remains in the womb and either is expelled naturally later or removed in an operation

I’ve recently miscarried - why did this happen?
Miscarriage occurs in 10-20 per cent of pregnancies In the vast majority of these the cause is never identified, but it’s unlikely to be related to anything you did or didn’t do. There are thought to be several reasons why miscarriages occur (see p 25) There may be a genetic problem, in which the baby or placenta doesn’t develop normally, levels of the pregnancy hormone progesterone may be low; there may be an immune disorder m which the mother 3 immune system reacts against the pregnancy; an infection may be present; or there may be problems with the uterus or cervix. Miscarriages tend to be more common in older women.
The Miscarriage Association (see p.310) offers support and up-to-date advice and information about miscarriage. You may feel comforted to know that, statistically, any future pregnancy you have is likely to progress normally.
My period was late and now I’m bleeding really heavily -could I be having a miscarriage?
In the absence of a positive pregnancy test or a pregnancy confirmed by an ultrasound scan, it is difficult to know whether or not you were pregnant If you have had unprotected intercourse in the time since your last period, it is possible that you could have been pregnant and this is a miscarriage The lateness of your period may give a clue, but won’t confirm one way or another. If you have any other symptoms of pregnancy it might be worth doing a pregnancy test as sometimes, even when there has been bleeding, a viable pregnancy is discovered
However, it could also be a late period for no other reason than that this happens on occasion to everyone. A delayed period can be caused by  weight loss or gain, stress, or if you have been taking the oral contraceptive Pill but missed a dose.
Talk to your doctor if the bleeding continues:
you feel faint or experience palpitations; your period lasts for longer than seven days; you have more than six well-soaked pads a day; or if you have any severe abdominal pain Your doctor can carry out a blood
test to check your iron levels and possibly determine if you have been pregnant, in which case an incomplete miscarriage or ectopic pregnancy will need to be ruled out (see p.25)

I’m 10 weeks pregnant and getting cramping pains. Do I need to rest to avoid a miscarriage?
Cramping pains on their own without vaginal bleeding or spotting can occur at this stage of pregnancy. Sometimes pain can be felt as the ligaments stretch when the baby and -your uterus grows. There are also other possible causes for the pain aside from miscarriage, such as constipation or a urinary tract infection
Many doctors advise rest to avoid a ”threatened” miscarriage, but there is no strong evidence that this makes any difference to the outcome of a pregnancy If you feel like resting because you are in discomfort from the cramping pains then do rest, but if you feel happy continuing as normal then that may be the best option for you Soaking in a warm bath and practising relaxation techniques may ease the intensity of the pain If the pain increases or you get any bleeding or spotting, contact your doctor.
Does bleeding in pregnancy mean that miscarriage is inevitable?
No, many women experience bleeding in early pregnancy and then proceed to have a healthy pregnancy and baby. Indeed, some women have intermittent bleeding throughout pregnancy, Despite this, any bleeding should be investigated. This is usually done with a scan to determine if the pregnancy is viable (going to continue) and to identify if there is any indication of where the
bleeding is coming from. In very early pregnancy, it can be hard to see the pregnancy on a scan and a blood test to measure levels of the pregnancy hormone human chorionic gonadotrophin (hCG) may be done, mainly to rule out the possibility of an ectopic pregnancy (see p.25) Unfortunately for you this is a time of waiting; the timing of any further scans is usually determined by the findings of the initial scan and blood tests and the symptoms you are experiencing.

I’ve had three miscarriages before and I’m scared of trying again - is there anything I can do?
It is understandable given your experiences that trying to get pregnant again is a scary proposition. Following a third miscarriage, it is usual for your doctor to offer you a number of investigative tests
to see if a reason for the miscarriages can be found. In some cases, a cause is identified and treatment can be offered to help improve the outcome for subsequent pregnancies.
You are likely to be given a number of blood tests. These are to look for antibodies (proteins in the blood that fight any substance they recognize as foreign to your body), chromosomal abnormalities, and infection. You may also have a vaginal examination and swab and an ultrasound scan to check your womb and tubes. If a chromosomal abnormality is found, genetic counselling should be offered to discuss the implications for future pregnancies. The levels of the hormones progesterone and prolactin may also be checked as these can play a role in miscarriage. Sometimes, the cervix is found to be weakened and likely to open early If this is the case, you may be offered a cervical stitch that acts like a drawstring on the cervix and hopefully prevents future miscarriage or premature delivery
If you haven’t already been offered these tests, talk to your doctor about them before trying to get pregnant again so that you can begin any recommended treatment as soon as possible
My mum had two miscarriages -does that mean I am more likely to miscarry?
Ask your mum if she was given any particular reason for her miscarriages If for example, she knows that they were due to a chromosomal abnormality, such as sickle-cell disease, or if she had a medical condition such as heart disease, then there is a possibility that the condition is hereditary and the risk of miscarriage may be the same for you too.
However, it’s most likely that your mother’s miscarriages were unfortunate chance occurrences for which no reason was found If this is the case, then you are at no more risk of experiencing a miscarriage than any other woman your age. However, if you do become pregnant, it would be worth mentioning your mother’s pregnancy history at your initial antenatal appointment, as your family medical history is an important part of your medical notes during pregnancy.

I’ve had several miscarriages and my doctor has referred me to a genetic counsellor - why?
A genetic counsellor is a highly trained professional who supports families before and after conception. Quite often a miscarriage is caused by a genetic abnormality in the fertilized egg or embryo. This is usually a one-off and can affect any woman. However, if a woman has recurrent miscarriages, it may be that she is carrying a genetic condition
Women and their partners are referred to a genetic counsellor if either partner has a condition that can affect future children or the chances of becoming pregnant or continuing with a pregnancy (as they may be more likely to miscarry or be offered a termination) For example if there is a history of sickle-cell disease, a blood disorder that causes chronic anaemia and increases the risk of a preterm birth and health problems in the baby, it may be that either or both couples are carrying a gene that can affect a baby.
A genetic counsellor helps you understand how your genes could affect conception and pregnancy and about the tests available to determine if a fetus is affected. The counsellor will discuss a range of
issues, including the moral and ethical issues related to genetic testing, as it is common for couples to feel stress, guilt, and confusion in this type of situation.

I lost my baby, but I want to get on and try again - is this OK?
Although there are no hard rules about when to try for another baby, it is important that you allow yourself time to grieve and your body to recover before trying to conceive again. Some women feel able to try again within a month, while others may not feel ready for at least a year. Whatever you feel, it’s wise to let your hormones and body settle down after a miscarriage before considering another pregnancy. The usual advice is to wait for at least three months before trying to conceive again so that you feel both emotionally and physically prepared for another pregnancy. Your partner also needs to feel that the time is right for you both to try again.

We had a miscarriage at 20 weeks. Will the doctors find the cause so that we can move on?
Coping with the loss of a baby well into pregnancy is difficult and upsetting. Many women ask themselves why a miscarriage happened and feel unable to move on until that important question is answered. Unfortunately, unless this was a recurrent
miscarriage of three or more, there may not be an investigation, although it may be suggested that you have a cervical stitch in future pregnancies to stop the cervix dilating too early (see p 24)
It may be worth talking to a counsellor who
is trained to support women and families through such difficult times, your doctor or midwife may be able to refer you. You may find that discussing your miscarriage directly with a health professional helps to answer any concerns you or your partner have, and by communicating in this way you will have started to move forward and may begin to feel able to consider planning another pregnancy

My partner had a miscarriage. I’m being supportive, but I’m devastated too. What should I do?
Dealing with a miscarriage is very difficult for both women and men, but often far more attention is given to a woman, and a man’s feelings are simply ignored However, it’s important that you don’t internalize your loss and do acknowledge your feelings, which may range from feeling scared, disappointed, and out of control, to blaming yourself for not being supportive enough and mourning the loss of your identity as a father. Although you want to support your partner, you also need to recognize your own need to grieve, as working through your emotions can help you to come to terms with your loss more quickly
A good support network is important for both of you and it can help to find a sympathetic listener outside of your relationship. Initially, you may find discussing your feelings with another male easier than talking to your partner. You could also talk to your doctor, the midwife, or a counsellor, or contact the Miscarraige Association helpline.

What is a “D and C”?
D and C stands for dilation and curettage, a surgical procedure in which the opening to the uterus, called the cervix, is stretched (dilatation) and the tissue that lines the uterus is scraped away or removed (curettage). This procedure is sometimes carried out after a miscarriage to ensure that any of the remaining products of the conception and pregnancy have been removed
There are advantages and disadvantages to consider before having a D and C. The procedure is usually completed within two hours and most women resume their usual activities within a week. However, the need for routine surgical evacuation, or a D and C, following a miscarriage has been questioned because of potential complications, such as bleeding and infection. Ask your doctor for advice There are less invasive options than a D and C for dealing with a miscarriage. One method is simply to watch and wait to see if the uterus will spontaneously expel any remaining products of conception. Another option is a drug treatment that works by stimulating the uterus to contract and naturally expel pregnancy tissues.

The risk of miscarriage
There are several factors that can increase your risk of miscarriage.
Older women have an increased risk of having a miscarriage. It is thought that this is largely due to the fact that older women are more likely to have babies with chromosomal abnormalities, which may have problems developing and miscarry Some underlying medical conditions can also increase your chances of miscarriage, such as polycystic ovary syndrome or fibroids. Other factors that can increase your risk are if you are particularly underweight or overweight, smoke drink heavily, or take recreational drugs.
Miscarriages are also more likely the more pregnancies you have had.

Talking to others
Losing a baby during pregnancy can be devastating, leading to feelings of grief such as anger, depression, guilt, and anxiety. Talking to others can help you to work through your feelings.
* Ask your midwife or doctor to put you in touch with a counsellor who specializes in pregnancy loss
* Let close friends and family members know how you are feeling
* The Miscarriage Association is a great source of support and advice (see p.310). * Talk to your doctor or midwife about why the miscarriage may have happened.

Possible causes of miscarriage

About 1 in 4 first pregnancies ends in miscarriage, generally within the first 12 weeks. Often no cause is identified and it may not be investigated unless a woman has had three or more miscarriages in a row, known as ‘recurrent miscarriages”
Why has it happened? Some miscarriages occur because of a one-off genetic problem (caused by a faulty chromosome) when the baby does not develop properly. Genetic problems account for 60 per cent of early miscarriages If you think this may have been the cause, you can request tissue tests from the baby. Based on these results, you may be able to receive specialist counselling to discuss the risk of it happening again (see p.24). After 12 weeks, the chances of you losing your baby because of a chromosomal disorder reduce to about 10 per cent: however, if
Ectopic pregnancy
you are over 35, this risk is higher. Other less common causes of miscarriage include fibroids (non-cancerous growths), infection, problems with the uterus, hormonal imbalances, and immune system disorders. An ectopic pregnancy. below, occurs when the embryo implants in a Fallopian tube and needs to be removed
What can cause late pregnancy loss? A late pregnancy loss (referred to as a stillbirth after 24 weeks) can be due to the cervix being weak (or ‘incompetent’), causing the cervix to dilate too early. This accounts for 15 per cent of repeated miscarriages. In future pregnancies, a stitch around the cervix can strengthen this muscle and prevent it opening early Another cause of a late miscarriage can be if the placenta does not function properly and affects the baby’s growth.
fertilized egg implants in tube

preparing for pregnancy

TRYING FOR A BABY

We’ve been trying for a baby for months and I dread seeing my period- why isn’t it happening?

Trying to conceive can be very stressful, leading to feelings of anxiety and depression as the months pass without a positive pregnancy test. However, try not to become too disheartened; even if you don’t conceive in the first few months, statistically, you have a 90 per cent chance of conceiving within a year.
It is a good idea to keep a note of the dates of your menstrual periods as this makes it easier to calculate the fertile time of your cycle The best time for ”baby-making” sex is just before ovulation. The average length of a woman’s fertility cycle is 28 days, counting the first day of your period as day one. So if you have a regular 28-day cycle, you can predict that ovulation is likely to occur mid-cycle, on around day 14. If your cycle length varies, this can make calculating the mid-point more difficult, but observing and recording your body’s fertility indicators during your menstrual cycle can help you to identify your fertile time (see p 17).
Other measures you can take to maximize your reproductive health include taking pre-conceptual folic acid (see p 16), minimizing -your intake of alcohol, avoiding recreational drugs, stopping
smoking, and avoiding smoky environments. You should also check your rubella immunity before you become pregnant (see opposite).

How long should I leave it before I go to see my doctor?

There is no wrong or right amount of time to wait before going to see your doctor but a lot will depend on your age and personal circumstances. If you’re both under 35 and have no reason to suspect problems, for example, previous surgery
or irregular periods, then the usual advice is to seek help after about a year of trying to conceive. Women over 35 are advised to seek help earlier, as fertility starts to decline more rapidly after your mid-30s. Your doctor can carry out a few basic tests straight away to rule out obvious fertility problems, such as monitoring your hormone levels, screening for sexually transmitted infections, such as chlamydia (see p 18), and semen analysis for your partner. Your doctor may then refer you to a specialist.

My periods are really irregular - what are my chances of falling pregnant?

Menstrual cycles that vary more than a few days in length from month to month are considered irregular periods An irregular cycle can be troublesome when trying to get pregnant, but being aware of your fertility signs (see p.17) can help you to determine when you are approaching your short window of fertility. Irregular ovulation and menstruation account for around 30-40 per cent of fertility problems. Although there are many factors that determine how fertile a woman is, such as her age, whether her cervical fluid is wet enough to sustain sperm, or whether her Fallopian tubes are open, the most important factor is whether she ovulates — releases an egg — regularly each month. Sometimes, a condition called anovulation occurs in which there is a menstrual bleed but no ovulation. If you don’t release an egg each month, you won’t have as many chances to get pregnant, in which case you may be given drugs to encourage ovulation It would be wise to talk to your doctor about your cycle.

I don’t want to get pregnant yet but maybe next year - what can we do now to prepare?

Adopting a healthy lifestyle and improving your general wellbeing are sensible measures if you are planning a pregnancy Start by looking at your diet (see above). Is it well balanced? Could you cut back on the amount of salt, sugar, and fast or processed food you eat? You should also increase your intake of fruit and vegetables, particularly green leafy vegetables, which area good source of folic acid. Exercise is important too. If you have a current exercise regime it’s safe to continue with that, or take up gentle exercise, such as swimming or walking which are ideal before, during, and after pregnancy.
If you smoke, you should try to give up, as this is beneficial for your general health and, more specifically reduces the risk of miscarriage, stillbirth, premature birth, low birth weight, and sudden infant death. Likewise, you should try cutting down on or stopping your alcohol intake Current advice from the Department of Health recommends that you avoid alcohol completely while trying to get pregnant and once you are pregnant, as safe levels of alcohol intake are difficult to determine.
Checking your rubella status is a sensible measure as rubella can cause fetal abnormalities if you aren’t immune and contract the infection in the first three months of pregnancy If your immunity is diminished, you may be given a vaccine and should then wait three months before trying to get pregnant. If you have a pre-existing medical condition or are taking medication, talk to your doctor or practice nurse about how these may affect a pregnancy.
Once you start trying to get pregnant. make a note each month of the first day of your period as this is one question your midwife or doctor will ask to determine your estimated due date.

Should I be taking folic acid before trying for a baby?

Folic acid has been shown to reduce the incidence of neural tube defects, such as spina bifida, in a fetus. If you are planning a pregnancy, you should take a daily folic acid supplement of 400 micrograms up to three months before conception and then continue with this until the 12th week of pregnancy This supplementation is in addition to a well-balanced diet that includes green leafy vegetables and pulses, both of which are good natural sources of folic acid. Many breakfast cereals also contain folic acid, as do some fruits, such as oranges, papaya, and bananas.
Any woman with epilepsy who takes anti-epileptic drugs should take a higher dose (of 5mg) of folic acid supplementation.

I’m on the Pill but want a baby - what is the next step for me?

Whether you are taking the combined Pill, containing oestrogen and progesterone, or the mini Pill, which contains only progesterone, stop taking the Pill at the end of the packet. You will have a withdrawal bleed as usual and then your next bleed will be a natural period Don’t worry if your normal periods don’t start immediately; for some women, it can take a few months for their menstrual cycle to return.
Some doctors recommend allowing a month or two for your natural cycle to return before trying to conceive. Others believe there’s no point in waiting. However, it can help to wait for one natural period before trying to get pregnant, as this means the pregnancy can be dated more accurately and you can start pre-pregnancy care, such as taking folic acid and adopting a healthy lifestyle. Don’t worry if you do get pregnant sooner it will not harm the baby.

I’m a bit of a binge drinker. Is this OK as long as I stop once I’m pregnant?

It would be far better for your health and the health of a future baby to stop binge drinking before you conceive The effects of alcohol on a developing baby or fetus are influenced not only by the amount
of alcohol consumed, but by the pattern of drinking with binge drinking in pregnancy considered particularly harmful. Binge drinking and alcohol addiction have been shown to affect the health of the developing baby, so if you know that you drink more than you should, consider how you can reduce your intake before conceiving Government policies now advise total abstinence from alcohol, but do acknowledge that the occasional drink in pregnancy is unlikely to result in harm to the fetus.

Does smoking stop you becoming pregnant?

There is evidence that smoking compromises your menstrual and reproductive health. Women smokers who try for a baby can take up to two months longer to conceive than non-smokers. It is not clear how smoking damages women’s fertility, but it may affect the release of an egg before fertilization or the quality of the eggs It is thought to take around three months for fertility to improve after stopping smoking.
Giving up smoking is one of the single most important things you can do for yourself and for the health of a future pregnancy If you currently smoke, then it is wise to consider giving up, or at least cutting down, even if you don’t plan to have a baby straight away The British Medical Association estimates that smoking and passive smoking are responsible for up to 5,000 miscarriages and 120,000 cases of impotence in men aged between 30 and 50 each year. Women who smoke are also more likely to have an ectopic pregnancy.
Medical research has also shown that smoking affects the development of
the womb as they are starved of oxygen are growing. Smoking remains one of the few potentially
factors associated with low birth weight, birth stillbirth, and cot death.

My partner says soft drugs are OK - but should we stop now we’re planning a baby?

By soft, drugs, you may be referring to nicotine or cannabis. Tobacco smoke and cannabis smoke are
likely to be harmful to fetal development and be avoided by pregnant women and any man who might become pregnant. or is planning become pregnant, in the near future. A chemical present in cannabis known as THC is thought to reduce luteinizing hormone (LH) in the genitals. This hormone triggers ovulation in women and is involved in sperm production in men. So, as well as being potentially harmful to a fetus, smoking cannabis can result in a short-term decrease in reproductive ability.

Is it safe to take prescribed or over-the-counter medicines?

If you are trying to conceive it’s best to avoid taking any drugs prescribed or otherwise. Some medicines can decrease fertility, so tell your doctor you are trying for a baby if you need a prescribed medicine This is just as important for men as for women, as some prescriptions can affect sperm production or development. Talk to your doctor too if you are on long-term medication as he or she may be able to prescribe an alternative if the original drug is known to have an effect on fertility If you do require short-term pain relief. then a low dose of paracetamol is considered safe but talk to your doctor or pharmacist if in doubt.

My partner had a vasectomy -can it be reversed?

Although the decision to have a vasectomy is usually considered an irreversible one, in some cases the procedure can be reversed. If a reversal is required, an operation called a vaso-vasostomy is performed by an urologist using microsurgery The success of the operation depends on many factors, but chiefly on the length of time since the vasectomy was performed, as the likelihood of the tubes becoming blocked increases with each year that goes by . However the operation is successful in more than 80 per cent of men who have the reversal within 10 years after a vasectomy Even if the vasectomy was done over 10 years ago, there is still a reasonable chance of success.

I don’t seem to be falling pregnant - is it because I’m overweight?

Being overweight can affect your fertility. Estimating your body mass index (BMI) - a measure of your body fat based on your weight and height - helps you gauge whether you have a healthy weight for your height. A normal body mass index is 19-24; a BMI of 25-29 is considered overweight; 30-39 obese; and over 39 extremely obese.
Fertility rates appear to be lower and miscarriage rates higher in women who are overweight, so women planning a pregnancy are encouraged to maintain a BMI in the range of 20-25 to improve their reproductive health The reasons for links between BMI and fertility aren’t entirely clear, but the suggestion is that your hormonal balance becomes disrupted when your body has more fat-related weight than is optimal. If you are overweight, you also have a higher risk of complications during pregnancy, such as high blood pressure and diabetes, and the extra weight of pregnancy will put more strain on your joints.
Even a small weight loss can increase your ability to conceive and have a healthy pregnancy. If you’re concerned about weight, you may find it useful to talk to your doctor or practice nurse for advice.

I like to be really skinny - will that stop me having a baby?

Being underweight, with a BMI of less than 19, can cause hormonal disturbances that disrupt ovulation and in turn affect fertility. this relationship between weight loss and lack of ovulation has been well documented and observed in young athletes, ballet dancers, and gymnasts Surpisingly underweight women often find it difficult to believe that their weight is standing in the way of conception, since they are more likely to be rewarded by society for being thin. Suggestions that she should gain weight may be a thin woman’s first encounter with being told that her health is not optimal. A recommended BMI of 20-25 is advised to avoid problems with ovulation, and you may need to take steps to try to gain weight in a sensible way If tests show that you are not ovulating regularly, you may also be offered medication to deal with the problem.

I’ve had STIs in the past, but everything is fine now - will that stop me conceiving?

A previous sexually transmitted infection (STI) should not cause problems if it was found early and treated successfully. However, chlamydia and gonorrhoea can have long-term consequences if left untreated especially in women. Untreated STIs also can be passed on to your baby.

I’m 37 and would like to start trying for a baby - have I left it too late?

Increasing numbers of women are delaying their first pregnancy until they are in their late 30s and early 40s and, as with any life choice, this has advantages and disadvantages The main concern for women is that their fertility does decrease with advancing age, and so for some women it may take a little longer to get pregnant, or they may find that they need to look at ways of assisting conception (see p.27). Also, the risk of conceiving a baby with a chromosomal abnormality such as Down’s syndrome increases as you get older, rising from a 1 in 356 chance at 35 to a 1 in 240 chance at 37.
Fertility guidelines indicate that if you are over 35 and haven’t got pregnant after six months of trying, then you should seek medical advice. If you do conceive, it is likely that you will be more closely monitored during pregnancy than younger women because of the increased risk of the baby being
smaller than expected or other complications occurring in pregnancy and labour
On the other hand, many older women have no problems conceiving, and there are positives to being an older mum. Older mums are more likely to breastfeed than younger mums and often feel more assured and confident in their own capabilities because of life experience.

Is my endometriosis preventing me from getting pregnant? We’ve been trying for two years.

Endometriosis occurs when cells from the lining of the uterus, known as the endometrium spread to other areas, such as the Fallopian tubes, ovaries, and pelvis, which can cause scarring and blockages that can affect fertility Although you have endometriosis it won’t be assumed that this is the only cause of your problem. The general advice for any couple who have been trying to get pregnant for over 18 months is to seek medical advice, and it is likely that you will both be offered investigations to determine if there is any specific reason why a pregnancy isn’t happening
There is some evidence to suggest that diet plays a part in the symptoms of endometriosis; it is thought that increasing the intake of vitamins C and E plus B1, B6 and B2, together with increasing the intake of essential fatty acids, such as omega-3 and omega-6, and reducing the intake of red meat and trans fats found in processed foods, could help to reduce the symptoms of endometriosis and in turn improve the fertility of women with the condition.

Preconception diet
A varied, balanced diet is key to good reproductive health. Certain foods in particular contain essential vitamins and minerals that are thought to benefit eggs and sperm and the health of the future embryo. These include foods rich in vitamins A, B, C, and E, folic acid, calcium, omega-3 and omega-6 essential fatty acids, zinc, and selenium.

Signs of ovulation
Ovulation occurs when an egg. or ovum is released from the ovary, To become pregnant sperm must meet and fertilize an egg and the resulting embryo must implant in the uterine wall There are signs to look for that indicate ovulation: * A change in cervical mucus from being sparse or thick and opaque to being clear. jelly-like, and stringy
• A rise in your temperature (see right)
• Mid-cycle or ovulatory bleeding thought to result from the sudden drop in oestrogen that occurs at ovulation.
• Localized pain
• Swelling of the vulva before ovulation, especially on the side that you ovulate.

Stopping contraception
When to stop contraception before conceiving is fairly straightforward, although for some methods a degree of planning is required.
* Barrier methods, such as the diaphragm and sheath, can be stopped immediately once you decide to start trying
* If you have an IUD, you will need to make an appointment to have your coil removed; you can start trying straight away after this * If you are on the Pill, finish the packet
before stopping (see p. 16) Your cycle may take time to settle, although some women conceive as soon as they stop the Pill

Chlamydia is the most common sexually transmitted infection in the UK.Although it is curable, many people are not aware of the health risks it presents. Up to 70 per cent of chlamydia infections in women have no obvious symptoms, so a large number of cases are never diagnosed. The risk is that untreated chlamydia can cause pelvic inflammatory disease, which is the most common cause of female infertility In a large number of investigations, there is a clear link between chlamydia infection and tubal infertility, whereby the infection causes adhesions and scar tissue to form on the Fallopian tubes, causing blockages in the tubes and increasing the risk of complications such as ectopic pregnancy
In a Finnish research study, chlamydia antibodies were found in the semen of 51 per cent of infertile men compared to 23 per cent of fertile men, and the study therefore concluded that chlamydia may affect male fertility as well as female fertility,
The classical STIs, such as syphilis and gonorrhoea, are usually easier to recognize and subsequently diagnose and treat.