Posts Tagged ‘reproductive health’

I don’t want to breastfeed
bottlefeeding your baby
I don’t want to breastfeed - can you tell me what to do?
If you do not want to breastfeed, you can either bottlefeed your baby expressed breast milk or formula milk. There are many women who do not breastfeed because they receive a lack of support and find that the advice available is insufficient. However, having a go at breastfeeding, even if this is just for one week, will benefit your baby.
If you have chosen to bottlefeed you will need to decide on a few things. First, you need to work out which type of formula you want to use. Take some time to look at the many brands on the market and opt for one that you feel will be right for your baby Ask your midwife or health visitor for advice if you are not sure You will also need to purchase bottles, teats, and a sterilizing unit. This can be confusing as there are lots to choose from, so you will need to take some time to find out about the available options and which unit will work best for you (see p.239)
Bottlefeeding sounds so complicated. Are there “dos” and “don’ts” to remember?
Yes, it is important to bottlefeed safely. The NHS provides guidelines for safe bottlefeeding
* Always make sure you use a sterilized bottle. cap, and teat for each feed
* Ideally, make up one feed at a time and discard any leftover milk at the end of a feed.
* Use boiled tepid water that has been left to cool for up to half an hour before making up a feed.
Put the water into the bottle before the formula.
Don’t pack the formula into the scoop: instead, level it off gently with a knife.
* Warm the feed — not in a microwave, but in a bowl of hot water — and test the temperature before giving it to your baby
* Avoid swapping scoops from different makes of infant formula milk as different scoops may be different measurements.
I feel guilty for not breastfeeding - should I?
No! The main thing is to ensure that your baby receives the best possible care in life that you are able to provide. If it is not possible for you to breastfeed, then formal milk feeds are a safe option. However, you need to feel comfortable with your decision and not be swayed by others. You may want to look at the advantages and disadvantages of both breast- and bottlefeeding. That way you’ll be sure you’ve made the right decision for you and your baby without feeling guilty Once you have made an informed decision, communicate this confidently to family, friends, and your healthcare provider.
Is formula milk as good as breast milk?
Breast milk is universally considered the ideal nutrition for your baby, and the World Health Organization (WHO) recommends exclusive breastfeeding for the first six months of life as it provides all the nutrients a baby needs However,

Bottles and teats
Getting ready to bottlefeed your baby
There area variety of bottles and teats available in different styles.
You will need between four and six bottles and teats As well as larger bottles measuring 250ml (8fl oz), you may also want a couple of smaller bottles of 125 ml (4fl oz). Teats come with different sized holes to make the flow of milk faster or slower to suit your baby’s needs. Some teats are therefore recommended for newborns and some for hungrier older babies,
there area variety of high-quality, nutritional baby formula milks available that scientists and medical experts have spent years developing. Most infant formula milks are derived from cow’s milk, but are modified to resemble breast milk as closely as possible. If you feel confused, discuss the different brands with your midwife or health visitor.
What exactly is in formula milk and how similar is this to breast milk?
If you read the labels on different brands of formula, there are not many variances. The Infant and Dietetic Association website (see p 310) provides a table comparing the contents of the five main brands
available in the UK. Baby milk must provide energy, fat, protein, carbohydrate, vitamins, minerals, and trace elements, and the quantity of each nutrient is specified by law. The proportions of energy supplied by protein, fat, and carbohydrate in infant formulas are similar to those in mature breast milk
* The fat content. In infant formulas this is based on blends of dairy or vegetable fats that are chosen partly depending on their levels of unsaturated fat. Omega 3 fats may be added as these are vital nutrients for growing brains and bodies Formula milk does not have the fat-digesting enzyme, lipase, which accounts for the unpleasant-smelling stools of formula-fed babies.
* The protein source. In formula milk, this is either cow’s milk, in the form of casein or whey, or soya (see p,240) The amino acid content of formula is equivalent to that of breast milk to meet the needs of the rapidly growing baby.
* Lactose. This may be included in formula; mature breast milk contains about 7 per cent carbohydrate in the form of lactose, which is thought to be important for brain development.
* Vitamins, minerals, and trace elements. These are added to formulas to meet the nutritional needs of the baby and to comply with legal requirements. * Iron. This is vital to your baby’s wellbeing, being essential for healthy blood, growth, and development, and this is added to formula brands.
* Other components. Infant formula may contain other components that are found naturally in breast milk, such as long-chain polyunsaturated fatty acids (for brain and membrane development), oligosaccharides (to aid digestion and immunity), or nucleotides (to promote healthy growth and development and to help the immune system).
There are some components of breast milk that cannot be replicated in formulas For example, breast milk contains important antibodies that help protect babies against infection and illness and these are not present in formula milk. However, prebiotics, which are nutrients found in breast milk that strengthen a baby’s natural immune system, may be added to some brands of formula

How to bottlefeed
Preparing and giving feeds
Bottlefeeding, using formula or expressed breast milk, can seem daunting at first, but becomes easier once you get into a routine.
How do I start?You will need at least 4-6 bottles and teats, with at least one or two sterilized and ready. You can sterilize by steaming, microwaving, boiling, or using a sterilizing liquid. Your choice will depend on the cost and what you find easiest. Before sterilizing, rinse a bottle first with warm soapy water using a bottle brush, taking care to clean the top of the bottle and inside the teat.
How do I make up a feed? Wash your hands and make up a feed according to the instructions. Put the correct amount of tepid boiled tap water
into the sterilized bottle first and then add the right number of level scoops of powder, Never add extra powder as this could make your baby ill. Don’t put a half finished feed back in the fridge - throw it away and use a fresh bottle next time
How do I give the feed? Test that the milk is not too hot by putting some on the inside of your wrist (never use a microwave to warm up milk) Find a comfortable position and always hold your baby’s head slightly higher than his body. Put the teat gently into his mouth and slowly tip the bottle so that only milk, not air, gets into the teat You can wind your baby - gently pat or rub your baby’s back - halfway through the feed, or wait until the end. Throw away any milk that is left over.

KEEPING BOTTLES CLEAN:

Sterilizing equipment
Before using new bottles and teats, and each time you use them, wash and sterilize them. Wash them in warm, soapy water with a bottle brush, and rinse thoroughly. Sterilizing methods include: * Electric steam sterilizing, which takes about 10 minutes, plus the time it takes for equipment to cool
* Microwave steamers, which take around 5 minutes. The equipment remains sterile for up to 3 hours if the lid is left on. * Equipment can be sterilized by boiling, which takes around 10 minutes. The pan must not be used for another purpose and you may find that teats wear out more quickly
* Cold water sterilizing tablets can be used either in a special sterilizer, or in a suitable clean container with a lid. This takes around 30 minutes and the equipment can be left in the solution for up to 24 hours; the solution needs to be changed each day. * Dishwashers need to be set on a high temperature and some parents prefer to wait until after a year before using these.
Is it OK to combine breast-and bottlefeeding?
Yes, it is possible to combine breastfeeding with bottles of expressed breast milk or formula, and many women choose to do this rather than stop breastfeeding altogether.You may also decide to do this if you are returning to work.
Feeding from a bottle uses a different technique to feeding from the breast, and your baby may take a little time to get used to it, which can make it quite a struggle to introduce bottles It may help to warm the teat and to get someone else to offer the bottle the first time, as your baby may be able to smell your milk if you hold him and will be likely to want to be breastfed instead Holding him in a different position, such as propped up against your front and facing away from you, may also help
Before deciding to introduce the bottle, it’s worth considering that breastfeeding does get easier and that there is a lot of extra work involved with bottlefeeding in terms of preparing feeds. Also, as your breast milk is produced on a supply and demand basis, introducing bottles for some feeds
will affect your milk production. If you do want to combine the two, talk to your health visitor or a breastfeeding counsellor about how to manage this so that you can maintain breastfeeding
Will people treat me like a failure if I can’t breastfeed and have to use formula?
Many mothers do feel pressure from friends and family to breastfeed their newborns It is unlikely that you will be treated as a failure, as Western society is very accepting of bottlefeeding and, on the contrary, it is a continual effort to try to promote breastfeeding in our society. In November 2007, the Department of Health actually banned baby milk manufacturers from advertising infant formula for children under six months old on television and in parenting magazines.
Guidelines aside, although breastfeeding is a wonderful experience, it can sometimes be very hard work to establish If you find that you are struggling to establish breastfeeding, it’s worth seeking help from your midwife, health visitor, or breastfeeding counsellor before giving up
completely. However, if you find you simply cannot breastfeed, or you choose not to, you should try not to feel guilty as formula-fed babies grow and develop perfectly well. This is your baby and you will have your baby’s best interests foremost whatever action you decide to take.
Which formula milk should I buy?
There area number of brands that have a very similar nutritional content and you may need to chat to your local midwife or health visitor, or even family and friends with little ones, when trying to decide which one to use. Sometimes, babies are born prematurely and may need a special formula, or occasionally may react to a particular brand. If your baby was born full-term and is healthy, it is usually down to personal preference.
Manufacturers modify cow’s milk to make formula for human babies by adjusting carbohydrate, protein, and fat levels, and adding vitamins and minerals. There are two main types of formula milk, which have different ratios of the two proteins in milk: whey and casein. Those that are suitable for babies from birth contain more whey than casein The ratio of whey to casein in these milks is similar to that of breast milk, so it is thought to be easier for new babies to digest Milks that are marketed for the ”hungrier” baby (known as ”follow-on” milk) are casein-dominant and take longer to digest.
Why do some people use soya-based formula and is it safe?
Soya-based formula is made from soya beans, which are modified for use in formula with vitamins, minerals, and nutrients. Some parents consider giving a soya-based formula if their baby has an intolerance or sensitivity to cow’s milk formula. Soya infant formulas are nutritionally similar to cow’s milk-based formulas. The protein used in soya formulas is an extract of the soya bean, which has a high protein content. However, the UK government recommends that you should always seek the advice of a health professional before giving soya-based formula to
your baby. The current Department of Health advice is that soya formula milk should not be given automatically to babies with a sensitivity to cow’s milk, as there are other types of formula that are suitable for most babies with an allergy or intolerance that may be more favourable than soya. So if you are considering soya milk, make sure you seek medical advice first.
The carbohydrates used in soya milk contain glucose syrup, which may damage your baby’s teeth over a period of time, so if you are using soya formula, make sure you take your baby to the dentist once his teeth come through and tell the dentist that your baby has a soya formula. The Food Standards Agency also highlights concerns that soya-based formula could affect reproductive health. This is because soya contains phytoestrogens, substances found naturally in some plants, which may mimic cr block the action of the hormone oestrogen As this is a potentially sensitive time in a baby’s development, it is not clear whether soya-based infant formula could affect a baby’s reproductive development.
How should I hold my baby when I’m giving him the bottle?
Bottlefeeding can be a wonderful time for bonding with your baby by holding him close. Find a position that both you and your baby like — think about whether you are right- or left-handed and the age and size of your baby. You can cradle your baby or simply sit your baby on your lap. You will help reduce wind by giving your baby his bottle in as upright a position as possible. Also take care to tilt the bottle so that the teat and neck are always filled with formula and never leave your baby to feed unattended by propping the bottle up. Ask your midwife or health visitor for further advice
How long do you need to sterilize bottles for?
The recommendation is that you sterilize bottles and teats for at least the first year of your baby’s life. It is during this time that they are most vulnerable to germs and viruses, which if contracted could cause illness and possibly dehydration.
Can I make up feeds in advance?
Ideally, you should make up each feed fresh. The Department of Health and Food Standards Agency’s recommendations on the preparation and storage of formula milk advise that the risks associated with using powdered infant formula milk are reduced if each feed is made up fresh, as the longer the formula is stored, the greater the risk of bacterial growth. They do acknowledge that there are times when this is not practical, for example if you are going to leave the house for an extended period, or if you are dropping off a baby at a childminder’s or nursery. In this case, you should prepare the feeds in separate bottles as instructed and then store them in the fridge (see below). This is a departure from previous information so can seem unusual to mothers who have previously bottlefed Discuss this with your midwife and health visitor
How long can pre-made feeds stay in the fridge?
Although it is not recommended that you make up bottles of infant formula milk in advance to store in the fridge because of the risk of bacteria developing, if you need to do this, store them in the back of the fridge, not the door, to ensure they are below 5°C (4 PF) and never store feeds for longer than 24 hours (although this is considered too long for young babies). Formula milk is not suitable for freezing.
Taking a break
Is it safe to warm a bottle and take it out to use later on?
Carrying warm formula milk in an insulated carrier is not safe, as warm milk is a good breeding ground for bacteria The safer option is to make a feed up fresh for your baby just before it is required If you are out, you can carry boiled water in an insulated container ready to mix with formula powder when you need it Ready made-up milk feeds that come in little cartons are a more expensive option, but are handy for instantly decanting into a sterilized feeding bottle. If your baby is reluctant to take milk at room temperature, you could use a travel bottle-warmer, which can also be used to heat up containers and jars of baby food
What precautions should I take making feeds with bottled water when I’m travelling?
When using bottled water to make up a feed, make sure the seal is still intact. Use still, not sparlding, water, and avoid water with high concentrations of the minerals sodium, nitrate, or flouride. Boil the
One of the major plus points of bottlefeeding is that anyone can feed your baby, allowing you to have some time off and rest.
* Getting your partner involved in feeding is a great way to help him bond with and feel close to your baby
* Sharing feeds gives you a break and you can take it in turns to do night feeds
* If you are switching from breast- to bottlefeeding, it may be easier to get someone else to give your baby the bottle, as your baby may reject the bottle from you wanting to be breastfed instead water in a kettle in exactly the way you would boil tap water at home and wash and sterilize your feeding equipment as usual Large bottles of mineral water should be stored in a fridge after opening For convenience, you may prefer to use smaller bottles of mineral water if you are travelling from place to place. For extra convenience, ready-to-feed milks are available in cartons so you do not have to carry bulky tins of powdered milk with you. Although more expensive, these cut down on the amount of work you have to do and mean that you can be sure of good hygiene in the absence of adequate facilities
I’ve heard that bottlefed babies have smellier poo - is this true?
This does seem to be the case Bottlefed babies may have one bowel movement a day or only have a bowel movement once every three or four days.
Avoiding tummy upsets
Small babies are more susceptible to gastrointestinal infections so it’s important to observe strict hygiene while bottlefeeding. One of the most important aspects while bottlefeeding is to ensure that all the equipment involved in the bottlefeeding process is sterilized properly and spotlessly clean with no trace of old milk. This means sterilizing the bottles, teats, and lids (see p.239). If your baby doesn’t complete a feed, don’t be tempted to give it to him later to finish as germs that are present in the baby’s mouth may have transferred to the bottle and can then breed in the milk When you are travelling or out for the day, you need to take care transporting feeds Ready-made formula is probably the safest way to feed your baby while on the move, or adding formula to the water when you need it. Changes in water in different regions sometimes cause tummy upsets in bottlefed babies.
are normal. A bottlefed baby’s stools are pale brown smelly, and more formed than those of a breastfed baby. Some baby formula milks give a greenish tinge to the stool. It is thought that unabsorbed fat causes the unpleasant-smelling stools in formula-fed babies. Breast milk is better absorbed, which means the stools usually have less odour
Will my baby get more wind if he is bottlefed?
Wind refers to the air in your baby’s tummy. It is swallowed along with milk during feeds, but also when he cries. It will fill his tummy before he has drunk enough milk and be uncomfortable Also the faster flow of milk from a bottle can make babies take in more gulps of air. Some babies suffer with wind and need burping after every feed Breastfed babies tend to get fewer problems with wind than bottlefed ones as they control the flow of milk at the breast and so suck at a slower pace, swallowing less air with the milk They also have smaller and more frequent feeds and may be fed in an upright position, both of which can reduce wind
Some babies have trouble bringing up wind and their discomfort is obvious You can reduce wind by feeding your baby in an upright position and tilting the bottle so that the teat is full of milk and not air. If your baby doesn’t burp after a couple of minutes, he probably doesn’t need to. Wind your baby by gently rubbing his back or placing him over your shoulder Some babies only seem to be able to get rid of wind through hiccuping. If the wind is severe, your health visitor or doctor may suggest medication.
Is it OK to give my baby water as well as milk?
Formula milk does tend to be less thirst-quenching than breast milk as the strength of formula doesn’t vary whereas breast milk varies in consistency, with the beginning of a feed tending to be more watery If your bottlefed baby still seems hungry after a feed, it could therefore be that he is thirsty and some cooled boiled water may help to placate him In hot weather he may need regular top-ups of water.

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.