Before Baby
What to know if you’re ready to start a family
By Lisa Fields

Trying to have a baby can be an exciting time for couples. But it can also become a stressful period, especially if the process takes longer than you expect and your sexual encounters transform from spontaneous fun to scheduled drudgery.

Fortunately, there are several things that you can do outside of the bedroom to increase your chances of conception. The five recommendations below come from trusted OB/GYNs and infertility specialists who want to help couples on their quests to become parents.

You should know: See your doctor before getting pregnant.

Nearly half of all pregnancies in the U.S. are unplanned, which means a considerable number of women don’t visit their doctors before conceiving. But meeting with your OB/GYN first can help you prepare for your life-changing event.

“It’s a great idea to get an annual gynecological exam if you’re anticipating becoming pregnant in the near future,” says Louis Manara, DO, medical director of the Center for Reproductive Medicine & Fertility in Voorhees. “Your gynecologist can order lab tests, checking to see if you have immunity for German measles and chicken pox, which is good to know, so you don’t have to worry about birth defects that might occur with those diseases.”

If you take prescription medication for any health condition, from depression to high blood pressure, see the prescribing doctor before trying to conceive, because many drugs shouldn’t be taken during pregnancy.

“A number of women we see take maintenance medications if they have depression, anxiety or any other ailment,” Manara says. “Get in touch with those physicians and discuss whether those are safe to take in pregnancy. Talk about perhaps changing those medications to something that would be safe – or curtail and taper off unsafe drugs, if possible.”

You should know: Getting pregnant takes more than you think.

Getting pregnant isn’t just about sperm meeting egg – your overall physical condition can influence what happens. Taking steps to improve your health and well-being may improve your chances of conceiving.

“It’s important for women to become healthy before becoming pregnant,” says George Taliadouros, MD, founder and director of the Delaware Valley Institute of Fertility & Genetics in Marlton. “Many things can affect a pregnancy, from smoking and alcohol consumption to weight.”

Tobacco and alcohol have been linked to miscarriage, birth defects, intellectual disabilities and low birth weight, so it’s wise to quit before trying to get pregnant. (Most women won’t know they’re expecting for the first four to six weeks of pregnancy, so they may unknowingly expose their babies to these substances.)

If you’re thinking about becoming pregnant, start taking a daily prenatal vitamin containing 400 micrograms of folic acid before you try to conceive. Daily folic acid can prevent serious birth defects like spina bifida – when the spine doesn’t close – and anencephaly: when a large part of the brain and skull are missing.

“If a woman takes prenatal vitamins before she gets pregnant, she reduces the chances of this occurring by 80 percent,” Taliadouros says.

Taking steps to achieve – and maintain – a healthier body weight can also increase your chances of getting pregnant more easily.

“If a woman is very thin or very obese, she can have difficulty conceiving,” Taliadouros says. “A study published in 2011 found that as a woman’s body weight increases, there is difficulty in conceiving and an increase in miscarriage.”

Even modest changes in weight can have a profound effect on conception, so ask your doctor if you should be on a diet and exercise plan.

You should know: Timing is everything.

Some couples trying to have babies have sex every day or even twice a day. Others schedule their sexual encounters for every other day. Still other couples have no set schedule and simply hope for the best.

Timing does matter, but you need to know when you ovulate.

“Time your relations around the time of ovulation, which is known as the fertile window: a period of six days ending on the day of ovulation,” says Oumar Kuzbari, MD, a reproductive endocrinologist and fertility specialist at South Jersey Fertility Center in Marlton. “There’s a period of 12 to 24 hours when the egg is released when it can get fertilized. Sperm can live for up to 72 hours. We say at least every other day during the fertile window to get the highest chance of getting pregnant.”

There are several ways to predict ovulation. Several websites offer online ovulation calculators. Pharmacies sell over-the-counter ovulation kits and fertility monitors, which make predictions based on hormone levels. Some women with abnormal cycles will need a doctor to help them pinpoint the time of ovulation.

Once you’ve figured out when to have sex, there’s nothing particular to do other than try. “There is no perfect sexual position,” Kuzbari says. “But avoid using lubricant. Some lubricants may interfere with the sperm.”

You should know: Sometimes you may need help.

It can be stressful trying to conceive month after month without success, but many couples achieve pregnancy on their own by being persistent. If you’ve been trying for several months, you may wonder: How long should we continue trying without seeing an infertility specialist? Experts recommend that young couples who aren’t pregnant within a year should seek help. Older couples should seek help even sooner.

“One year of unprotected intercourse is reasonable to try, as long as the woman’s cycles are regular and the woman is under 35,” Manara says. “But in women who are 35 or older, that window should be shortened. After six months, the woman should get a basic evaluation to make sure that all systems are OK.”

A woman is most fertile in her 20s. Fertility levels decline over time, dropping more steeply around age 35. At 30, a woman has a 20 percent chance of conceiving during any given menstrual cycle. By 40, her chances drop to less than 5 percent per cycle.

“Age is something that we still struggle with as far as infertility issues,” Manara says. “Some women lose their fertility at a more accelerated rate than others.”

But no matter your age, see an infertility specialist if you have an irregular menstrual cycle. “Any woman with cycles longer than 32 days apart, from the first day of her period to the first day of her next period – 36 or 38 or 45 days – that signifies an ovulation problem,” Manara says. “It wouldn’t be inappropriate to try for a short while, but shorten the time before seeking help. Try for six months for younger couples with that situation, or sooner for older couples.”

You should know:  Either partner can cause infertility, so both should be checked.

Infertility problems aren’t inherently male or female: Either partner could have an issue that makes it difficult to conceive. For this reason, infertility specialists want to see both partners during the initial office visit.

“Infertility problems are caused by female factors 40 percent of the time, male factors 40 percent of the time, and both male and female factors about 20 percent of the time,” Kuzbari says.

During a first visit, the doctor will ask about each partner’s medical history, give the woman a physical examination and test both the man and woman.

“For a male, we do a semen analysis,” Kuzbari says. “We look at the number of sperm and their volume, movement and concentration. For a female, we assess ovulation and do a basic ultrasound and imaging study to examine the ovaries and uterus to make sure there are no fibroids. We also want to see if the fallopian tubes are blocked.”

Fertility specialists will offer different treatments to couples, depending upon test results. “If the woman is not ovulating, we can give her medication to make her ovulate better, and we’ll measure her ovulation reserves, especially if she’s over 35, to see if she’s working with a lot of eggs,” Kuzbari says.

“If she has a blockage in her tubes, we can do surgery to open the tubes. If the man has low sperm count, we can place the sperm closer to the egg, hoping the sperm will meet the egg and fertilize it,” he adds.

The doctor may also decide that in-vitro fertilization (IVF) is appropriate. Although it’s a widely discussed option, not everyone who visits an infertility specialist needs this procedure. “We can do IVF if the sperm count is very, very low or if the woman has a blockage in her tubes,” Kuzbari says. “We take the egg out through a minor procedure and fertilize the egg with sperm in a dish.”

November 2014
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