implantation in the uterus
Now known as a blastocyst, made up of around 100 cells, the bundle burrows into the lining of the womb and an embryo begins to form
I’m so thrilled about your desire to have a baby and say with confidence that there are few experiences in life that top the moment when your pregnancy is confirmed! It’s always a miracle when you consider how many couples experience difficulties when trying for a baby, so our warm congratulations—whether you are just starting a family or bringing a new addition into your current family—a baby to love and be loved by
Tune in to every passing moment and enjoy this season in your life as much as you can
Although time passing during pregnancy can feel like an eternity as the months roll on and your pregnancy grows, believe me when I say “enjoy!” This is such a special period for expectant parents and you will probably look back and marvel at just how quickly it really passed. My advice is to slow down and enjoy this chapter in your life. Before too long you will have entered into the next season following the birth—don’t wish this time away too quickly
Although time passing during pregnancy can feel like an eternity as the months roll on and your pregnancy grows, believe me when I say “enjoy!” This is such a special period for expectant parents and you will probably look back and marvel at just how quickly it really passed. My advice is to slow down and enjoy this chapter in your life. Before too long you will have entered into the next season following the birth—don’t wish this time away too quickly
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, the
average couple has an 80 percent chance of conceiving within a year. It is a good idea to keep a note of the dates of your menstrual periods, since 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 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 midpoint more difficult, but observing and recording your body’s fertility indicators during your menstrual cycle can help you identify your fertile time
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, the
average couple has an 80 percent chance of conceiving within a year. It is a good idea to keep a note of the dates of your menstrual periods, since 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 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 midpoint more difficult, but observing and recording your body’s fertility indicators during your menstrual cycle can help you identify your fertile time
How long should I wait 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, since fertility starts to decline more rapidly after your mid-30s. Your doctor can carry out a few basic tests right away to rule out obvious fertility problems, such as monitoring your hormone levels, screening for sexually transmitted infections, such as chlamydia and semen analysis for your partner. Your doctor may then refer you to a specialist
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, since fertility starts to decline more rapidly after your mid-30s. Your doctor can carry out a few basic tests right away to rule out obvious fertility problems, such as monitoring your hormone levels, screening for sexually transmitted infections, such as chlamydia 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 becoming 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 can help you determine when you are approaching your short window of fertility. Irregular ovulation and menstruation account for around 30–40 percent 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 medication to encourage ovulation. It would be wise to talk to your doctor about your cycle
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 can help you determine when you are approaching your short window of fertility. Irregular ovulation and menstruation account for around 30–40 percent 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 medication to encourage ovulation. It would be wise to talk to your doctor about your cycle
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
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
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 well-being 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 getables, particularly green leafy vegetables, which are a good source of folic acid. Exercise is important too. If you have a current exercise regimen it’s safe to continue with that, or do gentle exercise, such as swimming or walking, which are ideal before, during, and after pregnancy If you smoke, you should try to quit, since 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. The best advice is to avoid drinking alcohol completely even while trying to get pregnant. You should, of course, refrain from drinking alcohol once you are pregnant, since safe levels of alcohol intake are difficult to determine. Checking your rubella status is a sensible measure since rubella can cause fetal ormalities 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 preexisting medical condition or are taking medication, talk to your health-care practitioner 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 since this is one question your midwife or doctor will ask to determine your estimated due date
Adopting a healthy lifestyle and improving your general well-being 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 getables, particularly green leafy vegetables, which are a good source of folic acid. Exercise is important too. If you have a current exercise regimen it’s safe to continue with that, or do gentle exercise, such as swimming or walking, which are ideal before, during, and after pregnancy If you smoke, you should try to quit, since 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. The best advice is to avoid drinking alcohol completely even while trying to get pregnant. You should, of course, refrain from drinking alcohol once you are pregnant, since safe levels of alcohol intake are difficult to determine. Checking your rubella status is a sensible measure since rubella can cause fetal ormalities 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 preexisting medical condition or are taking medication, talk to your health-care practitioner 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 since 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 balanced diet that includes green leafy vegetables and legumes, both of which are good natural sources of folic acid. Many breakfast cereals also contain folic acid, as do some fruits, such as oranges, papayas, and bananas. Any woman with epilepsy who takes anti-epileptic drugs should take a higher dose (of 5mg) of folic acid supplementation
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 balanced diet that includes green leafy vegetables and legumes, both of which are good natural sources of folic acid. Many breakfast cereals also contain folic acid, as do some fruits, such as oranges, papayas, 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 estrogen and progesterone, or the mini pill, which contains only progesterone, stop taking them at the end of the package. 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
Whether you are taking the combined pill, containing estrogen and progesterone, or the mini pill, which contains only progesterone, stop taking them at the end of the package. 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, since 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 also by the pattern of drinking, with binge drinking and chronic alcohol consumption 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
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 also by the pattern of drinking, with binge drinking and chronic alcohol consumption 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 from 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 nonsmokers. 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
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 nonsmokers. 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 right away. The American Medical Association estimates that smoking and passive smoking are responsible for a large percentage of miscarriages and impotence in men aged between 30 and 50 each year. Women who smoke are also more likely to have an ectopic pregnancy or miscarriage. Medical research has also shown beyond doubt that smoking affects the development of babies in the womb since they are starved of oxygen while they are growing. Smoking remains one of the few potentially preventable factors associated with low birth weight, premature birth, stillbirth, and Sudden Infant Death Syndrome (SIDS
My partner says soft drugs are OK—should we stop now that we’re planning a baby
By soft drugs, you may be referring to nicotine or marijuana. Tobacco smoke and marijuana smoke are highly likely to be harmful to fetal development and should be avoided by pregnant women and any woman who might become pregnant, or is planning to become pregnant, in the near future. A chemical present in marijuana known as THC is thought to reduce luteinizing hormone (LH). 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 marijuana can result in a short-term decrease in reproductive ability
By soft drugs, you may be referring to nicotine or marijuana. Tobacco smoke and marijuana smoke are highly likely to be harmful to fetal development and should be avoided by pregnant women and any woman who might become pregnant, or is planning to become pregnant, in the near future. A chemical present in marijuana known as THC is thought to reduce luteinizing hormone (LH). 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 marijuana 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, since some prescriptions can affect sperm production or development. Talk to your doctor too if you are on long-term medication, since 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 acetaminophen is considered safe, but talk to your doctor or pharmacist if in doubt
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, since some prescriptions can affect sperm production or development. Talk to your doctor too if you are on long-term medication, since 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 acetaminophen 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 requested, 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, since the likelihood of the tubes becoming blocked increases with each year that goes by. However, the operation is successful in more than 80 percent of men who have the reversal within 10 years after a vasectomy. Even if the vasectomy was done more than 10 years ago, there is still a reasonable chance of success
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 requested, 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, since the likelihood of the tubes becoming blocked increases with each year that goes by. However, the operation is successful in more than 80 percent of men who have the reversal within 10 years after a vasectomy. Even if the vasectomy was done more than 10 years ago, there is still a reasonable chance of success
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, jellylike, and stringy.
✱ A rise in your temperature (see right). ✱ Mid-cycle or ovulatory bleeding thought to result from the sudden drop in estrogen that occurs at ovulation. ✱ Localized pain. ✱ Swelling of the vulva before ovulation,
especially on the side that you ovulate A change in your basal body temperature can indicate ovulation. Just after ovulation, your temperature rises between 0.5 and 1.6° F (0.3 and 0.9° C). Ovulation kits can be
purchased over the counter from pharmacies and supermarkets. These simple urine tests detect a surge in the level of luteinizing hormone (LH), which occurs just prior to 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, jellylike, and stringy.
✱ A rise in your temperature (see right). ✱ Mid-cycle or ovulatory bleeding thought to result from the sudden drop in estrogen that occurs at ovulation. ✱ Localized pain. ✱ Swelling of the vulva before ovulation,
especially on the side that you ovulate A change in your basal body temperature can indicate ovulation. Just after ovulation, your temperature rises between 0.5 and 1.6° F (0.3 and 0.9° C). Ovulation kits can be
purchased over the counter from pharmacies and supermarkets. These simple urine tests detect a surge in the level of luteinizing hormone (LH), which occurs just prior to ovulation
I don’t seem to be getting 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
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 fatrelated 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
diabetes, and the extra weight of pregnancy will put more strain on your joints
I like to be really skinny—will that stop me from 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. Surprisingly, 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
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. Surprisingly, 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 like to be really skinny—will that stop me from 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. Surprisingly, 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
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. Surprisingly, 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 STI s in the past, but everything is fine now—will that stop me from conceiving
A previous sexually transmitted infection (STI) should not cause problems if it was found early and treated successfully. However, chlamydia and gonorrhea can have long-term consequences if left untreated,
especially in women. Untreated STIs also can be passed on to your baby
A previous sexually transmitted infection (STI) should not cause problems if it was found early and treated successfully. However, chlamydia and gonorrhea can have long-term consequences if left untreated,
especially in women. Untreated STIs also can be passed on to your baby
I’ve had STI s in the past, but everything is fine now—will that stop me from conceiving
A previous sexually transmitted infection (STI) should not cause problems if it was found early and treated successfully. However, chlamydia and gonorrhea can have long-term consequences if left untreated,
especially in women. Untreated STIs also can be passed on to your baby
A previous sexually transmitted infection (STI) should not cause problems if it was found early and treated successfully. However, chlamydia and gonorrhea can have long-term consequences if left untreated,
especially in women. Untreated STIs also can be passed on to your baby
Chlamydia is the most common sexually transmitted infection in the US. Although it is curable, many people are not aware of the health risks it presents. Up to 70 percent 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
Chlamydia is the most common sexually transmitted infection in the US. Although it is curable, many people are not aware of the health risks it presents. Up to 70 percent 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 percent of infertile men compared to 23 percent of fertile men, and the study therefore concluded that chlamydia may affect male fertility too. The classic STIs, such as syphilis and gonorrhea, are usually easier to recognize and subsequently
In a Finnish research study, chlamydia antibodies were found in the semen of 51 percent of infertile men compared to 23 percent of fertile men, and the study therefore concluded that chlamydia may affect male fertility too. The classic STIs, such as syphilis and gonorrhea, are usually easier to recognize and subsequently
diagnose and treat
diagnose and treat
I’m 37 and would like to start trying for a baby—have I waited too long
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 fertility does decrease with 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 having a baby with a chromosomal abnormality such as Down syndrome increases as you get older, rising from a 1 in 356 chance at 35 years old to a 1 in 240 chance at 37 years old
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 fertility does decrease with 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 having a baby with a chromosomal abnormality such as Down syndrome increases as you get older, rising from a 1 in 356 chance at 35 years old to a 1 in 240 chance at 37 years old
I’m 37 and would like to start trying for a baby—have I waited too long
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 fertility does decrease with 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 having a baby with a chromosomal abnormality such as Down syndrome increases as you get older, rising from a 1 in 356 chance at 35 years old to a 1 in 240 chance at 37 years old
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 fertility does decrease with 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 having a baby with a chromosomal abnormality such as Down syndrome increases as you get older, rising from a 1 in 356 chance at 35 years old to a 1 in 240 chance at 37 years old
Fertility guidelines indicate that if you are over 35 years old and haven’t become 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 labor
Fertility guidelines indicate that if you are over 35 years old and haven’t become 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 labor
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, your doctor make the assumption that this is the only cause of your problem. The general advice given to any couple who has 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
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, your doctor make the assumption that this is the only cause of your problem. The general advice given to any couple who has 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
Is my endometriosis preventing me from getting pregnant? We’ve been trying for two yearsEndometriosis 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, your doctor make the assumption that this is the only cause of your problem. The general advice given to any couple who has 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 your intake of fruits and vegetables, as well as foods high in 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
How is the egg released and fertilized
After menstruation, the body secretes follicle-stimulating hormone (FSH), which acts on the ovaries to mature
a follicle containing an egg. At the time of ovulation, a rise in the level of luteinizing hormone (LH) triggers the release from the ovary of an egg, which travels into the fallopian tube to await fertilization by a sperm. Up to 300 million sperm are released in each ejaculate, and of these only around 200 make it into the fallopian tube. These remaining sperm swarm all over the egg and many sperm may bind to its surface. At this stage, the sperm then shed
After menstruation, the body secretes follicle-stimulating hormone (FSH), which acts on the ovaries to mature
a follicle containing an egg. At the time of ovulation, a rise in the level of luteinizing hormone (LH) triggers the release from the ovary of an egg, which travels into the fallopian tube to await fertilization by a sperm. Up to 300 million sperm are released in each ejaculate, and of these only around 200 make it into the fallopian tube. These remaining sperm swarm all over the egg and many sperm may bind to its surface. At this stage, the sperm then shed
How are genes inherited
The sperm and egg each contain 23 chromosomes that carry the genetic material of the parents. As human cells contain 46 chromosomes, once the egg and sperm fuse, their chromosomes join to provide the fertilized cell with a full complement of chromosomes. Each egg and sperm carries its own unique set of genes in the
chromosomes, which means that the resulting baby has its own individual genetic makeup. The exception is identical twins; they result from one egg and sperm and inherit the same genetic code
The sperm and egg each contain 23 chromosomes that carry the genetic material of the parents. As human cells contain 46 chromosomes, once the egg and sperm fuse, their chromosomes join to provide the fertilized cell with a full complement of chromosomes. Each egg and sperm carries its own unique set of genes in the
chromosomes, which means that the resulting baby has its own individual genetic makeup. The exception is identical twins; they result from one egg and sperm and inherit the same genetic code
From conception to implantation
The fertilized cell that results from the fusion of the egg and sperm is called a zygote, which divides into two identical cells and continues to divide as it begins its journey down the fallopian tube until it forms a bundle of cells known as a morula. By the time it reaches the uterus, it forms a bundle of around 100 cells, called a blastocyst. About a week after fertilization, the blastocyst embeds itself in the lining of the uterus, the endometrium. At this point the pregnancy is established; the blastocyst develops into an embryo and the placenta develops.
The hormone human chorionic gonadotrophin (hCG) is released; this stimulates the production of progesterone, which maintains the lining of the uterus.
The fertilized cell that results from the fusion of the egg and sperm is called a zygote, which divides into two identical cells and continues to divide as it begins its journey down the fallopian tube until it forms a bundle of cells known as a morula. By the time it reaches the uterus, it forms a bundle of around 100 cells, called a blastocyst. About a week after fertilization, the blastocyst embeds itself in the lining of the uterus, the endometrium. At this point the pregnancy is established; the blastocyst develops into an embryo and the placenta develops.
The hormone human chorionic gonadotrophin (hCG) is released; this stimulates the production of progesterone, which maintains the lining of the uterus.
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 periodlike 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 by surgery
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 periodlike 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 by surgery
The risk of miscarriage
What can increase the likelihood of a 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
What can increase the likelihood of a 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
I’ve recently miscarried—why did this happen
Miscarriage occurs in 10–20 percent 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 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 in which the mother’s 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
Miscarriage occurs in 10–20 percent 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 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 in which the mother’s 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
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 be 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 since 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 an oral contraceptive pill but missed a dose. Talk to your midwife or 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 do 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
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 be 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 since 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 an oral contraceptive pill but missed a dose. Talk to your midwife or 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 do 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
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 will make 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 to continue as you normally would then that may be the best option for you. Soaking in a warm bath and practicing relaxation techniques may ease the intensity of the pain. If the pain increases or you get any bleeding or spotting,
contact your doctor
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 will make 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 to continue as you normally would then that may be the best option for you. Soaking in a warm bath and practicing 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 an ultrasound to determine if the pregnancy is viable 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 an ultrasound 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 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 the blood tests and the symptoms you are experiencing
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 an ultrasound to determine if the pregnancy is viable 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 an ultrasound 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 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 the 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 counseling should be offered to discuss the implications for future pregnancies. The levels of the hormones progesterone and prolactin may also be checked since 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
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 counseling should be offered to discuss the implications for future pregnancies. The levels of the hormones progesterone and prolactin may also be checked since 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 mom had two miscarriages—does that mean I am more likely to miscarry
Ask your mom 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 prenatal appointment, since your family medical history is an important part of your medical record during pregnancy
Ask your mom 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 prenatal appointment, since your family medical history is an important part of your medical record during pregnancy
QI’ve had several miscarriages and my doctor has referred me to a genetic counselor—why
A genetic counselor is a highly trained professional who supports families before and after conception. Often a miscarriage is caused by a genetic abnormality in the fertilized egg or embryo. This is usually a one-time occurence and can affect anyone.
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 counselor if either partner has a condition that can affect future children or the chances of
becoming pregnant or continuing with a pregnancy since 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 anemia and increases the risk of a
preterm birth and health problems in the baby, it may be that either or both parents are carrying a gene that can affect a baby. A genetic counselor helps you understand how your genes could affect conception and pregnancy and about the tests available to determine if a fetus is affected. The counselor will discuss a range of issues,
including the moral and ethical issues related to genetic testing, since it is common for couples to feel stress, guilt, and confusion in this type of situation
A genetic counselor is a highly trained professional who supports families before and after conception. Often a miscarriage is caused by a genetic abnormality in the fertilized egg or embryo. This is usually a one-time occurence and can affect anyone.
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 counselor if either partner has a condition that can affect future children or the chances of
becoming pregnant or continuing with a pregnancy since 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 anemia and increases the risk of a
preterm birth and health problems in the baby, it may be that either or both parents are carrying a gene that can affect a baby. A genetic counselor helps you understand how your genes could affect conception and pregnancy and about the tests available to determine if a fetus is affected. The counselor will discuss a range of issues,
including the moral and ethical issues related to genetic testing, since 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
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
Possible causes of miscarriage
Losing a baby in pregnancy
About 1 in 4 first pregnancies ends in miscarriage, generally within the first 12 weeks. Often no cause is identified and 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-time genetic problem (caused by a faulty chromosome) when the baby does not develop properly. Genetic problems account for 60 percent 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 specialized counseling to discuss the risk of it happening
again. After 12 weeks, the chances of you losing your baby because of a chromosomal
disorder reduce to about 10 percent; however, if you are over 35, this risk is higher. Other less common causes of miscarriage include fibroids (noncancerous 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 percent of repeated miscarriages. In future pregnancies, a stitch around the cervix can strengthen this muscle and prevent it from opening early. Another cause of a late miscarriage can be if the placenta does not function properly and affects the baby’s growth
Losing a baby in pregnancy
About 1 in 4 first pregnancies ends in miscarriage, generally within the first 12 weeks. Often no cause is identified and 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-time genetic problem (caused by a faulty chromosome) when the baby does not develop properly. Genetic problems account for 60 percent 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 specialized counseling to discuss the risk of it happening
again. After 12 weeks, the chances of you losing your baby because of a chromosomal
disorder reduce to about 10 percent; however, if you are over 35, this risk is higher. Other less common causes of miscarriage include fibroids (noncancerous 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 percent of repeated miscarriages. In future pregnancies, a stitch around the cervix can strengthen this muscle and prevent it from opening early. Another cause of a late miscarriage can be if the placenta does not function properly and affects the baby’s growth
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 from dilating too early It may be worth talking to a counselor 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
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 from dilating too early It may be worth talking to a counselor 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 your loss of 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 also 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 or to a trained counselor
for additional support
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 your loss of 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 also 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 or to a trained counselor
for additional support
Talking to others
coming to terms with your loss
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 counselor who specializes in
pregnancy loss.
✱ Let close friends and family members know how you are feeling.
✱ Share Pregnancy and Infant Loss Support is a great source of support.
✱ Talk to your doctor or midwife about why the miscarriage may have happened
coming to terms with your loss
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 counselor who specializes in
pregnancy loss.
✱ Let close friends and family members know how you are feeling.
✱ Share Pregnancy and Infant Loss Support is a great source of support.
✱ Talk to your doctor or midwife about why the miscarriage may have happened
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 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
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 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
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 STIs, such as HIV and syphilis
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 STIs, 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 milliliter of semen, with 75 percent of these alive and 50 percent 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, and to wear loosefitting underwear to avoid overheating the testes. If a problem is found, you will be referred to a specialist.Try to avoid becoming stressed since this can also affect fertility. Learning relaxation techniques with
your partner and practicing these regularly will help
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 milliliter of semen, with 75 percent of these alive and 50 percent 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, and to wear loosefitting underwear to avoid overheating the testes. If a problem is found, you will be referred to a specialist.Try to avoid becoming stressed since this can also affect fertility. Learning relaxation techniques with
your partner and practicing 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 doctor will go through each one with you, and together you can make a decision about which is most appropriate depending on your problem. You can also contact the Center for Disease Control and Prevention(CDC)
✱ 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 Intrafallopian Transfer (GIFT). This is for couples for whom no cause for infertility has been found. It involves stimulating the ovaries to produce eggs, which are removed, mixed with sperm 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 This is ideal for most problems,
including blocked tubes
✱ IntraCytoplasmic 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
✱ 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
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 doctor will go through each one with you, and together you can make a decision about which is most appropriate depending on your problem. You can also contact the Center for Disease Control and Prevention(CDC)
✱ 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 Intrafallopian Transfer (GIFT). This is for couples for whom no cause for infertility has been found. It involves stimulating the ovaries to produce eggs, which are removed, mixed with sperm 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 This is ideal for most problems,
including blocked tubes
✱ IntraCytoplasmic 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
✱ 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 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
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 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, 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
Conditions such as polycystic ovary syndrome(a hormonal imbalance that causes ovarian cysts)and endometriosis 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, 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
top left
Endometriosis causes cells from the lining of the uterus to travel to other areas such as the ovaries and tubes, which can affect fertility.
top right
Here, a special dye injected through the cervix reveals a blockage in the left
fallopian tube since the dye has been unable to enter the tube.
bottom left
If the head,or cap, of the sperm is
abnormally shaped it will be
unable to fertilize an egg.
bottom right
In polycystic
ovary syndrome, cysts in the
ovaries mean that the follicles
are unable to mature and
produce ripened eggs
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.IVF treatment occurs in cycles, since 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 “down-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, multiple embryos are transferred into the womb. If an embryo successfully attaches to the inside of the womb and continues to grow, a pregnancy results
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.IVF treatment occurs in cycles, since 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 “down-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, multiple 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(IntraCytoplasmic Sperm Injection)
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-birthsper-cycle-started.” This information is available
from each clinic.Overall, couples have a better success rate if the woman is age 23–39 years, has been pregnant or had a baby, and has a normal body weight (a BMI between 19 and 24). The older a woman is, the less likely she is to conceive and maintain the pregnancy.Figures show that for every 100 women who are 23 to 35 years, more than 20 will get pregnant after one IVF 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.
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-birthsper-cycle-started.” This information is available
from each clinic.Overall, couples have a better success rate if the woman is age 23–39 years, has been pregnant or had a baby, and has a normal body weight (a BMI between 19 and 24). The older a woman is, the less likely she is to conceive and maintain the pregnancy.Figures show that for every 100 women who are 23 to 35 years, more than 20 will get pregnant after one IVF 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 treatment The process of IVF
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 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 IVF, drugs, such
as clomiphene and hMG (human menopausal gonadotrophin) may be used to stimulate your
ovaries to produce several eggs. While you are undergoing this treatment, you will need to visit your clinic frequently in order 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 estrogen, which is released around ovulation. What happens next? Once your follicles are 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 will need to produce some sperm on the same day as the egg collection.For sperm collection, ask the staff members at
your clinic for instructions regarding timing and specimen collection
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 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 IVF, drugs, such
as clomiphene and hMG (human menopausal gonadotrophin) may be used to stimulate your
ovaries to produce several eggs. While you are undergoing this treatment, you will need to visit your clinic frequently in order 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 estrogen, which is released around ovulation. What happens next? Once your follicles are 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 will need to produce some sperm on the same day as the egg collection.For sperm collection, ask the staff members at
your clinic for instructions regarding timing and specimen collection
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