Prior To Conception

Prior To Conception

Prior To Conception
Before planning to have a baby, visit your doctor to check for risk factors that may cause complications with our pregnancy. Prenatal vitamins should be taken before you start trying to get pregnant so that your body is ready to support another life. Some medical and dental procedures cannot be done while pregnant so you can discuss with your doctor what steps need to be taken to address those issues before becoming pregnant.

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    As you age, you have an increasing chance of having a baby born with a birth defect. Yet most women in their late 30s and early 40s have healthy babies. See your doctor regularly before you even start trying to get pregnant. She will be able to help you prepare your body for pregnancy. She will also be able to tell you about how age can affect pregnancy.

    During your pregnancy, seeing your doctor regularly is very important. Because of your age, your doctor will probably suggest some extra tests to check on your baby's health.

    More and more women are waiting until they are in their 30s and 40s to have children. While many women of this age have no problems getting pregnant, fertility does decline with age. Women over 40 who don't get pregnant after six months of trying should see their doctors for a fertility evaluation.

    Experts define infertility as the inability to become pregnant after trying for one year. If a woman keeps having miscarriages, it's also called infertility. If you think you or your partner may be infertile, talk to your doctor. Doctors are able to help many infertile couples go on to have healthy babies.

    This answer is based upon source information from the National Women's Health Information Center.

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    A preconception checkup is a medical checkup you get before pregnancy. It helps your healthcare provider make sure that your body is ready for pregnancy. You can get a preconception checkup any time -- even up to a year before you want to get pregnant. If you can, meet with the healthcare provider you want to take care of you when you do get pregnant. Learn more at: marchofdimes.org
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    A OBGYN (Obstetrics & Gynecology), answered on behalf of
    Several tests may help gauge a patient's fertility potential, also known as ovarian reserve:
    • Day 3 levels of FSH and estradiol: Follicle stimulating hormone (FSH) is a hormone released from the brain that triggers egg development by the ovary. Estradiol is the hormone produced by the ovary as the egg develops. Patients with an elevated estradiol and/or FSH level on the third day of a menstrual cycle have poor pregnancy rates with both ovulation induction and in vitro fertilization.
    • Clomiphene citrate challenge test (CCT): The day three FSH and estradiol levels may be normal in patients with decreased ovarian reserve. The CCT is another test to more thoroughly evaluate fertility potential. Clomiphene citrate is a medication given orally on menstrual days five through nine. Estradiol and FSH are measured on day three and day 10 of the cycle. Elevated blood levels of these hormones are associated with very low pregnancy rates with fertility treatment.
    • Response to fertility medications: The response to injectable high-dose fertility medications is another method for determining ovarian reserve. Patients with decreased ovarian reserve require larger amounts of medication to produce eggs and generally have lower pregnancy rates with ovulation induction and in vitro fertilization. Egg donation is an option for those patients who do not conceive with other therapies or have abnormal ovarian reserve testing. Egg donation involves using eggs donated by another woman. Patients may provide a donor (typically a sister or close friend) or an anonymous donor may be provided.
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    Birth spacing is the period of time between giving birth and getting pregnant again. It's also called pregnancy spacing or interpregnancy interval (also called IPI). It's best to wait at least 18 months (1½ years) between giving birth and getting pregnant again. Too little time between pregnancies increases your risk of premature birth (before 37 weeks of pregnancy). The shorter the time between pregnancies, the higher your risk. Learn more at: marchofdimes.org/birthspacing
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    In most situations two people achieve pregnancy, and both should optimize their health prior to attempting conception. Many studies indicate that the following advice will improve a couple's chance of conceiving:

    1) The greatest chance of conception follows intercourse during the fertile time of a woman's cycle. For most women the fertile time typically includes the day of ovulation and a few days preceding ovulation. This portion of the cycle can be prospectively identified at home using urine LH testing. Urine LH test kits, also called "ovulation predictor kits" are available over-the-counter in pharmacies. Urine LH increases one to two days before ovulation.

    2) Women and men attempting conception should try to get their body mass index (a measure of height and weight) into the healthy range, typically regarded as 20 to 25 kg/m2. For men and women, being too thin or too heavy reduces the chance of conception.

    3) Women and men should stop smoking prior to attempting conception. Cigarette smoke contains toxins that interfere with the development of the egg, sperm, and the process of conception.

    4) Women should reduce their caffeine intake to no more than two cups of coffee daily, or no more than 250 mg of caffeine daily. Caffeine intake greater than five cups daily can increase the risk of miscarriage.

    5) Women with depression or significant anxiety may want to address these symptoms before attempting conception. Studies suggest that optimal mental health improves fertility.

    6) Women should reduce their alcohol intake to no more than four standardized drinks per week (a standardized drink is 12 ounces of beer, 5 ounces of wine, or 1 ounce of spirits).

    7) Women planning conception should start taking folic acid, approximately 800 micrograms daily. This reduces the risk of a specific birth defect of the nervous system -- neural tube defect.
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    Pregnancy complications are increased in obese women, and individualized pre-conception assessment and counseling are strongly recommended. Before pregnancy, a specific weight reduction program tailored to the individual woman should/could include diet, exercise, and behavior modification. These should all precede a surgical remedy and be given an appropriate time to have an effect. Fortunately, for those who do choose the surgical remedy, recent studies have not shown (early studies did) an increase in adverse perinatal outcomes.
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    A , Internal Medicine, answered
    1. Update your immunizations, particularly chicken pox, measles, mumps, rubella, and influenza (seasonally)
    2. Discuss preconceptual genetic testing, especially if you are of Ashkenazi Jewish or Mediterranean ancestry
    3. Review your personal and family history of diseases, especially diabetes, heart disease, asthma, high blood pressure, kidney disease, epilepsy, thyroid disease, phenylketonuria (PKU), thalassemia, iron-deficiency anemia, and sickle-cell anemia
    4. Review your reproductive history, including fertility issues, multiple miscarriages, abnormally shaped uterus, endometriosis, sexually transmitted diseases, tubal problems, polycystic ovary syndrome (PCOS)
    5. Have a blood test to determine your blood type and screen for toxoplasmosis, syphilis, HIV, and Group B Strep
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    A OBGYN (Obstetrics & Gynecology), answered on behalf of
    Patients will often ask me, "What should I do when I'm trying to get pregnant, when I'm trying to start a family?" "How do I maximize my chances of conceiving?" I usually recommend to them that they take a multivitamin that contains folic acid. That helps give them all the nutrients that they need in order to be healthy and also to help support a developing baby.

    I also recommend that the patients keep a calendar of their menstrual cycle, so if they do have trouble conceiving, we can take a look at that calendar and figure out where the problems may be occurring.

    I usually also recommend that if patients have other medical conditions, they make sure that those are under control. So if they have diabetes, they should see their primary-care manager and make sure that is well controlled.

    The other issue that comes up frequently with fertility is related to weight. There is definitely an ideal weight for women when it comes to conceiving. If they're underweight, oftentimes their menstrual cycles will cease -- they're usually not fertile during that time. If they're overweight, similar things can occur with irregular menstrual cycles and inability to conceive. Often, all that many women need is appropriate counseling about nutrition and exercise therapy in order to help them start their family.
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    If you have diabetes, you'll need a physical exam before you get pregnant. Your doctor will be looking for any health problems that could be a risk to your health or your baby's health. If possible, these problems should be identified and treated before you get pregnant. Share your health history with your doctor and nurse. Include:
     
    • your diabetes management
    • menstrual and pregnancy history
    • birth control method
    • health problems (for example, diabetic ketoacidosis (DKA), high blood pressure, infections, other diseases)
    • whether you have support from family and friends
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    A , Neurology, answered
    Medication choices need to change with pregnancy to make sure you minimize risks to your baby. Before you start trying to get pregnant, you should talk to your doctor about your headache treatment. You will need to:
    • Learn about safe and effective non-drug treatments that you can
             use to control headaches throughout your pregnancy and
             after delivery.
    • Make sure the headache medications you are using are safe for
             you to take when trying to get pregnant and throughout
             pregnancy. This reduces risks to the baby if you become
             pregnant while taking the medications.
    • Try to get your headache pattern under as good control as
             possible before you become pregnant.
    • Talk to your doctor before using any non-prescription medications
             and supplements to make sure they are safe during
             pregnancy.
    • Take a multivitamin with at least 400 micrograms of folate every
             day. This helps to prevent spinal cord defects.
    Remember that there are many safe and effective non-drug and drug treatments for you to use throughout pregnancy. Making treatment changes before you become pregnant is the best way to provide the safest treatments for your developing baby and to make sure you have an effective treatment regimen in place to adequately control your headaches.