Preparing For Pregnancy
Trying to get pregnant can be both exciting and stressful. There are many factors that influence fertility and if you’re planning a pregnancy, we recommend you prepare yourself. Below are some of the things you should take into consideration. Some will help you in reaching your goal of pregnancy and others are preventative measures to ensure the health of your baby.
It is recommended you seek advice if you have not been successful after 6 to 12 months of trying. However, if you feel like it is taking too long there are a few simple steps you can take on your journey to fulfil your dream of having a family. By getting others involved does not mean you have given up, it just means you are seeking consultation and fact gathering. You do not need anyone’s permission and it does not mean you have to do anything.
Fertility & Phases of the Menstrual Cycle
There are many methods used to predict ovulation. These include measuring changes in temperature, saliva, urine and vaginal mucus. However, due to a number of external influences they are not always reliable.
Simple maths is often very helpful. Record your longest and shortest menstrual cycle. The potential fertile time starts 16 days before the end of your shortest cycle and ends 12 days before the end of your longest cycle. There is also a reliable progesterone blood test that can be used to confirm ovulation.
There are a variety of fertility and ovulation tracking apps available that can assist with gathering this information.
A good healthy diet will include fruit and vegetables each day, and good quality protein, such as lean meat, fish, eggs, pulses (eg beans, lentils). You also need to consume complex carbohydrates, whole grains, plenty of calcium (preferably in the form of low fat dairy products). It is best to avoid excessive additives such as colours, flavours and preservatives and keep to a relatively low fat diet which includes mainly healthy fats.
Weight issues are important for both men and women when considering fertility. Obesity increases the risk of heart conditions, diabetes and hormonal imbalances, which can lead to infertility. If you are overweight, your body mass index (BMI) will be greater than 25. The closer to a BMI 25, the better, and remember any weight loss in this situation will improve your fertility. See a dietician and exercise physiologist for expert individualised advice.
Women who are underweight (BMI less than 20) are also at risk of reduced fertility. If you are underweight and your period cycles are long or irregular, a small weight gain may be beneficial, or cut back on strenuous exercise.
You will benefit from being fit prior to pregnancy. For women who are unfit, developing at least a moderate level of fitness is advisable. However, it is also best to limit intense or high impact exercise and no more than 4 hours high intensity exercise per week is recommended. For an exercise program tailored to your specific needs we recommend seeing an exercise Physiologist when preparing for pregnancy or if you become pregnant. Men should also aspire to a reasonable level of fitness.
Smoking can affect the fertility of both males and females, causing erectile dysfunction and increased DNA damage to sperm and eggs. Smoking can also increase the risk of miscarriage while pregnant.
Women should stop all alcohol while trying to conceive and during pregnancy, while men should aim to keep to current “safe drinking guidelines” – average 2 drinks a day maximum, with several alcohol free days each week and no more than 4 standard drinks in one session.
Certain drugs have been found to adversely affect male fertility, including;
- Recreational/ illicit drugs
- Psychotherapeutic agents
- Chemotherapeutic agents
- Hormones (anabolic steriods)
Effects can include:
- Direct gonadotoxic effects which means direct harm to the testes
- Alterations in the production and release of hormones
- Erectile dysfunction
- Direct effects on libido
Both men and women need to aim for less than 200mg of caffeine a day, which equals a maximum of 1-2 coffees or glasses of cola/energy drinks, or 2-3 teas, and not too much chocolate, either! If you need to cut down, do so slowly to reduce the impact of withdrawal symptoms.
Both men and women should avoid excessive heat from baths, saunas or spas when trying to conceive and during pregnancy. Men should also avoid any other situations where their scrotal area is unable to keep cooler than the rest of the body. Keep laptops on the desk and off the lap!
Maintaining a positive state of mind also improves your health and well-being, and you chances of a successful pregnancy. A degree of stress in life is inevitable, but how you deal with it is important. At Repromed we provide patient support for individuals and couples. Our patient support officers have extensive therapeutic experience and have specialised skills and knowledge in the field of infertility.
Folate supplementation is recommended at least 1 month prior to pregnancy and for 3 months into the pregnancy as this reduces the chance of the baby having a defect in the neural tube, such as spina bifida. Folate can be taken alone or in combination with other pre-pregnancy supplements.
A blood test can show if you are immune to rubella. If not, immunisation will be recommended. Similarly it is recommended that women preparing for pregnancy have a blood test to check their immunity to varicella. If you are not immune, you can be immunised to reduce the risk of infection in pregnancy.
Be sure to update your smear test if it is nearly due. It is better to have one a bit early than be due in the middle of a pregnancy and find out that you have an abnormality on your smear that needs attention.
The Effects of Age on Fertility
Both men and women have a reproductive lifespan. As women are born with all the eggs they will ever produce, age becomes an issue. Female fertility declines slightly at 30 years and there is a significant decline around 37 to 38 years of age. By the time a woman is 40 years old her fertility is a quarter of when she was 30. The miscarriage rate increases with age from about one in seven for women aged less than 25 years to about one in two at 40 years of age.
Sexually Transmitted Infections
Sexually transmitted infections may impact a couple’s fertilty. Chlamydia is a common sexually transmitted infection (STI) caused by the bacterium, Chlamydia trachomatis. In women, untreated infection can spread into the fallopian tubes and cause the tubes to become blocked at the very ends. This is known as hydrosalpinx. They can also develop scar tissue around the fallopian tubes that makes it more difficult for the tube to “pick “up” the egg at the time of ovulation. This can lead to infertility and an increased risk for ectopic (tubal) pregnancy.
In men, if the infection is left undetected and untreated it can cause epididymitis – an infection in the ducts of the testicles where sperm mature. Epididymitis can manifest in shrinking of the infected testicle, abscesses, and infected sores in the surrounding scrotum area. This can ultimately lead to infertility.
Other infections that may impact fertility include:
- Genital warts
- Hepatitis B
Miscarriages are very common in our community. It can be a very distressing time for everyone concerned. Approximately 1 in 6-7 pregnancies will end in a miscarriage when the maternal age is less than 35. This risk increases with age to approximately 1 in 4 pregnancies by age 40, and is more frequent over 40 years. One of the most common causes of miscarriage is a genetic abnormality affecting the pregnancy.
If you have had one miscarriage this does not increase your risk of future miscarriages however recurrent miscarriage is the term used when 3 or more miscarriages have occurred.
If you have experienced pregnancy loss in the past you may wish to ask your doctor whether you need to be screened for risk factors for recurrent miscarriage.
In some instances people who have experienced recurrent pregnancy loss may be candidates for Pre-implantation Genetic Diagnosis (PGD) screening of embryos. At Repromed, your doctor will be happy to discuss this new technology with you to see if it would be of benefit to you.
Endometriosis is a common cause of period pain occurring just before or in the first few days of a period. It is caused by deposits of tissue from the lining of the uterus in areas outside of the uterus. This can sometimes lead to decreased fertility.
Symptoms of endometriosis may settle down after a pregnancy. Endometriosis can also be suppressed with medications or can be treated surgically. Treatment of endometriosis may improve fertility and decrease period pain for some time afterward. Please speak to your Repromed doctor about management options if you feel you have symptoms of endometriosis.
Polycystic Ovarian Syndrome: (PCOS)
PCOS is a diagnosis covering a broad range of symptoms. To have a diagnosis of PCOS, a woman must have 2 out of the following 3 criteria.
1. Irregular menstrual cycles
2. Signs and symptoms of high androgen (male homone) levels
3. Ultrasound appearance of PCOS- or lots of small cysts or follicles on the ovaries.
Women with PCOS are at a higher risk in the future of being diagnosed with diabetes or high cholesterol. It is very important for women with PCOS to keep a healthy lifestyle when it comes to diet, exercise and maintaining a healthy weight. Not only will this lower the risk of diabetes and high cholesterol in the future but will also possibly improve their fertility naturally.
Women with PCOS may need assistance to become pregnant if they do not have regular periods. Treatments can range from simple tablets and timed intercourse to more interventional methods such as IVF.
Please talk to your Repromed Doctor about what treatment options are most suitable to your needs.