There are some steps you should take before attempting pregnancy.
- Make sure you want to have a baby. This may sound foolish, but many couples approach the attempt to get pregnant without giving enough thought to the affects on their life of having a child. They say “Let’s get pregnant” instead of “Let’s have a baby.” Creating a baby and being pregnant sound glamorous. It may be glamorous, but you must really want to have a baby. Don’t get us wrong – we think having a baby is great. But is it great for you? You may think this never happens, but we do see new mothers who say: a. “If I had known what this would do to my life…” b. “I don’t know who is going to watch the baby so I can go back to work…” c. “I didn’t know how much it was going to cost to have a baby…” d. “My husband didn’t really want a baby and it’s driving us apart…”
- Learn all you can about your genetic history. If there is any significant history of genetic problems in the family, you might want to investigate it before attempting to get pregnant. This could include a relative with Down’s syndrome or other mental disability, muscular dystrophy, cystic fibrosis, hemophilia, or other inherited diseases. You may belong to a population group that carries an increased risk of disease specific to that group, such as Tay-Sachs disease in Ashkenazic Jews or certain types of anemia in blacks or in people whose ancestors came from Mediterranean countries. This applies to both wife and husband. Your own doctor can help you with advice in this area, or will refer you to a place where you can get more information. For example, we know of a Jewish couple, one of whom is a physician, who did not come in for care until about 12 weeks of pregnancy. They had never been tested for Tay-Sachs. They were sent to the local Tay-Sachs testing program and both turned out positive. By this time, she was 17 weeks pregnant. Since Tay-Sachs is a uniformly fatal disease with progressive neurological deterioration and death by age three, they were sent for genetic counseling. They were told that their offspring would have a 25 percent chance of having the disease and a 50 percent chance of being a carrier. Fortunately, it can be detected in the amniotic fluid and an amniocentesis was scheduled immediately. We were all relieved when the amniotic fluid revealed that the baby was not affected. But this should ideally have been known and planned before the pregnancy. If they had waited any longer and if the result had shown an affected baby, they would have had no choice but to continue the pregnancy and subject the baby to the certain fate of Tay-Sachs.
- Clean up your act! Both of you should get into the best physical shape possible. Stop all medically unnecessary drugs, especially recreational drugs, including marijuana. These can have an effect on fertility as well as on the baby. Avoid smoking and excessive amounts of alcohol or caffeine. Caffeine and smoking are both implicated in infertility. One study comparing smokers and non-smokers going through in vitro fertilization found that the smokers had lower fertilization rates, lower estrogen levels, required greater amounts of fertility drugs, and had lower pregnancy rates. Another study showed that a cup of brewed coffee daily was associated with a 50 percent reduction in the chance of conceiving each month. Caffeine’s effect on outcomes of infertility treatments has not been studied. Other sources of caffeine are tea, colas, and chocolate. If you are overweight, it is a good idea to lose the weight before you get pregnant and do it in a manner consistent with good nutrition. Then continue on a nutritionally sound weight-maintenance program. If your weight is normal or you are underweight, make sure that you are eating a well-balanced diet. If strenuous exercise has made your periods irregular, you might want to modify your routine while trying to conceive. Check at work for any environmental hazards to conception or pregnancy. Finally, if your level of stress is a problem, you can try to avoid stress or use stress reduction techniques. Your doctor can help you with this type of planning.
- Reduce STRESS There have been numerous university health studies linking the effects of stress to impaired fertility. Anywhere you are able to take it easy, go with the flow and release stress will help the fertility process. Your ovaries are surrounded by a network of nerves linked to the sympathetic nervous system. This is your body’s Fight or Flight response to fear. Chronic stress keeps this system perpetually engaged which, in turn, activates the nerves surrounding the ovaries. This impedes blood flow to the ovaries and thus reduces follicular development and ovulation. Even though you are a busy, active and engaged woman of the world, try to make time for yourself to unwind, and try to keep an even keel throughout all the activities of your life. Especially while you are menstruating – during your period, try to avoid the following: Stress, extreme temperatures of hot or cold, physical exertion (like jogging, marathons, long bicycling, etc.)
- Take prenatal vitamins daily. In preparation for pregnancy, authorities are recommending the use of vitamins containing the daily requirement for pregnant women. Do they help? Studies have suggested a much lower incidence of neural tube defects in infants whose mothers took vitamins containing 0.4 milligrams of folic acid before conception. In any event, they can’t hurt if taken when directed. These are easily obtained over the counter at any pharmacy and are fairly inexpensive. In order to obtain the dose of 1 mg of folic acid utilized in prescription prenatal vitamins, you will need to get a prescription from you physician. There are many different brands, but all contain about the same formula.
- 5. Consider existing medical problems. If there is any question of a medical problem, it is a good idea to have this evaluated and treated before getting pregnant. This is especially true if diabetes is present or suspected. Fertility will be greatest and the chance of fetal abnormalities will be minimized by starting the pregnancy with normal blood sugars. We recommend that all diabetics be checked and receive an okay from their doctor before even attempting to get pregnant. You should also be sure that other medical conditions are under control and that medications to control them are appropriate for pregnancy, since some medications can increase the chance of fetal abnormalities.
Maximizing Your Chances
A couple with normal fertility who have intercourse at or about the time of ovulation stands about a 20 to 25 percent chance that a pregnancy will result. In order to reach this level of maximum efficiency of the human reproductive system, be sure that:
- a. Intercourse occurs as close to the time of ovulation as possible.
- b. The man’s sperm is at optimal levels.
- c. The environment is suitable.
Intercourse can be timed to occur on the day of ovulation as determined by the calendar, examination of previous BBTs, cervical mucus, or (for the more scientifically minded) the urinary LH home test. Watch this video to learn more about BBT and how to start tracking your cycle
Precise timing may be more scientific, but it does tend to add stress to the process and can even take the fun out of it. Ideally, to be sure to maximize fertilization, have intercourse every other day around the estimated time of ovulation. We recommend having intercourse beginning 4-6 days prior to ovulation, every other day through the day of ovulation. Given the life of the sperm and the egg, this would tend to have sperm present during the “life” of the egg no matter when ovulation occurs. Currently no evidence exists that more frequent intercourse impairs fertility. In fact, having more frequent ejaculations is known o improve sperm motility. So, even if greater frequency of ejaculation reduces the per-ejaculation sperm count, the increased motility may result in a net gain of fertilization potential. For this reason, we do not advocate limiting sex in order to “save it up” for one prime time. Motility tends to decrease with longer periods between ejaculations. The best compromise appears to be a two-day interval to maximize your chances of conception. Further evidence suggests that the man-above-woman-below position is best for most couples, with the woman staying on her back for about 20 minutes following ejaculation. Elevating the legs and / or pelvis after intercourse may be beneficial as well. The use of artificial lubricants and douching after intercourse should be avoided.
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