All your pregnancy and birth: March 2010

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

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

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

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

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

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

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

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

Even a small weight loss can increase your ability to conceive and to have a healthy pregnancy. If you are concerned about your weight, you may find it useful to talk to your health-care provider for advice

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

Stopping contraception

ready for conception

When to stop contraception before conceiving is fairly straightforward, although for some methods a degree

of planning is required

Barrier methods, such as the diaphragm and condom, can be stopped immediately once you decide to start trying

If you have an IUD, you will need to make an appointment to have it removed; you can start trying right away after this

If you are on oral contraception, finish the package before stopping . Your cycle may take time to settle, although some women conceive as soon as they stop

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

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

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

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

On the other hand, many older women have no problems conceiving, and there are positives to being an older mom. Older mothers are more likely to breast-feed than younger moms and often feel more assured and confident in their own capabilities because of life experience

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

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

All about conception

the beginning of life

Conception occurs once an egg is successfully penetrated by one sperm. The journey of the egg and the sperm, although apparently simple, requires a whole complex chain of events to occur for fertilization and implantation to take place

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

their bodies and tails and release enzymes to help them burrow down into the egg. However, only one sperm can penetrate the innermost part of the egg, known as the oocyte. Once the egg and sperm have successfully fused together, fertilization has taken place

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