Thinking about getting pregnant, here’s what you need to know!

Now that you’ve decided to get pregnant, there are appropriate steps you can follow to prepare for this life changing event.  Ideally you and your partner want to allow yourself 6 months to go through a check list of pre-planning before actually becoming pregnant. This creates the foundation for a healthy pregnancy and healthy baby.

The Preconception Care Check List includes meeting with a gynecologist/healthcare provider 6 months ahead of time to see if you both are physically and mentally ready to have a healthy pregnancy.   Did you know that 50% of pregnancies are unplanned?  So for the 50% of you that want to have a planned approach to becoming their healthiest self here is the list to discuss with your healthcare provider.

It’s never too early to become your healthiest self.  Preparing for pregnancy should be thoughtful and deliberate.  If you follow the Preconception Care Check List this will ensure you are completely healthy and well educated as you begin the pregnancy cycle. 

 

Check-List for Preconceptional Care

• Medical History– A review of your medical history is important to ensure that you don’t have any underlying medical conditions, such as diabetes, high blood pressure, depression and seizures disorders that might cause problems during pregnancy or your unborn baby.  Good control of medical conditions prior to pregnancy is the key to avoid problems that can escalate during pregnancy and the post-partum period. 

 

• Family and Genetic History-Genetic or inherited disorders are important to identify in your family history.  Certain family disorders can put you and your partner at risk of having a child with an unexpected inherited medical condition.  Examples of this include a family history of birth defects, diabetes, seizure disorders, and developmental disabilities. A thorough discussion about your family’s genetic history will ensure nothing can be passed onto the baby. For example, if you or your partner is Jewish you would need to have a Tay Sach test to see if you are a carrier.  Your health care provider is there to guide you through the hurdles that may exist during this pre-game planning period.

 

• Controlling your BMI-Women with an abnormally high or low body mass index (BMI) can affect your chance of getting pregnant.  If your BMI is under 18 or over 30 this can cause hormonal disruption that can disrupt ovulation. Maintaining a healthy weight increases your chance of having regular ovulation and a better chance of becoming pregnant.

 

• Medication, Supplements, Herbs and other potential harmful drugs to avoid-Bring your paper bag of over-the-counter and prescription medications and herbs that you and your partner take on a daily basis for review. There are medications you might be taking that could be teratogenic or harmful to the embryo during the early stages of conception. Medications such as Rogaine (Minoxidil) commonly used for hair loss can also affect the quality of the sperm and should not be used during the pre-planning period.  Antibiotics that are commonly used for acene, such as Acutane and Tetracycline, pose potential harmful effects to the developing embryo.  Other OTC medications to avoid include aspirin and ibuprofen. Commonly used herbs to avoid include Dong quai, black cohosh, sassafras and mugwort.  

 

• Drug use of any kind including marijuana, nicotine or other recreational drugs. Surprisingly, substance abuse is one of the leading causes of complications during pregnancy.  These drugs contain chemicals that are harmful during the pre-planning period and pregnancy.  These drugs also have byproducts that are found in the vaginal fluids, affect the quality of sperm and ultimately the ability for the egg and sperm to fertilize. Marijuana use is commonly used as a recreational activity.  Marijuana-smoking makes the sperm hyperactive and less fertile.  Men show smoke marijuana also have a much lower volume of sperm.  Chronic marijuana users have the harmful byproduct, cannabinoid, present in their urine up to 30 days or longer.  The effects of tobacco smoking also effects fertility.  Men who smoke have a lower sperm count and abnormal shaped sperm. Women who smoke have an increase risk of spontaneous miscarriage and possibly ectopic pregnancy.  Pregnant smokers have an increase risk of premature birth, lower birth weight babies and sudden infant death syndrome (SIDS). Marijuana, nicotine or other drug use, all contribute to infertility and should be stopped months prior to attempting pregnancy.  Alcohol use should also be stopped 3 months prior to pregnancy due to its well-known relationship to birth defects.  Bottom line is if you and your partner smoke, drink alcohol, or take drugs it’s time to quit and start becoming your healthiest self.\

 

• Recurrent Sexually Transmitted Infections (STI’s)- A history of recurrent STl’s can cause infertility. Pelvic Inflammatory Disease “PID” is a common pelvic disease caused by sexually transmitted infections (STI’s) including Gonorrhea, Chlamydia and Syphilis.  Any of these STI’s can cause serious and potentially long-term reproductive problems that include chronic pelvic pain and infertility. It’s important for your health care provider to know your STI history since recurrent infections can lead cause scarring and blockage of the fallopian tubes which can prevent pregnancy. You and your partner should get STI’s tested as part of your routine check list for getting pregnant. 

 

• Avoid yeast or bacterial infections-Keeping the vagina healthy and pH balanced is important when trying to conceive.  Recurrent vaginal infections can negatively change the delicate balance that can affect the helpful mid-cycle egg white discharge that helps the sperm swim upstream into the uterus and to the fallopian tube where fertilization occurs. Plus, having sex with a yeast or bacterial infection can be painful and uncomfortable. Everyday routines including diet, medications, stress, and fragranced body and laundry soaps can disrupt the pH balance making the vagina a hostile place for sperm to get the job done. 

 

• Caffeine use? This deserves its own section to clarify how caffeine can be consumed in a safe manner.  We know that moderate caffeine consumption > 200mg/day (12oz cup of brewed coffee) was thought to be a contributing factor in miscarriages and preterm labor. The good news for coffee drinkers is the studies currently do not show that moderate caffeine consumption will lead to an increase miscarriage rate or affect your chance of conceiving.   I suggest limiting your caffeine intake to one cup of coffee or 2 cups of tea/day during the pre-pregnancy period.  Know how much caffeine is contained in the foods and beverages you eat so you can keep the quantity under 200mg/day which is considered a safe amount for your growing baby.  

Table 1. Caffeine Content of Foods and Beverages
Food and Beverages	Milligrams of Caffeine (Average)
Coffee (8 oz)      Brewed, drip      Instant	137 76
Tea (8 oz)      Brewed      Instant	48 26–36
Caffeinated soft drinks (12 oz)	37
Hot cocoa (12 oz)	8–12
Chocolate milk (8 oz)	5–8
Candy      Dark chocolate (1.45 oz)      Milk chocolate (1.55 oz)      Semi-sweet chocolate (1/4 cup)      Chocolate syrup (1 tbsp)	30 11 26–28 3
Coffee ice cream or frozen yogurt   (1/2 cup)	2
U.S. Department of Agriculture, Agricultural Research Service, 2000.

 

• It’s best for women to start taking folic acid three months before conception. Making sure that your prenatal or multivitamin contains at least includes 400mcg-1mg of folic acid is vital.  Folic acid has been shown to reduce the incidence of spinal defects, aka neural tube defects.  Another recent study showed women who took folic acid preconceptionally also had a reduced incidence of autism. And taking additional omega, 3 fish oil helps the healthy development of the fetal brain and visual system.  Additional vitamin D supplementation may also be needed if you are deficient.

When is the best time during the month to get pregnant?

 

I spend a great deal of time giving a brief biology lesson on knowing when during the menstrual cycle pregnancy can occur.  Understanding when is the right time during your menstrual cycle to conceive is essential. On average, women have a period every 28 days. Many women don’t have a perfect 28-day cycle and this can make it challenging to know when the egg is available for conception. Ovulation is the time when the egg is available to be fertilized over a 24-hour period. Typically, ovulation occurs 14 days prior to getting your period.  Some women notice an “egg white and slimy” discharge around the time of ovulation while others actually notice a twinge or slight pelvic discomfort. Since sperm lives for 3-5 days knowing when ovulation occurs makes timed intercourse a straightforward process.  The idea is to have the sperm waiting for the egg. For example, if you have determined that you ovulate on Day 15 (Day 1 being the first day of your period), then you can have timed intercourse on Day 14, 15 and 16.  Having intercourse on these days ensures that the sperm and egg are interfacing with hopes of an embryo being formed.  Additionally since the lifecycle of sperm is 72 hours, some experts suggest having intercourse on Day 10 and then abstaining until Day 14 based on the example. This way there is fresh sperm ready to find the egg in the fallopian tube where fertilization takes place.  I suggest purchasing an ovulation kit and or downloading the “maybe baby” app to help identify the fertile period of your cycle.  So when the time comes to start trying you are prepared with the tools to target the fertile days of the month.

How long does it take to become pregnant?

 

Now that you understand the timing of ovulation realize that it may take on average 6 to 9 months to conceive. Depending on your age, you have a 15 to 25% chance of conceiving each month if you are having timed intercourse. If you are timing your intercourse over a 3-month period, 50% of couples will conceive and if you are timing your intercourse over 6 months, 75% of couples will conceive. After 12 months of having timed intercourse approximately 90% of couples will have conceived.  The incidence of infertility in the United States is roughly 10 to 12%.

What diet recommendations do you have to help me get pregnant faster?

Eating a complete and well-balanced diet is a perfect way to optimize your health and energy level.  It’s important to know what your BMI is and what your healthy weight should be. Your BMI is calculated from your height and weight.  You can find out your BMI by using an online calculator at web sites such aswww.nhlbisupport.com/bmi. Being under- or overweight can affect your ability to get pregnancy and have a healthy pregnancy. A Nutritionist may be helpful in guiding you in the right direction. The Mediterranean diet has been embraced by the medical community as the model of healthy living. This style of eating combines a well-balanced diet, consumed in a relaxed environment and regular physical exercise.  Plant foods, fresh fruit, whole grains, fish, lean meats, unprocessed foods and healthy fats are the highlights of this diet which is perfect for the pre-pregnancy planning period.   Regular exercise, as little as 30 minutes of moderately intense exercise a day, can improve your health and well-being.  Exercise can reduce blood pressure, reduce blood sugar levels, lower cholesterol levels, control body weight and body fat and improve your quality of life. A minimum of 3-5 times a week is excellent for overall good health and preparedness for pregnancy. Sleep-nothing is more valuable than a good night’s rest. Women need an average of 6 to 8 hours of sleep per night. Water is vital for every system in our body.  You need to drink at least 8 glasses of water a day for optimal health.  Eating well, exercising regularly, adequate water consumption and getting a good night’s sleep contribute to being your healthiest self in preparation for pregnancy. 

 

What advice do you have for older mom’s about getting pregnant?

Concerns about infertility, medical complications and birth defects are more common in the over 35year women and should be discussed months prior to getting pregnant. Fertility declines progressively with age. The aging of eggs is a well-known biological phenomenon and what is referred to as our “biological clock”. As a woman gets closer to 40, the ticking becomes louder and by 45, it can be deafening. Fertility peaks between the ages of 20 to 24.  After 35year fertility declines quickly, especially as you get closer to 40year. Over 40year a woman will have a 50% miscarriage rate due to poor egg quality and quantity. Family planning should be done in your mid 30’s especially if you don’t have a partner.  Egg freezing is best way to avoid “old” eggs. Don’t wait for your clock to malfunction.

 If you have been trying for 6 months and are still not pregnant, you should speak to your healthcare provider about getting extra medical attention. 

If you are single and do not have a partner, the conversation of egg freezing can be discussed and explored.  

When it comes to increasing our chances of conceiving, is there a ‘best’ sex position for couples to try?

There are no known Cirque de sole sexual positions that have been medical proven to help get you pregnant but there is a healthy intuition that certain positions improve the fertility footprint in helping the egg and sperm meet up in the fallopian tube.  Since the cervix is the gateway into the uterus and fallopian tube it would make sense to have the sperm as close as possible to the cervix to help it swim up towards the eggs.  So, positions with deeper penetration-including Doggie style (sex from behind), Missionary and Cowgirl from behind supports getting the sperm as close to the cervix as possible.

What positions (if any!) should be avoided?

I am not aware of any sexual position that should be avoided if you are trying to conceive. I would avoid using salvia or unfriendly sexual lubricants that can affect the sperms motility to swim towards the egg. There are lubricants, Pre-Seed and Conceive Plus, which are sperm friendly and will not affect their ability to swim.

Would these positions differ for those who have a tilted uterus?

 

Varying sexual positions would not affect the chance of getting pregnant if someone had a tilted uterus. 

Is there anything couples can do after sex in order to increase chances of getting pregnant? 

Do not stand or sit up after having sex. Lie flat on your back and tilt your pelvis upwards (pillow under your hips) for 20 to 30 minutes allows the sperm time to swim up into the fallopian tubes where fertilization takes place. During this time, you can also have an orgasm which will also help propel sperm in the right direction.

What role does the female orgasm play when it comes to conception – if any?

 

Orgasms have many health benefits including increasing your chance of get pregnant. Even though it’s a bit controversially, the “upsuck hypothesis” is believed to help propel the sperm up into the fallopian tubes where fertilization takes place.  When a woman orgasms, strong muscular contractions help propel sperm, through the cervix and uterus, placing them in the fallopian tube where fertilization occurs. The relaxation effect of an orgasm also helps in the baby making process. Even though an orgasm isn’t a prerequisite to getting pregnant, it does seem to help increase the likelihood of conception. It is clearly a win win!

For queer couples using insemination, what options are available to make the experience less clinical and more sensual?

With same sex couples trying to conceive is a bit more medical on the road to creating a baby. Intrauterine insemination is typical performed by a healthcare provider in a medical office. Sperm is placed into the uterus or at the entrance to the cervix to allow it to reach the egg during ovulation. There are DIY insemination kits that can be done in the privacy of your own home allowing the partner, if one exists, to place the sperm in the vagina.  In the office of a health care provider, a partner can “inject” the sperm into the uterus once the insemination catheter is placed into the uterus by the health care provider. Discussing more personal strategies to bring a partner into the insemination process can be done with a receptive healthcare provider. 

 

Is there evidence that alcohol use before pregnancy can harm a developing fetus?

 

It’s been found that alcohol affects a women’s fertility.  Women who consume alcohol while trying to conceive are less fertile. The current recommendation is if you are trying to get pregnant you should not drink any alcohol.  If you decide to drink it’s best to limit your daily consumption to one to two alcoholic drinks per week.

Drinking before you are pregnant will not affect a future pregnancy but you may have trouble getting pregnant if you make alcohol a part of your daily diet.

                                                                                   

What is the best way to find an Obstetrician and hospital to delivery your baby?

Your pregnancy experience will depend significantly on your obstetrician and the hospital she is affiliated with.  You should know what your insurance policy covers and interview obstetricians to make sure you and your partner are comfortable with the doctor and the hospital they deliver at.   Hospital tours are available and encouraged so you can see firsthand where your baby will be born.