Getting ready for pregnancy
Getting pregnant is something that most of us take for granted, but conceiving isn't always easy. However, there are things you and your partner can do to 'prime' yourselves for pregnancy. Fertility specialist Dr Richard Fisher explains.
Having children is something our society places a high value on. Although some people will reject this option, for the vast majority of people, having children is both a biological and social imperative.
Despite this, it is often one of the things we prepare least well for. Contraception has given women an opportunity to choose the time they might ideally conceive, but only a small number realistically plan preconceptionally for the best outcome for themselves and their babies.
Doctors like myself tend to focus on those who have difficulty getting pregnant, rather than those who do it with ease. For most couples, conception occurs without problems. Conception is very much about chance, and some people are just luckier than others. Being lucky but unprepared, however, is not of benefit to either the mother or the baby.
Pregnancy illustrates very well the adage that prevention prior to the event is much better than resolution of a problem later. With an increasing knowledge of risk factors, not only to the fetus in utero but to that child's children as well, special care prior to and during pregnancy seems wise.
Getting pregnant is not meant to be a military exercise. The aim should be to maximise the chance of a healthy pregnancy while still retaining the concepts of love and passion. If pregnancy takes a while to achieve, even this aim becomes more difficult.
Few couples make major life decisions without some discussion with close friends and family, but this discussion seems very limited when it comes to planning to conceive. That arm's-length relationship is satisfactory as long as pregnancy happens quickly, but if it does not, then relationships become complicated by the lack of knowledge of those close to you about your desires, and the frustrations that occur when they are not met. Those to whom you might turn for support in good times and empathy in bad simply don't know what to do. The ratio of what appear to be stupid or unsympathetic comments to expressions of real care will only change when knowledge of the goal is shared.
As with many things, timing is everything, and the right time will be different for everybody. There are aspects one cannot change, such as the age you are when you meet your partner, and it seems only sensible not to attempt to conceive too early in a relationship. However, understanding the effect of age on conception, so that one can be realistic and informed about the chances of getting pregnant each month, is very important in managing one's own expectations, never mind anyone else's.
Knowing when ovulation occurs and, consequently, the best time for conception, is also important. One can, of course, try the "random chance" technique of getting pregnant, which tends to lead to a regularity of intercourse - which, although superficially attractive, is not particularly focused. The fantasy of persistent, regular sex seems to wear thin if conception does not occur quickly. In women with regular cycles, ovulation occurs around 14 days before the onset of her period, and intercourse on every second day through this time should be sufficient to give you as good a chance as anybody else.
For most people, it is unnecessary to take temperature charts, test saliva or urine for hormone changes, or learn to detect pre-ovulatory mucous changes for conception to occur.
If you must focus on a particular day, then the day before ovulation is the best time to try to conceive, when cervical mucous is at its most receptive. Sperm, like vegetables, are best used fresh. Saving up for a week to let loose a neutron bomb's worth of sperm at ovulation is unhelpful, as the sperm is aged and, consequently, subject to DNA degradation and reduced function.
So, how might one prepare best for pregnancy? A visit to your GP is a great place to start. Besides being able to confirm that you are immune to rubella (and consequently at no risk of contracting rubella in early pregnancy and damaging your baby), he or she will be able to take your blood pressure and some routine blood tests to make sure you have no unexpected underlying health issues. He will also be able to help you assess when ovulation is occurring, or is likely to do so, and is a good point of contact if things don't happen quickly. As part of that assessment visit, he will also talk about the sort of issues I discuss below, which are becoming increasingly important.
There are some things about which we have a degree of confidence. Weight, the use of drugs, be they recreational or prescribed, and the use of alcohol are known to have an effect both on conception and the growth and development of a baby.
Whether the use of supplements prior to conception is of help remains an unanswered question. There is clear evidence that the use of folic acid preconceptionally reduces the incidence of some congenital abnormalities, in particular spina bifida, but currently there is no definitive evidence that other vitamin or mineral supplements, in otherwise healthy women, improve the chance of conception or the outcome for their children. One needs to be careful of extrapolating from single pieces of information into a generalisation that creates a need for the "worried well" to change their lifestyle or supplement their diets unnecessarily.
Weight is clearly important. Being too big or too small can affect the chance of conception, the chance of miscarriage, and the outcome for the child. Both calorie restriction and calorie excess in early pregnancy are known in animals to alter the long-term health outcomes for offspring, and confirmation of the same effects in humans is beginning to appear.
Smoking negatively impacts nearly every aspect of fertility. The chance of getting pregnant per month is only 60% of your same-aged non-smoking sister; miscarriage rate increases significantly, as does the rate of ectopic pregnancies. In women who smoke and undergo IVF, less eggs are obtained, more failures of treatment occur, and more miscarriages occur.
There is an increasing body of literature which shows that caffeine is potentially harmful, both in terms of trying to conceive and in increasing the risk of miscarriage. The data suggests that limiting caffeine intake would be wise, although having a single coffee a day in our coffee-socialised society does not seem likely to adversely impact on the average woman.
It is easy to be supercilious about alcohol. It's probably true that more children are conceived following consumption of alcohol than without it, and it is ever-present in our society. It is clear, however, that any amount of alcohol is unsafe in pregnancy. The risks to the fetus are idiosyncratic, and everyone knows someone who has consumed alcohol in early pregnancy or throughout the pregnancy and their children have come to no harm.
Sadly, this is not universally true. Drinking in pregnancy carries unwarranted risks and should be avoided. Pre-conceptionally, the only truly accessible data comes from IVF programmes, where it has been shown that both the chances of conception were diminished and the risk of miscarriage was increased in women in proportion to the number of units of alcohol consumed in the time leading up to treatment.
In men, one additional drink per day increased the risk of failure of treatment by two to eight times, depending on the time period. It is always difficult to extrapolate findings from a specific treatment like IVF into natural conception, but it is reasonable to assume there must be some effect, even though it might be small.
Increasingly, men are asking what they can do to help improve their partner's chance of conception. Finding relevant data is particularly difficult in men, as the only outcome really worth measuring is whether a live birth occurs. Measuring sperm counts is not particularly useful, as it is so enormously variable, and within that variation there are so many potential outcomes.
Clearly, however, cigarettes (be they tobacco or marijuana), alcohol, and excess weight all appear to be detrimental and appear to increase the risk of long-term health effects on their children. Smoking more than ten cigarettes per day in men increases the risk of childhood cancer in their offspring fourfold. Men need to be aware that what they do now may well affect the quality of life of their children. Producing healthy sperm at conception is among the greatest gifts a man will ever give his children.
Planning precisely when conception will occur is always difficult and subject to biological chance. It would seem wise, however, to ensure that while attempting to conceive, both partners are aware of the need to be in the best health they can be at the time. Their children should then thank them (but almost certainly won't!).
Richard Fisher (FRCOG, FRANZCOG, CREI), together with Freddy Graham, established Fertility Associates in 1987 after previously starting up New Zealand's integrated infertility medicine group at National Women's. He is New Zealand's foremost medical spokesperson on matters of reproductive health, and has been an advocate for better access to care for couples with infertility throughout his career. He has four children and is married to Leigh, without whom he could never have practiced medicine with the enthusiasm and commitment he has. www.fertilityassociates.co.nz will tell you more about Richard and the team at Fertility Associates.
AS FEATURED IN ISSUE 5 OF OHbaby! MAGAZINE. CHECK OUT OTHER ARTICLES IN THIS ISSUE BELOW