Q: We've been trying for a baby for months and I dread seeing my period—why isn't it happening?
A: Trying to conceive can be very stressful, leading to feelings of anxiety and depression as the months pass without a positive pregnancy test. However, try not to become too disheartened; even if you don't conceive in the first few months, statistically, the average couple has an 80 percent chance of conceiving within a year.

It is a good idea to keep a note of the dates of your menstrual periods, since this makes it easier to calculate the fertile time of your cycle. The best time for “baby-making” sex is just before ovulation. The average length of a woman's cycle is 28 days, counting the first day of your period as day one. So if you have a regular 28-day cycle, you can predict that ovulation is likely to occur mid-cycle, on around day 14. If your cycle length varies, this can make calculating the midpoint more difficult, but observing and recording your body's fertility indicators during your menstrual cycle can help you identify your fertile time (see Signs of ovulation).

Other measures you can take to maximize your reproductive health include taking pre-conceptual folic acid, minimizing your intake of alcohol, avoiding recreational drugs, stopping smoking, and avoiding smoky environments. You should also check your rubella immunity before you become pregnant Check rubella status.

Q: How long should I wait before I go to see my doctor?
A: There is no wrong or right amount of time to wait before going to see your doctor, but a lot will depend on your age and personal circumstances. If you're both under 35 and have no reason to suspect problems, for example, previous surgery or irregular periods, then the usual advice is to seek help after about a year of trying to conceive. Women over 35 are advised to seek help earlier, since fertility starts to decline more rapidly after your mid-30s. Your doctor can carry out a few basic tests right away to rule out obvious fertility problems, such as monitoring your hormone levels, screening for sexually transmitted infections, such as chlamydia, and semen analysis for your partner. Your doctor may then refer you to a specialist.
Q: My periods are really irregular—what are my chances of becoming pregnant?
A: Menstrual cycles that vary more than a few days in length from month to month are considered irregular periods. An irregular cycle can be troublesome when trying to get pregnant, but being aware of your fertility signs (see Signs of ovulation) can help you determine when you are approaching your short window of fertility. Irregular ovulation and menstruation account for around 30–40 percent of fertility problems. Although there are many factors that determine how fertile a woman is, such as her age, whether her cervical fluid is wet enough to sustain sperm, or whether her fallopian tubes are open, the most important factor is whether she ovulates—releases an egg—regularly each month. Sometimes, a condition called anovulation occurs in which there is a menstrual bleed but no ovulation. If you don't release an egg each month, you won't have as many chances to get pregnant, in which case you may be given medication to encourage ovulation. It would be wise to talk to your doctor about your cycle.
Q: I don't want to get pregnant yet but maybe next year—what can we do now to prepare?
A: Adopting a healthy lifestyle and improving your general well-being are sensible measures if you are planning a pregnancy. Start by looking at your diet (see Preconception diet). Is it well balanced? Could you cut back on the amount of salt, sugar, and fast or processed food you eat? You should also increase your intake of fruit and vegetables, particularly green leafy vegetables, which are a good source of folic acid. Exercise is important too. If you have a current exercise regimen it's safe to continue with that, or do gentle exercise, such as swimming or walking, which are ideal before, during, and after pregnancy. If you smoke, you should try to quit, since this is beneficial for your general health and, more specifically, reduces the risk of miscarriage, stillbirth, premature birth, low birth weight, and sudden infant death. Likewise, you should try cutting down on or stopping your alcohol intake. The best advice is to avoid drinking alcohol completely even while trying to get pregnant. You should, of course, refrain from drinking alcohol once you are pregnant, since safe levels of alcohol intake are difficult to determine.

Checking your rubella status is a sensible measure since rubella can cause fetal abnormalities if you aren't immune and contract the infection in the first three months of pregnancy. If your immunity is diminished, you may be given a vaccine and should then wait three months before trying to get pregnant.

If you have a preexisting medical condition or are taking medication, talk to your health-care practitioner about how these may affect a pregnancy.

Once you start trying to get pregnant, make a note each month of the first day of your period since this is one question your midwife or doctor will ask to determine your estimated due date.

Q: Should I be taking folic acid before trying for a baby?
A: Folic acid has been shown to reduce the incidence of neural tube defects, such as spina bifida, in a fetus. If you are planning a pregnancy, you should take a daily folic acid supplement of 400 micrograms up to three months before conception and then continue with this until the 12th week of pregnancy. This supplementation is in addition to a balanced diet that includes green leafy vegetables and legumes, both of which are good natural sources of folic acid. Many breakfast cereals also contain folic acid, as do some fruits, such as oranges, papayas, and bananas.

Any woman with epilepsy who takes anti-epileptic drugs should take a higher dose (of 5mg) of folic acid supplementation.

Q: I'm on the pill but want a baby—what is the next step for me?
A: Whether you are taking the combined pill, containing estrogen and progesterone, or the mini pill, which contains only progesterone, stop taking them at the end of the package. You will have a withdrawal bleed as usual and then your next bleed will be a natural period. Don't worry if your normal periods don't start immediately; for some women, it can take a few months for their menstrual cycle to return.

Some doctors recommend allowing a month or two for your natural cycle to return before trying to conceive. Others believe there's no point in waiting. However, it can help to wait for one natural period before trying to get pregnant, since this means the pregnancy can be dated more accurately and you can start pre-pregnancy care, such as taking folic acid and adopting a healthy lifestyle. Don't worry if you do get pregnant sooner, it will not harm the baby.

Q: I'm a bit of a binge drinker. Is this OK as long as I stop once I'm pregnant?
A: 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 honestly assessing your lifestyle can motivate you to make the changes necessary for a healthy pregnancy 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.
Q: Does smoking stop you from becoming pregnant?
A: 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).

Q: My partner says soft drugs are OK—should we stop now that we're planning a baby?
A: 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.
Q: Is it safe to take prescribed or over-the-counter medicines?
A: 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.
Q: My partner had a vasectomy—can it be reversed?
A: 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.
Q: I don't seem to be getting pregnant—is it because I'm overweight?
A: 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 fat-related 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.

Q: I like to be really skinny—will that stop me from having a baby?
A: 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.
Q: I've had STIs in the past, but everything is fine now—will that stop me from conceiving?
A: 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.

Q: I'm 37 and would like to start trying for a baby—have I waited too long?
A: 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. 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.

Q: Is my endometriosis preventing me from getting pregnant? We've been trying for two years.
A: 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.

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