Wednesday, April 20, 2011

How to get pregnant

I have been asked "How do I get pregnant?" several times. Yes, it may seem like a silly question... we all know what you need to do to get pregnant. It's not so much asking how but more of asking what are the things to do to get ready to trying to concieve (ttc) to provide an optimal environment for pregnancy. I believe this is not only a valid question but a smart one.

First off I would say that if you are on any sort of hormonal birth control go off of it and try to start tracking your cycles without it. We all know timing is everything and you have to see how coming off hormonal birth control affects your cycle. It is different for everyone. I personally had no change after coming off the pill the first time. However I have heard of others having their cycle either changing a few days to a completley new schedule. Its important to give your body time to adjust to its natural cycle.

How long should you wait after coming off birth control?
That is a personal question and really only you and your doctor can decide what is right for you.  I have found various sites stating to wait at least one cycle. I think that's smart. I personally choose to wait 3 cycles to make sure everything was out of my system and I could properly track my cycle. However keep in mind that some women only forget to take a pill one day and they get pregnant. So once again, everyone is different.

Here are some online resources about ttc after birth control:
http://www.webmd.com/baby/guide/getting-pregnant-after-birth-control
http://www.thebabycorner.com/page/2425/

Are you on any medications?
I cannot stress the importance of this enough. If you are on any medications its best to discuss if it is safe to take prior to ttc and during pregnancy. See if you can obtain the medication's insert with full disclosure. I was on a migraine medication prior to ttc. Unbeknown to me, this medication was also used as an anti-seizure medication. Anti-seizure medications are linked to a plethera of birth defects. {of course I had no idea until much later, when it was too late} I came off this medication shortly before ttc but evidently there was still enough in my system to cause problems. I went on to have a baby girl born with Anencephaly who was stillborn in 2007. Though there is no solid evidence proving this medication caused it, the fact that my daughter died was proof enough to me. So please please please check the medication you are on if you are thinking of getting pregnant. It just may save your baby's life. {Also if you are a smoker it's best for you to quite smoking to increase your chances of getting pregnant, not to mention its better for children to not have any smokers in the home}

Tracking your cycle
This is probably the most important part of ttc, and the most complicated part of ttc if you ask me. First off Im sure you have heard that most women have a 28 day cycle. If you are on the pill, yes, it does that for you while you are taking hormones. Some naturally do have a 28 day cycle but many do not. Normal is anywhere from 21 - 35 days. Despite how many days your entire cycle is one thing is true for everyone. From your ovulation day (O-day) till the day you expect your period is always 14 days. {this is in regards to those without any fertility issues} Even with irregular cycles O-day to the day of your period {period= aunt flow= AF} is always 14 days. That 14 days is refered to as the two week wait (2ww) {to find out weather or not you are pregnant}.

The key is to DTD (do the deed) on the days leading up to your O-day and maybe even a day or so after your O-day. You can only get pregnant when you ovulate. Sperm can live inside your body up to 5 days so its good to start before your O-day because if you miss an opportunity to DTD on your O-day they still have a chance to do their thing inside you. Cycles have been known to act up while ttc, I think mostly because of stress, so there may be a chance that you O a little later than usual. That is why I suggest DTD even a day or so after your O-day. {a side note: not DTD during that time frame does not guarentee you will NOT get pregnant. This method should not be used as a form of birth control}

I had great success using Fertilty Friend to track my own cycles. What I love best about them is that they offer their basic ovulation calendar free of charge. You can upgrade to get notifications and added features for an additional price, but honestly, I never needed any of that stuff. The free version worked great for me. If you dont like the calendar offered on this site you can do a goole search for 'ovulation calendar' and you will get dozens of different links to one.

After I had my first two children I noticed that my cycle never went back to my 'normal' cycle. Having a baby just threw it off and it was sort of all over the place. So when I wanted to have another child, getting pregnant proved to be a little more difficult. The tracking on fertility friend just wasnt cutting it. So I invested in some OPK test (ovulation tests). They work the same was as a pregnancy test {you pee on them}. The way I found them to work best for me {with an irregular cycel} was to take 2 tests daily. Once in the morning when I first woke up and another in the afternoon. It is a test that predicts LH (Luteinizing Hormone) surge, and in turn, when you are likely to ovulate and possibly conceive. A surge can happen at any time and is gradual. So thats why you test twice a day. You may not have had a surge in the morning but you may later that evening. A positive test will have 2 lines. It starts out light and as your surge increases the lines will darken. Its as soon as you see a positive that you should DTD. Most OPK directions will tell you that you can stop testing after you get your first positive but I prefer to continue testing to see exactly how big of a window I have to get pregnant. I keep testing until the test goes back to negative {1 line}. During your window, or positive opk test days, DTD at least every other day. If you are looking for cheap OPK tests, I highly recomend buying from www.saveontests.com. They are affordable and come in huge packs. They also sell pregnancy tests and for those that are obsessive testers during the 2ww buying these will definately save you money. Also as a little fun fact, did you know that OPKs can also be used as a pregnancy test? Yep, if you are pregnant they will be positive as well. The way you know the difference between a positive for ovulationa and a positive for pregnancy is that the ovulation one will fade and eventually be negative. The positive for pregnancy will remain positive for as long as you remain pregnant.

Folic acid & prenatal vitamins
This is another important topic. I have dedicated an entire post to the importance of folic acid here. You must read this, it could end up saving your baby's life. But the short version is that as soon as you have decied that you want to ttc, you should get on prenatal vitamins. As to how far in advance, again that is something that you and your doctor should decide on. I personally start 3 months before. In addition to your prenatals it's important for you to take folic acid. You can find folic acid at any health food store, drugstore or vitamin shop.


What can the men do?
As you have imagined there is a lot less for men to do to get ready to ttc than women. However, there are steps they can take to create optimal conditions for getting pregnant.
1. Wear boxers, not briefs. Briefs cause the testicles to be closer to the body, thus keeping them warmer. Heat actually kills sperm. So for the most number of swimmers boxers are better.
2. Change to a healthier lifestyle.

Why diet matters for men
Nutrition has a direct impact on the potency of your sperm. Research shows that poor eating habits and regular consumption of alcohol, for instance, can lower the quality and quantity of sperm, making conception more difficult. And since infertility is nearly as much a man's issue as a woman's — up to 40 percent of fertility problems can be traced to men — eating healthfully now will boost your chances of conceiving a child.

Conception isn't the only reason to revamp your diet. Additional research shows that dads who drink heavily — the equivalent of two drinks a day — during the month prior to conception have babies who weigh on average 6.5 ounces less than other babies. Low birth weight is a serious medical condition that can affect your child's health and behavior for the rest of his life.

http://www.babycenter.com/refcap/pre...on/4188.html#1

Which nutrients are most important for men?
Your diet should be every bit as balanced, varied, and nutritious as your partner's. Specifically, future dads should:
Eat plenty of foods rich in vitamin C and other antioxidants: They help prevent sperm defects and boost its motility (movement). An eight-ounce glass of orange juice contains 124 milligrams. Aim for at least 60 mg of vitamin C daily, more — at least 100 mg — if you smoke.
Get more zinc in your diet. Several studies show that even short-term zinc deficiencies can reduce semen volume and testosterone levels. Great sources to help you get the 15 mg you need a day include oysters (six medium oysters have a whopping 76.3 mg), extra-lean ground beef (a three-ounce serving has 4.5 mg), baked beans (a one-cup serving has 3.55 mg), and dark chicken meat (2.38 mg per three ounces).
Fuel up on folic acid. Studies suggest that men with low levels of this key B vitamin — the same one women need to reduce the risk of neural tube birth defects — have low sperm counts. You may be able to get the amount you need (400 micrograms a day) from fortified breakfast cereals, leafy greens, legumes, and orange juice, but just to be sure, it can't hurt to take a folic acid supplement or a multivitamin.
Increase your intake of calcium and vitamin D. Infertility researchers at the University of Wisconsin at Madison suggest that consuming 1,000 mg of calcium and 10 micrograms of vitamin D each day may improve men's fertility. Good sources of calcium include low-fat milk (an eight-ounce glass has 414 mg) and yogurt (one cup has 302 mg of calcium). You'll find vitamin D in milk (an eight-ounce glass has two mcg) and salmon (a three-ounce serving has eight mcg).
Cut out or cut back on alcohol. While an occasional drink is generally considered safe, studies show that daily consumption of wine, beer, or hard liquor can decrease testosterone levels and sperm counts and increase the number of abnormal sperm in your ejaculate.
http://www.webmd.com/baby/features/can-dads-diet-make-healthier-baby

Some extra tips
The question of how often to DTD comes up a lot and once again it is a personal decision. I have come across a few forums that have discussed this. Its the age old question if its better to DTD everyday or every other day. It has been suggested that sperm need a regeneration period. If you DTD everyday the sperm quality is lower. But if you wait every other day it has replentished fully and you have more quality sperm. I have yet to see an offical study of this but I prefer to do every other day. Even if this were not true, I would still choose every other day because in my opinion DTD everyday is more of a chore than having fun. And its important to still enjoy yourself while trying to make a baby. Not only that but you would be surprised how burt out men can get by DTD everyday :)

My last tip is that after you have DTD stay laying down for at least 20 min. {Dont stand up, as this will cause the semen to leak} Keep a small pillow under your hips to slightly elevate your uterus and help the sperm reach your cervix. You dont want to prop a dozen pillows under you to the point that you are practically doing a handstand though haha! This will actually cause the semen to pool behind the cervix and none actually get inside to swim to the egg. Try to relax during this time and actually invistion the sperm getting to the egg. Possitive affermations and visualizartions really work wonders.

TTC after miscarriage/ stillbirth
Trying for another baby after a pregnancy loss is a personal choice. It is natural to want to become pregnant again right away after going through the heartache of losing a baby. However, you should wait to attempt again until you are physically, as well as emotionally ready. I would suggest you speak with your doctor to see when is the soonest you would be able to ttc physically. Below are some helpful links to information to help you make an informed decision:
http://www.americanpregnancy.org/pregnancyloss/mcgettingpregnantagain.html
http://miscarriage.about.com/od/tryingagainafterloss/Trying_to_Conceive_After_Miscarriage_Pregnancy_Loss.htm

Here are also some links to some ttc after loss forums:
http://forums.fertilitycommunity.com/trying-conceive-after-loss/
http://community.thebump.com/cs/ks/forums/4493594/ShowForum.aspx?MsdVisit=1
http://boards.babyzone.com/trying-to-conceive-after-loss-f431.html
http://community.babycenter.com/groups/a723395/ttc_after_a_2nd3rd_trimester_loss

Folic Acid

Researchers have found that 50-70% of NTDs (neural tube defects) can be prevented when women supplement their diet with folic acid, a water-soluble B vitamin. The Centers for Disease Control (CDC) recommends all women of childbearing age eat a diet high in folic acid or take a multivitamin with 0.4mg of folic acid each day, especially one month prior to conception through the first three months of pregnancy. This dosage is the amount found in most over-the-counter multivitamins. However, women who have had a previous NTD pregnancy are recommended to take an even higher dosage of folic acid prior to planning a pregnancy. They should increase the daily dose of folic acid from 0.4mg to 4.0mg (10x the recommended amount), one month prior to conception through the first three months of pregnancy. The 4.0mg of folic acid should only be obtained through a prescription from the doctor.




But even if you are not actively trying to get pregnant one should still take folic acid if you are engaging in any acts that may result in pregnancy. This is because the early spinal cord of the embryo begins as a flat region, which rolls into a tube (the neural tube) 28 days after the baby is conceived. When the neural tube does not close completely, an NTD (Neural Tube Defect) develops. NTDs develop before most women know they are even pregnant.


Its a good idea to increase your folic acid dosage even if you have not had history of a prior NTD. I am living proof that taking the recommended dosage does not prevent all NTDs. I was on the recommended dosage 3 months before trying to conceive and all through my pregnancy with Genesis. Had I been taking more folic acid she may have not been born with anencephaly. Though know that even with an increased intake of folic acid there is still a 1% chance you may have a child with a NTD. Another thing to keep in mind is that most people who have a child with a NTD hav had no prior family history of NTDs.


How a woman can get enough folic acid?

There are two easy ways to be sure to get enough folic acid each day:

  1. Take a vitamin that has folic acid in it every day. 

    Most multivitamins sold in the United States have the amount of folic acid women need each day. Women can also choose to take a small pill (supplement) that has only folic acid in it each day. 

    Multivitamins and folic acid pills can be found at most local pharmacy, grocery, or discount stores. Check the label to be sure it contains 100% of the daily value (DV) of folic acid, which is 400 micrograms (mcg).
  2. Eat a bowl of breakfast cereal that has 100% of the daily value of folic acid every day. 

    Not every cereal has this amount. Check the label on the side of the box, and look for one that has “100%” next to folic acid.

AudioAudiocast: Folic Acid Now Audio/Video file 
Listen to an audiocast about folic acid.








What Foods Contain Folic Acid?
Approximately half of all pregnancies are unplanned, so the U.S. Food and Drug Administration has taken steps to fortify certain foods so that all women of childbearing age get a daily dose of folic acid. The following foods can help you obtain your recommended amount of folic acid:


  • Leafy green vegetables, such as large spinach salad
  • Citrus fruits, such as orange juice
  • Beans
  • Breads
  • Cereals
  • Rice
  • Pastas

Can You Overdose On Folic Acid?
Folic acid has no known toxic level. If you were to eat a bowl of fully fortified cereal (400 micrograms), take 400 micrograms (0.4 milligrams) folic acid supplement, and eat fortified foods and foods rich in folate, women of reproductive age would not have a problem with too much folic acid. Even in very high amounts folic acid is non-toxic. Nevertheless, it is recommended that women consume no more than 1,000 micrograms of synthetic folic acid a day. Large amounts of folic acid may hide the ability to quickly diagnose pernicious anemia, a rare vitamin B-12 deficiency. This condition primarily affects the elderly population and, in some cases, can lead to neurological damage. Today, Doctors can use a simple definitive test to check for a B-12 deficiency. Folic acid is water-soluble. Water-soluble vitamins dissolve in water. Leftover amounts of the vitamin leave the body through the urine. That means you need a continuous supply of the vitamin in your diet. Because of this, overdose is not likely. Anything your body cannot absorb gets excreted through your urine.


Findings from a survey conducted in 1998 to assess folic acid knowledge and practices among women of childbearing age in the United States indicate that of all women surveyed, only 13% knew that folic acid helps prevent birth defects, and only 7% knew that folic acid should be taken before pregnancy to prevent birth defects.


You should not take folic acid if you have any of these conditions. You may need a dose adjustment or special tests to safely use folic acid:
  • Kidney disease (or if you are on dialysis)
  • Hemolytic anemia
  • Pernicious anemia
  • Anemia that has not been diagnosed by a doctor and confirmed with laboratory testing
  • An infection
  • If you are an alcoholic
  • If you are allergic to folic acid

Who Is At Risk:
NTD-affected pregnancy. It is not possible to predict which women will have a pregnancy affected by an NTD. 95% of NTDs occur in women with no personal or family history of NTDs. However, some risk factors are known:
  • An NTD-affected pregnancy increases a woman's chance to have another NTD-affected pregnancy by approximately twenty times
  • Maternal insulin-dependent diabetes
  • Anti-seizure medication use
  • Medically diagnosed obesity
  • High temperatures in early pregnancy (prolonged fevers and hot tub use, for example)
  • Race/ethnicity (NTDs are more common among white women than black women and more common among Hispanic woman than non-Hispanic women)
  • Lower socio-econimic status


Types Of Neural Tube Defects (NTDs)
There are two types of NTDs. The most common type are called the open NTDs. Open NTDs occur when the brain and/or spinal cord are exposed at birth through a defect in the skull or vertebrae (back bones). Examples of open NTDs are spina bifida (myelomeningocele), anencephaly, and encephalocele. Rarer types of NTDs are called closed NTDs. Closed NTDs occur when the spinal defect is covered by skin. Common examples of closed NTDs are lipomyelomeningocele, lipomeningocele, and tethered cord.

Lastly, spina bifida occulta (SBO) is potentially another form of an NTD in which there is a typically benign (or non-symptom-causing) bony change in one or more vertebrae, but not involving the nerves within the spinal column. The incidence of SBO is not well defined; however, it is more common than the NTDs described above. The cause and potential similarities, or, link to NTDs, has not been established.



Even More Folic Acid Resources: