Now that you are ready to conceive there are a few things to think about to make sure you and your baby to be are healthy. First of all, you will need to stop your birth control!. If you have been on pills or other hormonal birth control you have not been releasing eggs, and that process will need to return. It may return in a few days (we all know people who got pregnant after missing just 2-3 pills) or it may take a few months. So if you have an ideal time to conceive you may want to stop your pills a few months before that to give your body time to adjust to ovulating again. (If you do conceive a few days after getting off pills it is totally safe, so it is good to be prepared to be pregnant as soon as you discontinue birth control).
If you are a planner, we recommend waiting until you have a cycle on your own, off pills, before trying for pregnancy. This will make it easier for you to plan when to try (see below) and to know when you conceived. In the meantime, start taking a prenatal vitamin or any supplement containing at least 400 micrograms of folic acid. Studies have shown that folic acid reduces the risk of neural tube defects or spina bidifa. Ideally we should take folic acid before we conceive. If you smoke, it is time to stop. If you take any prescription medications talk to us or your prescribing doctor about whether they are safe to continue in pregnancy. Moderate amounts of alcohol are safe until pregnancy is diagnosed; after that we recommend abstaining altogether. Normal activities and exercise are also healthy to continue. Excessive exercise associated with a very low body fat can alter ovulation patterns, but if your cycle is normal off pills that is a good sign that ovulation is occurring.
If you or your partner’s family history is significant for any abnormalities that affect babies at birth such as Down’s syndrome, heart defects, cystic fibrosis, sickle cell disease or other genetic disorders, talk to us before conception and we can evaluate your risk and offer appropriate testing. If you do not know if you have had chicken pox, or are not sure if you are immune to rubella (german measles) we can test for immunity in a blood test before you conceive. If you need a vaccination it needs to be given a month before conception. These are all good topic to discuss at a preconceptual visit, and we love to meet partners at these visits too!
In high school I remember being taught that we can conceive at any time of the month. While this is not bad information for teenagers to believe, in reality there are only a few days of each monthly cycle that we are fertile. We count the days of our cycle with day 1 being the fist day of bleeding. Assuming we are having cycles about 26-32 days apart, most women release an egg (usually one and occasionally 2 or 3) on about day 12-16. After the egg is released, if we don’t conceive we will bleed again about 2 weeks later. The most fertile day is the day before the egg is released, because the sperm are already present in the fallopian tube when the egg appears. The day of egg release is the second most fertile day. Since the egg only lives for about 24 hours, by the day after ovulation we are no longer fertile.
It is good to remember that sperm can live 3-5 days in some cases, so having intercourse on day 10 could still result in pregnancy if the egg is released on day 14. Taking all that into account, for a woman with normal 28-30 day cycles, she should attempt pregnancy from about day 10-16. It is not necessary to have intercourse daily as sperm live for at least 2 days, so every day will work as well and is less stressful for some couples. If trying for a week each month is not practical, there are some over the counter tests that can narrow down the day of ovulation a little more accurately. Ovulation Predictor tests are available for any pharmacy and test for the presence of LH (lutenizing hormone ) in the urine.
The day before ovulation LH sharply rises and can usually be picked up in the urine. Since this identifies the day before ovulation, it identifies the most fertile 2 days of the cycle (the day of the positive test, and the following day). If we are having cycles that are longer than 32 days or shorter than 26 days we may have ovulation dysfunction that could hinder fertility. If cycles are significantly short or long we would offer some blood testing to evaluate for ovulation dysfunction.
Providing your cycles are generally regular, we advise trying for 6 months at the time of ovulation before worrying that anything is wrong, Sometimes things just take a few months. If you have not conceived within 6 months, or as soon as you have a positive pregnancy test at home, give us a call and we will be happy to see you.
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