Clearblue Advisors answer the most common questions regarding reproductive health, to enable you have a greater understanding of how your body works.
At Clearblue we actively engage with a range of leading Pregnancy and Fertility experts around the world, to support us in our commitment to help as many women as possible to increase their chances for a healthy pregnancy. Our experts, all highly-regarded within their fields, are specialists in areas such as Assisted Reproduction, Fertility and Early Pregnancy. They are here to provide you with comprehensive knowledge for a greater understanding of your reproductive life.
Monica Moore is the founder of “Fertile Health, LLC”, a consulting company created to train new nurses in reproductive endocrinology and to encourage nutritional practices into fertility centers. She is a Women's Health Nurse Practitioner, and was one of the nurse managers at Reproductive Medicine Associates of Connecticut (RMA of CT) and continues to work as a consultant for them. Prior to joining RMA, Monica was the donor nurse coordinator at the Atlanta Center for Reproductive Medicine. Monica's first job in reproductive endocrinology was at Cornell Center for Reproductive Medicine and Infertility 20 years ago.
Monica's passion lies in nutritional interventions for couples attempting pregnancy and for women diagnosed with PCOS.
Why is folic acid recommended when trying for a baby?
Folic Acid is a B vitamin that is used to generate new cells in the body. Research has shown that helps to prevent neural tube defects, such as spina bifida, in the baby when taken prior to, and during, pregnancy. The recommendation by the Center for Disease Control (the CDC) is to start taking 400 µg of folic acid 1 month prior to conception and continue it during the pregnancy. If a woman has had a child affected by a neural tube defect in the past, she should speak with her doctor about increasing the preconception dose.
Are there any foods I should avoid when trying for a baby?
Some foods are not recommended when attempting pregnancy because they can contain Listeria, a bacteria that can cause an infection that can be harmful to the baby. Any cheese product containing unpasteurized milk (such as brie or feta cheese) can be a vehicle for listeria, as can prepared salads that you might find in a supermarket. Also, raw foods (such as sushi, raw oysters or clams) can contain bacteria or parasites that are also harmful and should not be ingested. Women should also avoid fish that are high in mercury, like tuna and swordfish. Any raw fruits and vegetables should be thoroughly washed as well.
I have recently had a miscarriage; how soon can I start trying to get pregnant again?
For early, uncomplicated pregnancy loss, some women were advised to wait 3 months. But, according to a growing body of evidence, there is no reason to delay attempting pregnancy again after having a loss. In fact, some studies have shown that the uterus might be more receptive to a pregnancy following an early loss. If the loss was due to an ectopic or molar pregnancy, or accompanied by other complications (like infection), then that might require longer follow-up prior to attempting to conceive again.
I have been diagnosed with polycystic ovarian syndrome, will this make getting pregnant difficult and why?
Women with polycystic ovarian syndrome(PCOS) often do not ovulate regularly, and ovulation is necessary in order for fertilization and conception to occur. Fortunately, there are many medications that can induce ovulation, although a women's OB/GYN might refer her to a specialist to manage this.
As we are trying for a baby should we increase our frequency of intercourse? Can too much intercourse damage the quality or quantity of the sperm?
Most clinicians advise that men with normal sperm count should increase the frequency of intercourse around the woman's fertile window (just prior to and at the time of ovulation) to increase the chance that fertilization takes place. Although an increase in intercourse can decrease the volume and total number of sperm, the level seems to remain high enough to fertilize the egg and the quality of the sperm might even be improved as opposed to longer intervals between sperm production.
How long should I wait between my last pregnancy and trying for my next child?
The decision re: when to try for a subsequent pregnancy is a personal one based on the couple's age and desired family size. Medically the recommendation, according to the American College of Obstetricians and Gynecologists (ACOG) the optimal time between delivery and the next pregnancy is 18 months to 5 years. The greatest risk (for the subsequent pregnancy) occurs when this interval is < 6 months.
Can I ovulate more than once during my cycle?
Routinely, early on during a menstrual cycle, a ‘wave’ of follicles starts to grow. One of them establishes itself as dominant and continues to grow, while the others get reabsorbed by the body. It is possible to ovulate twice per menstrual cycle, but this is usually the result of two eggs ovulating around the same time and, should both of them be fertilized, can be the reason for non-identical twinning. Ovulating during two phases of the menstrual cycle, though, is extremely rare
Can certain sexual positions increase our chances of conceiving?
There is no optimal sexual position in terms of increasing chance of conception. The sexual position used should be one that provides the greatest comfort and enjoyment for both partners.
I suffer from endometriosis and am worried I won’t be able to get pregnant, is that true?
Women with mild endometriosis may conceive easily, although there is some data that that their chances of conceiving without help might be slightly lower than women without endometriosis who are a similar age. Those with moderate or extensive endometriosis, which can affect much of the female reproductive tract, should be proactive in speaking with their doctor as soon as they know they desire to conceive.
We are planning to try for a baby, are there any dietary supplements apart from folic acid that can help me?
Eating a balanced diet and maintaining a healthy weight are incredibly important prior to conception. Any additional nutritional needs can be met by taking a daily prenatal vitamin that contains the necessary vitamins and minerals. In addition, it's important to make sure that the prenatal vitamin contains DHA, which is an essential fatty acid that is critical for brain and neurological development. Babies depend on a maternal supply of DHA (since we do not produce it, and must get it from our foods or supplements). If the prenatal vitamin doesn't contain DHA, this should be added as a separate supplement to assure proper neurological health for the baby.
We are planning to try for a baby, are there any dietary supplements that my partner should be taking?
We always recommend that our patients obtain their nutrients from food, whenever possible, instead of relying on supplements. Although some studies have shown that men's sperm parameters might be improved by supplementing with a combination of certain minerals and anti-oxidants, whether or not this improvement translates into increased pregnancy rates (which is the ultimate goal) is unclear in the literature at this point. What is known, though, is that lifestyle changes, such as maintaining a healthy weight, stopping smoking or any recreational drugs, and minimizing alcohol intake can improve the quality of sperm.
My cycles never seem to be the same length, is that normal?
It is normal for cycle length to vary slightly as the amount of time it takes for a follicle (egg) to grow and mature can differ for women from cycle to cycle. If trying to conceive, though, it might be helpful to use a urinary ovulation predictor kit to help identify your fertile window.
Miss Emma Kirk is a Consultant in Obstetrics and Gynaecology at the Royal Free Hospital London, where she is the Lead for Early Pregnancy and Emergency Gynaecology. She has a special interest in Early Pregnancy and Gynaecological Ultrasound. She worked as a research fellow for many years and has published over 50 peer reviewed papers on early pregnancy topics. She has written many book chapters and edited her own book on Early Pregnancy Ultrasound. Emma is Coordinator of the European Society of Human Reproduction and Embryology Special Interest Group in Early Pregnancy. She is on the board of the Association of Early Pregnancy Units (AEPU) and is a medical advisor to the Ectopic Pregnancy Trust (EPT). She frequently lectures on different aspects of early pregnancy.
I got a pregnant result on a pregnancy test but am now spotting a little blood, is this normal?
It might be normal as long as it is just spotting, not like a normal period, and you are not experiencing any significant pain that requires more than a mild painkiller like paracetamol. If the spotting during pregnancy continues and /or you have any concerns speak with your doctor. If you continue to experience spotting during pregnancy your doctor will most likely arrange an early ultrasound scan.
I had a positive pregnancy test last week but have just taken another test now which is negative - am I pregnant?
If you followed the test instructions correctly the results of home pregnancy tests are very accurate. It may be possible that you experienced an early loss. Sadly this is not uncommon as about quarter of pregnancies will end in an early pregnancy loss. To be certain repeat another pregnancy test in a week's time.
I had sex last night; can I take a pregnancy test?
No, even if you had just ovulated and your egg has been fertilised, it is too early to test. It takes about a week for a fertilised egg to travel through the fallopian tube and implant into the lining of the uterus (womb). The hCG produced by the egg can only be detected in your urine once the egg has implanted. If you test before the egg has implanted (typically about 7 days before your missed period), there will be no hCG present, so a pregnancy test will always give a negative (Not Pregnant) result. The earliest you can test with the most sensitive tests currently available is 6 days before your missed period (typically 10 days after ovulation).
I've just discovered I am pregnant but I hadn't been planning for a baby. I'm worried as I have been drinking alcohol as normal - will it have damaged the baby?
It is unlikely to have harmed the baby and a continuing pregnancy is a sign that everything is normal. If you are concerned about your recent intake of alcohol you should discuss this further with your doctor. Going forward, the safest advice is to drink no alcohol at all whilst pregnant.
I think I got a false positive pregnancy test - is it possible?
Most pregnancy tests are over 99% accurate from the day you expect your period. However, I know it can be hard to wait and the most sensitive tests can be used up to 6 days before you miss your period, which is 5 days before the expected period. Be aware that if you choose to test early and get a not pregnant (negative) result you may simply be testing too early and you should test again on or after the day your period is due.
I'm taking the pill but have fallen pregnant - could this be a problem for my baby?
Taking the pill at any stage in pregnancy is unlikely to cause problems. Stop taking the pill when you find out that you are pregnant. Make sure that you tell your doctor that you fell pregnant on the pill, who will arrange for you to have the normal check-ups and scans for your pregnancy.
Michael Thomas - Not Pregnant yet Q&A
Michael A. Thomas, MD is a Professor of Obstetrics and Gynecology and is Fellowship and Section Director of the Division of Reproductive Endocrinology and Infertility at the University of Cincinnati, College of Medicine, Cincinnati, Ohio. His previous roles include Director of the Center for Reproductive Health at the University of Cincinnati and Vice Chairman of the Department of Obstetrics and Gynecology. He is board–certified in both Obstetrics and Gynecology and Reproductive Endocrinology and Infertility.
Professor Thomas gained his B.S. from Northwestern University, Evanston, Illinois, in 1980 and his M.D. from the University of Illinois, College of Medicine, Champaign, Illinois in 1984. His research interests include Contraception, Infertility, Stress and Reproductive Function, Reproductive Endocrinology, and Menopause. He is also a member of the Endocrine Society, the Society for Gynecologic Investigation (SGI) and the Society for Family Planning (SFP).
Professor Thomas is nationally recognized as a leader in the field of assisted reproduction and has published extensively in this area including articles in Fertility and Sterility, the Journal of Assisted Reproduction and Genetics, the Journal of Clinical Endocrinology and Metabolism, and Menopause.
Does stress affects my ability to get pregnant?
Stress probably has a minimal impact on a women's ability to get pregnant. Studies have shown that elite athletes and women with low female hormone production (eating disorders, low weight issues) activate their stress hormones, which can have an impact on their ability to release an egg. Normal day to day stress may not have as much of an impact on your ability to conceive. Usually stressful situations are short term and don't have an on-going affect on your fertility.
I have very short cycles, is that why I can't get pregnant?
The normal cycle range is usually from 23 to 35 days. Cycles shorter or longer than that range can be associated with fertility issues. Over the course of a woman's reproductive life span, her typical cycle lengths will fall in this time frame. If your cycles are usually less than 23 days, you should see your physician. The use of a home fertility monitor will help to predict the time of ovulation.
I've already had a child /(children) but am struggling to conceive this time; why might that be?
A number of factors can impede your ability to get pregnant even after having had a child in the past. The most common issue is your current age. If you had a child in the past and you are now over the age of 35 years, your ability to get pregnant may be decreased. You may also have developed a problem with your ability to ovulate consistently and/or a polyp or fibroid in the uterine cavity that may impact an embryo's ability to implant and thrive. Also, your male partner may have a sperm abnormality that has caused a decrease in his sperm count, motility or shape. If you are at all concerned consult your HCP?
I had a termination in the past; could it affect my ability to get pregnant now?
Usually a pregnancy termination will not affect your ability to get pregnant in the future. On rare occasions, you may develop adhesions in the uterus that can cause issues with future fertility. If you are having normal monthly cycles, the chances of these adhesions affecting your fertility are low. Seeing your fertility specialist or gynaecologist will be helpful in making sure your uterus has not been affected if you have been attempting pregnancy for one year, are under the age of 35 and have cycles between 23-35 days long. If you are over 35, consider a consultation after 6 months, and immediately if over 40.
I have heard you can have your ovarian reserve (the number & quality of eggs I have left) measured by Anti mullerian hormone and FSH blood tests - what does this mean?
In women over the age of 35, the majority of physicians routinely perform tests for ovarian reserve if you are attempting to conceive. Blood tests include an AMH or anti mullerian hormone test, which can be taken at any time in the menstrual cycle and even if you are on birth control pills. Anti mullerian hormone is made by the cells in the follicles of the ovaries and may be an early way of determining how much reserve is remaining in your ovaries. Interpretation of the results of this test may vary from health care provider to health care provider.
Also, on day 3 of the menstrual cycle (two days after you start your menses), you can obtain a blood test for Follicle Stimulating Hormone (FSH) and Estradiol. These two tests may be a way of determining waning ovarian function at the beginning of the menstrual cycle when a dominant follicle is being recruited for ovulation. Another test for poor ovarian reserve is an antral follicle count. During this test, a transvaginal ultrasound is used to determine whether the number of follicles that are ready for recruitment on Day 3 of the cycle. More detailed information on ovarian reserve testing can be found at www.reproductivefacts.org
I'm 35 and have not yet found my life partner but would still like to have a baby in the future, should I consider freezing my eggs now?
The American Society for Reproductive Medicine has recently stated that egg (oocyte) freezing is not considered experimental. Because of this, fertility centres can now freeze eggs for women who may want to use them in the future. Patients who are considering this option can either freeze eggs alone or freeze a combination of eggs and embryos (fertilized eggs) using donor sperm. As of now, the thawing of eggs and subsequent fertilization varies between fertility centres. Embryos are thought to have a better chance of thawing and implanting in your uterus than thawing eggs and attempting to fertilize at a later date.
I'm not sure I ovulate every month, what might cause this?
Women sometimes don't ovulate every month for a number of reasons. If you have menstrual cycles that occur every 23 to 35 days and you have symptoms of breast tenderness, bloating, pelvic or uterine cramping, or mood changes 3-14 days prior to your menstrual cycle, you probably are ovulating. However, if your cycles are usually over 35 days, you may not be ovulating consistently or not at all. The majority of women who do not ovulate and are not pregnant, may have Polycystic Ovary Syndrome (PCOS). PCOS is a condition that you are born with and can cause a woman not to ovulate (release an egg) on a regular and consistent basis. These women may also have adult acne or an increase in hair growth above the lip or below the chin. On ultrasound, the ovaries may be seen to have many small cysts inside them, that remain at a small size. Other conditions that can cause you not to ovulate include low thyroid function (hypothyroidism), high prolactin production (hyperprolactinemia), and during the time period prior to the menopause (perimenopause). If you feel that you are not ovulating consistently, you should see your health care provider.