The Everything Getting Pregnant Book: Professional, Reassuring Advice to Help You Conceive
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About this ebook
The Everything Getting Pregnant Book helps readers understand:
- Assisted Reproductive Technology
- Fertility surgery
- Low-tech fertility aids
- Male and female factor infertility
- Medication therapy
- Menstrual cycle basics
Whether couples are thinking about pregnancy and want to plan ahead or are already trying and have not yet met with success, The Everything Getting Pregnant Book will have them getting up for 3 A.M. feedings in no time.
Robin Elise Weiss
An Adams Media author.
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The Everything Getting Pregnant Book - Robin Elise Weiss
THE
EVERYTHING®
GETTING
PREGNANT
BOOK
Professional, reassuring advice
to help you conceive
Robin Elise Weiss, Certified Childbirth Educator
Copyright ©2004, F+W Media, Inc. All rights reserved.
This book, or parts thereof, may not be reproduced
in any form without permission from the publisher; exceptions
are made for brief excerpts used in published reviews.
An Everything® Series Book.
Everything® and everything.com® are registered trademarks of F+W Media, Inc.
Published by Adams Media, a division of F+W Media, Inc.
57 Littlefield Street, Avon, MA 02322 U.S.A.
www.adamsmedia.com
ISBN 10: 1-59337-034-2
ISBN 13: 978-1-59337-034-3
eISBN 13: 978-1-44052-279-6
Printed in the United States of America.
J I H G F E
Library of Congress Cataloging-in-Publication Data
Weiss, Robin Elise.
The everything getting pregnant book / Robin Elise Weiss.
p. cm.
(Everything series book)
ISBN 1-59337-034-2
1. Infertility — Treatment. 2. Conception. 3. Pregnancy.
4. Preconception care. I. Title. II. Series: Everything series.
RC889.W39 2004
616.6'92 — dc22 2003020366
This publication is designed to provide accurate and authoritative information with regard to the subject matter covered. It is sold with the understanding that the publisher is not engaged in rendering legal, accounting, or other professional advice. If legal advice or other expert assistance is required, the services of a competent professional person should be sought.
— From a Declaration of Principles jointly adopted by a Committee of the
American Bar Association and a Committee of Publishers and Associations
The Everything® Getting Pregnant Book is intended as a reference volume only, not as a medical manual. In light of the complex, individual, and specific nature of health problems, this book is not intended to replace professional medical advice. The ideas, procedures, and suggestions in this book are intended to supplement, not replace, the advice of a trained medical professional. Consult your physician before adopting the suggestions in this book, as well as about any condition that may require diagnosis or medical attention. The authors and publisher disclaim any liability arising directly or indirectly from the use of this book.
Many of the designations used by manufacturers and sellers to distinguish their products are claimed as trademarks. Where those designations appear in this book and Adams Media was aware of a trademark claim, the designations have been printed with initial capital letters.
This book is available at quantity discounts for bulk purchases.
For information, call 1-800-289-0963.
The EVERYTHING Getting Pregnant Book
Dear Reader:
So you are thinking that maybe you are ready to add a baby to your family. This is such a great time of learning about your body and the process of conception and pregnancy. It can really bring you together as a family.
For many of you reading this book, your journey toward having a baby will be simple and straightfor ward. You will use this book to learn how to prepare your body and your mind for conception and a healthy pregnancy. You can even learn information on how to try to time a pregnancy to lend more convenience to your life (though remember what they say about the best-laid plans!). This book will walk you through step by step.
Perhaps your fertility journey will not be as straightfor ward. You may find that you experience problems conceiving. Whether these range from ver y small and easily fixable problems to larger problems that require high-tech solutions, you will find information in this book as well. You will learn what type of testing and treatment is often required and how to find the right specialist to help you have the baby you’ve been dreaming about.
I hope you enjoy the journey toward having your baby that you will achieve by learning during this special period in your life. I also hope that your journey is a smooth one. Feel free to drop me a line and show off your baby pictures at www.robineliseweiss.com.
Have a happy and healthy birth!
9781593370343_0002_001The EVERYTHINGM® Series
Editorial
Production
Visit the entire Everything® Series at everything.com
To my dear friends: April, Eve, Jean, Kim, and Sharon
Contents
Top Ten Ways to Prepare for Pregnancy
Foreword
1 Deciding to Have a Baby
Are You Emotionally Ready?
Physical Fitness: A Whole New Definition
Fiscal Responsibility: Family Style
Taking Family Medical/Maternity Leave
What Will Your New Baby Need?
Only Child or More?
2 Body Basics: Preparing for Pregnancy
Acting Pregnant
Avoiding Alcohol
Nicotine and Smoking
Caffeine’s Common Effects
Chemical and Workplace Hazards
Enjoying Yourself
Physical Readiness: Not Just for Women
Pre-Baby Checkup
3 Menstrual Cycle Basics
Understanding Hormones
Putting Them All Together
The Ovulation Process
Determining Gender
Four Phases of the Menstrual Cycle
Tracking Your Cycle
Lifestyle Effects on Your Cycle
4 Sex: Procreative Recreation
Sex — Conception and Myths
Getting Physical: Positioning
Positioning for Special Situations
Location, Location, Location
It’s All About Timing
Talking About Sex with Your Partner
Getting Out of the Birth Control Mentality
Keeping the Romance Alive
5 Boosting Your Odds of Conception: Fertility Charting
How Pregnancy Occurs
Listening to Your Body’s Signals
Checking Your Cervical Mucous
The Position of Your Cervix
The Consistency of Your Cervix
Taking Your Temperature
Charting the Data
Natural Family Planning
Confusing Your Body’s Signals
6 Low-Tech Fertility Aids
Ferning Testers
Herbal Aids
Home Fertility Testing Kits
Fertility Charting as a Diagnostic Tool
Charting Software
Fertility Monitors
Using Information Wisely
7 Am I Pregnant?
Signs You May Be Pregnant
Pregnancy Tests
When to Test
Blood Tests
Using Ultrasound for Confirmation
Pregnancy Symptoms
Sharing the Good News
8 Facing Fertility Problems
What Is Infertility?
Measures of Infertility
Talking to Others
Deciding to Get Help
Where to Go from Here
9 Male Factor Infertility
How It Should Work
Sexual Dysfunction
Sperm Production
Structural Defects
Endocrine Problems
Other Causes
Vasectomy Reversal
10 Female Factor Infertility
Menstrual Disorders
Ovulation Disorders
Endometriosis
Tubal Factor
Uterine Anomalies
The Endocrine System
Other Medical Issues
11 Pregnancy Loss
Miscarriage
Bleeding in Pregnancy
Blighted Ovum
Molar Pregnancy
Ectopic Pregnancy
Stillbirth
Repeated Loss
Emotions
12 Secondary Infertility
What Is Secondary Infertility?
Getting Your Doctor to Listen
Causes of Secondary Infertility
Fitting in Between Two Worlds
Dealing with Family and Friends
Talking to Your Children
13 Choosing a Fertility Specialist
Who Cares for Fertility Patients?
Specialist Training
Getting Recommendations
Services Offered
Treatment Facilities
Who’s Who at the Infertility Clinic
Questions to Ask
14 Your Fertility Workup
Self-Help Tools
Hormone Levels
Ultrasound
Cervical Mucous
Post Coital Test (PCT)
Semen Analysis
Hysterosalpingogram (HSG)
Endometrial Biopsy
Laparoscopy
Preimplantation Genetic Diagnosis (PGD)
Unexplained Infertility
15 Insemination as Treatment
Who Benefits from Inseminations?
The Collection Process
Washing the Specimen
Intrauterine Insemination (IUI)
Intracervical Insemination (ICI)
With or Without Medications
Super Ovulation
Donor Insemination
16 Medication Therapy
First Line Medications
Ovulation Induction Medications
Medications for Assisted Reproductive Technology (ART)
Supplemental Medications
Medications for Men
Administering Meds
Medication Emergencies
17 Fertility Surgery
Hysteroscopy
Laparoscopy
Laparotomy
Myomectomy
Fallopian Tube Reconstruction
Lysis of Adhesions
Endometriosis
Uterine Repair
Male Surgeries
Preparing for Surgery
18 Assisted Reproductive Technology (ART)
Is Advanced Treatment for Me?
In Vitro Fertilization (IVF)
Assisted Hatching
Intracytoplasmic Sperm Injections (ICSI)
Frozen Embryos
Other Alphabet Soup Treatments
Emotional Aspects of ART
Unsuccessful Cycles
19 Egg Donation
Who Can Benefit?
The Egg Donation Process
Selecting a Donor
Cycle Synchronization
Shared Cycles: Divvying Up the Eggs
What It Takes to Become an Egg Donor
20 Third-Party Reproduction
Egg Donation
Sperm Donation
Surrogacy
Embryo Adoption
Infant Adoption
Ethical Debates
21 Financing Fertility
Health Insurance
Shared Risk
Special Programs
Shopping Around
Loans
Choosing the Right Options
22 Fertility Support
Staying Sane
Living Your Life
Keeping the Love Alive
Peer Support
Support Groups
Internet Support
Counseling/Therapy
Living in a Fertile World
23 Congratulations! You’re Pregnant!
Emotional Roller Coaster
Who’s Who in the Birth World
What to Look for
Multiples
Asking for Referrals
Your Outlook on Pregnancy
Your First Prenatal Visit
Appendix A • Resources
Appendix B • Basal Body Temperature Chart
Acknowledgments
The topic of fertility and infertility is one of a personal nature. Therefore I have been blessed to have so many people share their stories with me, including personal details of their struggles on the road to parenthood.
I want to thank the many mothers and fathers who took the time to share with me, these personal and triumphant stories with all the peaks and valleys. Without these families and shared experiences I would not have been able to explore the intensity of this topic. Many thanks go to:
Kim, who shared every single minute detail of her cycles with me, from the injections to the actual egg retrieval and embryo transfer. Thank you for allowing me to be one of the first people to hold your oocytes as you walked this path.
Dr. Nakajima and Dr. Carrillo, for allowing me to tour their facility and see how the inside of a fertility clinic is run. Your kindness, generosity, and standards of patient care are constantly amazing. You and your staff are truly extraordinary.
Jean, for sharing with me her desires for pregnancy and pregnancies, and for allowing me to be present at the birth of her last two miracles! You are a strong and amazing woman who has taught me so much.
The Wednesday afternoon crowd — including Marcy, Beth, Frances, Heidi, Bill, and the rest of the moms and dads — for sharing your fertility and birth stories. The personal insight you gave me really helped a lot in expressing the depth of this topic.
All of my online friends and confidants, including April and Sharon, you completely amaze me and keep my feet grounded.
Eve, for sharing the miracle of birth with me, over and over again.
Carol, my mother, for giving birth to me and sharing that passion with me.
Amanda, my sister, for being gracious about being born second and allowing me to share her miracles with her.
I am grateful for my miracles, Hilary, Benjamin, Isaac, Lilah, Owen, and Clara, who arrived just when I needed them, even if I didn’t know when or how that was.
Most of all, much love goes to Kevin, who walked with me down the path to parenthood. Even during the bumpy times, you were there to hold me and dry my tears. Thank you for also being there to hold my hand and wipe my brow as our miracles were born.
Top Ten Ways to Prepare for Pregnancy
1. Find out what your healthy weight is and do your best to attain that weight.
2. Cut down on your caffeine intake.
3. Stop smoking cigarettes or using tobacco products or other drugs.
4. Get into the habit of exercising at least thirty minutes each day.
5. Take prenatal vitamins, especially folic acid.
6. Avoid drinking any alcohol.
7. Eat healthy foods like vegetables and fruits to ensure you’re getting all the vitamins and minerals you need.
8. Be mindful of any chemicals you may work around — know what the hazards are.
9. Eat at least 75 grams of protein a day.
10. Quit taking birth control pills at least three months before you want to conceive.
Foreword
s9781593370343_0014_001 PREGNANCY, LABOR, AND DELIVERY are an age-old process. The joy of these events have been renewed time and time again. For many women, who will have only one or two full-term pregnancies in their lifetime, each pregnancy is a life-shaping event. For most individuals, it is a time of complete awe and wonderment. For others, it is the culmination of many years of effort against unfavorable odds.
As a reproductive endocrinologist, I am often asked to give my opinion on whether or not someone might have difficulty becoming pregnant. I like to review with couples that fertility declines with advancing maternal age and given our new technology, we can help many couples who were previously thought to be hopelessly infertile. Many women are unaware that their fertility decreases by half from the ages of thirty-five to forty years old and the occurrence of having a child affected with Down’s Syndrome increases from 1 in 365 to 1 in 100 deliveries. Given this information, many women in their early thirties might reconsider delaying having a child. For others who have difficulty conceiving, there are now new therapies that have made pregnancy more likely. For instance, the development of in vitro fertilization has allowed women with blocked or absent fallopian tubes to conceive. The next major step forward was the cryopreservation of embryos, allowing couples to conceive more than once after their original in vitro fertilization cycle. New developments like intracytoplasmic sperm injection (ICSI) improved the chance of conception for couples with a severe male infertility factor. Future developments will be the perfection of oocyte freezing and widespread availability of prenatal genetic diagnosis for different medical conditions and the prevention of miscarriages. There will be new ethical decisions to be made and becoming an informed patient will help make these complex decisions easier to make.
For many couples, I inform them that physicians can now help almost everyone conceive. The conception, however, depends on three major factors. The first is how much you can undergo emotionally and physically before you conceive. For some, the tests and treatment are associated with discomfort and they are psychologically draining. Couples may want to reevaluate their desire for children and would rather change their goal, rather than becoming further depressed or stressed. The second major variable is that treatment may be determined by one’s financial situation or whether or not they have insurance coverage for infertility therapy. Often couples need to perform procedures repeatedly their chance of conceiving is low for that given therapy. Often the increased financial burden leads them to stop therapy. The third and last factor is determined by the flexibility of the couple to consider other treatment options. For some couples with an extreme male infertility factor, the husband will not accept donor sperm, leaving the couple with only one option: to perform in vitro fertilization with intracytoplasmic sperm injection. Similarly, some couples will not consider the use of donor oocytes and continue less successful therapies until they have exhausted their financial resources. These three factors ultimately play some role in the couple’s ability to conceive.
For many of you, you’ve already begun the process to conceive by reading this book. The following chapters will help you with the basics to achieve a pregnancy. If you’re concerned you’ll have trouble, then reading this book will help you in advance before you see your physician. The more educated you can be about the subject of fertility, the less likely you will be surprised or unprepared to deal with possible future events. The author of this book, Robin Elise Weiss, is well prepared to introduce you to the topic of planning for your baby. Best wishes on the journey and feel free to make choices that are right for you and your family.
Steven T. Nakajima, M.D.
Associate Professor and Director
Division of Reproductive Endocrinology and Infertility
University of Louisville School of Medicine
Louisville, Kentucky
Chapter 1
9781593370343_0014_001Deciding to Have a Baby
The decision to have a baby is a very big one. There are many tough questions to ask yourself and your family. For instance, you need to look at your physical and mental health before making this decision. You may even need to address some financial issues. While the decision can be made on the spur of the moment, it’s best to plan ahead.
Are You Emotionally Ready?
As the old joke goes, I won’t become my mother.
As everyone knows, these are famous last words.
Having a child is mentally and emotionally taxing. You will have new physical worries about your new baby and your body. You need to look at all the relationships around you as you begin to contemplate this journey.
Your Husband or Partner
You and your husband or partner have probably already thought about the kind of parents you want to be. Do you want to be the same type of parents you had? Do you want to be different? More importantly, how do the views you have match up with the ideas held by your partner?
The two of you need to be in the same place on the decision to have a child for the smoothest ride down the aisle of babes. If you and your partner see eye to eye on the decision to have a baby you’ve crossed a huge hurdle. Though not the only hurdle in your way, it is a large one.
Another hurdle that can be a real eye-opener if you and your partner haven’t discussed it is that of how to raise your children. This topic delves into many personal aspects of your life and your very essence of being. For example, what religion will you raise the child? How do you feel about discipline? Where will you live?
These may seem like no-brainers to you. Perhaps you feel you’ve already had these discussions with your partner. Even so, it can’t hurt to revisit the issues that are most important to you. And if you come across conflicting views don’t panic! It’s not the end to your child-bearing years. You haven’t ended before you’ve begun. Simply sit down and try to reach a compromise.
A compromise doesn’t have to mean perfect agreement. Perhaps you really want to move to the suburbs but your husband wants to stay in the city close to his job. Talk about the real issues under the surface. Is he worried about the commute? Is he worried about money? Are you concerned about crime and city schools? Perhaps there is a compromise you can make to satisfy all of the needs that are really important. The only way to find out is to talk about it.
9781593370343_0016_001Only 50 percent of pregnancies are actually planned ahead of time. That means that 50 percent of the people who are parents made these decisions along the way. Do not fear all is lost if you find yourself on opposite sides of the table on parenting issues.
Find a time that is calm and not hurried to hash things out. Don’t choose breakfast or dinner times but rather make it a quiet and comfortable discussion. Use I
statements when stating how you feel. For example, I am worried about living in the city with a new baby.
Rather than, You don’t care if we raise the baby in the noisy city.
Try not to discuss everything all at once. One or two major topics are about all anyone can handle in an evening. Also try not to make rash decisions or make compromises you can’t live with. Offer to sleep on it or to do more research. Use your network of friends and family to figure out how you wish to parent. Read books, talk to neighbors, and watch others as they raise their kids. You’ll navigate the paths ahead of you more easily than you thought if you talk it out.
It’s much easier to see both sides when you are sitting down and calmly and rationally discussing issues. Take a piece of paper and one of you should mark down the pros and cons of each of the ideas discussed. Seeing what you are discussing on paper can often clear up misunderstandings and give you a better idea of where your spouse stands on the issue. This better understanding often leads to agreement on information and future decisions. It also teaches you great conflict resolution skills! Try to use these quiet, nonthreatening tactics each time you address any issue that is important to you.
Your Parents
You may be concerned with how your parents will view you as a parent. If so, you are likely to see them partially as role models and partially as adversaries in the process of child-rearing. They will have advice that you may want to take, but they may also have advice that is simply not right for your family.
It’s okay to not raise your baby the same way either of your parents raised you. Just be aware that this can lead to some hurt feelings along the way. Explain to your parents and in-laws that you are doing what you feel is right for your baby given the information that is available today. Try not to let differences in parenting styles take center stage in your conversations.
Other Children
Subsequent children are a whole new ball game! Your other bundles of joy are getting older. They might think a new sibling is the neatest thing since sliced bread, or it could be the worst thing to happen in their lives. Prepare them with the information they need to know. You should offer age-specific information all along the way, from even the youngest child on up. Information can be in the form of books, videos, and exposure to other babies and small children. The older the child the more they will be able to grasp the concept of a new baby and the earlier you can talk to them about this. Younger children have very little concept of time and therefore have complications with being told too soon. It’s also wise to tell them only the information that they are asking for and not more information than they are ready to handle. If you’re unsure of the question that they are asking, try to probe them for more information about their question.
9781593370343_0017_001Check out local hospitals, birthing centers, and other educational centers for tips on preparing other children for a new baby. Many offer free sibling preparation classes. These classes usually discuss sibling rivalry, what having a new baby in the house is like, and the basics of baby care. It may also include a tour of the nursery.
Friends
Having a baby changes everything when it comes to your friends. If you have friends without children, you can expect more changes to your relationships with them than with your friends who already have children of their own. You simply are going through two different stages of life and this gap may enter into your relationship with your single or childless friends.
If you are having your first child, you will likely find that you will grow closer to your other friends with children in many cases. This may be because you have more in common, which can be nice.
However, you may find that you develop a parenting style that is radically different from that of your friends and you or your friends may find this different style threatening. What you need to remember is that parenting styles are a very personal choice. You need to do what works for your family and that may not be what works for your friends and their families. Reserve judgment, however, as all parents encounter challenges that will throw them from time to time.
If you are the first person in your social group to have a baby, then you might find that your friendships become more strained. This is truer after the baby comes than before. While your friends will be happy for you, they will often feel as if you are changing in a way that excludes them from the picture.
You can assure them that while you may be more limited in what you will be able to do, you will still be able to go out with them occasionally. You might also assure them that you will be perfectly capable of conversing about something other than your new baby! Having a baby doesn’t change who you are; it adds a new dimension.
Physical Fitness: A Whole New Definition
Physical preparedness for your new baby means looking at your lifestyle and deciding what is baby-friendly and what is not. It means making changes in how you live your life for a healthier pregnancy and baby.
You will likely want to look at your home. How old is your home? Do you have any lead paint? Do the slats between your stair railing meet safety requirements? Going through your house and looking for obvious and not-so-obvious problems and health hazards is really important to the safety of your new child.
Your car needs a checkup! Does your car measure up for the baby-to-be? Do you have room to add another person safely with a seat belt? How old is your car? Do you have an appropriate amount of car insurance? These