The Unofficial Guide to Getting Pregnant

The Unofficial Guide to Getting Pregnant

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Product Details

ISBN-13: 9780764595509
Publisher: Wiley
Publication date: 10/31/2005
Series: Unofficial Guides Series , #142
Pages: 456
Product dimensions: 5.23(w) x 8.30(h) x 1.00(d)

About the Author

Joan Liebmann-Smith, Ph.D., is a medical sociologist and an award-winning medical writer. Her articles have appeared in such publications as American Health, Ms., Newsweek, Redbook, Self, and Vogue. She is the author of In Pursuit of Pregnancy and co-author of The Unofficial Guide to Overcoming Infertility. She has also written a book on women and substance abuse to be published in 2006. Dr. Liebmann-Smith is a consultant at the Strang Cancer Prevention Center and is on the board of the National Council on Women’s Health. She was a member of the board of directors of RESOLVE, INC. and co-president of RESOLVE, NYC.

Jacqueline Nardi Egan is a medical journalist and editor. She specializes in writing educational programs for physicians, allied health professionals, patients, and consumers. She has been the editor of several specialty medical publications and a contributor to national consumer magazines. She is co-author of The Unofficial Guide to Overcoming Infertility.

John J. Stangel, M.D., a board certified specialist in Reproductive Medicine, is the Westchester County Medical Director of Reproductive Medicine Associates of Connecticut, and has a private practice in Rye, New York. Dr. Stangel has also been the Medical Director of the Westchester Affiliate of the Institute for Reproductive Medicine and Science at Saint Barnabas Medical Center; the Clinical Director of Reproductive Medicine at Montefiore Medical

Center; and the Medical Director of IVF America.
Dr. Stangel is a charter member of the Society of Reproductive Endocrinologists (SART) and the Society of Reproductive Surgeons. He is the editor and contributing author of the textbook Infertility Surgery, has published numerous scientific papers and articles, and has contributed to many textbooks. Dr. Stangel is the author of Fertility and Conception and co-author of The Unofficial Guide to Overcoming Infertility.

Read an Excerpt

The Unofficial Guide to Getting Pregnant


By Joan Liebmann-Smith

John Wiley & Sons

ISBN: 0-7645-9550-4


Chapter One

A Healthy Start

GET THE SCOOP ON ...

The importance of the preconception exam * Making healthy choices * Fertility considerations for older men and women * What you can do to preserve your fertility * Pregnancy after cancer treatment

You and your partner most likely have spent a good deal of time discussing if you'd like to have children, and if so, when to start your family. Many couples believe that choosing when to start trying to become pregnant is the most difficult decision they will make, and in some ways, they're right. But deciding to have children is just the beginning; there are many other key choices you should make now that can help improve your chances of conceiving, having a healthy pregnancy, and most importantly, a healthy baby.

The preconception checkup

Everyone is aware of the importance of prenatal checkups, but a preconception checkup is equally important. Both partners should be in good physical condition before starting a family. Therefore, it makes sense for both of you to get a physical exam before attempting a pregnancy. The main purpose of the preconception exam is to rule out diseases that can interfere with your chances of conceiving and carrying a healthy baby to full term. A routine physical exam might turn up a condition or conditions that can reduce your fertility, such as diabetes, thyroid disorders, or sexually transmitted diseases (STDs). Although the woman is the one who becomes pregnant and gives birth, both parents can pass on genetic disorders. And because medical conditions, both past and present, affect the development of sperm and their ability to fertilize eggs and produce a healthy embryo, men must ensure that they too are healthy.

The preconception exam goes well beyond specific reproductive issues and encompasses general health and lifestyle considerations that can affect you before, during, and long after a pregnancy. Most primary care providers-such as family physicians, general practitioners, internists, physician assistants, and nurse practitioners-can conduct preconception exams on both men and women. Because many women use their OB/GYN (obstetrician/gynecologist) as their primary care physician, they may want to see him or her for the preconception exam as well. But not all OB/GYNS will fill the role of a primary care physician, since they are trained specifically in female reproduction. Be sure to ask your OB/GYN if he or she is willing to act in this capacity and screen you for nonreproductive health problems that can also interfere with your becoming pregnant and carrying a healthy baby to term.

You'll want to bring your partner along when you go for a preconception checkup. It's important for both partners to be aware of the medical issues related to conception, pregnancy, and childbearing. The preconception checkup should take place at least three months before you start trying to conceive. If you need certain immunizations, you will have to postpone attempting a pregnancy for at least three months.

Reproductive health

Obviously, reproductive health is of prime importance. Before a woman even attempts to become pregnant, her doctor should be aware of her reproductive history, including menstrual disorders; past and current contraceptive use; past pregnancies, abortions, and miscarriages; and past and current STDs.

Sexually transmitted diseases (STDs)

It's essential that both partners be screened for STDs before attempting to become pregnant. STDs have been on the increase and can have serious adverse effects on fertility, pregnancy, delivery, and offspring. STDs can lead to pelvic inflammatory disease (PID), which is the major cause of infertility.

The most common STDs-and those most responsible for PID and its aftermath, infertility or ectopic pregnancy-are chlamydia and gonorrhea (which we'll discuss in more detail in a moment). When recognized and treated promptly, these infections are usually easily treated with appropriate antibiotics. If left unchecked, these organisms can travel from the vagina and cervix up the reproductive tract. However, the organisms are not found in nearly one third of women with PID, although they might have been present in the early stages of the infection.

Because STDs often don't cause symptoms, they can be passed unknowingly countless times between partners, causing extensive damage. It's often not until you're trying to conceive or you suffer an ectopic pregnancy that their damage is discovered. Although a history of STDs or multiple sexual partners increases the chances of having a current STD, virtually any sexually active man or woman can be infected. It's therefore important that both partners are tested for the following STDs prior to attempting a pregnancy.

Chlamydia

Chlamydia is one of the most prevalent STDs in the United States, with almost three million new cases every year. Because it rarely produces symptoms in either men or women, it's known as the "silent infection." If untreated, chlamydia can cause PID and damage the reproductive system. Not only can chlamydia interfere with conception and pregnancy, it can also have serious consequences for newborns. Babies born to women with active chlamydial infection are subject to infection during passage through the birth canal. If they pick up the organism, it can cause serious eye infection and pneumonia. Chlamydia does not affect men as seriously as it does women, although some severe cases can lead to sterility. Antibiotics can easily and inexpensively cure chlamydial infection in both men and women.

Gonorrhea

Approximately 700,000 men and women contract gonorrhea, a bacterial infection, each year. Gonorrhea can cause tubal damage in women and scarring and obstruction of the epididymis-the long tube attached to the testicle in which sperm mature before being released-in men. Gonorrhea often does not produce symptoms in men and women, but can cause pain, burning when urinating, and vaginal or penile discharge. If untreated, gonorrhea can cause infertility in men and PID in women, thus increasing a woman's risk of infertility, ectopic pregnancy, and miscarriage. Babies born to mothers infected with gonorrhea can be born blind, with serious joint infections, or with life-threatening blood infections.

HIV/AIDS

STD screening would be incomplete without testing for HIV/AIDS. Indeed, the American College of Obstetricians and Gynecologists (ACOG) recommends that the HIV antibody test be offered to all women seeking preconception care. It's critical to make sure you and your partner do not carry the AIDS virus not only for your own sakes, but also for the sake of your future child. Having AIDS is no longer the death sentence it once was, thanks to antiviral agents that can successfully control the virus. But without proper treatment and special precautions during pregnancy and childbirth, the AIDs virus can be passed from the mother to the fetus.

HPV

Human papillomavirus (HPV) is the most common STD in the United States, with more than six million new cases each year. An astonishing 80 percent of American women will have acquired the virus by the time they reach 50. Although some people get genital warts from the virus, most have no symptoms. Although HPV has not been directly linked to infertility, genital warts, if large, can cause problems during pregnancy and delivery. The virus can also be transmitted to a baby during childbirth, and there is a small chance that the infant can develop a rare but serious condition called laryngeal papillomatosis (warts on the throat).

One of the biggest concerns about HPV is that it can cause cervical cancer. In fact, virtually all women with cervical cancer have HPV. The good news is that only one in a thousand women with the virus develops invasive cervical cancer. HPV is typically diagnosed by a Pap smear in women, but there is no test yet available for men. When abnormal cervical cells are found, it's recommended that women undergo treatment to remove the precancerous cells. Unfortunately, the treatments themselves occasionally impair fertility or prevent the woman from carrying a baby to term. If left untreated, however, a woman can develop cervical cancer and need a hysterectomy.

HPV can also cause other cancers in the female and male reproductive systems, such as cancer of the vulva, vagina, and penis. Cancer treatment can result in infertility or sterility, a topic discussed later in this chapter. Although there is no known cure for HPV, it can-and should-be treated.

Genital herpes

Genital herpes is caused by the herpes simplex virus (HSV). While one form of herpes, HSV-1, typically causes blisters or cold sores around the lips, the other form (HSV-2) usually causes blisters or sores in the genital region. Approximately 45 million Americans (20 percent) over the age of 12 are infected with HSV-2. It's more common in women than men; one in four women has this virus compared with one in five men. Most of the time people have no symptoms and they may be unaware of having the virus until they break out in painful blisters or sores. Although genital herpes doesn't normally interfere with conception, it increases the risk of premature delivery. HSV can also be transmitted to the fetus during pregnancy or the baby during delivery. Half of the babies who are infected either die or suffer nerve damage. If a woman has an active case of genital herpes at the time of delivery, a Caesarian section is usually performed to protect the baby. Although the painful symptoms of HSV can be treated, there is no cure for the virus. Unfortunately, HSV increases the risk of acquiring HIV and AIDS.

General health issues

It's important for your health-care professional to know if you or your partner has now or has had in the past any illness that could have serious reproductive consequences. A variety of disorders can cause fertility problems, miscarriages, or other problems during pregnancy or delivery, and even birth defects. In the following section we discuss just a few of the more common conditions that may be of concern, and that are easily screened for during a preconception exam.

High blood pressure

High blood pressure (hypertension) can cause serious medical and pregnancy complications for both mother and fetus. A blood pressure reading of greater than 140/90 mmHg should alert you and your health-care provider. If you're already being treated for high (or low) blood pressure, consult your doctor to make certain the drug or drugs you're taking are safe to use during pregnancy and breastfeeding.

Diabetes

If you or your partner have diabetes and you are thinking about trying to conceive, be certain to get your blood sugar (glucose) under control. Uncontrolled diabetes can have serious adverse effects on fertility in both men and women. For example, diabetes in women can prevent ovulation or implantation. And women whose blood sugar is not under control have an increased risk of miscarriage, stillbirth, and giving birth to a baby with birth defects. Men with diabetes may suffer from erectile dysfunction (impotence) as well as a condition called retrograde ejaculation, the backward movement of semen into the bladder instead of forward out the urethra.

Thyroid disease

Both hypo- and hyperthyroidism can lead to infertility and miscarriage. If you are being treated for thyroid disease, check with your doctor to make sure your medication is safe to use during pregnancy and nursing.

Other medical considerations

A pregnant woman may contract any number of diseases that can adversely affect her pregnancy or cause birth defects. A preconception exam should include testing for immunity against the following diseases. (There's some controversy about how long you should wait to conceive after vaccinations, ranging from a minimum of one month to three months. To be on the safe side, it would be prudent to wait.)

Rubella (German measles)

Even if a woman has had German measles or was previously vaccinated, she should be tested for her current immune status. If she is not immune, she should receive a rubella vaccination at least three months before attempting a pregnancy. Contracting German measles early in a pregnancy can be devastating to the fetus. It can cause deafness and serious eye, heart, and neurological problems; it can also lead to fetal death, miscarriage, or premature delivery.

Chickenpox

Women who never had chickenpox are probably not immune and should be immunized against this disease. As with rubella, pregnancy should be postponed for three months after the vaccination. If a pregnant woman gets chickenpox in the first or early second trimester of pregnancy, the fetus is at risk for serious neurological and eye problems or limb deformities.

Toxoplasmosis

Women should be screened for toxoplasmosis, a mild, common parasitic infection that can cause serious birth defects, especially during the first trimester. The infection is commonly transmitted through undercooked meat and animal feces, and there is no immunization available. Women who are found not to be immune should make sure any meat they eat is well done and wear rubber gloves when emptying cat litter or working in the garden, where animal feces may be hidden.

Hepatitis B

This liver infection can be contracted through sexual contact or exposure to infected feces, or blood, urine, saliva, or other bodily fluids. It is the only form of hepatitis that can cause serious harm to newborns. Women should be screened for hepatitis B and those found not immune should be vaccinated at least three months before attempting to conceive.

Rh incompatibility

It's important for you and your partner to know both your blood type and Rh or Rhesus factor before you become pregnant. This information is, of course, necessary in the event a blood transfusion is needed. But there are other reasons for couples to have this information before they attempt a pregnancy. Of special concern for a future pregnancy is Rh incompatibility.

There are four blood types (A, B, AB, or O) and each blood type can have one of two Rh factors (Rh positive or Rh negative). Rh is a protein that coats the surface of red blood cells. Most people-85 percent of white Americans and an even larger percentage of African-Americans and Asians-are Rh positive. The remaining 15 percent are Rh negative. Having a different blood type from your partner isn't a problem. Nor is there a problem if the mother is Rh positive and the father Rh negative. But if the future mother is Rh negative and the future father is Rh positive there could be a problem. To be more precise, if the woman is A-, B-, AB-, or O- and her male partner is A+, B+, AB+, or O+, the baby has a 50 percent chance of being Rh positive, and your pregnancy would be Rh incompatible. If, however, the mother is Rh positive and the father Rh negative, there would be no problem.

Rh incompatibility is not usually a problem in a first pregnancy, but can be deadly to the fetus in a subsequent pregnancy. When a pregnant Rh negative mother carries an Rh positive fetus, the baby's blood can leak into the mother's circulatory system. Her immune system may react to the baby's blood as if it were a foreign substance, and to protect itself, creates antibodies to destroy the baby's blood.

The good news is that this problem is entirely preventable when proper precautions are taken. If an Rh negative woman has ever had a pregnancy, abortion, miscarriage, amniocentesis, or blood transfusion, there is a possibility that she has been exposed to Rh positive blood and will be sensitized. If your partner (or sperm donor) is Rh negative and you become pregnant with an Rh negative baby, you must receive a RhoGAM (Rh immune globulin) injection in the 28th week of pregnancy. To ensure that your next pregnancy will not be a problem, you must also get another RhoGAM shot within 72 hours of giving birth, having a miscarriage, or stillbirth.

(Continues...)



Excerpted from The Unofficial Guide to Getting Pregnant by Joan Liebmann-Smith Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

Table of Contents

Introduction.

I. Preparing for Pregnancy.

1. A Healthy Start.

The preconception checkup.

Healthy choices.

Age and fertility.

Age and problem pregnancies.

Preserving your fertility.

Pursuing pregnancy after cancer treatment.

The road to pregnancy.

Just the facts.

2. Conception and Misconceptions.

Reproduction 101.

The journey toward conception.

When everything goes right.

Misconceptions.

Just the facts.

II. Pursuing Pregnancy.

3. Try, Try Again.

Realistic expectations.

Ovulation: a woman’s key to conception.

Sperm: the key to male fertility.

When everything seems to be going wrong.

Just the facts.

4. What Conceivably Can Go Wrong?

Coming to terms.

Whose problem is it, anyway?

What’s the problem?

Structural abnormalities in women.

Structural abnormalities in men.

Unexplained infertility.

Just the facts.

III Doctors and Diagnoses.

5. Choosing the Right Doctor.

Putting off the consultation.

Looking for Dr. Right.

Making the most of your consultation.

Taking charge of your fertility treatment.

The doctor-patient relationship.

Switching doctors.

Just the facts.

6. Getting to the Root of the Problem.

The infertility work-up.

Narrowing the possibilities.

Specialized tests for women.

Specialized tests for men.

Genetic testing.

Diagnostic decisions.

Getting ready for treatment.

Just the facts.

IV. Traditional Treatments.

7. Fertility Drugs and Other Nonsurgical Treatments.

Indications for fertility drugs.

Back to basics.

Ovulatory disorders and fertility drugs.

A guide to fertility drugs.

Fertility drugs for men.

Artificial insemination.

Just the facts.

8. Surgical Solutions.

Surgical innovations.

Surgical solutions for women.

Surgical solutions for men.

To have or not to have surgery.

Just the facts.

V. The Assisted Reproductive Technologies.

9. The Current and Future State of the ARTs.

Who do the ARTs help?

What’s involved?

The ARTs from A to Z.

Promising new techniques.

Cryopreservation today and tomorrow.

Embryonic stem cell research.

Cloning.

Just the facts.

10. Considering the ARTs.

Emotional considerations.

Medical considerations.

Other considerations.

Choosing an ART program.

Making sense of ART success.

Factors influencing success.

Other important decisions to make.

Just the facts.

VI. Alternative Solutions.

11. Is Third-Party Reproduction Right for You?

Third-party reproduction options.

Considering third-party reproduction.

To tell or not to tell.

The adoption option.

Just the facts.

12. Pursuing Third-Party Reproduction.

Sperm donation.

Egg donation.

Embryo donation (and sperm/egg donation).

Traditional surrogacy.

Gestational carriers.

A summary of the options.

Finding a program or agency.

Screening and other guidelines.

Important questions to ask.1

Just the facts.

13. Complementary and Alternative Solutions.

Complementary and alternative medicine (CAM).

CAM and infertility.

Should you go the alternative route?

Just the facts.

VII. The Social, Emotional, and Financial Sides.

14. The Infertile Couple.

...And doctor makes three.

Sex on schedule.

Fertility fights: whose fault is it, anyway?

How men and women cope with infertility.

Talking it over...and over.

Fertility rights.

Long-term effects.

Just the facts.

15. Living and Working in the Fertile World.

Coming out.

The fertile earth.

Job interference.

Working through your problems.

Just the facts.

16. Surviving and Resolving Infertility.

A multitude of losses.

Regaining control.

Mourning your losses.

Survival strategies.

Deciding that enough is enough.

Childless by chance...or choice.

Just the facts.

17. Money Matters.

The costs of treatment.

The insurance debate.

What’s covered, what’s not.

Cost-cutting strategies.

State mandates.

A few final thoughts.

Just the facts.

A. Glossary.

B. Recommended Reading List.

C. Resource Guide.

D. Sample Genetic Testing Flow Sheet.

E. State-by-State Infertility Insurance Coverage.

Index.

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