There is a fantasy surrounding pregnancy portraying it as a blissful state when women glow with health and the miracle of life. It is a time when most women feel pride in their bodies, more forgiving of their imperfections, and awestruck by their body's capabilities. Yet, when a woman has experienced miscarriage and/or infertility, a pregnancy can be filled with fear and anxiety.
Pregnancy losses or difficulty conceiving often lead women to mistrust their body, and view it as defective. The minute the pregnancy is detected, elation and excitement are eclipsed by worry even if there are no indications that anything is amiss.
My miscarriage was a "missed miscarriage," meaning that there was no cramping or bleeding because my body did not recognize that there had been a fetal demise. It was discovered at my routine 12 week ultrasound that the fetus had stopped developing two weeks earlier. Although I had sensed something was wrong when my nausea and fatigue suddenly vanished, friends and loved ones reassured me that symptoms often come and go, and there was no reason to worry.
When I got pregnant with my older daughter several months later, I was terrified of having another loss. After all, I had no evidence that my body could carry a pregnancy to term. The first three months were extremely frightening for me. I didn't like to talk about being pregnant and didn't go public with the pregnancy for almost five months, long after it was obvious to most people. For reassurance, I weaselled so many ultrasounds out of my sympathetic family doctor, that my husband joked I was going to be banned from the clinic.
Before every check up and ultrasound throughout the entire pregnancy, I would get tearful and scared. Any moment I could not feel her moving, I would start to panic. I rented a Doppler so I could check for the heartbeat at home between obstetrician visits. I did not buy any clothes or toys or baby equipment until I was eight months pregnant because I felt superstitious. I worried excessively about how anything might affect the health of the pregnancy (walking behind a smoker on the street, waking up and discovering I was sleeping on my back, etc.). I even worried about my worry. I simply felt I could not relax until I was holding a healthy baby in my arms. Fortunately, eventually I did.
After struggling with secondary infertility, I was lucky to become pregnant with my youngest daughter within weeks of beginning treatment. This time I thought it would be easier. After all, in the end I had already had a relatively uneventful pregnancy and delivered a perfect, healthy daughter. But this was not the case. Instead, I wondered if it was really possible that I could do it again.
I tried to keep the pregnancy secret until I was 16 weeks -- despite people suspecting it when I was just five weeks along. I would ignore pats on the back and congratulatory handshakes as if they had not happened. I rented a Doppler again. I became tearful before every ultrasound and exam. I worried that my weird diet I had assumed due to cravings and aversions would negatively affect my baby's development. I worried about the airport scanners when we travelled. I worried and I worried and I worried some more. I worried until the day I gave birth to another perfect little girl.
Given the struggles many people face when trying to have their family, I got off easy. Now, as an infertility counsellor, I see many women who have suffered unimaginable losses, and years of failure and disappointment. You might expect that once these women get pregnant, they are instantly ecstatic, but the reality is that many go through what I did. Until they go home with a healthy baby in their arms, they are filled with fear, doubt, guilt, and also sometimes envy.
We are not women who will ever experience that radiance that is supposed to accompany pregnancy. Instead, there is a dark cloud which casts a shadow over our pregnancies. One which eclipses the excitement, pride, and joy of impending motherhood. The confidence, innocence and bliss that other women experience will never be our story.
1. Your fertility is mostly determined by genetics, which influences how many eggs you are born with. Doctors believe that the number of eggs you have at birth determines the length of time you will remain fertile. At birth, women have about two million eggs in their ovaries. For every egg ovulated during your reproductive life, about 1,000 eggs undergo programmed cell death. Other things, such as smoking cigarettes and certain types of chemotherapy, can accelerate egg cell death and promote an earlier menopause.
2. Regular menstrual cycles are a sign of regular ovulation. Most women have regular cycles lasting between 24 and 35 days. This is usually a sign of regular, predictable ovulation. Women who do not ovulate regularly have irregular menstrual cycles. Those who do not ovulate at all may have a genetic condition called polycystic ovarian syndrome (PCOS).
3. Basal temperature charting does not predict ovulation. An older method of tracking ovulation involves taking your oral body temperature each morning before getting out of bed. This is called basal body temperature. This method is used to spot a rise in basal temperature, which is a sign that progesterone is being produced. The main problem with using this method is that your temperature rises after ovulation has already occurred. This makes it more difficult to time intercourse at an optimal time for conception. A better method is to use over-the-counter urine ovulation predictor test kits such as Clearblue Easy. These kits test for the hormone that prompts ovulation, which is called luteinizing hormone (LH).
4. Most women with blocked fallopian tubes are completely unaware they may have had a prior pelvic infection. About 10 percent of infertility cases are due to tubal disease, either complete blockage or pelvic scarring causing tubal malfunction. One major cause of tubal disease is a prior pelvic infection from a sexually transmitted disease such as chlamydia. These infections can cause so few symptoms that you may be completely unaware your tubes are affected. This is why fertility physicians will order a dye test of the tubes, called a hysterosalpingogram (HSG), if you have been trying and failing to conceive for 6 months or longer.
5. In most cases, stress does not cause infertility. Except in rare cases of extreme physical or emotional distress, women will keep ovulating regularly. Conceiving while on vacation is likely less about relaxation than about coincidence and good timing of sex.
6. By age 44, most women are infertile, even if they are still ovulating regularly. Even with significant fertility treatment, rates of conception are very low after age 43. Most women who conceive in their mid-40's with fertility treatment are using donated eggs from younger women.
7. Having fathered a pregnancy in the past does not guarantee fertility. Sperm counts can change quite a bit with time, so never assume that a prior pregnancy guarantees fertile sperm. Obtaining a semen analysis is the only way to be sure the sperm are still healthy!
8. For the most part, diet has little or nothing to do with fertility. Despite popular press, there is little scientific data showing that a particular diet or food promotes fertility. One limited study did suggest a Mediterranean diet with olive oil, fish and legumes may help promote fertility.
9. Vitamin D may improve results of fertility treatments. A recent study from the University of Southern California suggested that women who were undergoing fertility treatments, but had low vitamin D levels, might have lower rates of conception. This vitamin is also essential during pregnancy. At Pacific Fertility Center, we recommend our patients take 2,000-4,000 IU per day.
10. Being either underweight or overweight is clearly linked with lowered levels of fertility. The evidence in recent years is that obesity is clearly linked with a longer time to conception. Having a body mass index less than 18 or over 32 is associated with problems ovulating and conceiving, as well as problems during pregnancy.
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