Pregnancy: Preparing for Pregnancy

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Ready, Set, Go: Preparing for Pregnancy

WebMD Live Events Transcript

You've made up your mind to start a family. But is the rest of your body ready, too? We discussed optimizing your conception chances, as well as the tests and tips you need to know about before you start trying, with Glade Curtis, MD, coauthor of Your Pregnancy Week by Week, as part of the Preserving Your Fertility Cyber Conference, on Sept. 29, 2004.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

MEMBER QUESTION:
How do I maximize my efforts of TTC if I notice that my cycle is not regular?

CURTIS:
That's a good question, and one that most people don't need to worry about, because pregnancy happens without planning very often. One of the best things you can do to maximize your chance of success is to try to find out when you are ovulating each month. In other words, find that time during the cycle when you are able to get pregnant. People use lots of different methods to determine this, including taking their temperature, buying ovulation kits at the store, or getting to know their own body.

I think the most important thing, though, is to not get too caught up in this and make it harder to get pregnant and make it more of a scientific process than something that will just happen naturally, if you let it.

MEMBER QUESTION:
How do I maximize my efforts of TTC if my cycle is regular, but I have been TTC for a year?

CURTIS:
If your cycle is regular and you have been unsuccessful for a year, then I believe it is time to sit down with your partner and your provider and talk about things that you can do to increase your chances of pregnancy and also what tests you might consider in the months to come.

While we're on this subject, I feel like I should mention a few things that some couples ignore or forget:

  • When you are trying to conceive, intercourse once a day is plenty. More than that probably doesn't help, because it takes a man 24 hours to regenerate a sperm count.
  • After intercourse, lie in bed. It is sometimes even helpful to elevate your hips. Don't jump up and run to the bathroom or take a bath.
  • It is a good idea not to use douches or lubrication or any type of foreign substances that will change the environment in the vagina.

Those are simple suggestions, but they have saved many couples from going through further testing or workup for infertility.

MODERATOR:
If after a year of trying you are not pregnant, do you recommend seeing a specialist, like a reproductive endocrinologist?

CURTIS:
After a year of trying I would start with a regular ob-gyn that also does infertility. In most places those doctors can help you with what you need. They are the ones that usually will refer a more complicated situation to an infertility specialist at a university. So I wouldn't go directly to the university; I would start with your regular ob-gyn, and in most cases you'll be successful.

"One of the best things you can do to maximize your chance of success is to try to find out when you are ovulating each month."

MEMBER QUESTION:
I am about to ovulate but never know when the right time is to have intercourse. Some say every 24 hours; others say every 48 about four days prior to ovulation and continue through ovulation day.

CURTIS:
I have seen and heard both 24 and 48 hours. The advice I give to patients is to try and have intercourse about once a day during that time that they are trying to get pregnant. This may not always be possible because of work, travel, or even disagreements. But during the time you're trying to get pregnant it is a reasonable goal.

If you're timing it with your ovulation, I think it is good to begin the day that you think you are ovulating and then, if possible, continue for two or three days after that.

Again, we're applying science to something that has happened naturally for a lot of years and a lot of people, and part of the key to success is relaxing and letting it happen.

MEMBER QUESTION:
How do you let it naturally happen and not stress about it when you have been TTC for over a year? I find it very hard to not think about it.

MEMBER QUESTION:
It's very difficult to let go and think of it to happen naturally especially when you are doing everything and still not getting pregnant. How do you get de-stressed and stop thinking or planning it?

MEMBER QUESTION:
Can stress affect conceiving? Every month I wait for the result to show positive, but I've heard that stress plays a role. Is it true?

CURTIS:
The questions about relaxing and letting it happen are very good questions, and I think first of all it is important for those trying to get pregnant to know that even in the best of situations, where everything is normal with both partners and they have regular intercourse, pregnancy can take anywhere from eight months to a year to happen. I say that because frequently patients will come in to see me, upset and discouraged, and you can tell there's been a fight, an argument. They've been trying to get pregnant for two months without success and now they're discouraged and certain that it's not going to happen. Most couples, if they try for more than a year and up to two years, will find they are successful.

Now, chances are that many who are participating today are those who have been through infertility tests or infertility surgery and are discouraged. I don't blame you, because those tests can be expensive and discouraging, but I think it helps in trying to get pregnant if somehow you can keep a positive attitude. I think another key is somehow keeping the romance in the attempts to get pregnant and not letting this become a lab experiment. That is going to take support from both partners, and perhaps this is an area where you can ask your partner for help.

Another factor involved is family. Family can put a lot of pressure or stress on a couple. They can even be critical of a couple that has not conceived.

I do believe stress can be a factor, and the easy answer is to not let this stress you out. I really think this is another place to work with your partner together to not let the pressure and stress get to you. When you see your doctor and talk about getting pregnant, ask for time periods to try different strategies, so that you know a strategy might take six months or a year to work and it might be easier to survive when it doesn't work the first month or two.

MODERATOR:
If nothing else, stress can make you feel like not making love, and that's a REAL impediment to pregnancy, I'd say.

"Another key is somehow keeping the romance in the attempts to get pregnant and not letting this become a lab experiment."

MEMBER QUESTION:
If you had to pick just three things to do to help a woman get pregnant, what would they be?

CURTIS:
No. 1: Find the right guy. No. 2: Like that right guy and make sure he likes you. No. 3: Make sure you get together often enough during the time when you can get pregnant.

More seriously, getting pregnant is a very individual thing -- individual for each woman and for each couple -- and it will take working together and cooperation and getting along in order to conceive. I think each couple can pick out three things that will work for them. So I think it's a difficult question to answer on an individual basis.

MEMBER QUESTION:
Can being underweight affect fertility?

CURTIS:
Yes, it can. One of the main ways that being underweight can affect getting pregnant is it can change your periods, or even make it so that you don't have periods at all. This can be a problem, especially for athletes who are training heavily and stop having periods. Along with not having periods, they are also not ovulating, which means they are not making eggs and won't get pregnant.

A woman that is underweight and trying to get pregnant, or gets pregnant, should try to gain more weight during her pregnancy and even before she gets pregnant. Doing this will give her baby a better chance at being healthy during pregnancy and after birth.

MEMBER QUESTION:
Drinking alcohol: How much does this really affect TTC and fertility in both men and women? What is too much?

CURTIS:
The issue of alcohol and pregnancy has changed over the years. When we wrote books 20 years ago about pregnancy, the message was it was OK to drink a little bit and maybe a glass of wine with dinner was OK. Around that same time we began to learn about fetal alcohol syndrome and the affects of alcohol on pregnancy.

So the best answer I can give to this question is one that isn't going to be very popular, and that is at this point we do not think there is a safe amount of alcohol during pregnancy. More and more studies indicate that even moderate drinking may affect the unborn fetus. We certainly know that alcohol crosses the placenta and the fetus is exposed, and in extreme cases there are defects to the baby that are called the fetal alcohol syndrome, or abbreviated as FAS.

I believe that this is also an issue when you are trying to conceive because my feeling is when you are trying to conceive you should eat, exercise, and take care of yourself the same way you would while you were pregnant, because you don't know exactly when conception will occur. It is true that many women drink small or moderate amounts during pregnancy and things are OK, but if you really want to do what is the lowest risk for your baby, it would be best to keep the amount of alcohol exposure as low as possible.

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MEMBER QUESTION:
Have you ever heard of douching with boric acid to change the Ph balance to help conceive?

CURTIS:
I don't think it is a good idea to douche at all, or with anything, while you are trying to get pregnant. Claims have been made over the years about different things to use to make it so that you conceive a boy or a girl or even multiple pregnancies. My feeling, very strongly, is that douching will make it so that you don't get pregnant, and I would advise strongly against it while you are trying to conceive. It doesn't usually work, and I think in most cases it will make it harder for you to conceive.

"If you really want to do what is the lowest risk for your baby, it would be best to keep the amount of alcohol exposure as low as possible."

MEMBER QUESTION:
I exercise regularly and want to know if it is OK to exercise when you are ovulating? Will it affect ovulation or my chances of conceiving?

CURTIS:
I think exercise is great when you are trying to conceive, during early pregnancy, and during regular pregnancy. My caution would be that if you have had complications in the past, such as recurrent miscarriage or bleeding during pregnancy or premature labor or delivery, it would be best to talk with your provider about your exercise plan before you become pregnant.

I would put this in the category of preparing for pregnancy, and when you are trying to get pregnant you exercise, you eat, and you take care of yourself as though you were already pregnant. By that I mean you maintain the level of exercise you are already doing and don't increase it, such as by training for a race or a marathon.

MEMBER QUESTION:
I am going for my annual next week. Any specific tests or questions I should ask my ob-gyn about since we will be trying within the next year to get pregnant?

CURTIS:
I wish everyone planned ahead like this. By going for your annual exam you can make sure that your PAP smear is normal, and you can also make sure that you don't have other medical problems. Included in this would also be reviewing medications that you take, such as thyroid medication, and also planning, as far as medical tests. If you have never been pregnant before, then it would be OK to ask about checking for rubella antibodies.

During that visit a good question to ask would be, "I am planning to get pregnant in the next year, is there anything about my health that I need to take care of?" The answers to that question will be specific for you with regards to your health, your weight, and even your nutrition. The questions would need to be specific for your health, but could save you a lot of trouble and concern by taking care of things before pregnancy.

MEMBER QUESTION:
Is one intercourse position better if TTC?

CURTIS:
Most infertility specialists will recommend that you take gravity to its fullest advantage, and that means for a woman to be lying on her back. Anatomically, the vagina is tilted from the outside to the top of the vagina, or where the cervix is, when a woman is lying on her back. By using that position it allows the sperm that are deposited in the back of the vagina to stay there and have a chance to go into the cervix and through the uterus. That would be my recommendation.

MEMBER QUESTION:
Hello, I am currently overweight for my height (I have lost 15 pounds over the past two months). My husband and I have been trying to get pregnant now for nine months without any success. I'm 32 years old. Should I begin to panic?

CURTIS:
If you are a little bit overweight, it shouldn't make a difference in getting pregnant. Being overweight when trying to get pregnant, or during pregnancy, is pretty common. It would be ideal to lose the weight before you become pregnant, because once pregnancy happens, you will be advised not to diet. However, what is ideal in this world doesn't usually happen.

One of the problems with being overweight is that it can change your periods. This, then, creates a problem as far as knowing when or if you are ovulating. Another concern would be trying to lose weight and taking diet medications when you are trying to conceive. Most of these medications are not considered safe during pregnancy and should be avoided.

"One of the problems with being overweight is that it can change your periods. This, then, creates a problem as far as knowing when or if you are ovulating."

MEMBER QUESTION:
Is it OK to use saliva as lubrication if you're dry during intercourse? And is oral sex ok when TTC?

MEMBER QUESTION:
Does using lubrication for dryness decrease your chance of conception?

CURTIS:
Lubrication can be an important issue when you are trying to conceive. One thing that happens to most women around the time of ovulation is an increase in vaginal discharge. Some women are able to tell that they are ovulating or when it is happening just by the change in discharge. If you are very dry when you think you are ovulating, that would be something to tell your doctor, because it could be a clue about your ovulation.

As far as substances for lubrication, I would advise not using them because of the possible effects they could have in making it so that you can't conceive. In your specific case, that would be a good question for your provider.

MEMBER QUESTION:
Why does it take so long for the average couple to get pregnant? Is the timing so hard to get right?

CURTIS:
With everything that we have discussed today I think it's important to recognize the miracle that happens during pregnancy. As I say that, I'm looking at a picture of two of my grandkids. Somehow, a sperm and an egg get together, fertilization occurs, and from that about nine months later, a baby is born. I think it is a miracle that it even happens at all, and sometimes the best things that we can do in trying to get pregnant is to not do too many things to get in the way so that it can happen. I think it's important to be aware of the miracle of pregnancy and attempt to get pregnant with confidence, and when it doesn't happen to get help from someone who knows what they're doing.

MODERATOR:
We are out of time. Thanks to Glade Curtis, MD, for joining us. For more information from Dr. Curtis, pick up a copy of his book, Your Pregnancy Week by Week . And be sure to explore all the TTC info here at WebMD, including our message boards, where you can post comments and questions for fellow WebMD members and our in-house health professionals. You can also explore the web site of RESOLVE: The National Infertility Association, at www.resolve.org.



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Reviewed on 10/11/2004 3:10:06 PM

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