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Wednesday, December 11, 2013
- I have a fear that I cannot get pregnant. How can I find out whether or not I can get pregnant?
- I have a 25-day menstrual cycle. Where do I start counting to find the best days to try, and when am I most fertile?
- Will an irregular menstrual cycle make it harder for me to get pregnant?
- Does orgasm increase or decrease the chance of conception? I've heard that the contractions of the vaginal muscles during orgasm might even push the sperm away.
- Can using a lubricant during sex interfere with sperm travel and egg fertilization?
- Can I become pregnant on my first ovulation after stopping the pill? What would the pros and cons of trying to do so be?
- I am concerned that my childbearing years are limited because I'm 37 years old and haven't had children yet. How long do most women have before they reach menopause?
- I'm afraid I might get pregnant, not know it right away, and take medication that harms the fetus. Can I harm the fetus immediately after conception? How soon after conception will I know I'm pregnant?
- What is the earliest date I can use the home pregnancy test after having sex?
- I am using the basal body temperature record in trying to conceive. I am confused because I am having several spikes in my temperature. What would be causing this? I am not on any medication.
- Are there effective methods to increase the chances of conceiving a boy or a girl?
- I was on Accutane for acne treatment and was carefully monitored to be sure I wasn't pregnant, since the drug is so likely to cause birth defects. Now, I would like to conceive and wonder if Accutane has any lasting effect that could cause birth defects. Could the drug have damaged my eggs?
Becoming pregnant involves, in basic terms, three things:
Because this involves many different elements, the easiest way to see if you can have children is to try to become pregnant. Infertility is the inability for a couple to achieve a pregnancy with one year of unprotected intercourse. There are tests to determine infertility, but these are only valid in couples that have failed to become pregnant after trying.
You are most fertile around your day of ovulation. This day is best determined by counting 14 days back from the first day of your menstrual period. If your cycle length is consistently 25 days, then day 11 (with day 1 being the start of your menstrual period) is most likely your day of ovulation. If you take into consideration the variation in cycle lengths, by adding and subtracting 2 days, you have your most fertile period each cycle. You should also consider establishing care with your obstetrician prior to pregnancy so you can be adequately counseled. He or she will assess your possibilities of risk reduction to help insure the healthiest pregnancy.
Irregular cycles are a sign of possible ovulation problems. When ovulation occurs at normal intervals, the menstrual cycle does, too. Women who have irregular or no ovulation have irregular patterns of menstruation or possibly no menstruation. While an irregular cycle might make getting pregnant more difficult, there are fortunately tools such as ovulation predictor kits that can help you.
There is no evidence to suggest that it is necessary for conception or that its absence prevents pregnancy. A woman should have no difficulty achieving pregnancy with or without orgasm. There is also no evidence to show that the contractions of the vaginal muscles do anything to inhibit the sperm's migration into the uterus.
Although not a reliable form of contraception, lubricants can interfere with the ability of the sperm to survive in the vagina, as well as the ability to migrate into the uterus.
Yes, you can get pregnant on you first ovulation after you stop taking birth control pills. There is no increased risk to the baby if you become pregnant immediately after going off of the pill. Ovulation may be more unpredictable the first month off the pill. That may effect the baby's due date if you do become pregnant.
The average age of menopause in women in the United States is approximately 51 to 52 years of age. The range at which most women go through menopause is between the ages of 48 and 55. Although the pregnancy rate sharply declines to near zero at the age of menopause, there is a significant decrease in the years prior to menopause. The age most quoted as having a significant decline in pregnancy rate is age 35. The chance of having a healthy baby at age 35 is only about 50% of that of a woman at age 25. Having said this, there are scores of women who are greater than age 35 who have had healthy normal pregnancies without any complications. The following are pregnancy rates after one year of trying to conceive for a given age: 74% (age 31); 62% (age 31-35); 54% (age greater than 35).
The symptoms of pregnancy are different for every woman. Some will tell you that they experience morning sickness before the first pregnancy test, others will not know until they are months pregnant. A urine pregnancy test will usually detect a pregnancy after the first missed period. When you are trying to conceive, you should assume pregnancy in making decisions about medications to take, until proven otherwise.
Medicating during pregnancy is a tough area of discussion. Most medications haven't been tested in a controlled fashion for pregnant women (two groups of pregnant women, half given the test drug, and the other given a placebo). Most are observational studies that looked at groups of pregnant women exposed to the drug and look at the outcomes. There are some medications that we know cause harm when used in pregnancy and should be avoided. The vast majority haven't shown us to be harmful after observing many women on the medication, but haven't been tested. The recommendation is that if there is a definite benefit that outweighs the risks, the medication can be used. I know this may sound vague and arbitrary, but there is little else to help. Your best bet is to contact your physician regarding any medication you may take while trying to get pregnant.
A home pregnancy test detects a pregnancy the day of a missed period by detecting hCG (the pregnancy hormone) in urine. Assuming a 28 day cycle, and conception on or about day 14 of the cycle, a test may become positive approximately 14 days after intercourse. Any pregnancy test may have a false negative result, especially if done too early. It is possible that a home pregnancy test could detect a pregnancy before the missed period but it cannot reliably detect pregnancy that early. What that means is that a positive test before your missed period may mean you are pregnant but a negative test does not mean you are not pregnant. Waiting for a missed menstrual period and then doing the home pregnancy test will give you the most reliable answer. There are more sensitive blood tests that can detect very small amounts of hCG. Only a physician can order those.
Basal body temperature is taken to determine if ovulation is occurring. Prior to ovulation, the basal body temperature is usually below 98. Once ovulation has occurred and progesterone is the main hormone, the temperature will often rise a full degree. The temperature increase will occur after ovulation and does not indicate the best timing for intercourse to result in a pregnancy. Rather, you are looking for a pattern, so you can anticipate ovulation in coming months. It is also important to remember that your temperature will vary slightly each day. Possible problems could be the wrong type of thermometer, activity, timing, or method. You need to be using a basal body thermometer (a glass thermometer that is divided by tenths of degree). Also, you need to take your temperature daily BEFORE getting out of bed, or doing any activity (such as shaking down the thermometer) and after at least three hours of sleep. You must also take your temperature in the same manner each day. Keep your charts and after a couple of months of data, take them to your health care provider for a complete evaluation.
Aside from using advanced molecular biologic techniques, there are no reliable ways to influence the gender of your child. Gender selection is a technique that can be performed, but is reserved for cases of severe genetic conditions that affect male infants. Its use is limited because it can only be performed during an in vitro fertilization cycle. Be wary of claims about techniques and products that can influence the sex of your child - any method has a 50% chance of being successful.
Drugs can either affect a woman's eggs (which are uncommon except for radiation or chemotherapy) or affect the development of the fetus during the pregnancy (which is more common). Accutane is a Category X drug, which means it should not be used during pregnancy for any reason. Furthermore, women who are taking such drugs should be provided with contraception to avoid pregnancy until they are finished taking the drug. As far as Accutane is concerned, it can only affect a pregnancy if you take it while you are pregnant. Accutane is similar in structure to Vitamin A and that is how it causes its harmful effects. If you took the drug three years ago, it will not be a problem now. For more information on pregnancy and drugs, click here.
Last Reviewed: May 28, 2002
Arthur T Ollendorff, MD
Associate Professor of Obstetrics and Gynecology
College of Medicine
University of Cincinnati