Perhaps the only advantage of infertility is that it gives you a chance to better plan for a healthy conception, pregnancy and delivery. Following is some general information which you may want to keep in mind regardless of how you conceive.

Vitamins & Iron

Adequate intake of folic acid decreases the likelihood of severe nervous system deformities in the offspring. The current recommended daily intake of folic acid for all women of the reproductive age is 0.4 mg (which is the amount contained in most multivitamins). Pregnant women are advised to take 0.8-1.0 mg of folic acid daily (which is the content of many prenatal vitamins such as NatalinsRx and Stuart Prenatals). Folic acid is found naturally in liver, beans, peas and leafy green vegetables. If you have not been taking folic acid, you need not be alarmed because with the good nutritional standards in the United States most women get enough folic acid in their diet.

During pregnancy the body’s iron stores can become depleted. Iron is not usually contained in standard multivitamins, but a small amount of iron (typically 60 mg) is contained in prenatal vitamins. Therefore, you may consider taking prenatal vitamins even before conception. However, more is not always better and the safety of mega doses of vitamins has not been established in pregnancy. Specifically, pregnant women should not ingest more than 8,000 I.U. of Vitamin A per day because of its association with birth defects.

Smoking, Alcohol & Caffeine

There is strong evidence linking smoking with both male infertility and female infertility, increased chance of miscarriage, retarded fetal growth, placental abruption and other unfavorable pregnancy outcomes in addition to the well-known general health hazards. We cannot recommend strongly enough that both partners quit smoking because passive smoking carries many of the same risks. Once pregnancy is established, alcohol is contraindicated and caffeine intake by the mother needs to be kept below 200 mg per day (the content of one cup of coffee or one cola soft drink).

Toxic Substances

Toxic substance exposure can make it difficult to conceive and could be harmful to the growing fetus. Some species of fish, such as shark, swordfish, tuna, striped bass and bluefish, may contain undesirable amounts of toxins such as PCBs and methylmercury and should be avoided or eaten only in small amounts while pregnant. Cod, haddock and pollock are considered the safest fish. Salmon, flounder and sole are relatively safe and can be eaten in moderation.

Raw and undercooked eggs, fish, shellfish, chicken and meats may contain parasites and/or unacceptable levels of bacteria which can cause serious food poisoning. Therefore, these foods should be avoided during pregnancy. Maintain good kitchen hygiene and cook all foods to the recommended temperature to reduce the risk of food poisoning.

Cat feces and cat litter also pose a risk of transmitting toxoplasmosis which is harmful to the developing fetus.

Body Weight

It is best to be neither underweight nor overweight during pregnancy. If possible, try to achieve your recommended weight before conceiving. Do not follow a negative calorie diet while pursuing conception and during pregnancy.

1st Trimester TLC

After experiencing either infertility or pregnancy losses many women are understandably anxious about their pregnancies and desire close follow-up during the first trimester. By convention, the gestational age of pregnancies is counted from last menstrual period (LMP) with ovulation occurring at the gestational age of 2 weeks, i.e. on day 14 of cycle. The first trimester spans the initial 13 weeks from LMP. It is during these first three months that the vast majority of pregnancy losses occur adding greatly to the emotional roller-coaster faced by many of our patients.

Obstetricians usually do not see pregnant women until 9-10 weeks so they are often unfamiliar with active management of early pregnancy. We have found that patients clearly benefit from close monitoring during the first trimester of their much-desired pregnancies. In fact, many already pregnant women have sought out our practice specifically for the first trimester care and management.

The goals for first trimester care are threefold:

1. to accurately determine as soon as possible whether the pregnancy is progressing normally;

2. to provide hormonal and other support to potentially viable pregnancies;

3. to offer emotional support and a scientific explanation when pregnancies fail.

Our protocol includes sequential tests of hCG, which is secreted by the placenta, as well as progesterone hormones. Rapid rise in hCG with doubling of levels at least every 2 days is the earliest indicator of a healthy pregnancy. Progesterone hormone, which is secreted by the ovary after ovulation, relaxes uterine muscle and thus permitting the pregnancy to growth. In normal pregnancies progesterone level is at or above 25 ng/mL.

High resolution vaginal ultrasound is invaluable in following early pregnancies. First and foremost ultrasound allows us to determine the location of pregnancies either within the uterine cavity or outside the uterus (ectopics). In addition to localizing the pregnancy, the initial scan at 5-6 weeks shows the number of sacs and the presence of either yolk sac or early fetal heart activity. Later ultrasounds follow fetal development by measuring the CRL (crown-rump length in mm) and fetal heart rate in bpm (beats per minute). Most of the pregnant patients in our practice have 2-4 scans during the first trimester.

In the frequent cases of bleeding or spotting in the first trimester, ultrasound can be reassuring when fetal growth continues. In some cases a collection of blood can be seen within the uterus (sub-chorionic hemorrhage) usually in proximity to the placenta. Patients with a large sub-chorionic hemorrhage benefit from pelvic rest and restricted activities until the hemorrhage resolves.

Once your pregnancy has progressed to 11-12 weeks, the chance of a pregnancy loss diminish dramatically to less than 5%. At that point you are referred back to your obstetrician. If you do not have an obstetrician we will help you find one within your health insurance plan and geographic area. Many patients initiate early prenatal genetic testing during the transition from our office to their obstetrician.

Our pregnancy patients come to us from Oakland, Sacramento, San Francisco, the Bay Area, Berkeley and neighboring locations.