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Preconception Questions to Ask Your Doctor Before You Conceive

For many couples, having a family is a dream that they have always wanted. For many prospective parents, holding a baby in their arms gives them wonderful thoughts of infinite bliss. Having a child is truly a privilege and a blessing. Yet to be honest and realistic, some couples will struggle or will fail in obtaining their goal to conceive.

This doesn’t mean that they do not deserve children, it is just a fact of life and the way of the world. If you have been struggling, do not lose hope, as you still have options that will help you to become a parent. Here are some helpful topics and questions that you should consult with your health care provider before beginning your journey to parenthood.

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14  Your Gynecological Check-up

The first thing every woman would like to know is, am I fertile? Further questions include, how long will it take for me to become pregnant? And, when should I seek help so I can get pregnant? Furthermore, what are the best, (if needed) fertility treatment options for me?

Go ahead and schedule your first pre-conception immediately if you and your partner are ready to start a family. The first step is to gain some insight and to educate yourself about your personal health and options for your future. Your physician must conduct an assessment of your overall physiological health and can provide you with answers that pertain to you and only you in your personal case.

Here are some common and necessary procedures that will be done so your doctor can obtain data that will provide her with answers to your questions.

  • Calculating your age (including months)
  • Weight check & BMI determination (obesity can create diabetes which hinders conception)
  • Evaluating your family history
  • Blood Analysis-to test for Vitamin D levels, Anemia, Hepatitis B, STD’s, and your thyroid are some that are basic protocol. Abnormal findings of them are known to hinder successful conception
  • Undergoing a physical examination
  • Urine Analysis-looks for Bladder (UTI) or Kidney Infection
  • Gynecological related ailments such as

  1. Endometriosisa: A painful condition where tissue in the uterus (endometrium) is found elsewhere in the female reproductive system, including the fallopian tubes, ovaries, vagina, and other related areas.
  2. Pelvic inflammatory disease: When any infection occurs in a woman’s upper reproductive system, commonly caused by STD’s
  3. Polycystic ovarian syndrome: A very common cause of infertility, where too much LH (luteinizing hormone) is produced causing the ovaries to produce too much testosterone. Women suffering from this are known to not ovulate, experience long irregular periods, and have unexplained weight gain/obesity, hair growth, and acne.
  4. Fibroids: Benign tumors that grow and develop in the uterus
  5. Ovarian cysts: Fluid filled sacs that are in or on the ovary, and
  6. Irregular menstruation-being overweight/underweight, exercising too much, eating disorders, prior birth control use are some causes of this.

13  A Short Guide to Conception

Ovulation is when an egg, known as an oocyte is released from the ovaries and travels down the fallopian tubes to be fertilized by sperm. This usually occurs on days 12-14 from the 1st day of a woman’s menstrual period, but can be anywhere between day 12-18. 

The egg only has a short window of life of only 12 to 24 hours after the start of ovulation. Sperm can live up to 72 hours in your body after ejaculation, and a man's semen can consist of 100 to 200 million potential sperm wanting to be the lucky one that is able to fertilize the egg.

It can take up to 30 minutes for the sperm to swim up the fallopian tubes and another 20 minutes to find the egg. If the sperm is successful in penetrating the egg, this could take another 20 minutes to break through its shell and complete it's the job of fertilization. The egg, now called a zygote divides itself into 2 cells and makes its way down the fallopian tubes for another 6 days while continuing to divide itself. It turns into a blastocyst, consisting of 100 cells now, and is ready to implant itself in the uterus.

After sex, it is recommended that you lie down flat with your hips and legs elevated with pillows for about 15 minutes and let gravity do its work.

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10  What Are the Effective Ways to Predict Accurate Ovulation?

Here are some techniques that you can use to time your cycles of ovulation. It can be tricky, however as some tests can predict right before you ovulate, as well as when you are ovulating. It can be confusing as to predict when you are most fertile, so read the instructions carefully!

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8  How Old is Too Old to Have a Baby Naturally?

Experts will give you a range of answers when discussing the chances a woman has in conceiving a baby while she ages into her 20’s, 30’s and 40’s. Here is some useful data to use as a guideline in factoring how age affects fertility.

Age- Success within a year

20-24- up to 96% within a year (20-25% success rate a month)

25-29- up to 86% chance within a year. (5-20% success rate a month)

30-34- up to 75% chance within a year, (10-15% success rate a month) (miscarriage rate is up 20%) 1 in 952 chance for Down syndrome

35-39- conservative views estimate 66% within a year (8-10% success rate a month), invasive testing required. 1/365 chance for down- syndrome

40- Only a 5% success rate to conceive each month as 90% of eggs are chromosomally abnormal. 1/90 chance for Down syndrome. (the last chance to freeze your eggs is between ages 40-42)

45+- up to 3-4%, but the average is 1% success rate a month (use of reproductive aid and use of an egg donor is highly recommended) 1/30 chance for Down syndrome

What is important to infer from the research is that fertility does indeed decline with age. A newborn girl is born with about 1 million eggs in her body and only contains about 300,000 after menarche or her first menstrual period as a pre-teen/teenager. From then on, eggs are released during ovulation until menopause, or the termination of reproduction.

Not every egg will mature and be free of genetic abnormalities (aneuploidy), also known as chromosomal defects. In normal circumstances, a sperm and egg combined have 23 pairs of chromosomes resulting in 46 chromosomes total. Having an extra or missing chromosome causes genetic disorders such as Down syndrome, or could end in miscarriage.

Women will also experience losing the follicles, which are placed just beneath the surface of the ovaries and release the eggs, known as the “loss of ovarian reserve” These changes may begin around 32 years of age and begins to increase more and more around 37 years of age

This is because the amount and quality of eggs naturally decline as the body slowly prepares itself for pre-menopause. At age 30, most women have only 12% left of the eggs they were born with. The body reacts by pushing itself to release eggs by releasing FSH or (follicle stimulating hormone) The older you are, the fewer eggs you have, and the more FSH you need to be able to release your eggs.

Too much FSH can result in having more than one egg be released, so this is why older women are more susceptible to having twins.

Women who are older than 35 are found to be more at risk for gynecological health problems such as ovarian cysts, fibroids, or endometriosis and other disorders that inhibit conception. They are at risk for other health issues that include higher blood pressure and diabetes that also hinder conception. As women grow older, birth defects such as Down syndrome and miscarriage drastically increase so invasive testing must always be done for women over the age of 35.

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6  Is it Him, and Not Me?

Amazingly, 35-40% of the time it is the guy who is experiencing fertility troubles. Do not be so quick to judge that it is always the woman who is experiencing problems. Here is a quick checklist to check to see if any of this could apply to your case.

  • Age is a factor, fertility declines at around 30, and quickly escalates at 45 as age affects sperm quality and count, although 80-year-old men have been known to father babies.
  • Being, at least, 20lbs overweight leads up to 10% infertility
  • Being underweight leads to a lower sperm count
  • Anatomical issues such as
  • -Varicocele-abnormal blood flow within the veins of a testicle(s) that inhibits sperm quality and production.
  • -Erectile dysfunction
  • -Retrograde ejaculation-where semen flows backward and not outside of the penis
  • Having an untreated STD can cause epididymitis, which causes inflammation of the vessels that allow the flow of sperm to come out of the testicles
  • Cancer treatments
  • Illegal drug use
  • Tight underwear or jeans and hot weather can cause sperm to be deformed
  • Toxic environments with hazardous chemicals

5  Do I Need to Quit Alcohol, Nicotine and Prescription Drugs?

Yes, your lifestyle will definitely need to change the moment you find out that you will be starting a family. Having children means that you will need to sacrifice yourself. You can also think of it as a fresh start to a healthier lifestyle. Here are some common habits that couples question to kick to the curb once they are ready to conceive.

Nicotine- The more you smoke, the faster your eggs will age, and the harder it will be to get pregnant as older eggs are more at risk for miscarriage, and increasingly difficult to fertilize and implant in the uterus. Nicotine declines the quality and quantity of sperm, making it harder to conceive. So yes, both of you should quit all kinds of smoking altogether.

Alcohol- Heavy or binge drinking can disrupt your ovulation cycle. It is advised that you cut down on the drinking or stop altogether if possible. However, no amount of alcohol is okay throughout pregnancy so start preparing to wean yourself off the booze for good once you are pregnant.

Prescription drugs- Check out the FDA risk category for the prescription you are taking if you plan on continuing its use throughout pregnancy. Speak to your doctor about how the drug could affect conception and how it affects an embryo/fetus. Stopping a drug cold turkey could be even riskier than if you continue to take it, so make sure you consult your physician before you make your choice. 

If you have decided that you would like advanced help, stop by your OB to get a referral to an reproductive endocrinologist (RE) or check out the Society for Assisted Reproductive Technology (SART) for a list of clinics with their documented outcomes. Here is a brief overview of the technologies in medicine that will assist you to get pregnant without sexual intercourse.

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3  Assisted Reproductive Technologies (ART)

Keep in mind that ART procedures are very expensive, but the good news is that 15 states have laws that require insurance companies to provide coverage for some services. It is important to consult with your insurance to understand what kind of coverage you have as you may have to shell out the entire cost out of your own pocket.

  1. In Vitro Fertilization (IVF) is the most common procedure used in ART's. About 130,000 cycles are conducted per year in the U.S., resulting in 52,000 babies per year! Cost: $12,400, according to babycenter.com! Here is a quick explanation of how it works.

  • -Hormones, (Clomid) or (gonadotropin) are used to stimulate the ovaries to function properly and so they will produce eggs in the woman.
  • -The eggs (about 8-15) are extracted from the woman from a needle inserted into the vagina and a sperm sample is taken from the man
  • -In the lab, an embryologist chooses the healthiest sperm and eggs, fertilizes them, and freezes what he can to use for future cycles (cryopreservation)
  • -A catheter is placed in the vagina and a syringe is used to insert the embryos into the uterus. (the number of embryo’s that are inserted depends on your case, and age)
  • -the doctor will conduct a blood test 2 weeks later to confirm if the procedure is a success or not, or you can take an at home pregnancy test

2.Intracytoplasmic Sperm Injection (ICSI) is highly used for complications in male fertility

  • -Used in addition to IVF
  • -Eggs are “washed” of their outer coating so they can easily be penetrated. A chemical is used to slow sperm down (as the embryologist can catch it easily) and it is directly inserted into the egg

3. Gamete Intrafallopian Transfer (GIFT). This is more expensive and invasive than IVF

  • Egg and sperm are collected the same way as IVF, but are immediately placed into the fallopian tubes during the procedure and are not produced in the laboratory

4. Zygote Intrafallopian Transfer (ZIFT): Similar to GIFT but the eggs are fertilized by the technician in the lab. Usually, on the same day the eggs are implanted into your fallopian tube. It is explicitly clear that a fertilized egg is planted in your body.

5. Egg Donor: Another woman voluntarily extracts and uses her eggs instead if your eggs are not viable.

6. Sperm Donor: Easier and cheaper, as it is very simple to collect sperm

7. Surrogate: A woman who volunteers to physically carry out your pregnancy for you. There are 2 types.

  • Gestational carrier- a woman who uses eggs that do not belong to her
  • Traditional carrier- a woman who uses her own eggs to be fertilized with the sperm of a couple whom cannot produce viable eggs

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1 In conclusion....

Remember that many couples struggle with infertility, so don’t give up just yet. You will always have options to be a parent, and it takes a certain type of person to do that, even though your child is not biologically yours. Humans can be mothers and fathers to their children, but the difference is that you will be that, as well as their parent, which, unfortunately, not everyone in this world does. 

Good luck on your journey, have a positive attitude, see the glass half full, and most of all, always have hope!

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