Pregnancy Planning

How long should it take to fall pregnant?

Most healthy couples fall pregnant within the first year of trying. Women older than 35 can take longer to fall pregnant. Unprotected sex about three times a week before ovulation gives couples the best chance of falling pregnant.

What should I know about fertility?

1. Fertility declines with increasing age. Age-related fertility problems increase after 35 years, and significantly after 40 years. For example, while 1 in 6 couples will have issues with fertility, 1 in 3 women will have fertility issues after the age of 35.
2. Your fertility should never be presumed. The only true way to test fertility is to try and see if you fall pregnant. The reason we call it family planning, is you have to have some idea of when you want to start and finish adding to your family. Most women overestimate both their fertility and the reliability of IVF as a backup plan.  In women undergoing IVF aged over 35, 18% were unaware of the impact of age on fertility. And 88% of women in the US overestimated by 5-10 years the age when fertility begins to decline.
3. Health can affect your fertility. If you have unresolved medical issues, it’s best to sort these out and to try to optimise your health to ensure the chance of falling pregnant.
4. Around 1% of all births are due to IVF.
5. In cases of treated infertility (with assisted reproduction) just under half is due to male infertility, and about 40% to female infertility.
6. 1 in 35 men will have issues with fertility, while 1 in 25 men will have a low sperm count.

Nutrition

It is important to eat healthily before, during and after pregnancy. Pregnancy and breastfeeding create extra demands for certain nutrients, including iron, calcium, iodine and many vitamins. Make sure your diet is varied and includes adequate amounts of the following: vegetables, breads and cereals, dairy foods for calcium, lean meats, chicken and fish for iron, and fruit.

Folic acid

Folic acid supplements prevent serious birth defects. Women should take one tablet of folic acid 0.5mg for a minimum of one month (ideally three months) before falling pregnant, and for the first three months of pregnancy. Folic acid reduces the risk of having a baby with a neural tube defect such as spina bifida. If you have diabetes, are taking anti-epileptic medication or have a family history of neural tube defects, you may be at a higher risk and should discuss this with your doctor.

Iodine

Iodine is essential for the production of thyroid hormones. These hormones are vital for the development of the brain and nervous system of the fetus, and in babies and young children. Evidence shows that many Australian women do not get enough iodine from food alone. Women should take 150 micrograms of iodine daily if they are planning a pregnancy, are pregnant or breastfeeding. Women who have thyroid problems should talk to their doctor prior to taking a supplement.

Exercise

Regular, moderate, and non-contact exercise is important. Avoid intense exercise and getting overheated.

Infections

Some infections before conception and in pregnancy can present a risk to the fetus. These infections include influenza (the flu), rubella, syphilis, toxoplasmosis, listeria, cytomegalovirus and HIV. Having a fever during pregnancy can also be harmful to the baby so taking paracetamol may be advised.

Influenza

Influenza can cause serious problems when you are pregnant. Even if you are generally healthy, changes in immune, heart, and lung functions during pregnancy make you more likely to get severely ill from the flu. Pregnant women who get the flu are at higher risk of hospitalization, and death, than non-pregnant women. Severe illness during your pregnancy can also be dangerous to your developing baby because it increases the chance for significant problems, such as premature labour and delivery. Getting a flu shot is the most important step in protecting against flu. Getting a flu shot is also the best way to protect your baby from getting a serious flu infection after birth. Flu shots are safe for both mother and baby, and can be given at any stage of pregnancy. Flu shots are free for all pregnant women.

Rubella

Rubella (German measles) infection in pregnancy can cause serious birth defects. Most women have been vaccinated against rubella and are immune, but this immunity can wear off over time. It is important to get a blood test for your rubella immunity status before becoming pregnant. You can be vaccinated if your immunity is low, but you should take care to avoid getting pregnant within 28 days of your vaccination.

Varicella

Varicella (chicken pox) infection in pregnancy can also be harmful so you should consider vaccination before becoming pregnant. Your GP can check if you need this. But you must take care to avoid getting pregnant within 28 days of your vaccination.

Listeria

Listeria can cause fetal death if contracted during pregnancy. It is caused by common bacteria which can contaminate food. It has been found in many fresh and unprocessed foods such as unpasteurised milk, soft cheeses, cold processed meats, pre-cut fruit and salads, pâté, raw seafood and smoked seafood. To avoid a listeria infection in pregnancy, it’s best to:

• avoid the foods listed above
• carefully wash raw vegetables
• thoroughly cook all foods of animal origin
• thoroughly clean utensils after preparing uncooked food

Have a look at the NSW Health Food safety during pregnancy document for more detailed information.

Toxoplasmosis

This infection can have a similar effect to listeria. It is acquired by close contact with infected cats or eating uncooked or undercooked meat. Pregnant women should get another person to clean cat litter boxes daily, wear disposable rubber gloves for handling soil likely to be contaminated with cats’ faeces, and carefully wash hands after gardening or handling raw meat. All meat should be well cooked through before eating.

Smoking, alcohol and other drugs

Smoking is not advised during pregnancy. Ideally quit three months before conception. Avoid exposure to passive smoke. It is not safe to drink alcohol during pregnancy. Stop other recreational drugs and discuss over-the-counter drugs with your doctor or pharmacist.

Genetic counselling

If you have had a child with a genetic disorder, a family history of genetic disorders, or if you’re over 35 you are at higher risk. Genetic disorders include Down’s syndrome, thalassaemia, cystic fibrosis, haemophilia and Tay-Sachs disease; some of these are more common in certain populations. Your doctor can provide advice about genetic testing and counselling for yourself and your partner. Your doctor can also advise you about the tests that are available during pregnancy to detect abnormalities.

Blood group

Your GP will check your blood group so the Rhesus factor is known. Rhesus-negative blood in the mother requires medical attention.

Checkpoint summary

• See your doctor for routine blood tests and a health check
• Stop smoking
• Stop alcohol and other social drugs
• Review current medications
• Follow a healthy diet
• Take folic acid for at least 1 month before conception and for the first three months of pregnancy
• Take iodine supplementation pre-pregnancy, in pregnancy and when breastfeeding
• Develop a good exercise routine
• Ensure influenza, rubella and varicella immunity
• Have a Pap test
• Eat freshly cooked and freshly prepared food
• Consider family history and genetic counselling
• Consider health insurance cover
• Visit the dentist.

For more information about shared care please click on the links below:
http://www.slhd.nsw.gov.au/rpa/womenandbabies/infoPregnant.html