Clearblue Advisors answer the most common questions regarding reproductive health, to enable you have a greater understanding of how your body works.
At Clearblue we actively engage with a range of leading Pregnancy and Fertility experts around the world, to support us in our commitment to help as many women as possible increase their chances for a healthy pregnancy. Our experts, all highly-regarded within their fields, are specialists in areas such as Assisted Reproduction, Fertility and Early Pregnancy. They are here to provide you with comprehensive knowledge for a greater understanding of your reproductive life.
Bill Ledger - Planning for a baby Q&A
Bill Ledger is Professor and Head of Department of Obstetrics and Gynaecology at the University of New South Wales in Sydney Australia, where he moved from being Head of Department at University of Sheffield, UK, in 2011. He is also Director of Research and development at IVF-Australia. He has published extensively on infertility and its causes, is on the Editorial Board of several major journals including Fertility and Sterility and BJOG, and was also a member of the Human Fertilisation and Embryology Authority until his move in 2011.
Why is folic acid recommended when trying for a baby?
There is good evidence that having a good level of folic acid in the bloodstream at the time of conception substantially reduces the risk of the baby having neural tube defects such as spina bifida. Public health authorities in UK, USA and elsewhere recommend that healthy women take 0.4 or 0.5 mg folic acid per day (this is available in many pre-pregnancy vitamin supplements) and those with risk factors for poor folic acid metabolism, such as women taking anti epileptic drugs or with MTHFR gene mutations should take 5.0 mg per day. What is important is to have it in the egg before it is fertilised.
Are there any foods I should avoid when trying for a baby?
Most foods are completely harmless during pregnancy and it's important to maintain a balanced healthy pregnancy diet with sensible amounts of the various nutritional categories. However there are worries at present about listeria infection that can be caught from unpasteurised and raw foods. These include unpasteurised milk, soft cheeses, pre-prepared salads (for example, from salad bars), unwashed raw vegetables, pate, cold diced chicken and pre-cut fruit and fruit salad. To prevent listeriosis avoid these high risk foods and thoroughly cook raw food from animal sources, such as beef, lamb, pork, or poultry, keep and prepare raw meat separate from vegetables, cooked foods, and ready- to-eat food and wash raw vegetables and fruit thoroughly before eating.
I have recently had a miscarriage; how soon can I start trying to get pregnant again?
In the past, gynaecologists advised women to wait at least three months before trying to become pregnant after a miscarriage. However research has shown that the chance of a healthy pregnancy is no different if you try again after the first normal period after the miscarriage. There is no benefit from waiting and many women want to try again as soon as is safe. However make sure that you feel ready psychologically. It is healthy and normal to grieve for the lost pregnancy and not everyone wants to be pregnant again immediately.
I have been diagnosed with polycystic ovarian syndrome, will this make getting pregnant difficult and why?
Women with polycystic ovary syndrome often don’t ovulate, or at least not regularly. This group of women will have irregular or infrequent periods. If you are not ovulating then the egg is not released from the ovary to pass into the Fallopian tube in order to be fertilised and implant in the uterus.
There are several treatments for anovulation (a cycle when no egg is released) with polycystic ovary syndrome. These include Clomifene tablets (Clomid) and injections of fertility drugs. Your doctor will be able to advice on this and refer you to a specialist clinic for help.
As we are trying for a baby should we increase our frequency of intercourse? Can too much intercourse damage the quality or quantity of the sperm?
Sperm that are stored within the testicles for too long accumulate damage to the DNA and are less fertile. With couples who have frequent (daily) intercourse, the man will have a lower sperm count per ejaculation but the sperm will be more fertile. If you are trying to conceive then try to have intercourse at least every other day around the time of ovulation.
The Clearblue ovulation tests can help with this. If you like to have intercourse more often, then this will do no harm. However it’s important also to avoid stress so if you prefer less frequent intercourse then just try a little harder at this time of the month.
How long should I wait between my last pregnancy and trying for my next child?
It's obviously important for your young baby to have time with their Mum and Dad, both for the physical support from breast feeding but also the nurturing and bonding that are vital to your baby's development in the early months. Many women who breast feed will notice a delay in their periods restarting after childbirth, although this cannot be relied on as a form of contraception.
It's also important to decide what size of family you want, and work this out against your age. The age of the couple, especially the woman, has a big impact on chances of getting pregnant again. If she's over 35 or comes from a family with early menopause then it's worth trying again sooner. This is also the case if the man is over 45.
Can I ovulate more than once during my cycle?
Yes, it's possible to ovulate twice but this usually happens at about the same time of the cycle. This is how non-identical twins occur, from ovulation of two separate eggs. It happens more often in women over 35 which is one reason why the older group have more twins (the other is that many IVF clinics will replace two embryos for older patients whereas those under 40 generally have one embryo replaced)
Can certain sexual positions increase our chances of conceiving?
This seems to be an old wives tale. Many women notice that semen seems to 'leak back' from the vagina after intercourse and so lie on pillows or with their legs in the air after sex. However this loss is just the seminal fluid - the motile sperm move very rapidly into the cervical mucus so don’t worry about this leakage.
Is it true that laying with my legs in the air for 30mins after intercourse improves my chances of getting pregnant?
Probably not. See above - if it's going to happen then it will, and lying in unusual positions won't help.
I suffer from endometriosis and am worried I won’t be able to get pregnant, is that true?
Many women with mild endometriosis will conceive easily although chances of subfertility even for the mild group are higher than the background rate for age. Severe endometriosis can damage the Fallopian tubes and ovaries, and the adhesions that can come with endometriosis can also block the tubes. Your gynaecologist will be able to advise you on what to do about this. Don't try for more than a few months without getting advice.
We are planning to try for a baby, are there any dietary supplements apart from folic acid that can help me?
Folic acid is the most important. However it’s worth having your vitamin D level checked and taking a replacement if you are deficient (which many of us are). If you have a diet that is light in red meat then you may need an iron supplement and if you have a vegan diet then other supplements may be worth considering. However there is a large industry designed to sell vitamins and supplements to women wanting to be pregnant, and there's not much evidence that healthy young people with a balanced diet need to take all of these potions.
We are planning to try for a baby, are there any dietary supplements that my partner should be taking?
Not unless he has specific health problems or has dietary restrictions. If you've been trying for a while its worth asking your doctor to arrange a sperm count for him - if this is normal then don’t worry about diet. Stop smoking, drink moderately on two or three occasions per week, keep your weight in the normal range for your height (but don’t lose too much) and enjoy a happy love life.
My cycles never seem to be the same length, is that normal?
Many women quite naturally have a menstrual cycle that varies by a few days month to month. If you are trying for a baby, accurately identifying your wider fertility window can be an advantage. See the available solutions in the video below.
Emma Kirk - Am I pregnant? Q&A
Miss Emma Kirk is a Consultant in Obstetrics and Gynaecology at the Royal Free Hospital London, where she is the Lead for Early Pregnancy and Emergency Gynaecology. She has a special interest in Early Pregnancy and Gynaecological Ultrasound. She worked as a research fellow for many years and has published over 50 peer reviewed papers on early pregnancy topics. She has written many book chapters and edited her own book on Early Pregnancy Ultrasound. Emma is Coordinator of the European Society of Human Reproduction and Embryology Special Interest Group in Early Pregnancy. She is on the board of the Association of Early Pregnancy Units (AEPU) and is a medical advisor to the Ectopic Pregnancy Trust (EPT). She frequently lectures on different aspects of early pregnancy.
I got a pregnant result on a pregnancy test but am now spotting a little blood, is this normal?
It might be normal as long as it is just spotting, not like a normal period, and you are not experiencing any significant pain that requires more than a mild painkiller like paracetamol. If the spotting during pregnancy continues and /or you have any concerns speak with your doctor. If you continue to experience spotting during pregnancy your doctor will most likely arrange an early ultrasound scan.
I had a positive pregnancy test last week but have just taken another test now which is negative - am I pregnant?
If you followed the test instructions correctly the results of home pregnancy tests are very accurate. It may be possible that you experienced an early loss. Sadly this is not uncommon as about quarter of pregnancies will end in an early pregnancy loss. To be certain repeat another pregnancy test in a week's time.
I had sex last night; can I take a pregnancy test?
No, even if you had just ovulated and your egg has been fertilised, it is too early to test. It takes about a week for a fertilised egg to travel through the fallopian tube and implant into the lining of the uterus (womb). The hCG produced by the egg can only be detected in your urine once the egg has implanted. If you test before the egg has implanted (typically about 7 days before your missed period), there will be no hCG present, so a pregnancy test will always give a negative (Not Pregnant) result. The earliest you can test with the most sensitive tests currently available is 6 days before your missed period (typically 10 days after ovulation).
I've just discovered I am pregnant but I hadn't been planning for a baby. I'm worried as I have been drinking alcohol as normal - will it have damaged the baby?
It is unlikely to have harmed the baby and a continuing pregnancy is a sign that everything is normal. If you are concerned about your recent intake of alcohol you should discuss this further with your doctor. Going forward, the safest advice is to drink no alcohol at all whilst pregnant.
I think I got a false positive pregnancy test - is it possible?
Most pregnancy tests are over 99% accurate from the day you expect your period. However, I know it can be hard to wait and the most sensitive tests can be used up to 6 days before you miss your period, which is 5 days before the expected period. Be aware that if you choose to test early and get a not pregnant (negative) result you may simply be testing too early and you should test again on or after the day your period is due.
I'm taking the pill but have fallen pregnant - could this be a problem for my baby?
Taking the pill at any stage in pregnancy is unlikely to cause problems. Stop taking the pill when you find out that you are pregnant. Make sure that you tell your doctor that you fell pregnant on the pill, who will arrange for you to have the normal check-ups and scans for your pregnancy.
Michael Thomas - Not Pregnant yet Q&A
Michael A. Thomas, MD is a Professor of Obstetrics and Gynecology and is Fellowship and Section Director of the Division of Reproductive Endocrinology and Infertility at the University of Cincinnati, College of Medicine, Cincinnati, Ohio. His previous roles include Director of the Center for Reproductive Health at the University of Cincinnati and Vice Chairman of the Department of Obstetrics and Gynecology. He is board–certified in both Obstetrics and Gynecology and Reproductive Endocrinology and Infertility.
Professor Thomas gained his B.S. from Northwestern University, Evanston, Illinois, in 1980 and his M.D. from the University of Illinois, College of Medicine, Champaign, Illinois in 1984. His research interests include Contraception, Infertility, Stress and Reproductive Function, Reproductive Endocrinology, and Menopause. He is also a member of the Endocrine Society, the Society for Gynecologic Investigation (SGI) and the Society for Family Planning (SFP).
Professor Thomas is nationally recognized as a leader in the field of assisted reproduction and has published extensively in this area including articles in Fertility and Sterility, the Journal of Assisted Reproduction and Genetics, the Journal of Clinical Endocrinology and Metabolism, and Menopause.
Does stress affects my ability to get pregnant?
Stress probably has a minimal impact on a women's ability to get pregnant. Studies have shown that elite athletes and women with low female hormone production (eating disorders, low weight issues) activate their stress hormones, which can have an impact on their ability to release an egg. Normal day to day stress may not have as much of an impact on your ability to conceive. Usually stressful situations are short term and don't have an on-going affect on your fertility.
I have very short cycles, is that why I can't get pregnant?
The normal cycle range is usually from 23 to 35 days. Cycles shorter or longer than that range can be associated with fertility issues. Over the course of a woman's reproductive life span, her typical cycle lengths will fall in this time frame. If your cycles are usually less than 23 days, you should see your physician.
I've already had a child /(children) but am struggling to conceive this time; why might that be?
A number of factors can impede your ability to get pregnant even after having had a child in the past. The most common issue is your current age. If you had a child in the past and you are now over the age of 35 years, your ability to get pregnant may be decreased. You may also have developed a problem with your ability to ovulate consistently and/or a polyp or fibroid in the uterine cavity that may impact an embryo's ability to implant and thrive. Also, your male partner may have a sperm abnormality that has caused a decrease in his sperm count, motility or shape. If you are at all concerned consult your HCP?
I had a termination in the past; could it affect my ability to get pregnant now?
Usually a pregnancy termination will not affect your ability to get pregnant in the future. On rare occasions, you may develop adhesions in the uterus that can cause issues with future fertility. If you are having normal monthly cycles, the chances of these adhesions affecting your fertility are low. Seeing your fertility specialist or gynaecologist will be helpful in making sure your uterus has not been affected if you have been attempting pregnancy for one year, are under the age of 35 and have cycles between 23-35 days long. If you are over 35, consider a consultation after 6 months, and immediately if over 40.
I have heard you can have your ovarian reserve (the number & quality of eggs I have left) measured by Anti mullerian hormone and FSH blood tests - what does this mean?
In women over the age of 35, the majority of physicians routinely perform tests for ovarian reserve if you are attempting to conceive. Blood tests include an AMH or anti mullerian hormone test, which can be taken at any time in the menstrual cycle and even if you are on birth control pills. Anti mullerian hormone is made by the cells in the follicles of the ovaries and may be an early way of determining how much reserve is remaining in your ovaries. Interpretation of the results of this test may vary from health care provider to health care provider.
Also, on day 3 of the menstrual cycle (two days after you start your menses), you can obtain a blood test for Follicle Stimulating Hormone (FSH) and Estradiol. These two tests may be a way of determining waning ovarian function at the beginning of the menstrual cycle when a dominant follicle is being recruited for ovulation. Another test for poor ovarian reserve is an antral follicle count. During this test, a transvaginal ultrasound is used to determine whether the number of follicles that are ready for recruitment on Day 3 of the cycle. More detailed information on ovarian reserve testing can be found at www.reproductivefacts.org
I'm 35 and have not yet found my life partner but would still like to have a baby in the future, should I consider freezing my eggs now?
The American Society for Reproductive Medicine has recently stated that egg (oocyte) freezing is not considered experimental. Because of this, fertility centres can now freeze eggs for women who may want to use them in the future. Patients who are considering this option can either freeze eggs alone or freeze a combination of eggs and embryos (fertilized eggs) using donor sperm. As of now, the thawing of eggs and subsequent fertilization varies between fertility centres. Embryos are thought to have a better chance of thawing and implanting in your uterus than thawing eggs and attempting to fertilize at a later date.
I'm not sure I ovulate every month, what might cause this?
Women sometimes don't ovulate every month for a number of reasons. If you have menstrual cycles that occur every 23 to 35 days and you have symptoms of breast tenderness, bloating, pelvic or uterine cramping, or mood changes 3-14 days prior to your menstrual cycle, you probably are ovulating. However, if your cycles are usually over 35 days, you may not be ovulating consistently or not at all. The majority of women who do not ovulate and are not pregnant, may have Polycystic Ovary Syndrome (PCOS). PCOS is a condition that you are born with and can cause a woman not to ovulate (release an egg) on a regular and consistent basis. These women may also have adult acne or an increase in hair growth above the lip or below the chin. On ultrasound, the ovaries may be seen to have many small cysts inside them, that remain at a small size. Other conditions that can cause you not to ovulate include low thyroid function (hypothyroidism), high prolactin production (hyperprolactinemia), and during the time period prior to the menopause (perimenopause). If you feel that you are not ovulating consistently, you should see your health care provider.