by Dr Agilan Arjunan, Fertility Specialist & Gynaecologist, evelyn Fertility & Women Specialist Clinic, Petaling Jaya ( Malaysia)
“Making the decision to have a child – it is momentous. It is to decide forever to have your heart go walking around outside your body.” However, preparing for motherhood involves much more than merely deciding to have children. Careful planning and preparation are required to ensure that you and your partner achieve a successful pregnancy journey. In this article, I will focus on 3 main aspects that you need to prepare. They are pre-pregnancy care, fertility tests and treatments, and the psychological aspects of parenthood. By taking the time to prepare, you may increase your chances of having a healthy pregnancy and a smooth transition into parenting.
Your first step before conceiving actually starts months in advance. Pre-pregnancy care is crucial to ensure a healthy pregnancy and baby. Make an appointment to see your gynaecologist or a fertility doctor. During this appointment, you can review your medical history, assess any potential risk factors, and go over your options for reproductive testing and treatment. A basic preconception check includes general blood screening for both women and men, which also includes screening for Thalassaemia carrier status, Rubella antibody level, and sexually transmitted infection status. You would also need a pelvic ultrasound scan to look for structural abnormalities such as uterine fibroids and ovarian cysts. The male partner can do a basic semen analysis test in addition to the blood screening tests.
Taking folic acid supplements, at least 400 micrograms daily, both before and throughout pregnancy can significantly reduce the chance of birth disorders such as neural tube malformations. However, folic acid is not the only vitamin that you need. Prenatal vitamins are suggested to make sure you are getting the vitamins and minerals needed for a healthy pregnancy. Along with other essential ingredients, prenatal vitamins usually contain adequate folic acid, thus you do not have to necessarily take additional folic acid.
Smoking, drinking alcohol, and doing recreational drugs can all have a harmful impact on the development of your unborn child even before you are aware that you are pregnant. It is beneficial to stop these behaviours for at least three to six months before trying to conceive. Fertility research has proven that smoking and alcohol abuse have a detrimental effect on both the semen quality and ovarian egg reserve of the woman. If you need help quitting, talk to a healthcare provider or clinic offering these programs. You can also join a support group that can motivate and support your efforts.
Keeping a healthy weight range and exercising frequently can improve your chances of having a safe pregnancy. Being overweight may raise the chance of complications during pregnancy such as gestational diabetes mellitus and pregnancy-induced hypertension. These complications may affect the pregnancy in the form of iatrogenic preterm labor or stillbirth. It is best to work towards a healthy weight before getting pregnant. Regular exercise, like walking, swimming, or playing your favourite sports, can keep you active and improve your general health.
If you are taking prescription medications for your health, it is critical to discuss this during your pre-pregnancy period. Some medications may need to be changed before or during pregnancy in order to ensure the best results for you and your unborn child. For example, some medications for hypertension are not safe to take when you are pregnant. Your doctor can suggest an alternative medication that is safe in pregnancy. Any pre-existing medical illnesses such as Diabetes Mellitus, Hypertension and Thyroid disorder needs to be well controlled prior to conception. Uncontrolled medical illnesses can increase your risk of a miscarriage.
How about vaccination? Apart from the Covid-19 vaccination, an important vaccine to consider would be Rubella vaccine. In your pre-pregnancy blood screening tests, you would know if you have adequate Rubella antibody. This antibody will eventually protect your baby in the womb from Rubella infection. If you are not immune to Rubella, consider taking the Rubella vaccine at least one to two months before pregnancy.
In rare circumstances, if you have a family history of a genetic condition, discuss with you gynaecologist about possibility of transmission to you baby. Remember, not all genetic diseases are transmitted via parents and many occur by chance. Genetic testing can help you detect any potential risks to your unborn child and give you the knowledge you need to make pregnancy-related decisions.
By taking the time to address any medical issues, maintain a healthy lifestyle, and discuss your options with your doctor, you may increase your chances of having a safe pregnancy and healthy baby.
Fertility Tests and Treatments
One in six to seven couples face infertility. If you have been trying to get pregnant for more than a year (or six months if you are over 35), it is time to visit a fertility specialist. Basic fertility tests, in many circumstances, help you to understand the obstacles faced and you can plan your fertility journey with confidence.
Fertility testing typically involves both the partners. These tests include semen analysis to assess sperm quantity and quality, egg reserve test for the women. Egg reserve test can be done by counting the antral follicle count via an ultrasound scan or by a blood test called Anti-Mullerian Hormone (AMH). An imaging tests called Hysterosalpingography (HSG) can determine patency of your Fallopian tubes. Other hormonal blood test is done if your fertility specialist suspects any underlying illnesses based on your fertility history. Once the underlying cause is identified, appropriate fertility treatment can be started.
In women who do not ovulate regularly, especially in a woman with PCOS, ovulation-inducing medication is a common treatment that can increase the likelihood of pregnancy. Another treatment option is intrauterine insemination (IUI), which involves injecting sperm directly into the womb during ovulation to increase the likelihood of fertilisation.
In vitro fertilisation (IVF), which includes fertilising eggs in a fertility lab and transferring the embryo/s into the womb, is another fertility treatment option. IVF may be more suitable for couples with male factor infertility, blocked Fallopian tubes and after unsuccessful multiple IUIs. Age factor of the female partner plays an important role in deciding the initial fertility treatment option.
You should be aware that fertility treatments can be expensive and local insurance do not cover them. It is essential to plan and do your fertility tests at the right time and place to avoid any financial constraints. Dealing with infertility can be emotionally exhausting. Support groups are available for couples who need assistance in coping with the emotional and psychological repercussions of infertility and fertility treatments.
In summary, timely and appropriate fertility testing and treatments can be helpful for couples who are having difficulties getting pregnant.
Mental preparation for parenting is just as important as physical preparation. While being pregnant can be a joyful and exciting time, it can also be emotionally challenging. Hormonal changes, physical discomfort, and the possibility of becoming a parent can all make anxiety worse.
It is important to keep your mental wellness throughout your pregnancy. If you feel stressed out or overwhelmed, you should talk to your obstetrician about your issues. They can provide you with proper guidance and support. A referral to a psychiatrist should be considered in severe circumstances. Psychiatric illness during pregnancy can be easily overlooked, thus it is important for the partner and close family members to keep an eye for this issue.
It can also be a good method to make friends and get support from other pregnant women through online forums or support groups. By swapping stories and discussing similar worries, you could feel more connected and less alone.
Deep breathing exercises, yoga, and meditation are a few stress-relieving techniques that may be beneficial. These techniques can help you reduce and manage your stress, which is good for your overall mental health and wellbeing.
Every woman’s pregnancy journey is different, so it is crucial to pay attention to your body and get help when you need it. You have a wealth of tools at your disposal, like your doctor, support networks, and online communities, to guide you along the path.
By actively taking part in your pregnancy preparation, you can create the foundation for a fruitful and pleasurable journey towards parenting. Whether you are just starting to consider having a child or are well on your way, the key is to take things one step at a time and enjoy the experience. Best wishes as you start your journey to motherhood.