Pregnancy after infertility

Pregnancy after infertility and especially after Assisted Reproductive Technology may be a time of both great excitement and great anxiety.

Early changes in pregnancy
Some women experience many different symptoms of pregnancy whilst others do not have any.
The most common changes in early pregnancy are:
* Breast enlargement and nipple tenderness
* Frequent urination
* Nausea and vomiting
* Fatigue
* Increased vaginal discharge
* Headaches
* Mild cramping
All these changes are considered normal.

Problems in early pregnancy
Some symptoms which are experienced in early pregnancy are not normal and should be reported to your doctor. These include:
* Any vaginal bleeding
* Abdominal pain
* Severe cramping
* Persistent vomiting
* Painful urination (eg. burning or scalding)
* High temperatures

Pregnancy monitoring
Most women who have conceived following Assisted Reproductive Technologies will have a vaginal ultrasound scan between 6-8 weeks of the pregnancy. This will determine that the pregnancy is in the uterus and also how many embryos are present. If the uterus is empty, it may indicate an ectopic pregnancy and further investigation will be required.

Miscarriage
Miscarriage occurs in approximately 20% of all pregnancies. The causes of miscarriage vary according to many factors such as age and the cause of infertility. Maternal tobacco usage has also been found to increase the risk of spontaneous abortion. Most miscarriages occur due to random problems with the embryo and are unrelated to the health of the mother.

Multiple pregnancies
Multiple pregnancies occur more frequently with the use of fertility drugs and Assisted Reproductive Technologies. If more than one embryo has been replaced, there is a 20% chance of having a multiple pregnancy. A multiple pregnancy has a higher risk for pregnancy loss or premature birth and will require closer monitoring.

Nutrition
It is most important to have a well balanced, healthy diet during pregnancy. This should consist of fresh fruit and vegetables, protein in the form of meat, fish, eggs or tofu, carbohydrates and dairy products. Many pregnant women prefer to have smaller meals frequently during the day rather than 2 or 3 larger meals. It is also important to have an adequate intake of water, at least 6-8 glasses per day.
Research has shown that the chance of having a baby with spina bifida is much less (up to 70%) if the vitamin folate is increased before the pregnancy and for the first 3 months of the pregnancy. The recommended daily dose is 0.5milligrams(mg) or 500 micrograms (mcg).

Alcohol, Tobacco and Drugs
Anything that a woman ingests during pregnancy can reach the developing fetus via the maternal bloodstream and has the potential to harm the fetus. Smoking may cause premature delivery and the child may be born with a low birthweight and may have learning difficulties.
Some medications may be harmful to the fetus, especially in the first three months. It is best not to take any medications either prescribed or over the counter, without consulting your doctor.
Alcohol and recreational drugs also have the potential to harm the developing fetus.

Infection
Toxoplasmosis is a bacterial infection which can cause birth defects if acquired in the first 12 weeks of pregnancy. It is associated with eating undercooked meat and exposure to cat faeces. Women who are pregnant should not handle the cat’s litter box. Gloves and good hygiene offer some protection.
Listeriosis is a bacterial illness caused by eating contaminated food. In pregnant women the infection is usually a mild illness but it can affect the unborn baby and can lead to miscarriage or stillbirth. High risk foods include soft cheeses eg brie, camembert, soft serve ice creams, precooked meat products eg. pate and pre-cooked deli meat. Infection risk is reduced with good food handling techniques and eating only freshly prepared foods.

Exercise
Exercise in all forms is healthy but should be discussed with your doctor if in doubt.
Many women who conceive using Assisted Reproductive Technologies may have been given some restrictions from their doctor on intercourse in the first few weeks of the pregnancy. Women with ovarian hyperstimulation syndrome may find intercourse to be very uncomfortable and should not have sex until the condition resolves. Some women find that sexual desire changes during pregnancy. Sexual intercourse is safe during pregnancy and will not harm the pregnancy. However, if there are any concerns, it is important to check with the doctor.

Summary
The transition from infertility to pregnancy can be a difficult time for a couple who are thrilled to be pregnant but have an underlying fear that things will go wrong. Many couples don’t let themselves get too excited and delay telling family and friends of the news. The reality of a pregnancy may be very different from what was expected. Pregnancy is the goal of infertility treatment and hopefully will end with the delivery of a healthy baby