When the pregnant person’s life is in danger

Some preexisting health conditions as well as some pregnancy complications can put your pregnancy health and safety at risk. Expert provider can help manage many of these conditions to allow a pregnancy to progress long enough that the baby is viable (able to survive outside of the womb). But some health conditions and pregnancy complications cannot be managed safely long enough to reach this point. Continuing the pregnancy in these cases would mean certain or high likelihood of death, loss of uterus, or other long-term medical complications — like stroke and other permanent disabilities for the parent. 

Recent federal legislation aims to secure abortion rights in all cases when a parent’s life is in danger, but it is in dispute in several states. Even a delay in care in these situations can have devastating short and long-term health impacts. 

Before we explain the conditions and complications you should be aware of, there are some steps you can take before you become pregnant to support your health. 

Understand the laws in your state

Abortion access varies depending on your state — and in many places your pregnancy trimester, your provider, and your age. In some states, if you’re a minor, you’ll need one or both of your parents’ consent. You can find a state by state breakdown here.

Schedule a preconception visit with your provider 

A pre-pregnancy checkup helps your healthcare provider make sure that your body is ready for pregnancy and often includes some health screenings. During this appointment, you can ask your provider any questions you have about your general and fertility health. 

Consider pre-pregnancy carrier screening

You may discuss this at your pre-pregnancy appointment. A carrier screen is a genetic test that can help you understand your risk of having a baby with a genetic disorder. And you can request it before you’re pregnant. Carrier screening is one of many tools to help you go into starting or growing your family with more information about your risks and options. 

Let’s review conditions and complications that can happen during pregnancy. If you experience one of these, then your state abortion laws could impact your care.

Ectopic pregnancy 

Ectopic pregnancies are early pregnancies that implant and grow in the wrong part of the body — outside of the uterus. The most common location of an ectopic pregnancy is in a fallopian tube, but can happen anywhere within the abdomen, including on the liver or bowel. 

Ectopic pregnancies can never result in a healthy pregnancy and lead to severe internal bleeding and death if left to grow. The only medical treatment available is abortion. The earlier these pregnancies are identified by ultrasound, and treated, the safer it is. If you live in a highly restrictive state, it’s important to know how your provider treats this type of situation. Will you have early ultrasounds? Will you have to travel if you need an abortion? Is there a local hospital that has experience navigating the legal difficulties of this situation? 

Severe hypertensive disorders 

Severe hypertensive disorders of pregnancy most commonly occur later in pregnancy. But, when they happen before viability (around 24 weeks), they are incredibly dangerous for parents. If the pregnancy is not ended, it can result in seizure, stroke, bleeding, and death. The only “cure” for these disorders is immediate delivery. There is no known long-term management option to safely allow the pregnancy to reach viability. Especially for parents with any history or high risk of hypertensive disorders, it’s important to discuss an emergency plan with your provider and any possible preventative steps.

Sepsis and bleeding 

Sepsis and bleeding are two other life threatening complications that can happen in early pregnancy where your body starts to miscarry or labor before about 24 weeks. In these situations, a pregnant person can experience their water breaking or heavy bleeding while their baby is still alive. The treatment for these conditions is delivery.

In states that don’t recognize the life of the parent as a valid reason for abortion, this can end in the death of the parent and the fetus. Even delaying care can increase the risk of serious infection (sepsis), need for blood transfusions and surgery, and death. Again, discussing your options with your provider early in pregnancy can help you feel at ease or make a necessary emergency plan.

When the fetus is at-risk or will not survive after birth

Finding out your baby has a complication or severe illness is one of the most devastating pieces of news to receive as a parent. Modern medicine has made enormous strides to treat certain conditions during pregnancy and work miracles for some people. However, there are chromosomal and genetic conditions that make it more likely for a fetus to die during the pregnancy or immediately after birth. There are also complex fetal differences that may survive birth, but not all parents feel they have the capacity to manage medically, emotionally, financially, or physically. Many people choose to end a pregnancy in these circumstances to reduce suffering for everyone and potential medical complications for the pregnant parent. 

The impact of abortion bans and restrictions

The abortion bans in many states do not have exceptions for these situations. These laws can be confusing and cause delays in care of the pregnant person. Knowing your state’s guidelines, and where you can travel to safely get the care you need is essential. In some states, specialized OBGYNs, called MFMs (Maternal Fetal Medicine specialists), will help identify and explain what is happening with your fetus, but they may be limited in discussing options. They may be able to refer you for a virtual appointment with an MFM out of state to have a more open discussion inclusive of more care options. Early genetic testing and counseling can leave more options open in states that only restrict abortion after a certain gestational age. 

If you find yourself in need of support or information after a devastating diagnosis here are some resources to explore: 

• Empty Arms
• Rare Disease information
• Neonatal donation
• Medical Ethics and Decision Making

Reviewed by the Ovia Health Clinical Team

Ovia’s goal is to support the health and wellness of our members throughout their reproductive health journeys. Ovia cannot, however, encourage or discourage the very personal decision of whether to have an abortion or counsel on whether and how an abortion may be performed in a particular case. Abortion may or may not be legal in your state and in your particular personal situation. None of the information made available through Ovia is intended to provide you with legal advice regarding abortion. Ovia may refer you to third-party websites or publications for additional information on reproductive health issues, including abortion. Ovia is not affiliated with these third parties and is not responsible for any information that they make available to you.

Dear Ovia, My partner of a few years isn’t sure if he wants to have kids and I know that I do. I thought he would change his mind on this as we got older, but he hasn’t…

I’ve had so much personal experience with this topic, this disagreement between partners happens so often! You’re not alone and it is SO tough. Every relationship involves compromise, but that level of compromise is up to you both. 

A big question: has your partner always maintained he’d like to be child free? Sometimes this feeling stems from childhood experiences, or his love for the life he has with you. Do these people change? Sometimes! But you can’t bank on it. The soul searching you have to do right now is your own. Can you live without being a parent? Will your relationship suffer because this need won’t be met? 

Many couples even take some time apart to ponder this exact question. If you take time apart, I would not frame the time you need as an ultimatum for him, but look at it as time spent evaluating your choices to be child free or seek parenthood another way. 

Parenthood is complex and life changing (I know there are some unicorn children out there, but most upend life as we know it). Having a partner who is all-in is amazing. There are so many people who are in your shoes waiting for that time to happen, but it generally can’t be rushed. 

More from this series

• Male fertility testing
• Dreams of a big family

The next steps 

If you’ve gone through fertility treatments like IUI or timed intercourse before, you’re likely familiar with the beginning steps of an IVF cycle. IVF cycles start with a monitoring appointment. During these appointments your fertility specialist will perform a transvaginal ultrasound to count your ovarian follicles, tiny fluid-filled sacs in the ovary that contain one egg each. Repeat ultrasounds throughout the cycle will monitor the growth of these follicles, giving you an estimate of how many eggs you might retrieve. You will also have blood drawn to make sure your hormone levels correspond with the growing follicles. The closer you get to the day of your egg retrieval, the more frequent monitoring appointments become. 

IVF medications

During a typical menstrual cycle, multiple eggs grow but only one egg reaches the point of ovulation. IVF uses medication to develop all of the eggs because the goal is to collect as many eggs as possible in one round. Most of the medications you’ll use during IVF are injections. Some injections are subcutaneous, or under the skin, while others are intramuscular, and go into the muscle. With practice, it’s easy to do the under the skin injections in your lower abdomen by yourself. The intramuscular ones are a bit harder to do and may require help from a partner, friend, or nurse. Most people find the injections get easier the more they do them. Your clinic nurse will have plenty of tips to make things easier if you’re having challenges.

Stimulation medications

The medications you take, and their dosages, change throughout the cycle. The first medications are stimulation medications, or “stim meds” as they’re more commonly known. These injections help multiple follicles grow. Research suggests that 9-11 days of stim meds produces the best outcomes. However, your cycle may be longer or shorter depending on how your body responds. As your follicles grow, you may feel some bloating, soreness, and heaviness in your lower abdomen. Some bloating and discomfort is normal, but if it becomes excessive and painful to the touch, let your doctor or nurse know right away. 

Once your follicles grow large enough, it’s time to trigger ovulation. Some trigger shots, like stim meds, are done under the skin while others need to go into the muscle. Follicles ranging from 12–19 mm on the day of the trigger shot are most likely to be mature and fertilize. You must take your trigger shot at the exact time provided by your fertility clinic, typically 36 hours before your scheduled egg retrieval. Your clinic will also monitor estrogen levels at this critical point in time.

Egg retrieval 

Egg retrievals usually occur under light sedation, so you will be asleep for the procedure. Most retrievals are performed vaginally, the doctor uses a probe similar to the wand used for transvaginal ultrasounds, except this wand has a place to slide a hollow needle through. The needle goes through the wall of the vagina and into the follicle to retrieve the egg. Your fertility specialist will let you know how many eggs they retrieved when you wake up from the procedure. You may have some cramping and bleeding following the procedure, but these symptoms usually go away within a day or so. It is also common to feel very fatigued, so planning a day or two of recovery is ideal when possible.

Embryos 

After the egg retrieval, your fertility clinic’s embryologist will use your partner’s sperm, or donor sperm, to fertilize your eggs. From there, the newly formed embryos grow either three or five days before being transferred to your uterus and/or frozen. The number of embryos that make it to day three or five will be less than the number of eggs retrieved. Typically, 80% of the eggs retrieved are mature and 80% fertilize, but only 30-50% of embryos make it to day five. While this is often disappointing, it’s totally normal! At this stage most embryos will undergo testing for quality and genetics. This is an optional, but often highly recommended step, based on your personal history.

Embryo Transfer

One of the biggest moments on your journey to conceive is the day of embryo transfer. Unlike the egg retrieval, you will be awake for the embryo transfer. Most clinics will let your partner join you. Some clinics even have on-site acupuncture, and all clinics will recommend a plan for your care the day after transfer — sometimes recommending rest or bedrest. If you’re working, coordinating time off can cause some added stress. 

The 10 day wait

While the shots, blood draws, and procedures, may seem like the hardest part, having to wait 10 days to two weeks to take a pregnancy test tends to be the most trying. While most people don’t get pregnant on the first try, which can be very challenging, your odds increase with subsequent cycles.

Reviewed by the Ovia Health Clinical Team

Sources

• Abbara, Ali, et al. “Follicle size on day of trigger most likely to yield a mature oocyte.” Frontiers in endocrinology 9:193. April 2018. https://www.frontiersin.org/articles/10.3389/fendo.2018.00193/full 
• Murdock, Cynthia. “IVF Attrition Rate: Why Don’t All Eggs Create Embryos?” Reproductive Medicine Associates. April 2020. https://www.rmact.com/fertility-blog/ivf-attrition-rate 
• Sarkar, P., et al. “Duration of gonadotropin stimulation is predictive of IVF outcome.” Fertility and Sterility 108.3:e231. October 2017. https://www.fertstert.org/article/S0015-0282(17)31218-9/pdf 
• Smith, Andrew DAC, et al. “Live-birth rate associated with repeat in vitro fertilization treatment cycles.” JAMA. 314.24. 2015. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4934614/ 

What you can control

Timing of intercourse or introducing sperm

Making a baby is all about timing and, thankfully, you have control over how often and when you have sex or introduce sperm. Checking your cervical fluid and tracking your basal body temperature can help you know when you are ovulating to maximize your chances of success. For couples TTC through intercourse, the highest rates of pregnancy happen for those who have sex every day or every other day during the fertile window, which is the day of ovulation plus the 5 days beforehand. 

Your health

Having a healthy body is important overall, and it’s no different for baby making. This goes for your partner too. Having healthy habits such as eating nutritious food and integrating movement into your day can help prime your body for when you finally do get that positive test. Cutting down on alcohol and caffeine, avoiding smoking, and taking a folic acid supplement can help in your efforts to get pregnant.

Your mindset

It’s common to feel sad or frustrated when you’ve been TTC for a while with no results. Even if it’s taking a little longer than expected, with practice you can aspects of how you think about the situation. Staying relaxed and having a positive attitude can help make the process a little easier. And if you just rolled your eyes, we hear you. There are some specific things you can do to improve your mindset like talking to a therapist and setting boundaries around work. Even spending time outside has been shown to increase happiness.

Things you can’t control

How long it will take

Although it would be nice to have a crystal ball and know exactly when conception will happen, unfortunately there’s just no way to know for sure. Studies show that most couples (about 84%) will get pregnant within their first year of trying. This is reassuring, but of course, every person is different. Some may get pregnant on their first try while others may take 6 months or more.

Your fertility

Having a condition that affects fertility is not your fault. About 12% of women ages 15- 44  have difficulty getting pregnant or carrying a pregnancy to term. And even though it’s common, struggling to conceive can feel extremely isolating. It’s essential that you have a support system and/or a professional to speak with. 

When your friends get pregnant before you

When you’ve been TTC with no luck, hearing of a friend’s pregnancy can be bittersweet. Of course, you’re happy for your friend, but you may also feel a sense of sadness. Acknowledging your feelings, focusing on self-care, and remaining optimistically realistic can all be helpful in moving forward.

Reviewed by the Ovia Health Clinical Team

Sources

Mayo Clinic Staff. “How to get pregnant.” Mayo Clinic. Mayo Clinic. October 5, 2019. https://www.mayoclinic.org/healthy-lifestyle/getting-pregnant/in-depth/how-to-get-pregnant/art-20047611.

“Trying to get pregnant.” National Health Service. NHS. December 2, 2020. https://www.nhs.uk/pregnancy/trying-for-a-baby/trying-to-get-pregnant/.

“How long does it usually take to get pregnant?” National Health Service. NHS. September 4, 2018. https://www.nhs.uk/pregnancy/trying-for-a-baby/how-long-it-takes-to-get-pregnant/.

Sex Ed. class 2.0

Here, we’ve rounded up five things you should have learned from sex ed. class before reading this article, but will be useful to you long after you close it.

1. It is normal and healthy to masturbate

Masturbation is not just expected by boys and men, but encouraged. Yet, common cultural narratives tell girls and women that masturbation is dirty and wrong.

Here’s the thing: Nothing could be further from the truth. For people of all genders, masturbating is both normal and healthy! Benefits of masturbating include: reduced stress, boosted mood, and increased self confidence long term. And beyond being healthy, masturbating also feels good, which is absolutely reason enough to partake!

In summary: You should have been taught that masturbation is healthy. Further, you should have been encouraged to touch yourself in whatever locations, using whatever pressures, at whatever speeds, for however long, and however often you want.

2. STIs can be transmitted during oral sex

Despite the fact that many sex education curriculums rely on fear-mongering, few programs acknowledge sex acts other than penis-in-vagina intercourse exist, and therefore do not touch on potential risks of such acts. Like, oral sex for example.

From fellatio and cunnilingus to analingus, oral sex can bring Big Time pleasure for the giver and receiver alike. Still, important to know the potential risks. Ready?

While the risk is lower than it is during vaginal or anal intercourse, an STI can be transmitted during oral sex from a mouth or throat, to a penis, vagina, vulva, or anus — and vice versa. That means that, yes, an STI can infect body parts other than the genitals.

When oral STI symptoms do appear, they may include: sore throat, pain during swallowing, sores around the lips, sores and blisters in the mouth, and swollen lymph nodes. But as is true with STIs located elsewhere in the body, the most common symptom of an oral STI is no symptom at all. And that’s why it’s so important to get tested for oral STIs, between (oral sex) partners or once a year (whichever comes first). Oral STI testing involves a simple mouth or throat, and treatment typically involves an oral antibiotic or prescription mouthwash.

What can you do to reduce risk of STI transmission during oral hanky-panky? Glad you asked. With a partner who’s STI status you don’t know or who has an STI , you can use an external condom or dental dam to reduce risk of transmission.

3. PReP can be taken by all genders

PReP (pre-exposure prophylaxis) is a daily oral medication that can be taken by HIV-negative people to greatly reduce their risks of contracting HIV, if exposed to the virus. Highly effective, PrEP is one of the best additions to the sexual health space…ever.

While there is more that can be done to spread awareness about PReP to all people, cis-women in particularly tend to be less likely to take PReP. The problem is that people of all sexual orientations, genders, and genitals are susceptible to HIV, if exposed to the virus through sex, intravenous drug use, contaminated blood transfusion, or pregnancy. In fact, globally more than half (52%) of HIV-positive people in the world are women.

No matter your gender, to figure out if you’re a good candidate for PrEP read the federal guidelines put out by the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) and/or talk to your healthcare provider.

4. Sex is not supposed to be painful

No, not the first time you have it. No, not during anal sex. No, not postpartum. Pain is the body’s way of telling you that something is wrong — and it’s a message worth listening to.

Sometimes pain during sex is a sign that you need additional lubrication or that your not-yet aroused-enough for what’s happening. In these instances, slowing down and adding lube can turn your sex session from “ouch” into “ooh!”.

When sex is consistently painful, however, or you experience these symptoms outside of sex (for example: while urinating or inserting a tampon) there may be an underlying condition. Pain during sex is a common symptom of conditions like hypertonic pelvic floor, endometriosis, vaginitis, vulvodynia, vaginismus, and pelvic inflammatory disease.

If you’re experiencing pain during sex, stop. If you want to continue having sex, try slowing down and/or add a store bought lubricant. If the pain becomes more chronic, bring it up with your healthcare provider or seek out the guidance of a trauma-informed pelvic floor specialist.

5. Consent is an informed, ongoing, and enthusiastic agreement to engage with someone that can be withdrawn at any time

As of 2020, only 9 states required consent be taught in sex education curriculum. That means that a whopping 41 states don’t teach students the importance of receiving “Y-E-S”, nor validated the decision to say “N-O” at any point during a sexual encounter.

The failure of this absence becomes obvious when looking at the responses from a recent survey of people ages 18 to 25. In it, 53% admitted that they didn’t realize that consent can be withdrawn once someone is already naked (it can!) and just 13% said they’d feel comfortable discussing consent with their sexual partner.

While the staggering sexual assault statistics cannot be blamed on any one thing — curriculums in sex ed. class suffer from widespread avoidance of consent, and it certainly isn’t doing anything to help reduce the number of people assaulted.

If you’re reading this and haven’t yet learned about consent, take the time to read The Consent Checklist by Meg-John Barker and/or Beyond Yes & No by Kai Werder.

Reviewed by the Ovia Health Clinical Team

Sources

• “Facts and figures: HIV and AIDS.” UN Women. UN Women. July 2018. https://www.unwomen.org/en/what-we-do/hiv-and-aids/facts-and-figures. 
• “Pre-exposure Prophylaxis (PrEP) Care System”. CDC. CDC. September 10, 2020. https://www.cdc.gov/hiv/effective-interventions/prevent/prep/index.html#About-PrEP. 

Here’s the latest from the Ovia Health Clinical Team, including answers to your questions and some practical guidance. 

If I’m pregnant and I get COVID-19, will the infection be worse?

It’s possible. Research indicates that pregnant people and recently pregnant people (within 42 days of giving birth) are at higher risk for significant complications from COVID-19 than their non-pregnant peers. This means that while the overall risk for severe illness is low, there is an increased risk of hospitalization, intubation and mechanical ventilation, blood clots, and requiring intensive care. There is also an increased risk of adverse pregnancy outcomes, including preterm birth and possibly an increased risk of pregnancy loss when compared to pregnant women who did not get COVID-19. 

These risks are compounded for Black pregnant people, who have long experienced nearly twice the risk of preterm birth when compared to white people. Many studies have demonstrated that race is likely an independent risk factor when it comes to healthcare outcomes like preterm birth, separate from other risk factors like income or education. That race-related risk may stem from chronic stresses of societal racism as well as the race-related inequalities that have been identified within the healthcare system. 

Pregnant parents who test positive for COVID-19 should be offered a discussion about the medication Paxlovid. You can read more about that here.

What can I do to prevent infection?

Prevention is no different for pregnant people than it is for anyone else. Follow the advice that you receive from your local health department, from the CDC, and from your healthcare provider. Avoid going to public places if you think or know you have COVID-19, to prevent spreading it to others. 

If you know local rates of Covid are high, wear masks when indoors and practice social distancing. Being vaccinated has been shown to provide protection against severe COVID-19 disease. However, you can still get sick and pass the illness on to vulnerable people who aren’t vaccinated or cannot be vaccinated (like newborns).

Is hand sanitizer safe in pregnancy?

Yes, Yes, YES. The CDC reports [3] that handwashing with soap and water is more effective than hand sanitizer. However, you can’t take the sink in your car or on a walk or to the grocery, so make sure you use hand sanitizer regularly in addition to handwashing. Furthermore, it’s often much easier to wipe hand sanitizer on your children’s hands than it is to get them properly washed, so consider this a regular habit as well.

If I get COVID-19, will I pass it to my fetus?

The most recent research on the topic says that transmitting COVID-19 while pregnant is very rare – for moms in North America, the rate was about 0.1%. This does not include the risk of passing it to your newborn during routine care postpartum. However, studies suggest that people who tested positive for COVID-19 during pregnancy are more likely to have complications, such as preterm birth [6]. There is no evidence that cesarean delivery reduces the risk of infection for Baby, so this is not recommended.

What about during and after birth?

It is extremely important that you call your healthcare provider before you go to the hospital if you think you have COVID-19. Once at the hospital, your provider knows what to do to reduce the risk that your baby (and the healthcare professionals who care for you) will become infected.

Keep in mind that testing positive for COVID-19 when in labor may cause changes to your birth plan and hospital stay. You may want to consider extra precautions in the last weeks of pregnancy to avoid this.

What is the risk to my baby? And what about the risk to my other children?

Children seem to be at less risk of becoming really sick with COVID-19 than adults are, but infants make up the bulk of serious cases and hospitalizations in children under 17. Current evidence suggests that babies are not likely to get COVID-19 from their mothers as long as preventative steps are taken, such as wearing a mask around your baby, washing your hands for 20 seconds prior to holding your baby, and having them sleep 6 feet away from you. You should still do everything you can to reduce the risk of exposure. Children with certain underlying conditions are at risk for complications from COVID-19, so it is important to keep them safe and communicate with their pediatrician.

Is breastfeeding safe if I think I have COVID-19?

There are many benefits to breastfeeding for parents and babies. It appears unlikely that COVID-19 can be transmitted through breast milk, though helpful antibodies can be passed along! 

If you test positive for COVID-19, this may impact the care of your newborn. In-hospital, the CDC recommends discussing with your provider the risks and benefits of caring for your newborn while sick. Mildly ill people generally room in and care for their newborns. If you are seriously ill, this may not feel like a physically possible or safe option. Once you are home, wash your hands frequently — and always before touching your baby. Wear a mask when you are within 6 feet of your baby or another person. If you have a caregiver who lives with you, they should also wear a mask whenever caring for your baby.

We know that with other illnesses, you pass antibodies to your baby through your breast milk. Antibodies are what your body makes to help fight off illness. The research into COVID antibodies in breastmilk is really encouraging and suggests that antibodies are passed through breast milk after infection or vaccination. 

What if I’m trying to conceive and not yet pregnant?

There’s no evidence that COVID-19 or any similar viruses impact conception or cause birth defects if you are sick when you conceive.

Should pregnant people get the COVID-19 vaccine?

Multiple well-respected clinical organizations, including the ACOG (the American College of Obstetricians and Gynecologists) and the ACNM (American College of Nurse-Midwives), recommend the vaccine to people who are trying to conceive, pregnant, and breastfeeding [11].

The first clinical trials for the COVID-19 vaccines manufactured by Pfizer-BioNTech, Moderna, and Novavax did not include participants who were known to be pregnant or breastfeeding. This is typical for pharmaceutical research. Recent studies have included pregnant people and show that there is no increased risk and that vaccines given in any trimester do not negatively impact pregnancy outcomes. In addition, vaccinating in the second or third trimester may offer additional protection to your newborn.

Additionally, none of these COVID-19 vaccines contain a “live” virus. This means you cannot get COVID-19 from the vaccines. In general, vaccines that do not contain “live” viruses are safe during pregnancy and do not have increased risks for infertility, miscarriage, fetal anomalies, or stillbirth. Side effects of the COVID-19 vaccines include pain at the site of injection, fever, fatigue, and chills. These typically go away after a couple of days. These side effects are normal and expected and are indicators of your immune system doing its job to learn to protect you from the virus. There have been very rare reports of unexpected, adverse reactions from the vaccines. A severe allergic reaction called anaphylaxis can happen in very rare cases. The incidences of these adverse events are so low that getting vaccinated remains safer than potentially getting infected with COVID-19. [12].

You can also reach out to the experts at Mother to Baby for more information. Your midwife, doctor, or other healthcare professional is also a great resource for more information about the COVID-19 vaccine. Ultimately, you are the one who knows what is best for your body and your family.

Reviewed by the Ovia Health Clinical Team

Sources:

Dara D. Mendez, Vijaya K. Hogan & Jennifer F. Culhane “Institutional racism, neighborhood factors, stress, and preterm birth”. Ethnicity & Health. 19:5, 479-499. October 18, 2013.

Jasmine D. Johnson et al., “Racial Disparities in Prematurity Persist Among Women of High Socioeconomic Status,” American Journal of Obstetrics & Gynecology 2. 2(3), 100104. Nov 10, 2020

James W. Collins Jr et al., “Very Low Birthweight in African American Infants: The Role of Maternal Exposure to Interpersonal Racial Discrimination,” American Journal of Public Health. 94(12), 2132–2138. December 2004.

Braveman Paula, et al. “Explaining the Black-White Disparity in Preterm Birth: A Consensus Statement From a Multi-Disciplinary Scientific Work Group Convened by the March of Dimes” Frontiers in Reproductive Health. Vol. 3. 684207 September 2, 2021.

The better you understand your unique menstrual cycle, the better you can understand your overall health.

Although the average menstrual cycle is 28 days, a cycle can actually be a few days longer or shorter and still be considered normal. Cycle length can also vary a little from cycle to cycle and still be considered normal.

Hormonal changes in the body trigger each cycle phase: menstrual, proliferative, ovulatory, and luteal. And while your period is the most recognizable phase, the other three are equally important and impact your energy levels, immune system, moods, and sleep patterns differently. Let’s dive in.

What are the menstrual cycle phases?

The body performs different functions throughout the four phases of the menstrual cycle, each of which plays a unique role in the reproductive process:

Proliferative: During the proliferative phase, ovarian follicles (structures in the ovary that each contain a single egg) mature and prime themselves for ovulation. Your hormones perform different functions that are geared toward the goal of producing an egg for fertilization during ovulation, the next phase. Although many follicles start maturing during the proliferative phase, usually only one eventually proves dominant, and becomes the sole egg available during ovulation.

Ovulatory: The ovulatory phase begins as a hormone surge forces the dominant egg to break free from its follicle and nest in a fallopian tube, where it will disintegrate if not fertilized within about 24-36 hours. Ovulation is the only phase in which you can get pregnant. But because sperm can live for up to five days in the reproductive system, if sperm is present in the short time leading up to ovulation, this can also result in conception.

Luteal: Following ovulation, the follicle that released the egg transforms into a corpus luteum, a structure that produces the pregnancy hormone progesterone. Progesterone thickens the lining of the uterus in preparation for a fertilized egg to make its home there for the next nine months. If conception occurs, the corpus luteum continues to produce progesterone to maintain a healthy pregnancy. If the egg is not fertilized, the corpus luteum ceases its progesterone production after about two weeks. This drop in progesterone signals menstruation to begin.

Menstruation: The onset of menstruation is considered to be the start and end of a menstrual cycle, as it signifies the end of an opportunity for fertilization for one egg (and the beginning for millions more). Menstruation is triggered when the corpus luteum of the last cycle’s unfertilized egg ceases to produce progesterone, usually occurring about two weeks after ovulation, causing the uterine lining to shed, along with a bit of blood. The length and intensity of a period varies from person to person and cycle to cycle, but usually lasts between 4-6 days. Once the period stops, the proliferative phase begins again, starting the reproductive process anew.

Reviewed by the Ovia Health Clinical Team

Read more

• The menstrual cycle and your hormones
• Tracking fertility during the proliferative phase
• 5 signs you might be ovulating

Sources

• Mayo Clinic Staff. “Menstrual cycle: What’s normal, what’s not.” Mayo Clinic. Mayo Clinic, 4/16/2013. Web.
• “Patient Fact Sheet: Am I Ovulating?” ASRM. American Society for Reproductive Medicine, 2014. Web.

What artificial insemination is and the types to consider

It’s essentially when sperm is introduced into a female’s uterus or cervix with the hope of getting pregnant without sexual intercourse. You might think of it as a little bit of assistance with getting pregnant. Just how are these methods different?

IUI

IUI stands for intrauterine insemination. This insemination method injects the sperm directly into the uterus. Because this insemination method will place sperm closer to the egg that other insemination methods, IUI is believed to have a slightly higher success rate than other methods. Many people who undergo IUI (and the following two forms of insemination, ICI and IVI) do it while also taking fertility drugs to increase egg production and, as a result, increase the chances of getting pregnant. If you’ve heard about IUI leading to a higher chance of multiples, it’s likely because of accompanying fertility treatments, not the procedure itself.

ICI

ICI isn’t a tasty frozen treat you can get at your local movie theatre – it stands for intracervical insemination. Intracervical insemination happens when sperm is injected into the cervix, which is the tissue that connects the vagina and the uterus. Unlike IUI, you can perform ICI with unwashed sperm. There is a recommendation that IUI and ICI be performed by a healthcare provider, but some couples have found success performing these methods of artificial insemination at home.

IVI

IVI means intravaginal insemination, which is when sperm is injected into the vagina. Of the three methods of artificial insemination, this one places the sperm farthest from the egg and therefore has the lowest success rate. However, it’s the cheapest method and doesn’t necessarily require assistance from a healthcare provider. If you’d like to try intravaginal insemination at home, it can be done with a clean syringe or a cervical cap.

IVF

You’ve probably heard of IVF, which stands for in-vitro fertilization, but this procedure isn’t actually a method of artificial insemination. IVF is sometimes confused with the above methods and believed to be a kind of artificial insemination, but it’s actually another type of assisted reproductive technology. For IVF, semen and an egg are combined to form an embryo, and that embryo is then implanted into the uterus.

So which method is best?

Each method of artificial insemination has its own set of benefits. The cheapest method of artificial insemination is IVI, and if you’re looking to inseminate at home, you might want to consider this method. But the most effective method might be IUI. And IVF is an effective form of assisted reproductive technology, but it’s expensive, and, like all of these methods, it isn’t guaranteed to work. Really, if you need a little bit of help getting pregnant and are considering one of these methods, it’s advisable to speak with your healthcare provider or a fertility specialist so that they can help you decide which method will be best for you.

How long does it take (on average) to get pregnant?

Many factors can influence how long it takes to get pregnant, including your cycle, general health, fertility conditions, age, and lifestyle.

Getting pregnant faster

Although it takes the average female up to six months to conceive, there are ways to improve fertility health and reduce time to pregnancy. Staying healthy through diet and exercise and taking folic acid supplements can greatly increase your chances of conceiving, relative to those who don’t do these things. Individuals who track their fertility data to pinpoint their ovulation are also able to speed up their time to conception. Even your mood might help with your fertility: some studies have found that happier emotional states correlate with faster conception.

How long is too long?

Although any female without a condition of infertility or sterility can get pregnant naturally before menopause, some may take a bit longer than others. Doctors recommend that couples who have not conceived after one year of trying seek a fertility consultation to determine if an alternative route to conception might be explored, whether it’s in vitro fertilization (IVF), surgery, or fertility medication. It’s recommended that women over 35 should seek a fertility consultation after six months of trying.

If you have any questions about trying to conceive or your fertility health in general, don’t hesitate to reach out to your healthcare provider for more information.

Read more

• Does pregnancy loss impact future conception?
• Trying to get pregnant for more than a year

Sources

• Dr. Walter Willett. “Nurses’ Health Study II.” National Institutes of Health. United States, 1989-. Web.
• “Nutrition During Pregnancy: FAQ001.” ACOG. American College of Obstetricians and Gynecologists, 4/15/2015. Web.

Gina Nebesar, Co-Founder of Ovia Health

I was so excited to speak with my two dear friends Becca and Jean Ann recently. Just this year they started on the crazy journey that is parenthood with their beautiful baby girl, Roz. They’re total badasses at home and at work, they’re incredible people, and now they have this gorgeous family. Their TTC journey took them a little while, and IVF helped them get pregnant, and I’m really grateful they could share their story – including incredible advice about choosing and buying sperm, real talk about IVF shots, and really candid conversation about adjusting to life as new moms.

IVF success stories: Two moms talk about growing their family… and how

I want to start by saying congrats! I know you just celebrated your 5 year anniversary, a big milestone. And an even bigger milestone is the birth of your baby girl! I’d love if you could start by telling us a little about your beautiful family.

Becca: We did just celebrate our five-year wedding anniversary, and in April we had our baby girl Roz. She’s almost 5 months old. And it’s been great so far!

I just left town for the first time, and left her alone this weekend with Jean Ann, her other mom. And in that 48 hours she learned how to roll over, without me there! And now she sleeps on her stomach, so I came home to a totally different baby. But I feel like she’s changing every single day, so it’s really awesome.

I love hearing about how people make the decision to start a family. Could you tell us a little bit about your journey to becoming parents?

Jean Ann: Because we’re two women, one question that I asked a lot is how we decided who will carry. And when your partner basically says, “One thing I’ve always wanted to do in my life is be pregnant and give birth, like, totally unprompted,” you’re like, “Cool, that seemed too easy.” Becca had always wanted to do that, and I’m still sort of on the fence – it doesn’t seem like something I have to do. So Becca had decided that she was excited about that a few years ago, and eventually I got more excited about it.

The first thing we had to do was choose a sperm donor. That was probably one of the biggest decisions we’ve ever made. Because you have to decide if you want an anonymous donor or someone you know. And we actually had a good friend who offered. And we took it pretty seriously, but ultimately decided it was important for us to have our own separate family unit. So then we looked at a lot of the websites for sperm. It’s basically like a KAYAK for sperm, and you can sort for different things.

Becca: It’s almost like online dating!

Jean Ann: We wanted someone that hopefully shared a lot of my characteristics. So were able to find someone who was half-Asian, he was getting a graduate degree in chemistry. We could even listen to a 45-minute interview with him where he talked about his favorite books, and he just seemed very thoughtful, quiet, serious, and nice.

Becca: We spent a lot of time looking for sperm – really thinking about these profiles and listening and narrowing it down. I remember we had all these pieces of paper on the kitchen table – we had written down the different donor numbers and which ones we liked – and then we narrowed it down.

And we actually had kind of had a long journey. It was about two and a half years from buying sperm until having Roz. Buying the sperm was step one. I remember, they were having an end-of-year sale, so we had to get it in before the end of 2015!

Were they really? Like, they were really having a sale?

Jean Ann: Yeah, it’s expensive. It’s something that there’s a lot of in the world, but it’s not cheap!

Becca: Well, it wasn’t quite a sale, but they were like, “We’ll throw in an Amazon gift card if you buy today!”

Jean Ann: “And three years of free storage!” But, yeah, we’ve actually spent several thousands of dollars on sperm, if you can believe it.

So, obviously, you found a great deal, but how did you get started with that process?

Becca: Really, we just Googled.

Jean Ann: There’s three or four big sperm cryo websites.

Becca: The one we went with is called California Cryo, one of the largest ones. For us, they felt right— it was a good website experience, and their customer service has been great. We did look at the big ones, some other small ones, and some local ones.

Jean Ann: But I think, for us, wanting a donor who was half-Asian like me was important, and that actually narrowed it down a lot. It went from like 550 to like, eight.

Becca: So then we could spend our time kind of really thinking through those people.

Jean Ann: You can definitely get a situation where there’s a run on the sperm. So we had this total disaster about a year later, where we had used up half the vials that we’d bought, and we were getting really low, and we went online, and they had sold out! And the donor had stopped donating! So we recommend you check what’s in stock a lot.

Becca: Yes, check frequently! And if you can afford it, buy more than you think you need.

Jean Ann: Buy a lot!

Becca: Because you can store it, and you can sell it back if you don’t need it.

Jean Ann: Nothing is worse than the feeling of having decided on someone to be your sperm donor and being very excited about them, and being halfway through the journey, and then realizing that if you want to have more than just one kid that you’re going to run out of sperm.

Becca: You’re going to run out and you may have to use different sperm.

Any other advice about that process for others that are just starting out with sperm donation?

Jean Ann: Just check your sperm stock frequently. And if you’re really excited and settled on someone, I would buy more than you need or just be willing to have a weekly reminder to check that it’s not running out.

Becca: I think the other thing is I would pony up for the extra access to information. Because I think, for us, the interviews with the sperm donors, that was the most impactful. You can only tell so much from a baby picture and some  generic likes and dislikes – which is the basic info you get – but I actually think you can get a pretty good feel for a person from something like an audio interview. It’s like a typical website where it’s like, “Pay to unlock this feature!” but it’s worth it to pay for that premium membership.

So, in December 2015, once you made that decision about your donor, how did things progress from there?

Becca: So that winter when we were back home from the holidays, we started trying to get pregnant, and we were doing IUI.

Jean Ann: You basically have two options, you can do IUI or IVF with donated sperm. IUI is basically artificial insemination.

Becca: Turkey baster!

Jean Ann: The turkey baster method, but at a facility. So we started with IUI.

Becca: I actually got very lucky with the first IUI try in February 2016. I was tracking my ovulation – I was using the Ovia app – and I was peeing on sticks and all of that, and when my ovulation test said I was ovulating we went in for the IUI, we did IUI, and I got pregnant that very first time. And it was amazing! We were so excited! First try!

And then in the spring at about 12 weeks I had a miscarriage. So I got almost through my first trimester, and I had a miscarriage. That sucked, that was a setback and sad, and that was really hard.

So the summer of 2016 was kind of recovering from that, and then it takes a while to get back on track, especially when you have a miscarriage when you’re that far along there’s a lot that your body has a lot to process and then re-regulate. And then we didn’t have a chance to try again until September of that year. So we got back on the horse and started trying again. And we were gonna continue to do IUI at that same facility because it had worked that first time.

And I started tracking my ovulation and going back in monthly, but something was wonky with my cycles. I would think I was ovulating, but I would go in and I wasn’t ovulating. I think one or two times we did get an ovulation, and we tried, but I didn’t get pregnant.

Jean Ann: And that’s when we started running out of sperm. And we realized that there wasn’t more. So that’s when we panicked, realized we couldn’t get anymore, and so we decided to move to IVF. But neither of our insurances, we thought, really covered IVF.  We were both on my insurance, and it wasn’t explicit. It was basically like, “Your IVF is covered, if it’s for a medical reason.”

Becca: “Medically necessary.”

Jean Ann: Yeah, “medically necessary,” that’s the phrase that’s used – and so I went down this whole rabbit hole to figure out if that means coverage if you’re gay. It took forever. But basically, no, being gay was not a “medically neccessary” reason, so it wouldn’t be covered. So I fumed about this for a while.

And then I ended up talking to our company’s head of HR kind of randomly about something else, and I just kind of mentioned this to her and didn’t expect it to go anywhere—I just figured this would sort of take some kind of lawsuit situation to change it— but she was like, “Oh, really? I didn’t know that!” Then two days later somebody that worked for her called and they were like, “Oh, we added it for same-sex couples to our insurance, so it’s covered now!” So I guess some advice would be to know that in terms of your health insurance, you may be able to change the coverage for something like this, depending on your company.

I constantly tell women to ask for those benefits, because they might end up with that exact same story. I was in a meeting recently with a health plan and an employer where we we pointed out in the language of the plan how it was alienating to same-sex couples. And the woman didn’t even realize it and was like, “I’ve gotta change it!” She had just never read the fine print before, but then took action to change it as well. I’m so glad that you asked about it, and I wish more people would!

Becca: Yeah, it was pretty awesome. So, we started IVF in the summer of 2017, and there’s a whole series of tests and all sorts of painful things they need to do to make sure you’re ready for it. And that takes months— you have to wait a few cycles, you have to get on the right timing. So I remember this being such a frustrating time in our lives. It felt like everything was going slowly and like everyday I had to be at the doctor doing some other painful thing. It was a rough period. It is funny now looking back on it, because it all feels like such a blur in retrospect, but at the time it felt really pronounced and painful.

Jean Ann: As someone that has now done IVF three times myself – and Becca has done it once – it’s not as bad as people think it is. It sucks giving yourself the shots, but it’s fast. It’s like a two week period of shots.

Becca: At this point we’ve both done it, because as the journey continues, we ended up having a baby and decided that we wanted to at least give ourselves the option to having another baby in the future with Jean Ann’s eggs.

Can you share more about that experience and what it’s like? Again, I’m sorry to hear about this part of the journey. I just can’t imagine having the 12 week miscarriage, that’s just awful, and the fear of the sperm running out, and then going through the pain of IVF. And I know you say it’s not that bad, but I think maybe you’re just tougher than many – that sounds really hard to me!

Becca: Honestly after being pregnant for nine months, you can barely remember the IVF, it’s like a blip. But I think that the shots – for us at least – I think the shots look scarier than they end up being.

Jean Ann: I feel like the first and second time you’re really just like, am I really going to stab myself in the leg with this needle?

Becca: The thought of it is tough. The first time is the hardest, because you’re just staring at this needle and you’re like looking at your leg, and you’re just like, so I’m really just going to push this in, huh? But it’s a needle, and it’s made to go in. I actually think over the two week period of shots, it gets progressively more painful toward the end. So the last few days are the worst. I think at that point you’re feeling a little bit bloated, you’re not allowed to go to the gym, you’re giving yourself shots every single night. For some reason those last few nights hurt the worst. At that point you’ve shot yourself everywhere on your legs, everywhere on your stomach, and you’re looking for a new spot. So those last few nights, you just want it to be over.

Jean Ann: And then you have the trigger shot, and everybody makes a big deal of the trigger shot. Somebody else gives you that one, and it has to be at an exact time – like, 1:45 in the morning, 10:30 p.m. – so when you go in to have your eggs be retrieved, it’s exactly 36 hours after the trigger shot.

Becca: And then for the egg retrieval process you do go under.

Jean Ann: Under some very temporary anesthesia. You’re all the way under, but it’s very short. And then you’re done!

Becca: And then there’s some anxiety as you wait to hear your egg count. For us we were doing embryos, so right when they retrieved the eggs they fertilized them with our frozen donor sperm. So after that you’re kind of waiting on eggshells – no pun intended – to hear how many of your embryos made it to day 3 or day 5, or just what the status of them is. And we’ve been on both sides of the spectrum. For me, I was really fortunate, I had a pretty high egg count, and with just one retrieval I got enough embryos that we felt comfortable and were able to freeze them. For Jean Ann, on her first and second try she didn’t get that many, and so she’s had to go through the egg retrieval process three times now.

Jean Ann: I will just add that for anybody that’s getting close to age 35, 35, you can get a blood test that will give you your AMH number. It basically tells you how many eggs, roughly, you have left. It’s a very good indicator or whether IVF is going to be a breeze and you’ll just have to do that once, or if your egg yield is going to be low and you’re going to have to do it multiple times like me. It is also a good predictor of if you will have to do IVF at all because the same number is also a good indicator of whether or not you will naturally be able to get pregnant. It’s a very easy first step.

Did you know about this AMH (or Anti-Mullerian Hormone) test before starting the IVF process, or did you learn about that after?

Jean Ann: Actually, someone at work told me about it. Because I was like, “I don’t think I want kids for a few years,” and this very matter of fact 40 year old man was like, “How old are you?” And I said, “35.” And he was like, “Just go get your AMH number. My wife had a low AMH number and it took us 5 years of trying and then we ended up adopting.” I was like, oh, my gosh!

And then I got the test, my AMH number was bad, and, indeed, it took me multiple times to do IVF. So I feel like this AMH blood test is pretty much free information.

A lot of healthcare providers might say no to that sort of testing, but I always suggest that people go to their provider and just insist on it. So, through this process, who was supporting you along the way? Obviously, you had each other. Was there anyone else in your life who was particularly helpful during this time?

Becca: Each other, for sure. I’m not a big oversharer, but it’s been really helpful for me to share, because what I’ve found is that as soon as I start talking about it, everyone has either a similar story themselves, or their friend does, or their sister does. So when I had my miscarriage, it was really helpful for me to tell people about it – even at work – and then people would share these success stories, and that made me feel better. And it was similar when going through IVF. I would talk about it with my friends, and they all had someone they knew who had been through it. At the time, I was really the first of my very good friends who was having a lot of trouble getting pregnant, and I felt a little bit alone, so their IVF success stories were helpful for me.

Jean Ann: But since then, now we know several people who’ve been through this.

Becca: We know people who’ve had miscarriages, been through IVF, and now I’ve been able to help them because we have this success story. So, for me, I would tell anyone who’d listen! And that helped me a lot.

Jean Ann: Then you had a pretty good pregnancy.

Becca: Yeah, and the IVF really worked well for us. We did an egg transfer, and I got pregnant on that first one, and then I had a pretty good pregnancy.

Jean Ann: And you have to give yourself these progesterone shots for the first 12 weeks.

Becca: No one talks about this!

Jean Ann: No one talks about this, but these are actually really terrible shots. And every night for the first 12 weeks that you’re pregnant—

Becca: You give yourself a progesterone shot in the butt.

Jean Ann: That was probably the worst part.

Becca: I think some doctors will allow you to do a suppository instead. So I went, like, running in after three nights of shots and was like, “Give me the suppository!” And they were like, “No, we highly recommend the shots.” They wouldn’t do it. So you’re giving yourself shots for 12 weeks. So much worse that the two weeks of IVF shots! It’s so much longer! So you’re basically so sore in the butt for the entire first trimester. But once we got through that, things were okay.

Jean Ann: Smooth sailing.

Becca: Yeah. I had a lot of heartburn, and that was my main symptom really.

Jean Ann: Then because you were a geriatric pregnancy, they told us that they wouldn’t let you go past one week over your due date. So we got an induction date for almost a week past your due date.

Becca: Yeah, 5 days past my due date they scheduled us for an induction. We went in, I got induced, and like these things do, it took forever to get a room, it took forever for the induction to start.

But then, like, once it started, it really started.I had pretty strong contractions for a long time, for like 15 hours. But I really wasn’t dilating. So, it was kind of sad, I kept having these big contractions and the doctor would go away and then come back a couple hours later to check my cervix and every time I was like, “Oh, I think I’m making progress!” and then she would check and be like, “Nope, still 3 cm. You’ve barely made it to 4 cm.” So I just wasn’t dilating. And then at some point, in about hour 16 or 17 of labor, I got a fever, and they said we’ve got to do a C-section. So we went in on a Thursday night, that Friday night at 11:30 p.m. she was born via C-section. And she was great!

Jean Ann: There’s so much pressure to not have a C-section and to be able to breastfeed right away and all this stuff, and, like, if you walk out with a healthy baby, that’s the goal, that is 100% success. I feel like people shouldn’t put that much pressure on how they want everything to turn out.

I know. There’s so much pressure for birth to be this perfect experience, just as planned. And I remember, too, even with me, I had a C-section, just feeling guilt, feeling like a failure, and realizing that, like, my baby’s awesome, and I really don’t care about how I got her! Do you remember what the first couple of days after Roz was born were like?

Becca: It’s funny, it’s such a blur. And I remember at the time saying to myself, I’m totally lucid and I’m recovering fine and I’m gonna remember all of this. And now I realize I don’t remember much of what those days were like!

I remember stumbling out of bed in the middle of the night and either feeding or pumping, and I remember napping a lot. Because I was recovering from a C-section, I needed a lot of help both during the days and the nights. So luckily I had Jean Ann to help, we had family, we got some help for me during the day when she went back to work. We were fortunate to be able to do that because I couldn’t lift the baby, but it’s all such a blur.

I do remember her being so cute. Like everything she did was so cute. I would feed her, and she’d fall asleep on me right after, and it was the cutest thing I’d ever seen! This weekend, actually, I saw a picture of Roz from her first few weeks. And I remember at the time looking at her and thinking, My newborn is so cute! She doesn’t look like a weird scrunched up newborn like every other one! She’s a perfect baby! And, like, five months later I realize that she definitely looked weird! But you just don’t see it at the time.

You do have an exceptionally cute baby! So what is it like now versus what it was like then?

Becca: I just feel like we’re getting more into what our life will look like for the next few years. Those first few weeks in my maternity leave I just kept thinking about how it was a temporary time – and it was wonderful, and I really enjoyed it – but now we’re trying to figure out what our real life looks like. Like how we manage the jobs and the baby, how we manage finding time for ourselves, how we manage time for the extended family who wants to visit. So, it’s different – I’m much more lucid, I’ve recovered from the C-section, all of that kind of blurriness is gone – but I’m in this, like, this half-place where I feel like, we don’t quite have enough time for everything. And I don’t know if this is just what the new normal is, or if we’re still figuring it out. So that’s kind of the phase we’re in now.

I feel like our journey has taken a lot of different turns. And where we are now – we’re so so happy and so lucky that we have this wonderful healthy baby – but it took a while. And it took a lot of different types of interventions, and along the way there were times when it felt like it wasn’t going to happen, but now she’s here, and she’s perfect, and it makes the last two and a half years feel like a blur, like just a blip. So it was all worth it.

Jean Ann: But at the time, it was tough. It can be very tough.

Becca: Yeah, and I guess some advice we would give is to try to release some of the expectations that you have and some of the perfection that you’re striving for, because you really just don’t know how things will turn out. Like, you might not always be able to hit that exact timing for getting pregnant that you want. Or we thought we wanted a boy, but we obviously love our baby girl! It turns out it doesn’t matter. So just to try to release some of that, to the extent that you can, because the journey is hard enough.