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.

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.

Common questions about the MTHFR gene: Answered

First off, what does the MTHFR gene do exactly? It’s responsible for making the enzyme, methylenetetrahydrofolate reductase (hence the MTHFR acronym and wordy gene name). This, in turn works with the B-vitamin folate to help to reduce the level of homocysteine in the body.

What does it mean to have a MTHFR gene variant?

There are two common gene variants (which is when the DNA sequence of a gene is different in different people) of this gene, and these are called C677T and A1298C. Studies have shown that women with two C677T variants have an increased risk of having children with neural tube defects (though these defects are rare, so the risk is still low). Men and women with the same two variants and elevated homocysteine levels may have an increased risk of blood clots (and people who have elevated homocysteine levels rarely have elevated levels just from the gene variants, so they should be evaluated for other risk factors that are known to cause this). Too much homocysteine in the body can be one risk factor for blood clots and heart disease, however many environmental and genetic factors influence risk for this.

Can the MTHFR gene affect pregnancy?

Associations between these common gene variants and a number of complications have been speculated and evaluated for in different ways, but no association has been found. These gene variants have not proven to be a risk factor for problems that may arise during pregnancy such as blood clots, pregnancy loss, or other negative health outcomes. Because of this, the American Congress of Obstetricians and Gynecologists (ACOG) do not recommend testing for MTHFR gene variants. If genetic testing does show a MTHFR variant, these variants on their own will not impact an individual’s medical treatment. And a medical geneticist will work hard to do a thorough and appropriate evaluation of symptoms to prevent incorrectly attributing medical problems to positive MTHFR status, which is not uncommon.

And what this all means for pregnant individuals is that prenatal care – including recommendations for prenatal vitamins or folate supplementation – will not change in major ways based on the presence of an MTHFR gene variation. Impacts include if, for example, a person has high homocysteine levels, medical providers will seek to identify all possible causes, and pregnant individuals will be advised to take standard folate dosages to reduce the risk of neural tube defects. Or, to use another example, if other symptoms indicate that it’s necessary, an individual may be referred from a medical geneticist to a hematologist or maternal–fetal medicine specialist for further evaluation.

Talk to your healthcare provider if you still have questions or concerns

If you have any questions or concerns about this, talk to your healthcare provider, as they can answer your questions.

Read more

• Genetic testing before pregnancy
• Getting healthy for fertility and pregnancy

Sources

• Scott E. Hickey, Cynthia J. Curry, and Helga V. Toriello. “ACMG Practice Guideline: lack of evidence for MTHFR polymorphism testing. Genetics in Medicine. 15(2): 153-156. February 2013. Retrieved August 28 2018. https://www.acmg.net/docs/mthfr_gim2012165a_feb2013.pdf.
• “Basic information about the MTHFR Gene.” Kaiser Permanente. The Permanente Medical Group, Inc., May 2018. Retrieved August 28 2018. https://mydoctor.kaiserpermanente.org/ncal/Images/GEN_MTHFR_tcm63-938252.pdf.
• “MTHFR gene variant.” U.S. Department of Health & Human Services, National Institutes of Health, National Center for Advancing Translational Services. Genetic and Rare Diseases Information Center, April 18 2018. Retrieved August 28 2018. https://rarediseases.info.nih.gov/diseases/10953/mthfr-gene-mutation.

The differences between an IVF and an ICSI

Articles and websites are known to use the two names (IVF and ICSI) interchangeably, without explanation, or definition. How are people supposed to know what these treatments are and how they’re different? Wait, are they different? Let’s start from the beginning.

In Vitro Fertilization (IVF)

You may already know a little about IVF because it’s probably the most popular form of assisted reproductive technology (ART) out there. It’s also the most expensive. One IVF cycle can cost anywhere from $8,000 to $30,000 depending on factors like age, health, or if you plan on using donor sperm or eggs. However, if IVF turns out to be the right choice for you, it may very well be worth the hefty price tag.

Many people who seek out IVF treatment do so because they have issues with fertility. These could include endometriosis, polycystic ovary syndrome (PCOS), problems with sperm function, and unexplained infertility. For people over 35, IVF may also offer a better chance of conceiving than traditional intercourse, ICI, or IUI. It’s always a good idea to speak to your healthcare provider when you are thinking about moving forward with any ART or other fertility treatments.

How IVF works

The IVF process can take up to two weeks, and there are several different ways to prepare the body for treatment based on individual health. These preparations include taking hormone-encouraging drugs to boost ovulation and improve chances of producing a high number of mature eggs. There are also medications to help prepare the uterine lining for fertilized embryos. Specialists work closely with patients to help develop a game plan.

When a healthcare provider gives the green light, mature eggs will be carefully retrieved from the ovaries. These eggs (or donor eggs) are taken to a lab where they will then be put in a petri dish with fresh sperm (collected shortly before the procedure), or sperm that has been thawed and prepared beforehand. These close living quarters will allow sperm to mingle with eggs in a way that is isn’t really possible during traditional intercourse. Aside from the setting of the petri dish, the fertilization process is much the same as during intercourse. In the end, one sperm should match up with one egg. Then it’s a bit of a waiting game. If the procedure is successful, after a period of two to six days, the fertilized embryo or embryos will finally be transferred to the uterus, where, hopefully, implantation will be successful and result in pregnancy! With IVF and ICSI, it’s sometimes possible to find out if it worked by taking a pregnancy test as soon as two weeks after implantation.

Intracytoplasmic sperm injection (ICSI)

This treatment is also used when people are having trouble getting pregnant, or by people using donor eggs or sperm. The name “intracytoplasmic sperm injection” makes ICSI sound like a very complicated treatment, but when you break it down, the concept is pretty straightforward. In truth, the term is just a really formal way of saying that during the ICSI process, sperm will be directly injected into an egg to fertilize it. But, what exactly does that mean, and how is it possible?

How ICSI works

ICSI is a form of IVF treatment, often referred to as “IVF with ICSI,” so both processes take place in a IVF lab. As for preparation, traditional IVF and ICSI are very similar, if not identical in some cases. The real difference between the two happens after the sperm and eggs have already been taken to the lab. Unlike traditional IVF, ICSI samples are not mixed together in a petri dish and left to match up on their own. Through the ICSI process, you are able to make the connection for them. A single egg is delicately held in a specialized pipette, while a very small and hollow needle carefully selects a single sperm and immobilizes it by picking it up. Once both parties are secured, the needle is slowly brought through the shell of the egg (zona) before reaching its goal at the center of the egg (cytoplasm). The needle then places the sperm within the cytoplasm. After injecting the sperm, the process is complete, and the needle is removed. Eggs are checked after a day or so to see if the process of “normal fertilization” has begun. Just like traditional IVF, the successfully fertilized eggs are then implanted in the uterine lining once they are mature enough.

Other things to consider

In the end, there really isn’t a “qualifying factor” that can say for sure whether you should use traditional IVF or ICSI treatment (though ICSI may be more effective in cases of severely low sperm count and unexplained male infertility). The process of egg retrieval and insertion of embryos into the uterus are the same between both options. Both are mostly painless, and have mild side effects. In fact, because ICSI has become more popular over the last decade with a 70% to 85% fertilization rate, many clinics have begun to use the two procedures interchangeably, and some have even begun using ICSI for every treatment!

We all know that it’s sometimes difficult to get a straight answer from the internet. We’ve covered the basics, but nothing can replace your healthcare provider’s knowledge and advice. Asking them detailed questions may be the first step in beginning your IVF journey!

Read more

• Sperm donation 101
• Egg donation: thinking it through

Sources

• Mayo Clinic Staff. “In Vitro Fertilization (IVF)”. Mayo Clinic. Mayo Clinic. March 22, 2018. https://www.mayoclinic.org/tests-procedures/in-vitro-fertilization/about/pac-20384716
• “Intracytoplasmic Sperm Injection- ICSI and IVF. Advanced Fertility Center of Chicago. Advanced Fertility Center of Chicago. 2017. https://www.advancedfertility.com/icsi.htm
• “Egg Donation Cost at the Advanced Fertility Center of Chicago”. Advanced Fertility Center of Chicago. Advanced Fertility Center of Chicago. 2017. https://www.advancedfertility.com/eggdonationcost.htm

Pregnancy test facts…and fiction

Here are some of the more commonly-held beliefs about taking a home pregnancy test, some of which are fact; others, fiction.

Fact or fiction? Your body starts making hCG after implantation.

Fact! After the fertilized egg implants, the placenta starts producing hCG, the pregnancy hormone. A woman’s hCG levels rise very quickly in early pregnancy, but the amount of hCG that a woman has can vary, depending on the individual. Some women have a lot of hCG right away, while others’ bodies take a little longer to start making noticeable amounts of hCG. This is why testing after a missed period can produce more accurate results.

Fact or fiction? Antibiotics can interfere with pregnancy test results.

Fiction. Certain fertility drugs that contain hCG could affect the results of a pregnancy test, but according to the Mayo Clinic, antibiotics or other hormonal medications like birth control pills don’t interfere with the results of a home pregnancy test.

Fact or fiction? You can use an ovulation test like a home pregnancy test to pick up your pregnancy early.

Fiction. In theory, you could, but it wouldn’t be worth the time or money. Basically, home pregnancy tests look for levels of hCG in a woman’s urine, and ovulation tests look for levels of luteinizing hormone (LH) in urine. Both hCG and LH show up nearly the exact same on an ovulation test, so if a woman has enough of either hormone in her body, an ovulation test could technically detect the hCG and show that she is pregnant.

The reason why you can’t use an ovulation test in place of a home pregnancy test is because home pregnancy tests are much more sensitive to hCG. Unlike ovulation tests, home pregnancy tests can pick up on the pregnancy hormone much earlier than ovulation tests. If you use an ovulation test to check for pregnancy, you have a much higher risk of a false negative (and honestly, who wants or even has time for that?).

Fact or fiction? A blood test is the only way to confirm 100% if you are pregnant.

Fiction. It’s true that blood tests are more accurate than home pregnancy tests, but only slightly. Blood tests have an accuracy rate of 99%, compared to the 97% accuracy rate of home pregnancy tests that use urine. If you get a positive pregnancy test at home, your provider will likely perform another urine test in his or her office, along with an ultrasound to confirm your pregnancy.

Fact or fiction? Tests that use pink dye are better than tests with blue dye.

Both? There’s not a ton of scientific evidence about this, but many women report that blue dye fades and blurs in a way that makes it much harder to read on a pregnancy test. No matter what test you use, if you get a positive, make sure to test again a few days later, and then schedule an appointment with your provider.

Sources

• “Pregnancy Test.” MedlinePlus. US National Library of Medicine, Oct 2016. Web. Accessed 8/18/17. Available at https://medlineplus.gov/ency/article/003432.htm.
• Liza Torborg. “Mayo Clinic Q and A: Ovulation predictor kits can be useful for couples trying to conceive.” MayoClinic. Mayo Clinic Foundation, Sep 2015. Web. Accessed 8/18/17. Available at https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-q-and-a-ovulation-predictor-kits-can-be-useful-for-couples-trying-to-conceive/.
• “Getting pregnant.” MayoClinic. Mayo Foundation for Medical Education and Research, Dec 2015. Web. Accessed 8/18/17. Available at http://www.mayoclinic.org/healthy-lifestyle/getting-pregnant/in-depth/home-pregnancy-tests/art-20047940?pg=2.

Call your healthcare provider if you experience these complications

When new symptoms appear, you might find yourself wondering if you should wait things out or call your healthcare provider right away. Some reasons that you should, indeed, go ahead and call your provider include:

If you experience unusual bleeding

Everyone’s periods are different, and what’s normal for one person might not be normal for another. Some women have light periods, others heavy. And for some women, irregular periods or spotting between regular periods might be par for the course. But if bleeding becomes different than what you’re used to – like, say, bleeding profusely during your period (enough to change pads or tampons every hour) or spotting between periods when this just isn’t typical for you- then you’ll want to be in touch with your healthcare provider to figure out just why these changes are occurring.

If you experience a lot of pain during your period

Many women experience cramping during that time of the month. But if you experience pain during your period that is extremely painful or incapacitating, pick up that phone and be in touch. Major pain could be a sign of a bigger problem. And even if it’s not, you shouldn’t suffer, and your provider can work with you to try to find ways to mitigate your discomfort.

If you notice vaginal itching, burning, odor, or an unusual discharge

Vaginal discharge is common – and you likely know what sort of a discharge is normal for you during different stage of your cycle – but if you experience a discharge that’s a bit different than normal, especially if it’s accompanied by an unusual odor, then touch base with your healthcare provider. Same goes for if you’re experiencing any vaginal itching or burning. These symptoms could be signs of vaginitis, a sexually transmitted infection (STI), or a yeast infection.

If you experience discomfort when you urinate

If you experience pain or discomfort when you urinate, it could be a sign of a urinary tract infection (UTI) or a sexually transmitted infection (STI). Sometimes pain while peeing might also be accompanied by a strange odor or discharge, or by fever, chills, or pain in your back. If you’re experiencing any of these issues – you guessed it – get in touch with your provider.

If sex is painful

Sex should be pleasurable, but if you’re experiencing unwelcome pain, give your healthcare provider a ring. There are a number of reasons this discomfort could be happening, and talking through just what exactly is painful with your provider can help you get back in the saddle – comfortably – in no time.

If you experience pain, fullness, or discomfort in your abdominal or pelvic area

If you have discomfort in your abdomen or pelvis area, talk things through with your provider. There are a range of reasons you might be experiencing feelings of pain, fullness, or other discomfort – everything from pelvic inflammatory disease, to ectopic pregnancy, to fibroids, to cysts, to endometriosis, to infection. This really runs the gamut, and an expert opinion is needed to determine whether the pain is a symptom of something critically threatening, or benignly uncomfortable.

If you have trouble getting aroused or climaxing

If you notice that you’re having trouble when getting intimate, either getting aroused or orgasming, your healthcare provider can help you work through these problems. Whether there are some underlying physical issues at play or it just takes a few small refinements in the bedroom, you deserve to have a healthy sex life, and your healthcare provider can help you work through these concerns.

If your period suddenly stops

If you’ve been sexually active and your period suddenly stops, the most likely explanation is that you’re pregnant. If you’ve been actively TTC, this might be just what you’ve been hoping for! You know what to do – pee on a stick and call your healthcare provider. And if you haven’t haven’t been sexually active, then obviously there might be something else at play, so be in touch with your provider to figure out what’s going on.

If you’ve been TTC for a while

Just what is a while? If you’ve been trying to get pregnant for a year (or six months if you’re over 35) and have not yet had a positive result, it could be time to be in touch with your healthcare provider to see if there are any underlying issues that might be preventing you from getting pregnant or if you need some extra help along the way.

If you have questions or concerns about your current method of birth control

If you’re not presently TTC and aren’t feeling so hot about your current birth control – maybe you’ve been experiencing side effects or just don’t think you current option jives with your lifestyle (perhaps you’re forgetting to take that daily pill?) – then your provider can help you find another option that will work best for you.

If you notice any other major changes

You know what’s normal for your body. And you might have noticed that much of the above list involves changes that signal something is different. So as a general rule, any major change that signals something is out of sorts is definitely worth being in touch with your healthcare provider. What if it’s something that doesn’t seem quite so major but definitely seems slightly off? Give them a call anyway. Err on the side of caution, and let your provider give you some guidance on what is likely a-okay and what warrants an office visit to have things checked out further.

Sources:

• The American College of Obstetricians and Gynecologists. “Benign breast problems and conditions.” ACOG. American Congress of Obstetricians and Gynecologists, June 2012. Retrieved September 26 2017. https://www.acog.org/Patients/FAQs/Benign-Breast-Problems-and-Conditions.
• The American College of Obstetricians and Gynecologists. “FAQ136: Evaluating infertility.” ACOG. American Congress of Obstetricians and Gynecologists, June 2012. Retrieved September 26 2017. https://www.acog.org/Patients/FAQs/Evaluating-Infertility.
• “Annual Exams.” Dartmouth-Hitchcock. Dartmouth-Hitchcock, Retrieved September 26 2017. http://www.dartmouth-hitchcock.org/gynecology/annual_exams.html.
• “Contraceptive Options.” Dartmouth-Hitchcock. Dartmouth-Hitchcock, Retrieved September 26 2017. http://www.dartmouth-hitchcock.org/gynecology/contraceptive_options.html.
• “Infections and Pelvic Pain.” Dartmouth-Hitchcock. Dartmouth-Hitchcock, Retrieved September 26 2017. http://www.dartmouth-hitchcock.org/gynecology/infections_pelvic_pain.html
• “Menstrual Problems.” Dartmouth-Hitchcock. Dartmouth-Hitchcock, Retrieved September 26 2017.
• “Period Problems.” Dartmouth-Hitchcock. Dartmouth-Hitchcock, Retrieved September 26 2017. http://www.dartmouth-hitchcock.org/gynecology/period_problems.html.
• “Sexual Health.” Dartmouth-Hitchcock. Dartmouth-Hitchcock, Retrieved September 26 2017. http://www.dartmouth-hitchcock.org/gynecology/sexual_health.html.

Learn about the different reproductive healthcare providers available

Having these options is pretty great, since it means you can seek out the care that you think would be best for you based on your views and values, your medical history, the level of care you will need, and, if you’re TTC, your pregnancy and childbirth preferences. You can choose from:

Certified nurse-midwife

These nurses have a nursing degree and additional training in midwifery. They provide women’s health care, prenatal appointments, and will be present for the labor and delivery of a baby.

Midwives are able to care for most pregnancies as well as labor and deliveries that are low-risk – and most women do fall into this category – as they can treat women who need little medical intervention. Their care is also based in the idea that pregnancy and childbirth are normal processes.

Many women who share this view may decide to choose a midwife for their care for this reason and because they want minimal medical intervention. Many midwives work with OB/GYNs so that if complications do arise and a pregnancy or delivery becomes high-risk, then a patient can receive more specialized care from doctors as needed.

Family practitioner

These are doctors who can also care for women with low-risk pregnancies. They are primary care physicians with a broad range of medical knowledge and so can provide a broad range of care – for everyone from children to older adults.

These doctors have three years of additional training after medical school and some may decide to focus on additional training in obstetrics during this time. Some women prefer to work with these doctors if they saw a family practitioner as their primary care doctor before trying to conceive or getting pregnant and so enjoy having continuous care with someone they already know. And these sort of doctors may simply be more common in rural areas or at particular hospitals.

However, because labor and delivery is only a part of their training and not their focus, much like midwives, they may need to refer women with certain issues to an OB/GYN. And while some will perform vacuum and forceps deliveries if needed, most do not perform C-sections.

Obstetrician-gynecologist or OB/GYN

These doctors have completed four years of training in obstetrics and gynecology after medical school. Their care focus and expertise is pregnancy and women’s reproductive health and they can provide a range of women’s health services.

Many of these doctors can deal with a range of healthcare needs – everything from low-risk pregnancies and deliveries to many types of high-risk pregnancies and deliveries, such as when interventions like a C-section may be needed.

These doctors typically provide prenatal appointments, will deliver the baby at the time of birth, but may not necessarily be with you throughout labor – rather, labor and delivery nurses or midwives may be present for that.

Maternal-fetal medicine specialist

These doctors are also called perinatologists, and they are trained to deal with the highest risk pregnancies. These doctors will not only have completed medical school and standard four-year training in obstetrics and gynecology, but also an additional two or three tears of training to deal with high-risk pregnancies.

If you are seeing another health care provider and any major health issues arise during pregnancy – such as multiples, preeclampsia, or chronic health problems – you may be referred to this type of specialist. These specialists will typically work in collaboration with your other doctors or nurses and may not necessarily attend labor and delivery.

Don’t be surprised at your next PCP appointment, here’s what to expect

But even if you’ve been to a PCP before, it may have been a while ago, or you may have never before had an appointment at a time when you were trying to conceive. So just what can you expect once you’re there? Your visit may include:

General physical exam

The general physical exam may be done by a nurse assisting your doctor, or done by the midwife. This usually consists of a height and weight check, as well as taking your blood pressure.

They may also ask you some basic questions, such as if there have been any major changes to you health since you last visited, what medications or supplements you’re currently taking, and if you have any major concerns that you’d like to discuss during the visit. They will also likely ask your the last dates of your period and about your period history.

Discussion of health history, concerns, and questions

This kind of visit also dedicates some time to speaking with your healthcare provider about your personal and family medical history. You may also discuss sexual history, options for contraception, fertility, and plans for conception.

As you discuss all of this, your provider will probably ask you a number of questions, and if you’re honest with your answers, your healthcare provider will be able to provide you with the best and most appropriate care. This is also the time for you to ask any questions you may have – no matter how personal, and even if you feel a bit embarrassed. Your healthcare provider is there to provide you with reliable medical knowledge, support, and to answer any and all questions you have.

Whether you’re actively trying to conceive or not, your provider will discuss reproductive health options that will work best for you. And if you want to try to conceive in the near future, this is the time to tell your provider about these plans so that they can share just how you can remain in good health as you TTC.

Physical exam

An accompanying nurse may or may not stay in the room with your healthcare provider during the physical exam. During this exam, you will likely be undressed and wearing a medical gown that opens in the front and a paper sheet to cover your lap, and the exam might include a pelvic exam, a bimanual exam, a breast exam, and a rectovaginal exam.

During the pelvic exam, your provider may examine the outside of your vagina, including your vulva and vaginal opening. Your provider may also examine the insider of your vagina and cervix with the help of a device called a speculum, which will hold open the vagina. They may also do an internal bimanual exam by placing gloved fingers inside your vagina as they place their other hand on your lower abdomen where your reproductive organs are located to feel them.

The provider may also do a rectovaginal exam as needed, which involves them placing one gloved finger in your vagina and another in your rectum.

The breast exam may involve your provider looking at and feeling your breasts for lumps or other abnormalities. They may also feel your neck and throat. As they do all of this, this they will aim to see and feel that you are healthy, and that they don’t observe any abnormalities.

During the physical exam you may feel some pressure or slight discomfort, but none of this should not be painful. If you do feel discomfort or pain, make sure you let your provider know.

Lab tests or screening

Based on your medical history and discussions with your provider, there is a chance they may recommend lab tests or screenings – whether routine or specialized – based on your healthcare needs. These might include a blood draw, a urine test, STD tests, or a Pap smear. These tests may happen before or after you meet with the provider.

Pap smears are done during the pelvic exam and involve your provider swiping your cervix with a small brush. (The cells taken from the swipe are then tested at a lab for cervical cancer and other abnormalities.)

No matter what type of provider you see, your healthcare provider is meant to be a partner in your care, helping you to maintain good reproductive health at every stage of your life.

Trying to conceive? What you should know about prenatal vitamins

Getting all the nutrients we need from the food we eat should be possible, but during pregnancy, there can be gaps that even the most careful person can’t avoid. According to the Dietary Guidelines for Americans, the U.S. population generally does not meet daily requirements for many nutrients.

Let’s start with a big one. Folic acid is a water-soluble vitamin that protects against neural tube defects like spina bifida. Getting enough folic acid through supplementation and diet is critical before becoming pregnant and when the neural tube is developing in the early days of pregnancy. Your supplement should have at least 400 mcg of folic acid. You can also consume foods high in folic acid, such as beans, leafy green vegetables, cereals, and enriched or fortified grains. Although you can buy prenatal vitamins that contain “folate,” folic acid is the only supplement that has been researched and shown to reduce the incidence of neural tube defects.

Iron is important for those who plan to become pregnant or who are pregnant. Iron deficiency anemia is the most common nutritional deficiency in the world, and in pregnancy, it can lead to preterm labor, low birth weight, or infant mortality. Unfortunately, getting enough iron from foods can be difficult, so your provider or midwife may suggest taking a supplement while trying to conceive and during pregnancy. Women 19 to 50 years old who are not pregnant need 18 mg of iron per day, and pregnant women need 27 mg per day. Meats, poultry, and fish are good sources of iron, as are many of the foods listed above that are high in folic acid. Having a source of vitamin C can make iron easier to absorb, so consider adding some strawberries to your spinach salad, red bell pepper to your broccoli, or taking your iron supplements with a small glass of orange juice. Iron can be constipating in supplement form, so you may need to experiment with which brand or type works best for you! When you’re ready to start TTC, you can also ask your provider to check your iron levels with a blood count and ferritin level.

Other things to consider

Each woman has individual needs, so talk with your provider or midwife before starting a supplement. You may need additional vitamins or minerals, and your provider can help identify the best options for you based on your health history and available lab work. Folic acid and iron can be found in prenatal vitamins, regular multivitamins, or sold individually. Remember, supplements are meant to do just what they say – supplement our diets. Taking vitamins shouldn’t replace healthy foods in your diet, like vegetables, fruits, whole grains, and protein. By enjoying a variety of healthy foods, you can maximize your nutrition and fertility while trying to conceive!

Sources

• Institute of Medicine. Food and Nutrition Board. Dietary Reference Intakes (DRIs): Recommended Dietary Allowances and Adequate Intakes, Vitamins Food and Nutrition Board, Institute of Medicine, National Academies. Available at: https://www.nal.usda.gov/fnic/dri-tables-and-application-reports. Accessed May 31, 2017.
• U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015 – 2020 Dietary Guidelines for Americans. 8th Edition. December 2015. Available at http://health.gov/dietaryguidelines/2015/guidelines/.
• “Neural Tube Defects.” march of dimes. March of Dimes Foundation, April 2016. Last reviewed: February 2022. https://www.marchofdimes.org/find-support/topics/planning-baby/neural-tube-defects

Jennifer Heinen, MS, RDN, LDN Founder, Nourish for Life

If you have been told that you have low iron stores or are anemic, you are not alone. Iron deficiency anemia is the world’s most common nutritional deficiency, and the WHO estimates that anemia affects 29.4% of people of childbearing age globally.

Diet changes that can help with anemia or iron deficiency

Although it is not clear how iron deficiency may affect fertility, a few studies have suggested that your chances of becoming pregnant may increase if you improve your iron status.

So why is your iron status important for TTC? Starting out your pregnancy with low iron can increase the risk of pregnancy anemia, which may lead to preterm labor, low birth weight, and infant mortality. In addition, during pregnancy you need more iron due to an increase in your blood volume, which provides oxygen to you and your baby. Although this may seem worrying, the good news is that there are many ways to improve your iron by consuming iron-rich foods in your diet!

There are two different kinds of iron in foods: heme and non-heme. Heme iron comes mainly from animal proteins, while non-heme iron can be found in plant-based foods. Heme iron is more easily absorbed by the body, which is why vegetarians may need even more iron than meat-eaters. Below are a list of iron-rich foods:

Heme:

• Red meat
• Poultry (especially dark meat)
• Pork
• Fish and seafood (like oysters, sardines and tuna)
• Eggs

Non-heme:

• Fortified breakfast cereals, bread, pasta
• Beans, legumes, seeds, and nuts
• Whole grains
• Enriched flours
• Cooked dark leafy greens
• Some dried fruit (mango, apricot)
• Dark chocolate

To get the most iron out of vegetarian-based meals, enjoy them with foods that have vitamin C. This combination helps absorb the non-heme iron. For example, eat broccoli with tomatoes, breakfast cereal with an orange, or bean salad with bell peppers and pineapple. On the flip-side, calcium can reduce the absorption of iron, so it is best to separate calcium food and supplements from your iron foods when you can. 

Even though many foods have iron, your doctor may recommend taking a supplement. If so, look for a supplement that contains vitamin C to increase absorption, and to avoid constipation and stomach aches that may come with taking iron, you can usually take it every other day. The Recommended Dietary Allowance of iron for women 19 to 50 years old is 18 mg per day, going up to 27 mg per day for pregnant people.

As you can see, it’s possible to improve your nutrition just by enjoying yummy foods! Talk with your healthcare provider if you have questions about your iron levels, anemia, or before making any changes to your diet or supplementation.

Reviewed by the Ovia Health Clinical Team 

Read more 

• What you need to know about iron deficiency anemia
• Why preventive health is essential for better health

Sources

• Aranda N, et al. Pre-pregnancy iron reserves, iron supplementation during pregnancy, and birth weight. Early Hum Dev. 2011 Dec;87(12):791-7.
• Chavarro JE, et al. Iron intake and risk of ovulatory infertility. Obstet Gynecol. 2006 Nov;108(5):1145-52.
• Institute of Medicine. Food and Nutrition Board. Dietary Reference Intakes (DRIs): Recommended Dietary Allowances and Adequate Intakes, Vitamins Food and Nutrition Board, Institute of Medicine, National Academies. Available at: https://www.nal.usda.gov/fnic/dri-tables-and-application-reports. Accessed May 31, 2017.
• Kaiser LL, Campbell CG. Practice Paper of the Academy of Nutrition and Dietetics Abstract: Nutrition and Lifestyle for a Healthy Pregnancy Outcome. J. Acad. Nutr. Diet. 2014; 7:1099-1103.
• WHO. The global prevalence of anaemia in 2011. Geneva: World Health Organization; 2015.
• U.S. Department of Agriculture, Agricultural Research Service. USDA National Nutrient Database for Standard Reference, Release 28. Accessed May 31, 2017.