Preconception Through Delivery

Pregnancy is a perfectly normal part of a woman’s life…at least, for some women. While many women will conceive with ease and experience risk-free pregnancies, the reality is that many others will face challenges. According to the Centers for Disease Control and Prevention (CDC), about 10% of U.S. women between the ages of 15 and 44 (6.1 million) will have trouble conceiving and/or carrying a child. Additionally, “high risk” pregnancies can present challenges for a mother-to-be, her unborn child, or both. No matter the circumstance a woman finds herself in, finding the appropriate health care provider and receiving consistent prenatal care can help build the foundation for a successful pregnancy.

Challenges With Pregnancy

By Pamela Boaz

Infertility-Challenges to Conception

For many women, difficulty begins with becoming pregnant in the first place. Infertility issues can bring frustration and heartbreak; fortunately, it is often temporary and treatable. The CDC estimates that one-third of infertility cases may be attributed to women and one-third to men, with the final third being either a mix of the two or from an unknown cause. The most frequent cause of infertility in women is ovarian dysfunction. Problems with ovulation are commonly caused by polycystic ovarian syndrome (PCOS), a hormonal disorder responsible for 70% of infertility in women who have trouble ovulating. Another cause of infertility is primary ovarian insufficiency (POI). Women with POI have ovaries that have failed to function properly before the age of 40. Other less common causes of infertility include blocked fallopian tubes, physical problems with the uterus, and uterine fibroids.

It comes as no surprise that the number one risk factor for infertility is a woman’s age. Women are born with all the eggs they will ever have, and the best eggs are used first. The National Infertility Association reports that by the time a woman is 40 years old, her chance of conceiving has decreased from 90% to 67%.

Just five years later, those odds drop to 15%, and her chance of miscarriage increases. Other risk factors for infertility include being overweight, smoking, alcohol use, stress, poor diet, intense physical training, and sexually transmitted infections.

A woman unable to conceive after a year of unprotected sex (or after six months if she is over 35) may consider consulting a physician. A woman’s OB/GYN is a great place to start. After collecting her medical history, an OB/GYN will do a physical examination and test for infertility issues. If no conclusions can be reached, a patient may be referred to a fertility specialist.

Fertility doctors have training in reproductive endocrinology and infertility (REI), a subspecialty of obstetrics and gynecology that focuses on hormonal dysfunctions and their relationships to infertility. These doctors can use a variety of tests to help determine why a women may not be producing eggs, or why eggs may not be able to reach her womb.

A hysterosalpingogram (HSG) or a laparoscopy may be used to look for blockage in the fallopian tubes. The HSG is an X-ray procedure, while the laparoscopy requires a small injection in the abdomen to allow the doctor to look for blockages in the fallopian tubes. Other diagnostic procedures may include a hysteroscopy to look for fibroids or polyps, or a sonohysterogram or pelvic ultrasound to evaluate the reproductive organs. A blood test may also be administered to help determine hormone levels during menstruation and the viability of the eggs.

Fertility drugs are usually the first course of treatment for women with ovulation problems. Working like natural hormones, these drugs can regulate or induce ovulation. Fertility drugs are often used in conjunction with intrauterine insemination (IUI), commonly called artificial insemination. IUI involves injecting sperm directly into the uterus near the time of ovulation.

Another approach to treating infertility is assisted reproductive technology (ART), the most common of which is In Vitro Fertilization (IVF). In Vitro involves taking a healthy egg from a woman and mixing it with sperm in a lab. After fertilization, which occurs in three to five days, the embryos are implanted in the uterus. “The beauty of IVF is that there is no question that the egg is picked up because we harvest it, and there’s no question that the sperm will make it, because we mix it. They are forced together,” says Dr. Joseph Bird, a fertility specialist at Chattanooga’s Fertility Center. “There is also no question that fertilization will take place, because we actually place it there. When you take all of those variables out of the equation— there is a 65 to 75% chance that it will be effective in women under 35 years of age. It’s a very efficient tool.” Intracytoplasmic Sperm Injection (ICSI) is another ART technique in which a single sperm is injected directly into an egg.

If infertility is caused by blockage of the fallopian tubes, endometriosis, or fibroid polyps, surgery will likely be the prescribed treatment. For women whose health problems prevent them from carrying a baby or for those who have ovaries, but no uterus, using a gestational carrier may provide another option. In these circumstances, a woman’s egg is fertilized by her partner’s sperm, and the embryo is then placed in the carrier’s womb. For a woman with few healthy eggs, choosing an egg from a donor bank may provide an option. Another ART method helps increase implantation success by opening the outer lining of the embryo. Dr. Bird emphasizes that almost every barrier to conception has been removed through advancements in fertility-based research and technology. “Sometimes people don’t understand that there are opportunities to really overcome their problem,” he says. “From the very first visit—we give patients hope. We tell them how we’re going to tackle it, what tests need to be done. We set out a road map for success at the very start.”

Facing the challenge of infertility comes with both emotional and financial costs; however, support is available from countless resources, including books, support groups, and counseling. In the event that pregnancy does not occur, adoption offers a loving alternative.

High-Risk Pregnancy – Contributing Factors

A pregnancy is considered high-risk if the woman or her child has an increased chance of having a health problem. While the term may sound frightening, calling a pregnancy high-risk ensures that mother and child will receive the appropriate attention. In the U.S., about 6 to 8% of all pregnancies can be classified as “high risk.” The following factors may put a woman at risk of having a high-risk pregnancy:

• Age: Pregnancies in women younger than 17 is risky because of the stress that pregnancy places on the adolescent body, and the risk factors extend to the newborn as well. Becoming pregnant is not only more difficult for women over 35, but it also comes with more risks. Older mothers are more likely to have multiple births and to develop gestational diabetes or high blood pressure, making their pregnancies high-risk.

• Lifestyle Choices: Lifestyle choices, such as smoking, drinking alcohol, or using illegal drugs, are detrimental both to the health of the pregnant woman and especially to the unborn child.

• Pre-existing Health Issues: Women who have a pre-existing health issue, such as diabetes, cancer, high blood pressure, kidney disease, or epilepsy, have pregnancies regarded as high risk.

Additional risk factors include carrying more than one baby (multiple pregnancy) or having had a prior miscarriage.Fertility-Sidebar

Prenatal Care – Essential Steps

Good health care is important for all women, but particularly for those who are trying to become pregnant. Women can take their own positive steps toward a healthier pregnancy by reaching a healthy weight and eliminating risky lifestyle behaviors prior to conception. This not only improves the health of a mother-to-be, it can increase the likelihood of becoming pregnant. Once pregnant, these positive changes also will support the health of the fetus.

Prenatal care is crucial and should begin early. Pregnant women should plan to visit a doctor for a routine check-up once a month for the first 28 weeks, every other week between weeks 28-36, and weekly from weeks 36 to birth. Each exam offers the opportunity to look for changes that may put the mother and/or child at risk. Dietary considerations, activity recommendations, and general information and support are also provided at these appointments. With a high-risk pregnancy, appointments may be scheduled more frequently and ultra-sound tests may be done more often. Blood pressure checks and urine tests are also part of the monitoring procedures.

Women with high-risk pregnancies need to be acutely aware of symptoms that indicate the need to call a health care provider immediately. These warning signs include:

• Fever, chills, or painful urination

• Vaginal bleeding

• Severe belly pain

• Physical or severe emotional trauma

• Ruptured membranes (your water breaking)

• Noticing the baby is moving less or not at all, especially in the last half of pregnancy

It is important to remember that while a high-risk pregnancy may require more attention from both the doctor and the mother-to-be, most all will lead to healthy, viable babies.

Help and support are available for women struggling with emotional or physical issues related to infertility or high-risk pregnancies. As participants in their own health care, women can take positive steps to increase their own health and the health of their babies. Advances in health care— from diagnostic techniques to methods of treatment—have vastly improved outcomes for women struggling with infertility. For pregnant women who face the added stress of health problems while carrying their child to term, the medical community continues to make great strides in treatment and care.

Pamela Boaz, a writer and editor, earned a B.S. degree from the University of North Florida and an M. Ed. from UTC. During her more than 30-year career in education, she has served as faculty advisor for student publications and written curricula for a variety of courses.

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