Getting Pregnant For Dummies. Sharon Perkins

Ask the most talkative member of your family for a family “birth history.” You may be surprised by what you discover. And remember, sometimes a vehement denial, such as “there’s never been any problem in our family,” may be a clue to dig a little deeper and find out why everyone is so defensive.

      Finding out important information

      Researching your family history can provide valuable information. For example, you may discover family genetic tendencies that could cause problems on your own reproductive road. Or you may find out that everyone in your family took six months to get pregnant, a fact that may put your mind at ease, particularly around month number five of trying without success.

      Before trying to get pregnant, you’ll want to know whether any diseases occur more than once on your family tree. If so, the disease may be caused by a dominant gene that you could pass on if you carry it, even if your partner doesn’t carry it. Some examples of this can be BRCA 1 and 2 (commonly known as the breast cancer gene, but it can affect men as well with increased predilection toward prostate cancer), muscular dystrophy, Huntington’s disease, and more. Depending on how open your family is, finding out this information can be difficult. Many families don’t discuss anything related to pregnancy, especially not problems getting pregnant, pregnancy losses, or genetic defects. Just a few generations ago, parents of children with genetic abnormalities were encouraged to put them in a home and tell the relatives the baby had been stillborn.

      If your family tree does hold a genetic problem or a birth defect that shows up more than once, you’ll probably want to have genetic testing done. A gene map, which can be done from a blood test, will show whether you carry abnormal genes that could cause problems for your child.

Sometimes the only thing you find out from family records is nonspecific, such as “all the Smith boys died young.” Try and pin down why they all died young: Did they have hemophilia or muscular dystrophy, or did they all fall out of the same apple tree?

      

If you and your partner are blood relatives, it is especially important to see a genetic counselor before getting pregnant. You may carry more of the same abnormal genes than unrelated partners would, which may make you more likely to have a child with a genetic problem. The risk for serious birth defects is 1 in 20 for second cousins and 1 in 11 for first cousins.

      Checking the stats of your race

      Even if you’re not aware of genetic illnesses in your family, certain populations tend toward specific issues. For example, while sickle cell anemia occurs in 1 of 8 African Americans, cystic fibrosis can be found in 1 of 26 Caucasians and at an even higher percentage among Ashkenazi Jews. Other diseases such as Tay-Sachs and Gaucher are also prevalent among the Jewish population.

      Many OB/GYNs suggest screening for the most likely diseases based on your heritage. It doesn’t hurt to get this done before you become pregnant. While many genetic diseases are recessive, meaning that both parents must carry the gene in order for the baby to develop the disease, should you turn up to be a carrier, your partner can be tested right away. If both you and your partner are carriers, each child from your union holds a 25 percent chance of inheriting both genes and thus the disease. Fifty percent of your children will be carriers of the disease and 25 percent will not have or carry the disease.

      THE GOOD NEWS ABOUT INHERITED DISEASES

      When it comes to inherited diseases, you have options your grandmother and mother never did. You can receive pre-pregnancy genetic counseling or have early pregnancy testing of the fetus for abnormalities. Your grandmother, who may have had children well into her 40s, was more likely to have a baby born with chromosomal abnormalities. Such problems are more common in women over 35, and there was no way to test for them during pregnancy in earlier generations. Your mother may have been afraid to have more than one child if she knew there was a family history of cystic fibrosis or muscular dystrophy. The problem that your aunt had during pregnancy from an inherited bleeding disorder is now a condition that can be diagnosed and treated during pregnancy, increasing your chances of having a healthy, full-term baby. Rh factors may have caused fetal death just two generations ago, but they can now be easily prevented by an injection of RhoGAM, which prevents the growing fetus from having its blood cells attacked in utero.

Remember, these are all statistical numbers. Some families where both parents carry a recessive gene disorder have multiple children in a row who have the disease, despite the 25 percent odds per child. Other families don’t. Statistics are based on large numbers of people and the likelihood of any one event occurring. You and your family may or may not fall into the statistical pattern. (We talk a lot more about what your genes do later on in Chapter 3.)

Seeing What Causes Infertility

      Infertility has many causes, and figuring out which applies to you may be very simple — or very difficult. Although women used to bear the brunt of blame for infertility, the truth is that male and female factors share equally in infertility. Consider the following statistics:

       One-third of infertility is caused by female factors.

       One-third of infertility is caused by male factors.

       Around 20 percent of infertility is unexplained.

       Around 10 to 15 percent of infertility is caused by a combination of male and female factors.

      Among women, the main causes of infertility are

       Ovulatory disorders: No ovulation or irregular ovulation

       Tubal disorders: Blocked or infected tubes

       Uterine issues: Fibroids, polyps, or adhesions

      For men the most common causes of infertility are

       Low sperm count

       Decreased sperm motility

       Abnormally shaped sperm

       No sperm at all in the ejaculate

Each of these categories of infertility can be caused by a number of things; for example, a decreased sperm count can be caused by a disease such as diabetes, by a birth defect, or by trauma. A woman can have blocked tubes from endometriosis, pelvic inflammatory disease, or from a congenital malformation. Anovulation can be caused by polycystic ovarian syndrome, premature ovarian failure, or by overexercising. While it may be fairly obvious what the problem is, finding the reason for the problem may be more difficult.

Diagnosing Infertility

      You may think this is a no-brainer: If you’re not getting pregnant, it seems like you’ve already diagnosed yourself with infertility! However, diagnosing a lack of pregnancy is the easy part; figuring out why you’re not getting pregnant is the hard part.

      After reading through Chapter 6, which discusses simple techniques for increasing your pregnancy odds, or Chapters 11 and 12, which explain some of the tests used to diagnose infertility, of this book, you may be able to diagnose the reason for your difficulty in getting pregnant without any help from your doctor. For example, you may be having sex at the wrong time of the month — your “infertility issue” may be solved with a calendar, a thermometer, and an ovulation predictor kit! Or you may not have realized how irregular your periods were — 35 days apart one month, 40 the next, 60 the next — maybe you’re not ovulating