Planning and preparation before the final reality of having a baby is one of the most exciting time in any couple’s life. But before planning a pregnancy, the best thing one can do is to prepare your body. After all your body is going to be the baby’s home for its first 9 months. So making that home as healthy as possible should be first on your agenda.

Go For A Preconception Visit:

Which is why most doctors recommend a preconception checkup. This visit enables your doctor to uncover any potential health problems before you get pregnant. The problems can then be prevented or treated and of course this will also give your doctor a head start to manage your pregnancy appropriately. It will also give you time to change your lifestyle, maximize your health, improve your chances of conceiving and remove chances of any potential dangers to the baby. A preconception checkup is quite similar to the normal first prenatal visit.

Discuss the following with your doctor –

Family history of genetic diseases and multiple births.

The pattern of your menstrual periods. This will be helpful in determining any abnormalities that should be treated before you become pregnant.

Any exposure to x-rays or poisons like lead etc., either at work or home.

General health – any serious or chronic diseases that you may have had – diabetes, low or high blood pressure, heart disease, epilepsy. There might be need to change some medications before conceiving.

Any history of sexually transmitted diseases as this makes conception difficult, might harm a developing baby or cause some other complications during pregnancy.

Medications – Even some over the counter drugs can affect the developing baby, so telling your doctor about every medicine that you are taking is essential. The doctor might want to change some medications and stop some before trying to conceive.

Vitamin and mineral supplements – high doses of these can also harm the fetus. So let your doctor determine the correct dosage of these for you.

Birth control measures – An IUD makes chances of conception difficult and also increases the risk of miscarriages. If you have been using birth control pills, it will take few weeks to 3 months for your body to return to its normal hormonal cycles so that you can become pregnant.

Prior pregnancies – Any problems with previous pregnancies can affect future pregnancies. Tell your doctor about any complications that were experienced like miscarriages, induced abortion or premature or multiple births.

Vaccinations- Complete and accurate information about your vaccinations to date should be supplied to the doctor.

Tests To Do :

A pelvic exam and a pap smear will help identify any problems with the pelvic region or the birth canal. Further tests if your doctor recommends.

Check your weight.

Blood and urine tests –Blood tests for anaemia and determining the Rh factor. Urine would be analyzed for signs of kidney diseases or diabetes. Tests for hepatitis B, syphilis and gonorrhea because these diseases can cause serious harm to the developing baby. Gonorrhea and syphilis can be cured prior to pregnancy. If you have hepatitis B the doctor will be prepared to give the baby hepatitis B immune globulin and the hepatitis B vaccine. Because the virus that causes AIDS can be passed to the baby, if you are at risk for AIDS, an HIV test will also be done at this visit.

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Prepare Your Body Before Conception - Part II

The nine months of pregnancy puts a lot of stress on your body so optimising your body’s health before trying to conceive will make that period happier and healthier -

Quit Alcohol, Tobacco, Caffeine And Illegal Drugs

As it is not known whether there is a safe level of alcohol consumption for the fetus, women should quit drinking before attempting to conceive. No form of alcohol is safer than any other. Beer and wine are just as bad for the baby as hard liquor. Some studies suggest that women who drink before pregnancy tend to have smaller babies. Persistent and significant drinking during pregnancy can cause fetal alcohol syndrome, as a result of which infants may be born with brain, heart, and nervous system problems, distinctive facial abnormalities, and mental retardation.

Smoking increases your chances of a miscarriage during the first trimester. Mothers who smoke are also more likely to go into premature labor; have a premature rupture of membranes; experience third trimester bleeding; have slower fetal growth, and deliver underweight babies. Prospective fathers who smoke should also quit, as exposure to “passive smoking” during pregnancy is also harmful. Smoking also impairs a woman's fertility. Smoking affects sperm and may impair male fertility too. You can't count on quitting smoking overnight, so it's best to start trying to withdraw from cigarettes well before attempting to conceive.

Pregnant women should limit themselves to the equivalent of one cup of coffee daily. Caffeine may increase the risk of late first or second trimester miscarriage. So start weaning much before conception.

Illegal drugs are bad for your health, whether or not you are pregnant and they can only harm a baby. If you use them, it's imperative to stop before trying to conceive.

Get Yourself In Shape

Control Your Weight

Overweight women have problems conceiving, have increased chances of developing diabetes or hypertension during pregnancy and are more likely to need a cesarean section. You cannot loose weight once pregnant so act before conceiving. Underweight women are more likely to give birth to underweight, premature babies. So it is important to get as close as possible to your optimal weight before conception.

Exercise Regimen :

Women who are physically fit tolerate pregnancy and delivery better. Ideally an exercise program should be started 1 year before becoming pregnant, but at 3 months before conception, will give your body a chance to adjust to the additional physical activity before facing the added challenges of carrying a child. If you haven't exercised before, start slowly. Consult your physician before starting the exercise regime. Likewise, see a doctor if you experience any symptoms during exercise. Resistance exercises, in which you lift weights so that your muscles are working against something, help strengthen your muscles, which will help you recover more quickly from labor and delivery and give you more strength to carry the baby after birth. Exercises to strengthen the back can be helpful in offsetting back pain, which is a very common problem during pregnancy.

The Periodic Cycle of a Woman

What is the female periodic cycle

The normal reproductive years of the female are characterized by monthly rhythmic changes in the rates of secretion of the female hormones and corresponding changes in the ovaries and sexual organs as well. This rhythmic pattern is called the female sexual cycle. The duration of the cycle averages 28 days.

Which hormones govern the female cycle

The Female hormonal system consist of five hormones –

Luteinizing hormone releasing hormone (LHRH)

Follicle stimulating hormone (FSH): FSH stimulates the ovaries and growing follicles.

Luteinizing hormone (LH): LH stimulates ovulation

Estrogen: It is responsible for regulating and sustaining female sexual development and reproductive function.

Progesterone: It prepares endometrium for implantation.

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Ovulation :

Sperm can live inside you for up to 5 days, and depending on the individual, maybe up to 7 days.

An egg is capable of being fertilized for 24 hours, then begins to deteriorate.

Learning to tell when you will ovulate is the hardest part. Because sperm can live inside us for several days, the time between the end of the blood flow and ovulation is the most dangerous time to have unprotected sex if you want to avoid pregnancy.

It is pretty easy to tell when ovulation has occurred if you learn the signs. There are several methods you can use to determine when ovulation has occurred.

The basal thermometer tells you when ovulation has occurred, but does not tell you when it is approaching.

Learning how to read your mucus is a pretty reliable way to know when ovulation is coming, however, waiting until you see fertile mucus to use condoms is risky, and semen can affect the mucus. There are some natural family planning books out there that tell you at the first sign of mucus, you should start using protection, In my opinion, that may be too late, for me personally, there are cycles where I only have a day or two of mucus before the stretchy mucus appears, and there are times where I will only notice a small amount of clear stretchy mucus, just once, with no mucus before that or after that. It is important not to rely on mucus alone. I use mucus characteristics to confirm the passing of ovulation, using my calender as a guide. I rarely have unprotected sex after Day 7 and never after Day 9 (and if I have unprotected sex on Day 8 or 9 I always feel nervous, knowing should I ovulate early I could become pregnant. By not having unprotected sex after Day 7 (this decision is based upon the information I've gathered from charting my cycle) I feel safe, and have not been pregnant for more than 4 years.

After fertile mucus is positively identified, I always wait a few days, usually for my own peace of mind, I wait until Day 19 even if I have seen fertile mucus several days before. When the stretchy mucus has dried up, ovulation has probably occurred. If you are just learning to chart your cycle and identify fertility signals, during the first 3 months (if your cycles are regular) use protection the entire cycle, if your cycles are irregular, you should chart for a minimum of 6 months, before relying on FAMethods. If there is any doubt to whether you have ovulated, don't take any chances, use protection. I hate to see women get pregnant when learning FAM. I had to learn the hard way, don't take any chances.

See Fertile Mucus for more information on how to identify fertile mucus. Remember that the most successful form of natural birth control is a combination of two or more methods.

Some women feel ovulation when it occurs, it could feel like a sharp pain, or some women experience a dull ache, it usually is felt in the lower abdomen, either on the right or left side. And will alternate sides each month. Most women do not feel ovulation occurring. This is good to let you know when ovulation has occurred, but does not give you warning to protect yourself against the sperm who can survive within our fertile mucus for 5 days or so. And sometimes fertile mucus is happening but since it come from the cervix it doesn't always make it down to the vaginal opening where we might notice it on the toilet paper.

There are two choices for help in determining when ovulation is occurring. First there is a basal thermometer. This is good for women who have a schedule, who wake up at the same time every morning. This is very good for women who have irregular cycles. Its main drawback, is that it gives you zero warning of approaching ovulation, it only tells you that ovulation has occurred.

For women who have regular cycles and/or who don't have a morning schedule, like myself, I don't rise at the same time every morning, using a plastic speculum was much more effective for me. I found it very reliable, extremely interesting, and a very enlighting experience. By observing my cervix I was able to tell when ovulation was approaching, when it was most likely occurring and watched the opening of my cervix (called the os) close. When it was completely closed again I knew ovulation was over and it was safe to have unprotected sex. For more information about cervical changes and observation.

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How are ovulation and menstrual cycle defined

Ovulation is the result of a complex series of events leading to the production and release of an egg. If that egg is fertilized and gets implanted in the lining of the uterus wall (endometrium) a pregnancy has commenced. If it is not fertilized, then it is lost together with the endometrium as the menstrual blood flow at the beginning of your next period. These events are collectively known as the Menstrual Cycle and are controlled by a pea-sized structure called the pituitary gland, which is attached to the undersurface of the brain.

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What happens during the menstrual cycle?

At the beginning of a period, a hormone called Follicle Stimulating Hormone (FSH) is released from the pituitary gland. FSH stimulates a follicle, on the surface of the ovary, to grow. Contained within the follicle is the developing egg.

During the next two weeks the egg grows and matures, and as it does so, a female hormone called estrogen is produced in increasing quantities by the ovary. The estrogen in turn enters the bloodstream and feeds back to a part of the brain above the pituitary gland where it is recognized by special receptors. If enough estrogen has been produced, this feed back process decreases the production of FSH.

Rising estrogen levels also trigger the output of another hormone from the pituitary gland called Luteinizing Hormone (LH). This leads to the release of the mature egg from the follicle. The escape of the egg from the ovary is known as ovulation.

After ovulation, the empty follicle forms a structure called the corpus luteum, which produces the second female hormone, called progesterone. The progesterone levels go up after ovulation, and maintain the endometrium in a state of readiness to receive a fertilized egg. If the fertilized egg does not implant itself in the endometrium, the progesterone level falls and a period commences. The whole cycle now begins once more.

Fertilization:

How does fertilization take place

During each month of the female sexual cycle, there is a cycle increase and decrease of FSH and LH.

Pre-ovulatory Phase:

The pre-ovulatory phase is the time between menstruation and ovulation. During the first few days after the beginning of menstruation, concentrations of FSH & LH increase several fold. These hormones cause accelerated growth of 6-12 primary follicles each month. When under the influence of FSH, the group of follicles continues to grow and secrete estrogen, one dominant follicle becomes mature graafian follicle i.e. continues to increase its estrogen production under the influence of an increasing level of LH. Small amounts of progesterone are produced by the mature follicle a day or two before ovulation.

Ovulatory Phase:

Estrogens, which have been liberated, stimulate the repair of the endometrium (uterus lining) and thicken it. New ovulation occurs on the 14th day i.e. there is rupture of mature graafian follicle. The post-ovulatory phase is the period between ovulation and the next menses. A single ovum is expelled from an ovarian follicle into the abdominal cavity in the middle of each monthly cycle. This ovum then passes through one of the fallopian tubes into the uterus and if it is fertilized by a sperm, it implants in the uterus where it develops into a fetus.

Menstrual Phase:

If fertilization does not take place, this ovum gets released in the menstrual phase. During the menstrual phase, follicles in each ovary begin to enlarge. Menstrual flow from the uterus consists of 50-150 ml of blood, tissue fluid, epithelial cells derived from the endometrium.

When is fertilization and pregnancy most likely to occur?

Fertilization of an egg can only occur if you have intercourse around the time of ovulation, the so-called ‘fertile phase’ of the cycle. If you are ovulating, this takes place l4 days before the onset of a period. This is a reasonably predictable event if you have a regular cycle but may be very unpredictable if you have a very erratic cycle.

What is necessary in order for pregnancy to occur

Ovulation is essential;

Intercourse must take place during the fertile phase of the cycle;

Your partner’s sperm count must be adequate to ensure that a sufficient number actually reach the egg;

The mucus in the cervix must not be unfavorable and/or hostile to the sperm;

There must not be any mechanical barrier preventing fertilization from taking place, such as blocked fallopian tubes or adhesions around the ovaries preventing the egg from gaining access to the tube and sperm.

Pre-Planning for your Pregnancy :

You have one child, and now have the opportunity to choose when to have the second. In the days of yore, when our grandparents had as many as 5 or 10 children, the age gap between the eldest and youngest was anywhere between 6 to 26 years. Those were the pre-pill days, when contraception was not as widely used as it is now. So today, how many years spacing between children would be ideal? What are the things you should consider?

“I have an 8 year old son. We used to live with my in-laws in a joint family, but moved out a while ago, and are now a nuclear family. I now want to have a second child. Will the age gap between my children be too much?”

- Namita Sadarangani

First of all, there is no ‘ideal’ age gap. What age gap is ideal depends upon your individual circumstances. There are certain advantages to a small age gap, and to a large age gap. It makes sense to consider the pros and cons of both, and then to decide what is best for you.

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Advantages of a larger age gap

If Namita starts planning for a child now, the age gap between her two children will probably be 9 years. While that may seem like a large age gap at this stage, consider that when her elder child will be 29, the younger will be 20, and at that stage the age gap will not seem to be so much. In addition, the elder child will be able to pass on expert advice in terms of career, personality development and relationships to his younger brother or sister. If he is well settled at the age of 30, he will be able to take his sibling under his wing, and give him or her a good career head start.

Her body has by now completely recovered from giving birth, and she has had time to nurture herself and get back into shape, ready to give birth a second time.

In another ten to fifteen years, when her firstborn has moved out of the house, started work in another city, or gone abroad for further studies, she will start feeling the first pangs of loneliness. If she has a second child, she will have another ten years of joy and fulfillment as she watch him or her grow.

If there is a larger age gap between siblings, the younger sibling gets to mix with the elder sibling’s friends, which is always a good experience for him. Younger kids enjoy hanging out with older kids, and they also pick up a lot from them (good and bad!),

The older child feels as though he is ‘in charge’ of his younger brother or sister. This inculcates a feeling of responsibility and nurturing in the firstborn.

If the age gap is a little more, then one child could be in school, while you attend to the second child. In addition, the elder child would have had his share of individual attention before his sibling was born.

If the age gap is less, a parent would not be able to get to know each child as an individual, with likes and dislikes separate from his sibling. In cases of a larger age gap, parents can enjoy and get to know each child as an individual.

Advantages of a smaller age gap :

While it would be difficult raising young children with a minimal age gap on your own, it gets easier if you enlist the support of family and friends. If you have an expert helper or maid to help you raise the children and look after them, you could definitely consider having two children close together.

· You could spend time with the both of them together, send them for classes at the same time, and they will be great company for each other.

· They will have common friends, and will learn to share things with each other. They will be able to play with the same toys, and with each other.

· There will rarely be a moment of loneliness for the children, as they would be living with their best friend.

· The children would, in all likelihood, have similar interests.

· An older child, who has been an only child for a long time, would find it harder to adjust to a new sibling, as opposed to a younger child.

In addition, if a mother has a second child within a couple of years of the first, she is already in the correct frame of mind. Changing diapers, running around her toddler, are all second nature to her. If she waits for around three years, and then gets back to it, she’ll probably feel as if she’s ‘back to square one’, but this way, she can have two children close together and then she is ‘free’ of babyhood after around 4 years, as opposed to 8 years.

Whatever you decide, remember that relationships between siblings can turn out to be great, whatever the configuration. Figure out what suits you best, keeping time, emotional and economic factors in mind, and then plan ahead.

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Pre-Planning for your Pregnancy

Is there any merit to waiting before trying to conceive

Allow time - say about three to six months – to get into shape, start good habits and get rid of any bad ones. Your partner’s health in the couple of months before you conceive is particularly important because it takes 70 days for sperm to develop.

Top 10 tips for initiating a healthy pregnancy

· Check with your doctor that all medications you are taking are safe during pregnancy

· Discuss any family illnesses, especially diabetes, hypertension and TB with your doctor

· Take a test for German Measles (Rubella)

· Try to stop smoking (both you and your partner)

· Eat a variety of foods with as much fresh food as possible

· Start taking folic acid supplements

· Limit your alcohol intake

· Avoid mould ripened soft cheeses, liver products, and lightly cooked eggs

· Start exercising so that you tone your muscles.

· If you are going to have an X-ray, even a dental X-ray, mention to your doctor that you may be pregnant.

The Birth Control Pill and Conception:

When should I stop taking the pill if I want to get pregnant

The pill should be stopped at least 2-3 months before deciding to get pregnant, so that the chances of fetal malformations are reduced. During this time, other forms of contraception, like condoms or creams, should be used. It is important to note that women who have had irregular cycles before starting the pill will have a significant delay (six months or more) in getting their first period

Is it true that the birth control pill causes infertility

Contrary to popular belief, the pill does not cause infertility, nor does it reduce the sex drive. There is also no benefit in going off the pill for a while (rest period) and then restarting it.

The Do’s of Pre-planning:

What should I discuss with my doctor before I try to get pregnant

Check with your doctor whether the medicines you are taking are safe during pregnancy. Also, discuss any medical conditions or illnesses like diabetes, hypertension, tuberculosis, etc that run in your family.

Do I need to change my diet ?

A mother’s diet can have a major impact on the child’s overall development, even while still in its mother’s womb. It is important that you eat a variety of foods with as much fresh food as possible. This will ensure that you get a wide range of vitamins and minerals in their natural form. If your diet is not healthy and you have a habit of eating junk food (non-nutritious calories), this is the time to start thinking about your baby and altering your diet.

Do I need to take any dietary supplements ?

It has been recommended that women planning a baby should take at least 400 mg of folic acid every day before they become pregnant, and at a minimum of the first 12 weeks of pregnancy. (Many doctors advise taking folic acid supplements for the entire duration of the pregnancy and nursing, but not necessarily while trying to get pregnant.) Many of the breakfast cereals are high in folic acid. Check the label on the cereal box.

Why do I need to take a test for German Measles ?

It is advisable to take a test for German Measles (Rubella) before getting pregnant because catching Rubella when you are pregnant could result in serious defects in the baby. A previous infection or illness may not have given you the immunity.

What are the benefits of exercise?

Carrying and delivering a baby requires that a mother be fit and to have muscles in good shape. If you are already not in shape, start exercising so that you tone your muscles, preferably before you get pregnant. It will be much easier to regain your figure post-pregnancy. Working out will also help you to lose excess weight, if any. However, do not go overboard. Excessive exercise can interfere with ovulation making conception difficult. It could also lead to rise in body temperatures that are harmful to the body.

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Natural Family Planning

Why should you drug your system or undergo surgeries and artificial implantations, when you have a natural option?

Natural methods of family planning (NFP) do not interfere with a person’s health in any way like other methods of family planning do. Other artificial family planning methods may have long-term effects on your fertility, while with natural family planning, such effects don’t arise.

The pill, for example, has certain benefits but along with the benefits, it also has side effects. In addition, if you forget to take the pill, the chances of pregnancy are higher.

Condoms act as a barrier while making love, and tend to diminish pleasure. With natural family planning this does not arise.

How effective is it?

This method of family planning is not 100% effective. In fact, the only methods of contraception that are 100% effective are:

1. Total abstinence

2. Removal of the ovaries

3. Castration

Vasectomy and tubal ligation have very low failure rates, and are almost 100% effective, but not quite. 14 out of every 10,000 vasectomies, 4 out of every 10,000 tubal ligations, result in pregnancies.

Do I need to have a regular cycle?

You need not necessarily have a regular cycle for this method to be effective, though if your cycle is completely skewed, you could consider another method of birth control. But even if you are a little irregular, you can tell when you are ovulating because of the discharge of cervical mucus. So, you can avoid having sex during this time. If you are regular with your period, natural family planning is 98% effective.

How can I tell when I am fertile?

As men are normally always fertile, this method of family planning depends on when the woman is fertile, and having intercourse when the woman is not fertile. So how can you tell when a woman is fertile? A woman is fertile when she discharges cervical mucus. The mucus has a consistency of raw egg-white. After ovulation, the mucus disappears. Other signs include a slight rise in a woman’s body temperature when she wakes up in the morning. This is best measured with a Basal Body Thermometer, as the rise is often just 0.5 degrees. She may also get a feeling called ovulation pain.

What advantages does this method of family planning have over others?

The natural method of family planning helps build the foundation for a better marriage, because a certain amount of healthy abstinence is introduced in the relationship. It also helps develop self control. In addition, it is a method done and discussed together. Both partners keep a tab on the wife’s menstrual cycle, and both are involved in this method of family planning. By keeping a tab of the wife’s cycle, any irregularity can immediately be noticed, and the doctor can be alerted. However, if the cycle is being regulated by the pill, any health issues may go unnoticed.

Before practicing natural family planning yourself, you should consult your gynaecologist for further information. Certain doctors are skeptical about the effectiveness of this method, as doctors tend to be of any natural methods. There are courses held throughout the world, which coach couples to practice natural family planning effectively. It must be remembered that this method not the rhythm method of birth control, and is more scientific and effective. Email [email protected] to join a class in Mumbai, Bandra.

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Ovulation and Fertilization:

What is the best time to conceive ?

In order for the woman to get pregnant, one of her eggs needs to combine with a man’s sperm (fertilisation). The woman’s body releases an egg (ovulation) roughly 14 days before her period. She is most likely to conceive during this time. The ovulation period is the time when the woman’s ovary releases an egg (ova) for fertilization.

The ovulation period roughly lasts for 24-48 hours during a cycle. Sperms, on the other hand, live for around 3 to 5 days, and sometimes even longer. Therefore, there is only a very short time each month when you are most likely to conceive. It may take up to a year to get pregnant, especially if your periods are infrequent or irregular, so there is no need to worry if you are not pregnant after a couple of months. You can use this time to enjoy yourself without using contraception.

When does ovulation take place during a cycle ?

A woman’s menstruation cycle is generally 28 days long, but could last anywhere between 25 to 35 days (or even longer). The cycle begins from the first day of menstruation and ends on the first day of the next menstruation. Roughly 14 days before the beginning of the next period, the woman’s body releases an egg. This egg generally lasts for 24-48 hours, known as the ovulating phase. If the egg is not fertilized (combined with a sperm) during this period, it is discarded by the body during menstruation. For a woman with a 28-day menstruation cycle, the ovulation period is approximately the 14th day of the cycle. For a woman with a 32-day cycle, ovulation will take place on the 18th day of the cycle.

Which are the most fertile days for a woman to conceive, and which are the safe days – Dr. A. Sahni ?

The most fertile period of a woman with a regular 28 day cycle is between day 10 (rarely 9) and day 18. The human ovum is susceptible to fertilization for 24 hours after ovulation. The sperm ejaculated into the vagina can live upto 5 days but can fertilize an ovum only for about 3 days. In a 28-day cycle the unsafe period is from day 7 to 21.the chance of conception is minimum (10/100 women a year) when coitus is avoided during these days. The first day of menses can be marked on a calendar for 6 months. Then by subtracting 18 days from the shortest cycle & 11 days from the longest cycle we get the first and last day of the fertile period, thus coitus should be avoided during this period to avoid conception.

Does ovulation take place every menstrual cycle ?

No, ovulation does not necessarily take place in every menstrual cycle. Even if your periods are regular, it is possible that you will not ovulate in a particular month. Painful periods generally imply that you had ovulated during that cycle. However, ovulation could take place even if the periods are not painful.

How often should a couple engage in intercourse in order to conceive ?

Too much sex or too little sex can cause problems in getting pregnant. In general, it is best to refrain from intercourse a few days before the ovulation period, so that the sperm count is high. Some doctors recommend that you have sex every alternate day during the fertile phase. Having sex everyday may reduce the sperm count.

Planning for Twins

What is the difference between fraternal twins and identical twins

There are two types of twins: fraternal and identical. Fraternal twins are the result of two eggs getting fertilized in the same ovulation phase. Identical twins are the result of a fertilized egg dividing into two. In the case of fraternal twins, an ultrasound scan of the expectant mother will show two separate sacks; identical twins, on the other hand, share the same sack.

Can one plan for having twins ?

Although it is not possible to plan for twins, it has been observed that the use of fertility drugs does increase the chance of multiple births. This is because fertility drugs cause more than one egg to be released in a particular cycle. As women in developed societies delay childbearing, they seem to have trouble getting pregnant. More and more women are asked to take fertility drugs, therefore the incidence of fraternal twins (or multiple babies) is on the rise.

Ready for Fatherhood?

There is more to making a baby than making love. All you expectant fathers should no longer think that pregnancy is just the job of the mother. Now you have to also do some work.

To start with, old time beliefs about wondrous powers of so-called fertility foods are pure fiction. But, that does not rule out the importance of a healthy lifestyle and good food habits. Good nutrition can greatly improve your chances of a quick transition from a husband to an expectant father.

Once you decide to have a baby, you both should choose a variety of low-fat, nutrient-rich foods from all types of food groups. Eating fruits, vegetables, whole grains, lean meats and dairy products each day will help ensure that you get the recommended dietary allowance of all the vitamins and minerals necessary for optimal reproductive functioning. Read on for some specific guidelines for potential `future fathers ‘.

Food facts :

Infertility is as much a man's issue as a woman's. Over 40 percent of infertility problems can be traced to men. Therefore, eating healthy will boost your chances of conceiving a child. Nutrition has a direct impact on the potency of the sperm. All you wannabe-dads, junk the junk for a while and take to healthy eating mantra seriously.

Eat plenty of foods rich in vitamin C, which cuts the risk of damaged sperms. Get more zinc in your diet. Zinc deficiencies can reduce semen volume and testosterone levels. Zinc sources include baked beans, chicken meat. Excessive amounts of zinc would not turn you into a baby making machine, There is, however, some scientific basis for the oyster recommendation as these are packed with the zinc nutrient.

Increase your intake of calcium and vitamin D. These improve men's fertility. Good sources of calcium include low-fat milk and yoghurt. You'll find vitamin D in milk and salmon.

Cut out or cut back on alcohol. While an occasional drink is generally considered safe, studies show that daily consumption of wine, beer or hard liquor can decrease testosterone levels and sperm counts.

A father's use of drugs can also cause birth defects, so drugs such as marijuana and cocaine are a total no-no. They can affect the brain chemistry responsible for releasing reproductive hormones.

Mend your lifestyle :

Quit smoking - Smoking lowers sperm counts so it is advisable to stop smoking before attempting a pregnancy. It will optimise your chances of conceiving. Besides second-hand smoke can be dangerous for your partner and the baby.

Dump stress -Even minimal stress can decrease a man's testosterone levels and sperm count. Chilling out can increase your potency. So ‘go for a holiday’ advise actually works. Practice yoga, Reiki, meditation… anything you agree with to keep one up on the modern day malady – stress. It’ll improve the quality of your life.

Workplace hazards - Exposure to radiation and chemicals can damage sperms. It’ll also lower sperm counts and cause genetic defects in children. If you're exposed to any such hazards on the job, ask for a temporary reassignment.

Avoid certain medication- Many medications can cause fertility problems and lower sperm counts. Ask your physician about the safety of any over-the-counter medications that you are consuming while attempting a pregnancy.

Avoid rough sports such as football, hockey, soccer, basketball, baseball, horseback riding - The danger is traumatic injury to genitals, which can hamper your ability to produce sperms or ejaculate.

No to hot tubs, saunas, and tight-fitting clothes - Testicles function best when they keep their cool. Steamy spa equipment, snug jeans, synthetic shorts and bikini underwear can all overheat your testicles and inhibit sperm production.

Medical screenings- There are various screening tests that can be done prior to pregnancy so that if a medical problem is found, treatment can be completed (infections, sexually transmitted diseases) or the medical condition can be managed. Do go for these.

Genetic screenings - A pre-conception visit to your physician can include discussion of possible inherited birth defects. Information about the medical histories of both families should be discussed. Blood tests can be done to identify carriers of certain genetic disorders. That will offer reassurance that your future baby will not be at risk for that disorder.

Read pregnancy –related books- Do take your role seriously and look up some books too, they’ll give you quite a few pointers. For instance, `The expectant father, facts, tips and advice for dads to be’, by Armin Brott

The new fathers panic book: Everything a dad needs to know to welcome his bundle of joy, by Gene B. Williams

She’s having a baby and I am having a breakdown, by James Douglas Barron

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Trying to Get Pregnant?

Conceiving isn’t always easy. Even very healthy couples have around a 25% chance of conceiving every month. Here are some tips.

Pre-Pregnancy Check Up

As soon as you decide to start a family, make it a point to have a complete health checkup. Your doctor will then advise you what changes you need to make in your lifestyle, if any, to increase your chances of not just becoming pregnant, but also of having a healthy pregnancy.

Remember, getting pregnant means that your body will be undergoing a lot of changes, and it needs to be in the best of health to do this. It is important that you divulge your entire medical history to your doctor. Also, let your doctor know if you are taking any medication, including regular over-the-counter drugs.

Your doctor may recommend that you get a few tests done, such as pap smear, blood test, blood pressure, urine analysis etc. If you have not had rubella, your doctor may advise you to get a vaccination, in which case you need to wait a couple of months before conceiving. Also, if you have any STD, it may be advisable to wait until the infection completely clears before trying to conceive.

Ovulation :

Once you have the green signal from your doctor and all tests have been clear, it is time to start working on getting pregnant. You are most fertile when you are ovulating, but it is a little tricky to figure out when exactly that is.

Although you are most likely to get pregnant around 14 days after your period, this method is not always completely reliable, especially if your periods are irregular.

Possibly the most accurate way to determine when you are ovulating is to take your basal body thermometer and check your cervical mucus.

A basal body thermometer will show you very minute changes in your body temperature. Take your temperature at the same time everyday, as soon as you wake up, before getting out of bed, and note it down in a chart. The day your body temperature is the highest in the month, is the day you are most fertile. Also, check your cervical mucus regularly. The day your cervical mucus is thick and a little transparent, almost the consistency of raw egg white, should coincide with the day your temperature is at its highest. This is when you should have intercourse.

Folic Acid :

Start taking folic acid or Vitamin B9 supplements. This reduces the risk of neural tube birth defects. Around 400 mcg a day should be appropriate when you are trying to conceive, and if you are pregnant, you may need around 600 to 800 mcg. In any case, this is a water soluble supplement, and so your body flushes out the excess. The only problem is that taking excessive Vitamin B9 supplements may conceal a Vitamin B-12 deficiency, often found in vegetarians. B9 is also found in foods like green leafy vegetables, lentils, wheatgerm, asparagus, broccoli, eggs, canned salmon and papaya, amongst others.

Now you’ve seen what you should be eating, here’s what you should avoid when you are trying to conceive. Cigarettes, alcohol, drugs

· Coffee

· Black tea

· Chocolates

· Soft drinks containing caffeine

· Too much Vitamin A, C or D. Once again, do take folic acid supplements. Undercooked meats and eggs. Avoid half boiled eggs.

Sex :

Have sex in the morning, since the semen has the highest sperm count then. Try to have sex in the missionary position, since it deposits the sperm closest to the cervix. Also, after sex, raise your hips to encourage the sperm to flow towards the egg.

Pregnancy - The Waiting Game

How long can it take to get pregnant :

Some couples are surprised to learn that conception does not take place as a matter of course once they stop using contraceptive precautions. Stopping the pill or noy using a condom does not work as simply as just unlocking the door to let the sperm in to fertilize a waiting egg. The fact is that if you and your partner do not have any infertility problems, there will be approximately a 1 in 3 chance of becoming pregnant as a result of unprotected intercourse during the fertile phase of each cycle. Those women who do become pregnant without any medical assistance generally do so within 2 years of trying, 80% conceiving during the first year.

When do I need to consult a doctor for help :

If you have been timing your intercourse and trying for more than 6 months without any success, it is time to see a gynecologist. The gynecologist will prescribe certain diagnostic tests and either treat you herself or send you (and/or your partner) to a fertility specialist.

Women all around me are getting pregnant, why can’t I

For the majority of women there is no problem in getting pregnant. If, however. you are one of the 10% of couples in whom there are factors which may delay or prevent the arrival of the much longed for baby, then despair and despondency can rapidly follow. This is not helped by the apparent ease that others about you seem to have in conceiving. The girl in your office having a termination of pregnancy, your sister having her third baby, babies in supermarkets and TV advertisements – everyone is having a baby except you – even people who don’t realty want one! You may even feel “IT ISNT FAIR!”.

Why you may have trouble Conceiving:

Although getting pregnant may seem like the easiest thing in the world, it is actually not so for many people. There are several reasons for this, and any one or more of the following may be applicable.

Late planning (advanced age)

The trend today is for women to complete their education and establish their careers before they think of settling down and starting a family. However, for a woman over the age of 35, conceiving becomes a problem. Infertility increases with age. Fertility peaks for both sexes in their mid-twenties and then appears to decline steadily in women over thirty and men over forty. Tubal infections, fibroid tumors and endometriosis are more common in older women and are a common cause for infertility.

Excessive drinking, smoking, drug use :

Research has shown that the excessive consumption of alcohol or the use of illicit drugs like marijuana, cocaine, heroin and crack, by a potential father prior to pregnancy can be the cause of infertility. Illicit drugs can also reduce the sperm count, damage the sperm, reduce testosterone levels, and change testicular functioning. (These are generally ejaculated with the sperm.) Heavy drinking can affect a woman’s menstrual cycle as well. Note however, that as long as drinking, smoking and drug use have been curtailed before getting pregnant, prior use seems to pose almost no risk to the baby.

Ovulation/menstruation problems :

Ovulation is a pre-requisite for getting pregnant. In women with regular menstrual cycles of 28-35 days, ovulation takes place once every cycle. However, many women have erratic menstrual cycles (often getting periods 3-4 times a year or even less). This means that they have fewer chances of getting pregnant not only because they have fewer possible fertile periods, but also because they may not be ovulating in every cycle. (Note that ovulation does not necessarily take place in every menstrual cycle).

Low sperm count (for males) :

The normal sperm count ranges from 20 million to 100 million sperm per cubic centimeter. Counts below 20 million may be a cause for difficulty in conception. Factors such as fatigue, excessive alcohol, smoking or other drug abuse, prostate gland infection, poor diet, or occupational exposure to chemicals can cause a small, temporary decrease in the sperm count. Varicocele is a condition when there are varicose veins on the scrotum. This is another cause for infertility and can only be corrected through surgery.

Retroverted uterus :

Many women are born with their uteruses facing backward (retroverted) instead of forward. This condition can be diagnosed either by your gynecologist, or through an ultrasound. One simple way to compensate for this problem of a retroverted uterus is for the woman to lie on her stomach after intercourse. (Women with regular uteruses who are planning to get pregnant are asked to lie on their backs and lift their legs from their hips after sex in order to improve the chances of fertilization). If retroverted uterus is the only problem, then in most cases the woman will conceive. However, if she still does not get pregnant, then the doctor may advise surgery.

Polycystic ovaries :

Cysts are formed when the follicle fails to rupture at the time of ovulation and begins to grow instead. This condition occurs due to hormonal imbalance and is marked by absent or infrequent menstruation. Women having this condition have a chronic tendency to have their periods at intervals ranging from every six weeks to six months. Conception becomes difficult due to irregular ovulation.

Intercourse pattern :

Very often, you may simply be mistiming your intercourse. In order for you to get pregnant, it is essential for you to have sex during your fertile days. It could also be possible that you may be trying too often in a particular cycle, and thereby causing a reduction in sperm count.

Tip for Self-help :

· Before seeking medical help, remember some of the things you can do to enhance your own fertility potential.

· Body weight, diet and exercise. Proper diet and exercise are important for optimal reproductive function. Women who are significantly overweight or underweight can have difficulty getting pregnant. Talk with your doctor about a healthy diet. Normal exercises, including aerobics, tennis, or jogging may improve your chance of conceiving; however, excessive exercise (for example, jogging over three miles per day) can affect your ovulation.

· Stop smoking: Cigarette smoking has been associated with a decreased sperm count in men. Women who smoke take longer to conceive.

· Stop drinking alcohol: Alcohol (beer and wine as well as hard liquor) intake in men has been associated with low sperm counts.

· Review your medications: A number of medications, including some of those used to treat ulcer problems and high blood pressure, can influence a man's sperm count. If you are taking any medications, talk with your doctor about whether or not it can affect your fertility.

· Many medications taken during early pregnancy can affect the fetus. It is important to tell your doctor or pharmacist that you are attempting to become pregnant before taking prescription medications or over the counter medications, such as aspirin, antihistamines, or diet pills.

· Stop abusing drugs: Drugs such as marijuana and anabolic steroids decrease sperm counts. If you have used drugs, discuss this with your doctor. This is confidential information. Both partners should stop using any illicit drugs if they want a healthy baby.

· Limit your caffeine: Limit you intake of tea, soft drinks and coffee.

Frequency of intercourse :

The simple rule is - as often as you like; but the more often you have sex, the better your chances. Thus, for couples who have sex only on weekends (often the price they pay for a heavy work schedule) the chance of having sex on the fertile pre-ovulatory day is only one-third that of couples who have sex every other day - which means they may take three times as long to conceive.

Timing of intercourse. Unlike animals, who know when to have sex in order to conceive (because the female is in "heat" or estrus when she ovulates), most couples have no idea when the woman ovulates. Timing intercourse during the "fertile period" is important and can be easily learnt. However, some couples are so anxious about having sex at exactly the right time that they may abstain for a whole week prior to the "ovulatory day " - and often the doctor is the culprit in this over-rigorous scheduling of sex. This over attention can be counterproductive (because of the anxiety and stress it generates) and is not advisable.

Position and technique of intercourse :

Pigs are very efficient at conserving semen - the boar literally screws his penis into the cervix of the vagina, obtaining a tight lock prior to ejaculation, to ensure that no semen leaks out. Humans do not have such well-designed mechanisms of technique - and perhaps this is because they are really not necessary. Most doctors advise a male superior position; and also advise that the woman remain lying down for at least 5 minutes after sex; and not wash or douche afterwards. A number of products used for lubrication during intercourse, such as petroleum jelly or vaginal cream, have been shown to affect sperm quality. Therefore, these products should be avoided if you are trying to get pregnant (a suitable alternative is raw egg white).

Is fertility lower at present?

Has the fertility of couples declined in modern times? Possibly. The reasons for this include:

The increasing age of women at the time of marriage and childbearing

The increased incidence of sexually transmitted diseases or STDs which damage the reproductive tract in both men and women

Decreasing sperm counts in men which is a worldwide phenomenon. An interesting observation made recently, has been that men's sperm counts worldwide have been falling in the last few decades. Whether this is due to environmental pollution; or to the stresses of modern day life remains unclear.

Where to get help

Most couples consult their family physician who will refer them to an obstetrician - gynecologist when infertility is a concern. This first visit should include both partners. The physician will usually outline the possible causes of infertility, and provide an evaluation plan. The first step should be to achieve an accurate diagnosis to try to find out why pregnancy isn't occurring. Once a diagnosis has been determined, the couple and physician should talk again about a treatment plan.

For difficult problems, referral to an infertility specialist may be suggested.

What is the right time?

If you have been having sexual intercourse two or three times a week at about the time of ovulation, without any form of birth control for a year or more and are not pregnant, you meet the definition of being infertile. Pregnancy may still occur spontaneously, but from a statistical point of view, the chances are decreasing and you may now want to start thinking about seeking medical help.

There is no "right" time to do so - and if it is causing you anxiety and worry, then you should consult a doctor. Even though you may be embarrassed and feel that you are the only ones in the world with the problem, you are not alone. Many couples experience infertility and many can be helped.

A note of caution

There are certain conditions that warrant seeing a doctor sooner:

· Periods at three-week (or less) intervals.

· No period for longer than three months.

· Irregular periods

· A history of pelvic infection.

· Two or more miscarriages.

· Women over the age of 35 - time is now at a premium!

· Men who have had prostate infections.

· Men whose testes are not felt in the scrotum

Do you have an Infertility Problem? By Dr. A. Malpani

When most couples get married they expect to have their own babies. Many naively expect they will get pregnant the very first month they try - and are concerned when a pregnancy does not occur. All of us go through a brief interlude of doubt and concern when we do not achieve pregnancy the very first month we try - and we start wondering about our fertility.

Only a 25% chance!

Before worrying, remember that in a single menstrual cycle, the chance of a perfectly normal couple achieving a successful pregnancy is only about 25%, even if they have sex every single day. This is called their fecundity, which describes their fertility potential. Humans are not very efficient at producing babies! There are many reasons for this, including the fact that some eggs don't fertilize and some of the fertilized eggs don't grow well in the early developmental stage.

Getting pregnant is a game of odds - it's a bit like playing Russian Roulette and it's impossible to predict when an individual couple will get pregnant! However, over a period of a year, the chance of a successful pregnancy is between 80 and 90%; so that 7 out of 8 couples will be pregnant within a year. These are the normal "fertile" couples - and the rest are "labeled " infertile - the medical text book definition of infertility being the inability to conceive even after trying for a year. Couples who have never had a child, are said to have "primary infertility,"; those who have become pregnant at least once but are unable to conceive again, are said to have "secondary infertility."

Factors that determine fertility :

The chances of pregnancy for a couple in a given cycle will depend upon many things, and the most important of these are:

The age of the woman. At the biologic clock ticks on, the number of eggs and their quality starts decreasing.

Frequency of intercourse. While there is no "normal" frequency for sex, the "optimal" frequency of intercourse if you are trying to get pregnant is about 3 times a week in the fertile period. Simply stated, the more sex the better! Couples, who have intercourse less frequently, have a diminished chance of conceiving.

"Trying time" - that is, how long the couple have been tryying to get pregnant. This is an important concept. The longer a couple has been trying to conceive without success, the lesser their chances of getting pregnant without medical help.

The presence of fertility problems.

What happens when a couple has a fertility problem?

The chances of their getting pregnant depend upon a number of variables multiplied together. Consider a couple where both the husband and wife have a condition that impairs their fertility. For example, the husband's fertility, based on a reduced sperm count is 50 percent of normal values. His wife ovulates only in 50 percent of cycles; and one of her fallopian tubes is blocked. With three relative infertility factors, their chance of conception is 0.5 (sperm count) X 0.5 (ovulation factor) X 0.5 (tubal factor) = 0.125, or 12.5 percent of normal. Since the chance of conception in normal fertile couples is only 25% in any one cycle, the probability of pregnancy in any given month for this couple without treatment is only 3 percent (0.125 X 25 = 0.03125)! Even if they kept on trying for 5 years, their chance of conceiving on their own would be 60% only. Thus, infertility problems multiply together and magnify the odds against a couple achieving a pregnancy.

This is why it is important to correct or improve each partner's contributing infertility factors as much as possible in order to maximize the chances of conception.

If infertile couples had 300 years in which to breed, most wives would get pregnant without any treatment at all! Of course, time is at a premium, so the odds need to be improved - and this is where medical treatment comes in.

Trying to make a baby?

Here are some tips on what you can do to increase your chances of conceiving.

1. Keep track of your period .

Have intercourse on days you are most likely to conceive. Timing is everything. Women are most likely to conceive on days they are ovulating. If you aren’t already keeping a menstrual calendar, start doing so now. Note down the dates your period starts, how long it lasts, and any other information you feel may be of help to your gynecologist. If you have irregular periods, it may not be easy to calculate the days you are ovulating

A menstrual calendar will also help you keep track of your date of conception, and you will consequently be able to calculate your due date with more accuracy.

2. Lie down after sex :

Don’t get up and run around immediately after having sex. Lie down for a while. This increases the chances of the sperm meeting the egg. It is even recommended that you place a high pillow, cushion or bolster under your hips after making love, to direct the sperm upwards towards the egg. Believe it or not, this really does help!

3. Discuss medication with your doctor

As soon as you decide to start planning for a pregnancy, visit your gynaecologist. She may put you on some vitamin supplements that will help prepare your body for the pregnancy. You could also ask her to prescribe something to increase chances of conception, especially if you feel time is against you.

4. Avoid coffee :

Give up drinking coffee at least for the time you are trying to conceive. Caffeine is believed to reduce the flow of blood to the uterus, restricting the growth of the baby. Studies also suggest that excessive caffeine contributes to a reduction in fertility levels. What constitutes excessive coffee? More than three cups a day is definitely excessive. One or two cups a day is fine but if you are having problems conceiving, give it up for now. If you can’t do without your daily cuppa, switch to decaf.

5. Reduce alcohol consumption

Reduce your consumption of alcohol. Alcohol reduces male fertility levels and so does smoking. Excessive smoking and drinking also affects the quality of sperm, so if you want to get pregnant, give up your vices for the time being. The chances of a healthy pregnancy are higher.

6. Breathe clean air :

If your workplace exposes you to hazardous materials or chemicals, this may affect the quality of your sperm, and it may cause a reduction of fertility levels. It is also unsafe for a pregnant woman to be exposed to hazardous material, as it may adversely affect the foetus, leading to birth problems.

7. Keep your vagina clean"

Saliva can kill sperm, and so can some forms of vaginal lubricants, glycerine and oils. While this shouldn’t matter if the male sperm count is very high, if you are having problems conceiving it is best to keep your vagina ‘sperm friendly’, which means no oral sex or lubricants. Similarly, don’t wear scented tampons and avoid vaginal sprays. Keep your vagina clean and natural. Avoid douching, as douching alters the natural acidity of the vagina. It may even lead to vaginal infections, which in a way defeats the very purpose of douching.

8. Yoga and exercise:

Trying to conceive? Here are some yoga asans which aid conception and help counter infertility.

# Ardha Matsyendrasana :

MATSYENDRA refers to the lord of the fish, and arhda means half, so this asana is also known as Half Lord of the Fish asana. If you have any spinal or back injuries, you should only do this pose under the guidance of an instructor.

In addition to aiding conception, Ardha Matsyendrasana has the following benefits:

Improves digestion and appetite, and aids constipation

Relieves menstrual discomfort

Aids asthma

Strengthens the spine and back

Ardha Matsyendrasana is an asana from the hatha yoga school, and is very powerful with numerous benefits. It is known to destroy deadly diseases and it energises, tones and rejuvenates the entire body.

1. Sit on a mat with your knees bent in front of you. Slide your left foot inwards, so it sits beside your right hip, with your thigh resting on the floor.

2. Place your right foot besides the knee of your left foot, so it crosses it.

3. Hold the foot of your right foot with your left hand.

4. The left hand should cross the knee from the inside, and hold the foot from the outside.

5. Twist, and place the other hand behind your back. Exhale when you twist.

6. Feel the stretch in your body, as all the organs stretch.

7. Repeat, with the opposite leg.

Help with the pose : This pose is difficult to achieve initially. You may find it difficult to grab your foot, and you may also find it difficult to turn. If you cannot reach the foot initially, try and reach whatever part of your leg you can – maybe the calf. Do this pose sitting close to a wall, so you can try and reach for the support of the wall as you turn around, instead of placing your hand on your back. Make sure you are not sitting too close to the wall though, you want to have place to turn around.

# Supta Padangusthasana: This is one of the more basic yoga asanas and once you learn how to do this, your flexibility will greatly improve with regard to various other asanas as well. The best part about this asana is that it stretches your back, spine and legs, without putting any pressure on your back or spine! And, of course, it aids conception. Other benefits include:

· Reduces flat foot

· Strengthens the knees

· Stimulates the prostrate gland

· Reduces blood pressure, backache, sciatica, and menstrual discomfort

· Improves digestion

1. Lie on your back, legs straight.

2. Bend your left knee as you exhale, and bring it to your torso.

3. Hug your thigh and hold this pose to the count of five.

4. Make sure your other leg is firmly pressed to the floor. Resist your knee and foot bending outwards, and pull them inward.

5. Loop a strap, cloth or rope around your left foot, and hold the strap with your hands as you straighten your foot.

6. Make sure your shoulders are touching the floor. You may find it easier to lift your shoulders, but make sure you resist the temptation!

7. Once your straighten your foot, draw it further back, so the angle between your legs is more than 90 degrees.

Paschimottanasana also aids conception, so make sure you add it to your workout. All the best!

Ovulation and Menstruation Problems

What are the various ovulation problems

There are five main categories of ovulation problems:

1. Oligomenorrhoea (very erratic periods): There is a defect in the feedback of estrogen from the ovary to the brain. In spite of this, levels of F.S.H., L.H. and estrogen are normal, but there is usually a menstrual disorder with either oligomenorrhoea or secondary amenorrhoea.

2. Amenorrhoea (never have a period or periods have stopped): The pituitary gland fails to produce F.S.H. and L.H. This, in turn, affects the ovaries, which fail to produce estrogen. Amenorrhoea is usually the representing symptom.

Menopause-like condition: The ovaries fail to respond or may be resistant to F.S.H. As is the case in menopause, the F.S.H. levels are very high and the estrogen level very low.

3. Polycystic Ovary Disease: This is a condition where there are multiple tiny cysts in the ovaries. The L.H. level is characteristically high with normal F.S.H. and estrogen levels. There is often oligomenorrhoea or amenorrhoea.

4. Hyperprolactinaemia: The level of the hormone prolactin is very high while the levels of F.S.H. and estrogen are lowered. This condition is known as hyperprolactinaemia.

5. There is either oligomenorrhoea or amenorrhoea. Discharge from the nipples is also a symptom of this condition as this is the hormone responsible for milk production.

If you have amenorrhoea, your specialist may recommend a test

called the Progesterone Challenge Test before the commencement of the “fertility drug” treatment. This involves taking progesterone tablets for five days. If the ovaries are producing estrogen, a withdrawal menstrual bleed should occur after progesterone tablets have been stopped.

Are ovulation problems reversible ?

With the exception of ovarian failure for which there is no treatment, all the other causes of ovulation disorders are treatable. If an ovulatory disorder lies at the root of your infertility, you can expect that with the appropriate treatment, the chances of your having a baby will be elevated almost to the levels enjoyed by the fertile population.

Is ovulatory disorder a major cause of infertility

At least 20% of the women attending an Infertility Clinic will have a problem relating to ovulation.

Your menstrual history may indicate the likelihood of an ovulatory disorder for example:

You may never have had a period, a condition called primary amenorrhoea;

Periods which were once present have now stopped altogether (known as secondary amenorrhoea);

Your cycle is so erratic. E.g. periods occurring every 1-4 months, that even if you are ovulating, ovulation is completely unpredictable (known as oligomenorrhoea).

Sometimes a woman’s B.B.T. Chart, day-21 progesterone assay or endometrial biopsy may show that despite the fact that she has an apparently normal and regular cycle, definite problems exist. Either she is not ovulating (anovulatory cycles), or the luteal phase of the cycle is too short, perhaps combined with lowered progesterone levels from the corpus luteum after ovulation. (Inadequate luteal phase).

Which drugs are used for the treatment of infertility ?

Many drugs are used in the treatment of infertility. The main drugs discussed here are Clomiphene, Human Chorionic Gonadotrophin (H.C.G.), Bromocriptine, Human Menopausal Gonadotrophin (hMG), Urofollitrophin (Pure F.S.H.) and Gonadotrophin Releasing Hormone (GnRH or LHRH).

Predicting Ovulation

How do I know when I am ovulating ?

When you are planning a baby, it is important to know whether you are going to be ovulating in that cycle, and if so, when are you ovulating. There are a few ways of determining ovulation:

(a) Ovulation Predictor kits:

Ovulation predictor kits are the most convenient method for predicting ovulation. Although slightly expensive, they offer you that luxury of testing in the privacy of your home. They simply require you to collect a few drops of urine and test them on the stick over a period of about 7-10 days of your likely ovulation time. The day the stick changes color to a shade darker than the previous days, you are likely to ovulate within the next 48 hours. If you have run out of all the sticks in the pack without detecting a color change, you may have to buy another test kit and continue testing. It could mean that either you have not yet ovulated, or that you may not be ovulating in this cycle.

(b) Basal Body Temperature (BBT):

This method requires the woman to keep a chart of her daily temperature readings. The temperature needs to be taken from the woman’s anus first thing in the morning while she is still in bed. It can be recorded using either special test kits available in the market, or a regular thermometer. The basis for this method is that a woman’s basal body temperature drops briefly and then rises half a degree following ovulation, and remains elevated until the start of the next period. Normal BBT is between 96 and 98 degrees, and after ovulation rises to 97 to 98 degrees. A rise in temperature that persists for at least 3 days indicates that ovulation has occurred.

(c) Mucus method:

Another method that is more recent depends on the analysis of the vaginal mucus. A few days before, also called the ‘dry’ period, there is very little mucus in the vagina. When there is white vaginal discharge in the vagina, it indicates the beginning of the ‘wet’ period. At the time of ovulation, the mucus becomes clear, sticky and stringy in nature, and can sometimes stretch to over a couple of inches between your two fingers.

(d) Ultrasound Scan:

Another way of determining your ovulation is through an ultrasound scan. An ultrasound scan is also usually used when it is critical for fertilization to take place at the precise time of ovulation, such as for artificial insemination. This method of predicting ovulation, although very reliable, is quite expensive.

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Fertilization

How does fertilization take place

During each month of the female sexual cycle, there is a cycle increase and decrease of FSH and LH.

Pre-ovulatory Phase:

The pre-ovulatory phase is the time between menstruation and ovulation. During the first few days after the beginning of menstruation, concentrations of FSH & LH increase several fold. These hormones cause accelerated growth of 6-12 primary follicles each month. When under the influence of FSH, the group of follicles continue to grow and secrete estrogen. One dominant follicle becomes mature graafian follicle i.e. continues to increase it’s estrogen production under the influence of increasing level of LH. Small amounts of progesterone are produced by the mature follicle a day or two before ovulation.

Ovulatory Phase:

Estrogens liberated stimulate repair of endometrium and thicken it. New ovulation occurs on the 14th day i.e. there is rupture of mature graafian follicle. Post ovulatory is the period between ovulation and next menses. A single ovum is expelled from an ovarian follicle into the abdominal cavity in the middle of each monthly cycle. This ovum then passes through one of the fallopian tubes into the uterus and if it is fertilized by a sperm, it implants in the uterus where it develops into a fetus.

Menstrual Phase:

If fertilization does not take place, this ovum gets released in the mentrual phase. During the menstrual phase, follicles in each ovary begin to enlarge. Menstrual flow from the uterus consist of 50-150ml blood, tissue fluid, epithelial cells derived from endometrium.

When is fertilization and pregnancy most likely to occur?

Fertilization of an egg can only occur if you have intercourse around the time of ovulation, the so-called ’fertile phase’ of the cycle. If you are ovulating, this takes place l4 days before the onset of a period. This is a reasonably predictable event if you have a regular cycle but may be very unpredictable if you have a very erratic cycle.

What is necessary in order for pregnancy to occur ?

Ovulation is essential;

Intercourse must take place during the fertile phase of the cycle;

Your partner’s sperm count must be adequate to ensure that a sufficient number actually reach the egg;

The mucus in the cervix must not be unfavorable and/or hostile to the sperm;

Side Effects and Risks of the Pill : What are the possible side effects of the birth control pill

Although over 85% of women have mild to no side effects to the pill, it is important to know the serious side effects so that appropriate measures can be taken in time:

Mild side effects:Nausea, weight gain (about 2 kgs), fluid retention, breast tenderness, spotting between periods. These side effects usually subside in the first three months. Moderately serious side effects:Breast pain, discharge or engorgement; rash, itching or jaundice; reduced tolerance to contact lenses; headaches or migraines; nervousness or depression. If you experience any of these side effects, you should inform your doctor. The doctor may be able to prescribe another brand of the birth control pill that may be more suitable for you. He may also ask you to stop the pills completely and resort to a different form of contraception.

Serious side effects:Blood clots are a serious side effect of the pill. Blood clots will exhibit different symptoms depending on the part of the body where they form. Some of these symptoms are leg tenderness or swelling; sudden chest pain or shortness of breath, partial or complete loss of vision or blackouts; numbness in any part of the body. If you experience any of these symptoms, you should immediately stop the pill and consult your doctor.

For whom is the birth control pill not advisable ?

The pill is also not advisable for the following women:

· Women over 35 who smoke;

· Women with high blood pressure, high cholesterol, or a family history of heart disease;

· Women with past or present breast, uterus or liver cancer;

· If a pregnancy is suspected

· There are also other reasons when a pill is not advisable. Your gynaecologist would be in the best position to make this decision since she would know your and your family’s medical history.

Some foods, habits, and medicines can harm your baby — even before he is conceived. Find out what to do and what to avoid when you're trying to get pregnant.

Before Pregnancy:

If you're thinking about getting pregnant, or are already pregnant, taking care of your health is more important than ever. Follow these tips for a healthy pregnancy:

Get 400 micrograms (or 0.4 mg) of folic acid daily. Eat foods fortified with folic acid, take a multivitamin, or take a folic acid pill to get your daily dose. Taking folic acid in a pill is the best way to be sure you're getting enough. Including 0.4 mgof folic acid (or folate) in your diet before you get pregnant and in the first three months of pregnancy can help prevent some birth defects. If you don't get enough folic acid, your baby's spine may not form right. This is called spina bifida (spy-nuh bif-uh-duh). Also, your baby needs folic acid to develop a healthy brain. Many doctors will prescribe a vitamin with folic acid. But you also can buy vitamins or folic acid pills at drug and grocery stores. Some foods rich in folate include: leafy green vegetables, kidney beans, orange juice and other citrus fruits, peanuts, broccoli, asparagus, peas, lentils, and whole-grain products. Folic acid is also added to some foods like enriched breads, pastas, rice and cereals. Get more details on folic acid.

One half of all pregnancies are not planned!

And many women don't realize they are pregnant for at least a few weeks. So you should always take care of your health. Your baby is counting on you for the best start at life!

Start watching what you eat. Load up on fruits, vegetables, and whole-grains (such as whole-wheat breads or crackers). Eat plenty of calcium-rich foods such as non-fat or low-fat yogurt, milk, and broccoli. Your baby needs calcium for strong bones and teeth. When fruits and vegetables aren't in season, frozen vegetables are a good option. Avoid eating a lot of fatty foods (such as butter and fatty meats). Choose leaner foods when you can (such as skim milk, chicken and turkey without the skin, and fish). Find out more about what to eat and what to avoid for a healthy pregnancy.

Tell your doctor if you smoke or use alcohol or drugs. Quitting is hard, but you can do it. Ask your doctor for help.

Get enough sleep. Try to get seven to nine hours every night.

Take steps to control the stress in your life. When it comes to work and family, figure out what you can and can not do. Set limits with yourself and others. Don't be afraid to say NO to requests for your time and energy.

Move your body. Once you get pregnant, you can't increase your exercise routine by much. So it's best to start before the baby is on the way.

Get any health problems under control. Talk to your doctor about how your health problems might affect you and your baby. If you have diabetes, monitor your blood sugar levels. If you have high blood pressure, monitor these levels as well. If you are overweight, talk to your doctor about how to reach a healthy weight.

Ask your mother, aunts, grandmother or sisters about their pregnancies. Did they have morning sickness? Problems with labor? How did they cope?

Find out what health problems run in your family. Tell these to your doctor. You can get tested for health problems that run in families before getting pregnant (genetic testing).

Make sure you have had all of your immunizations (shots), especially for Rubella (German measles). If you haven't had chickenpox or rubella, get the shots at least three months before getting pregnant.

Get checked for hepatitis (hep-uh-tie-tus) B and C, sexually transmitted diseases (STDs), and HIV. These infections can harm you and your baby. Tell your doctor if you or your sex partners have ever had an STD or HIV.

Go over all of the medicines you take (prescription, over-the-counter, and herbals) with your doctor. Make sure they are safe to take while you're trying to get pregnant or are pregnant.

Trying to Conceive

How do you figure out when you're fertile and when you're not? Wondering if you or your partner is infertile? Read on to boost your chances of conception and get help for fertility problems...

Fertility Awareness

· Infertility

· Reasons for Infertility

· Treating Infertility

· More Fact Sheets and Resources

· Fertility Awareness

· The Menstrual Cycle

· Being aware of your menstrual cycle and the changes in your body that happen during this time can be key to helping you plan a pregnancy, or avoid pregnancy. During the menstrual cycle (a total average of 28 days), there are two parts: before ovulation and after ovulation.

·Day 1 starts with the first day of your period.

·Usually by Day 7, a woman's eggs start to prepare to be fertilized by sperm.

·Between Day 7 and 11, the lining of the uterus (womb) starts to thicken, waiting for a fertilized egg to implant there.

·Around Day 14 (in a 28-day cycle), hormones cause the egg that is most ripe to be released, a process called ovulation. The egg travels down the fallopian tube towards the uterus. If a sperm unites with the egg here, the egg will attach to the lining of the uterus, and pregnancy occurs.

·If the egg is not fertilized, it will break apart.

·Around Day 25 when hormone levels drop, it will be shed from the body with the lining of the uterus as a menstrual period.

·The first part of the menstrual cycle is different in every woman, and even can be different from month-to-month in the same woman, varying from 13 to 20 days long. This is the most important part of the cycle to learn about, since this is when ovulation and pregnancy can occur. After ovulation, every woman (unless she has a health problem that affects her periods) will have a period within 14 to 16 days.

Charting Your Fertility Pattern:

Knowing when you're most fertile will help you plan or prevent pregnancy. There are three ways you can keep track of your fertile times. They are:

Basal body temperature method - Basal body temperature is your temperature at rest as soon as you awake in the morning. A woman's basal body temperature rises slightly with ovulation. So by recording this temperature daily for several months you'll be able to predict your most fertile days.

Basal body temperature differs slightly from woman to woman. Anywhere from 96 to 98 degrees orally is average before ovulation. After ovulation most women have an oral temperature between 97 and 99 degrees. The rise in temperature can be a sudden jump or a gradual climb over a few days.

Usually a woman's basal body temperature rises by only 0.4 to 0.8 degrees Fahrenheit. To detect this tiny change, women must use a basal body thermometer. These thermometers are very sensitive. Most pharmacies sell them for around $10. You then record your temperature on a special chart.

The rise in temperature doesn't show exactly when the egg is released. But almost all women have ovulated within three days after their temperatures spike. Body temperature stays at the higher level until your period starts.

You are most fertile and most likely to get pregnant:

two to three days before your temperature hits the highest point (ovulation), and

12 to 24 hours after ovulation.

A man's sperm can live for up to three days in a woman's body. The sperm can fertilize an egg at any point during that time. So if you have unprotected sex a few days before ovulation there is a chance of becoming pregnant.

1. Basal Body Temperature Method: Many things can affect basal body temperature. To get the most useful chart you should take your temperature every morning at about the same time. Things that can alter your temperature include:

· drinking alcohol the night before

· smoking cigarettes the night before

· getting a poor night's sleep

· having a fever

· doing anything in the morning before you take your temperature -- including going to the bathroom and talkiing on the phone

2. Calendar method - This involves keeping a written record of each menstrual cycle on a calendar. The first day of your period is Day 1. Circle Day 1 on the calendar. Do this for eight to 12 months so you know how many days are in your cycle. The length of your cycle may vary from month to month. So write down the total number of days it lasts each time. To find out the first day when you are most fertile, check your list for the cycle with the fewest days. Then subtract 18 from that number. Take this new number and count ahead that many days on the calendar. Draw an X through this date. The X marks the first day you're likely to be fertile. To find out the last day when you are fertile, subtract 11 days from your longest cycle and draw an X through this date. This method always should be used with other fertility awareness methods, especially if your cycles are not always the same lengths.

3. Cervical mucus method (also known as the ovulation method) - This involves being aware of the changes in your cervical mucus throughout the month. The hormones that control the menstrual cycle also change the kind and amount of mucus you have before and during ovulation. Right after your period, there are usually few days when there is no mucus present or "dry days." As the egg starts to mature, mucus increases in the vagina, appears at the vaginal opening, and is white or yellow and cloudy and sticky. The greatest amount of mucus appears just before ovulation. During these "wet days" it becomes clear and slippery, like raw egg whites. Sometimes it can be stretched apart. This is when you are most fertile. About four days after the wet days begin the mucus changes again. There will be much less and it becomes sticky and cloudy. You might have a few more dry days before your period returns. Describe changes in your mucus on a calendar. Label the days, "Sticky," "Dry," or "Wet." You are most fertile at the first sign of wetness after your period or a day or two before wetness begins. This method is less reliable for some women. Women who are breastfeeding, taking hormonal contraceptives (like the pill) using feminine hygiene products, have vaginitis or sexually transmitted diseases (STDs), or have had surgery on the cervix should not rely on this method.

To most accurately track your fertility, use a combination of all three methods. This is called the symptothermal method.

Infertility:

It is not uncommon to have trouble becoming pregnant or to experience infertility. Infertility is defined as not being able to become pregnant, despite trying for one year, in women under age 35, or after six months in women 35 and over. Pregnancy is the result of a chain of events. As described in the Fertility Awareness section, a woman must release an egg from one of her ovaries (ovulation). The egg must travel through a fallopian tube toward her uterus. A man's sperm must join with (fertilize) the egg along the way. The fertilized egg must then become attached to the inside of the uterus. While this may seem simple, in fact many things can happen to prevent pregnancy.

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Reasons for Infertility

1. Age: There are many different reasons why a couple might have infertility. One is age-related. Women today are often delaying having children until later in life, when they are in their 30s and 40s. A couple of things add to this trend. Birth control is easy to obtain and use, more women are in the work force, women are marrying at an older age, the divorce rate remains high, and married couples are delaying pregnancy until they are more financially secure. But the older you are, the harder it is to become pregnant. Women generally have some decrease in fertility starting in their early 30s. And while many women in their 30s and 40s have no problems getting pregnant, fertility especially declines after age 35.

As a woman ages, there are normal changes that occur in her ovaries and eggs. All women are born with over a million eggs in their ovaries (all the eggs that they will ever have), but only have about 300,000 left by puberty. Then of these, only about 300 eggs will be ovulated during the reproductive years. Even though menstrual cycles continue to be regular in a woman's 30s and 40s, the eggs that ovulate each month are of poorer quality than those from her 20s. It is harder to get pregnant when the eggs are poorer in quality.

Ovarian reserve is the number and quality of eggs in your ovaries and how well the ovarian follicles respond to hormones in your body. As you approach menopause, your ovaries don't respond as well to your hormones, and in time they may not release an egg each month. A reduced ovarian reserve is natural as a woman ages, but young women might have reduced ovarian reserves due to smoking, a prior surgery on their ovaries, or a family history of early menopause. Also, as a woman and her eggs age, if she becomes pregnant, there is a greater chance of having genetic problems, such as having a baby with Down Syndrome. Embryos formed from eggs in older women also are less likely to fully develop, a main reason for miscarriage (early pregnancy loss).

2. Health Problems: Couples also can have fertility problems because of health problems, in either the woman or the man. Common problems with a woman's reproductive organs, like uterine fibroids, endometriosis, and pelvic inflammatory disease can worsen with age and also affect fertility. These conditions might cause the fallopian tubes to be blocked, so the egg can't travel through the tubes into the uterus.

Some people also have diseases or conditions that affect their hormone levels, which can cause infertility in women and impotence and infertility in men. Polycystic Ovarian syndrome (PCOS) is one such hormonal condition that affects many women, and is the most common cause of anovulation, or when a woman rarely or never ovulates. Another hormonal condition that is a common cause of infertility is when a woman has a luteal phase defect (LPD). A luteal phase is the time in the menstrual cycle between ovulation and the start of the next menstrual period. LPD is a failure of the uterine lining to be fully prepared for a fertilized egg to implant there. This happens either because a woman's body is not producing enough progesterone, or the uterine lining isn't responding to progesterone levels at some point in the menstrual cycle. Since pregnancy depends on a fertilized egg implanting in the uterine lining, LPD can interfere with a woman getting pregnant and with carrying a pregnancy successfully.

Certain lifestyle choices also can have a negative effect on a woman's fertility, such as smoking, alcohol use, weighing much more or much less than an ideal body weight, a lot of strenuous exercise, and having an eating disorder.

Unlike women, some men remain fertile into their 60s and 70s. But as men age, they might begin to have problems with the shape and movement of their sperm, and have a slightly higher risk of sperm gene defects. They also might produce no sperm, or too few sperm. Lifestyle choices also can affect the number and quality of a man's sperm. Alcohol and drugs can temporarily reduce sperm quality. And researchers are looking at whether environmental toxins, such as pesticides and lead, also may be to blame for some cases of infertility. Men also can have health problems that affect their sexual and reproductive function. These can include sexually transmitted diseases (STDs), diabetes, surgery on the prostate gland, or a severe testicle injury or problem.

If you or your partner has a problem with sexual function or libido, don't delay seeing your doctor for help.

Top Causes of Female Infertility

Fertility can be a complicated thing. The causes of infertility can be male, female or both parties. Here are the most common causes of female factor infertility:

· Structural Issues
These account for about 15% of female factors. Mechanical issues usually refer to issues with the anatomy of the woman. It may be a blockage in the fallopian tube, a fibroid in the uterus, or a problem with the opening of the cervix.

Some of these factors may be caused by previous medications or surgeries, like DES exposure when the woman was a fetus herself, or a surgery that would disrupt the stability or the cervix. Some of these causes may be treated with surgical intervention while others may need other forms of specialized treatment.

· Mechanical Issues
Some 25-40% of women will have fertility problems due to mechanical issues, such as scar tissue that block the fallopian tubes or the uterus.

· Ovulatory Issues
As many as 30% of all causes of female factor infertility are due to issues with ovulation. This may be complete ovarian failure due to hormonal issues, etc. It could be merely a problem with the timing or detection of ovulation. This is usually evaluated and treated with medications to help restore ovarian function.

· Multiple or Unknown Factors
It is possible that a woman will have multiple factors involved in her cause of infertility. This is why prompt medical evaluation by a qualified practitioner is always important. About 10% of women will have unknown causes of infertility

Top Causes of Male Infertility

While there are many causes of male factor infertility, some are seen more commonly than others. These top causes of male factor infertility account for the majority of cases of infertility in men. Here is a listing of the top causes of infertility in men, in no particular order.

· Blockage of Sperm:The vas deferens that carries sperm from the testicles to the penis can be blocked for a variety of reasons including prior vasectomy, injury, infection or physical anomaly.

· Infections.
There are many types of infections that might cause sterility or low sperm counts in men. These can be recent infections or from childhood. Common infections can be mumps or certain types of sexually transmitted infections (STI).

· Chronic Disease
Diseases that can effect hormonal controls and sperm production, particularly when not controlled are also causes of infertility.

· Erectile Dysfunction (ED)
If you have a problem getting or maintaining an erection then there will be problems getting the sperm out. Sometimes this is caused by a chronic illness like hypertension or heart problems, it can also be caused by paralysis.

· Failure to Produce Sperm
If the body isn't producing sperm there can be many reasons. Some may be from hormonal issues of testicular failure, while others may be from treatments for certain illnesses and cancer like chemotherapy and radiation therapy.

· Exposure to Harmful Substances
Environmental or work hazards can also lead to problems with fertility.

· Injury
If you have experienced injury to your testicles you may also have issues with sperm production.

· Varicocele
This is a varicosity, or varicose vein in the testicle. The varicosity damages the blood flow to the testes, making sperm production slowed or stopped.

While the treatments and outlook for these causes of infertility in men differ, there may be treatment options for you. Be sure to talk to your doctor or reproductive endocrinologist about what outlook and treatment is best in your case.

Treating Infertility: You should talk to your doctor about your fertility if you:

·are under age 35 and, after a year of frequent sex without birth control, you are having problems getting pregnant, or

·are age 35 or over and, after six months of frequent sex without birth control, you are having problems getting pregnant, or believe you or your partner might have fertility problems in the future (even before you begin trying to get pregnant).

Your doctor can refer you to a fertility specialist, a doctor who focuses in treating infertility. This doctor can recommend treatments such as drugs, surgery, or assisted reproductive technology. Don't delay seeing your doctor because age also affects the success rates of these treatments.

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Ways to treat infertility.

1. Tests

The first step to treat infertility is to see a doctor for a fertility evaluation. He or she will test both the woman and the man, to find out where the problem is. Testing on the man focuses on the number and health of his sperm. The lab will look at a sample of his sperm under a microscope to check sperm number, shape, and movement. Blood tests also can be done to check hormone levels. More tests might be needed to look for infection, or problems with hormones. These tests can include:

·an x-ray (to look at his reproductive organs)

·a mucus penetrance test (to see if sperm can swim through mucus)

·a hamster-egg penetrance assay (to see if sperm can go through hamster egg cells, somewhat showing their power to fertilize human eggs)

Testing for the woman first looks at whether she is ovulating each month. This can be done by having her chart changes in her morning body temperature, by using an FDA-approved home ovulation test kit (which she can buy at a drug store), or by looking at her cervical mucus, which changes throughout her menstrual cycle. Ovulation also can be checked in her doctor's office with an ultrasound test of the ovaries, or simple blood tests that check hormone levels, like the follicle-stimulating hormone (FSH) test. FSH is produced by the pituitary gland. In women, it helps control the menstrual cycle and the production of eggs by the ovaries. The amount of FSH varies throughout the menstrual cycle and is highest just before an egg is released. The amounts of FSH and other hormones (luteinizing hormone, estrogen, and progesterone) are measured in both a man and a woman to determine why the couple cannot achieve pregnancy. If the woman is ovulating, more testing will need to be done. These tests can include:

·an hysterosalpingogram (an x-ray to check if the fallopian tubes are open and to show the shape of the uterus)

·a laparoscopy (an exam of the tubes and other female organs for disease)

·an endometrial biopsy (an exam of a small shred of the uterine lining to see if monthly changes in it are normal)

Other tests can be done to show whether the sperm and mucus are interacting in the right way, or if the man or woman is forming antibodies that are attacking the sperm and stopping them from getting to the egg.

2. Drugs and Surgery :

Different treatments for infertility are recommended depending on what the problem is. About 90 percent of cases are treated with drugs or surgery. Various fertility drugs may be used for women with ovulation problems. It is important to talk with your doctor about the drug to be used. You should understand the drug's benefits and side effects. Depending on the type of fertility drug and the dosage of the drug used, multiple births (such as twins) can occur in some women. If needed, surgery can be done to repair damage to a woman's ovaries, fallopian tubes, or uterus. Sometimes a man has an infertility problem that can be corrected by surgery.

3. Assisted Reproductive Technology (ART)

Assisted reproductive technology (ART) uses special methods to help infertile couples, and involves handling both the woman's eggs and the man's sperm. Success rates vary and depend on many factors. But ART has made it possible for many couples to have children that otherwise would not have been conceived. ART can be expensive and time-consuming. Many health insurance companies do not provide coverage for infertility or provide only limited coverage. Check your health insurance contract carefully to learn about what is covered. Also, some states have laws for infertility insurance coverage. Some of these include Arkansas, California, Connecticut, Hawaii, Illinois, Maryland, Massachusetts, Rhode Island, Texas, and West Virginia.

In vitro fertilization (IVF) is a type of ART that is often used when a woman's fallopian tubes are blocked or when a man has low sperm counts. A drug is used to stimulate the ovaries to produce multiple eggs. Once mature, the eggs are removed and placed in a culture dish with the man's sperm for fertilization. After about 40 hours, the eggs are examined to see if they have become fertilized by the sperm and are dividing into cells. These fertilized eggs (embryos) are then placed in the woman's uterus, thus bypassing the fallopian tubes. Gamete intrafallopian transfer (GIFT) is similar to IVF, but used when the woman has at least one normal fallopian tube. Three to five eggs are placed in the fallopian tube, along with the man's sperm, for fertilization inside the woman's body. Zygote intrafallopian transfer (ZIFT), also called tubal embryo transfer, combines IVF and GIFT. The eggs retrieved from the woman's ovaries are fertilized in the lab and placed in the fallopian tubes rather than the uterus.

ART sometimes involves the use of donor eggs (eggs from another woman) or previously frozen embryos. Donor eggs may be used if a woman has impaired ovaries or has a genetic disease that could be passed on to her baby. And if a woman does not have any eggs, or her eggs are not of a good enough quality to produce a pregnancy, she and her partner might want to consider surrogacy. A surrogate is a woman who agrees to become pregnant using the man's sperm and her own egg. The child will be genetically related to the surrogate and the male partner, but the surrogate will give the baby to the couple at birth.

A gestational carrier might be an option for women who do not have a uterus, from having had a hysterectomy, but still have their ovaries, or for women who shouldn't become pregnant because of a serious health problem. In this case, the woman's eggs are fertilized by the man's sperm and the embryo is placed inside the carrier's uterus. In this case, the carrier will not be related to the baby, and will give the baby to the parents at birth.

Counseling and Support Groups:

If you've been having problems getting pregnant, you know how frustrating it can feel. Not being able to get pregnant can be one of the most stressful experiences a couple has. Both counseling and support groups can help you and your partner talk about your feelings, and to help you meet other couples like you in the same situation. You will learn that anger, grief, blame, guilt, and depression are all normal. Couples do survive infertility, and can become closer and stronger in the process. Ask your doctor for the names of counselors or therapists with an interest in fertility.

Using home pregnancy tests can be an emotional and confusing process. Is that a faint pink line or is it just my imagination? Am I testing too early after my missed period? Read on to find out how and when you can tell if you're pregnant.

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How do pregnancy tests work?

What's the difference between pregnancy tests that check urine and those that test blood? Which one is better?

How do you do a home pregnancy test?

How accurate are home pregnancy tests?

Which brand of pregnancy test is the most accurate?

How soon after a missed period can I take a home pregnancy test and get accurate results?

I got a negative result on a home pregnancy test. Might I still be pregnant?

Can anything interfere with home pregnancy test results?

How do pregnancy tests work?

Pregnancy tests look for a special hormone in the urine or blood that is only there when a woman is pregnant. This hormone, human chorionic gonadotropin (hCG), can also be called the pregnancy hormone.

The pregnancy hormone, hCG, is made in your body when a fertilized egg implants in the uterus. This usually happens about 6 days after conception. But studies show that the embryo doesn't implant until later in some women. The amount of hCG increases drastically with each passing day you are pregnant.

Many home pregnancy tests claim they can tell if you're pregnant on the day you expect your period. But a recent study shows that most don't give accurate results this early in pregnancy. Waiting one week after a missed period will usually give a more accurate answer.

What's the difference between pregnancy tests that check urine and those that test blood? Which one is better?

There are two types of pregnancy tests. One tests the blood for the pregnancy hormone, hCG. The other checks the urine for this hormone. You can do a urine test at home with a home pregnancy test. You need to see a doctor to have blood tests.

These days, most women first use home pregnancy tests (HPT) to find out if they are pregnant. HPTs are inexpensive, private, and easy to use. Urine tests will be able to tell if you're pregnant about 2 weeks after ovulation. Some more sensitive urine tests claim that they can tell if you are pregnant as early as one day after a missed period.

If a HPT says you are pregnant, you should call your doctor right away. Your doctor can use a more sensitive test along with a pelvic exam to tell for sure if you're pregnant. Seeing your doctor early on in your pregnancy will help you and your baby stay healthy.

Doctors use two types of blood tests to check for pregnancy. Blood tests can pick up human chorionic gonadotropin ( hCG) earlier in a pregnancy than urine tests can. Blood tests can tell if you are pregnant about 6 to 8 days after you ovulate (or release an egg from an ovary). A quantitative blood test (or the beta hCG test) measures the exact amount of hCG in your blood. So it can find even tiny amounts of hCG. This makes it very accurate. Qualitative hCG blood tests just check to see if the pregnancy hormone is present or not. So it gives a yes or no answer. The qualitative hCG blood test is about as accurate as a urine test.

How do you do a home pregnancy test?

There are many different types of home pregnancy tests, or HPTs. Most drugstores sell HPTs over-the-counter. They cost between $8 and $20 depending on the brand and how many tests come in the box.

Most popular HPTs work in a similar way. The majority tell the user to hold a stick in the urine stream. Others involve collecting urine in a cup and then dipping the stick into it. At least one brand tells the woman to collect urine in a cup and then put a few drops into a special container with a dropper. Testing the urine first thing in the morning may help boost accuracy.

Then the woman needs to wait a few minutes. Different brands instruct the woman to wait different amounts of time. Once the time has passed, the user should inspect the "result window." If a line or plus symbol appears, you are pregnant. It does not matter how faint the line is. A line, whether bold or faint, means the result is positive.

Most tests also have a "control indicator" in the result window. This line or symbol shows whether the test is working or not. If the control indicator does not appear, the test is not working properly. You should not rely on any results from a HPT that may be faulty.

Most brands tell users to repeat the test in a few days, no matter what the results. One negative result (especially soon after a missed period) does not always mean you're not pregnant. All HPTs come with written instructions. Most tests also have toll-free phone numbers to call in case of questions about use or results.

How accurate are home pregnancy tests?

Home pregnancy tests (HPTs) can be quite accurate. But the accuracy depends on many things. These include:

How you use them - Be sure to follow the directions and check the expiration date.

When you use them - The amount of hCG or pregnancy hormone in your urine increases with time. So, the earlier after a missed period you take the test the harder it is to spot the hCG. If you wait one week after a missed period to test, you are more apt to have an accurate result. Also, testing your urine first thing in the morning may boost the accuracy.

Who uses them - The amount of hCG in the urine is different for every pregnant woman. So, some women will have accurate results on the day of the missed period while others will need to wait longer.

The brand of test - Some home pregnancy tests are more sensitive than others. So, some tests are better than others at spotting hCG early on.

Many HPTs claim to be 99% accurate on the day you miss your period. But research suggests that most HPTs do not consistently spot pregnancy that early. And when they do, the results are often very faint.

In a 2004 study, researchers tested the accuracy of 18 HPTs sold in retail stores. They found that only one brand consistently detected the low levels of hCG usually present on the first day of the missed period. This was the First Response, Early Result Pregnancy Test. The other tests missed up to 85% of pregnancies on the first day of the missed period. Most tests accurately confirmed pregnancies one week after the missed period.

Which brand of pregnancy test is the most accurate?

Some brands of tests can pick up lower levels of hCG than others. But limited research makes it impossible to say for sure which one is the best. Even so, two studies suggest that First Response, Early Result Pregnancy Test may be more sensitive than others. So for women who want test early, this may be a good choice.

How soon after a missed period can I take a home pregnancy test and get accurate results?

Many home pregnancy tests (HPTs) claim to be 99% accurate on the day you miss your period. But research suggests that most HPTs do not consistently spot pregnancy that early. And when they do, the results are often so faint they are misunderstood. If you can wait one week after your missed period, most home pregnancy tests will give you an accurate answer. Ask your doctor for a more sensitive test if you need to know earlier.

When a home pregnancy test will give an accurate result depends on many things.

These include:

How long it takes for the fertilized egg to implant in the uterus after ovulation. Pregnancy tests look for the hormone human chorionic gonadotropin (hCG) that is only produced once the fertilized egg has implanted in the uterine wall. In most cases, this happens about 6 days after conception. But studies show that in up to 10 percent of women, the embryo doesn't implant until much later, after the first day of the missed period. So, home pregnancy tests will be accurate as soon as one day after a missed period for some women but not for others.

How you use them - Be sure to follow the directions and check the expiration date.

When you use them - The amount of hCG in a pregnant woman's urine increases with time. So, the earlier after a missed period you take a HPT, the harder it is to spot the hCG. If you wait one week after a missed period to test, you are more apt to have an accurate result. Also, testing your urine first thing in the morning may boost the accuracy.

Who uses them - The amount of hCG in the urine at different points in early pregnancy is different for every woman. So, some women will have accurate results on the day of the missed period while others will need to wait longer.

The brand of test - Some home pregnancy tests are more sensitive than others. So, some tests are better than others at spotting hCG early on.

I got a negative result on a home pregnancy test. Might I still be pregnant?

Yes. So, most HPTs suggest women take the test again in a few days or a week.

Every woman ovulates at different times in her menstrual cycle. Plus, embryos implant in the uterus at different times. So, most home pregnancy tests (HPTs) suggest women take the test again in a few days or a week.

Sometimes women get false negative results (when the test says you are not pregnant and you are) when they test too early in the pregnancy. Other times, problems with the pregnancy can affect the amount of hCG in the urine.

If your HPT is negative, test yourself again in a few days or 1 week. If you keep getting a negative result but think you are pregnant, talk with your doctor right away.

Can anything interfere with home pregnancy test results?

Most medicines, over-the-counter and prescription, including birth control pills and antibiotics, should not affect the results of a home pregnancy test. Only medicines that have the pregnancy hormone hCG in them can give a false positive test result. A false positive is when a test says you are pregnant when you're not.

Sometimes medicines containing hCG are used to treat infertility (not being able to get pregnant). Alcohol and illegal drugs do not affect HPT results. But women who may become pregnant should not use these substances.

Bearing Labour Pains :

I am frightened at the thought of labour

Labour pains are a major damper in the joy of having a baby. The thought of the pain that you have to go through makes you ill. Pictures of pregnant women, screaming in pain, that you have seen in hundreds of films, flash through your mind. You can not get all those horror stories that you have heard out of your mind. This fear is very real, yet very normal.

Labour pains are a fact of life that cannot be avoided. There is no point dreading it and working yourself up. Take a childbirth education class and read up on the subject. Sometimes, the pain is easier to bear when you understand what is happening to your body. Prepare yourself physically by faithfully following a regimen of breathing and toning exercises. Remember that the pain is not going to last forever. With every successive contraction, you are that much closer to the end of the ordeal.

Being a Good Mother

Will it be love at first sight for the baby and me ?

Books and films can be quite misleading on this subject. It is not surprising if you do not feel a surge of maternal love when your baby is put into your arms for the first time. Physical closeness between mother and child after birth does not necessarily signify emotional closeness. The new mother’s first feeling is usually one of overwhelming relief that the ordeal is over and that she has a normal baby. It is not unnatural for you to feel that your baby is a stranger and to feel little more than neutral towards her. One study has shown that it takes an average of two weeks (and sometimes as long as nine weeks) for a mother to begin to have positive feelings towards her child.

The reaction of a mother to her newborn will depend on several factors: how long and painful her labour was, how she felt about having the baby, her previous interaction with babies, her relationship with her husband, general health and stress levels, and most importantly, her personality.

Give yourself and the baby a chance to get acquainted and the love will grow slowly and naturally.

Concerned about Losing your Figure. I am worried about losing my figure after childbirth ?

The mother’s breasts usually do increase in size by as much as 2-5 inches during pregnancy and remain enlarged for a few months after delivery until the mother continues to nurse her baby. In addition to breasts, the uterus also expands in size during pregnancy. Soon after delivery, however, it begins to contract to get back to its original size. The stronger the abdominal muscles, the faster the uterus shrinks. Any abdominal muscle toning exercises done during pregnancy and prior to getting pregnant will greatly improve the elasticity of the muscles and help in the uterus contracting back to its pre-pregnancy size. In addition, contrary to popular belief, you are more likely to regain your figure if you breast-feed your baby.

Will my breasts sag with pregnancy or breastfeeding ?

Since there are no muscles in the breast, only ligaments, your breasts will sag from the increased weight unless well supported by a good-fitting bra. These ligaments, once stretched, never return to their original size. Therefore, a bra with good all-round support should be worn at all times, preferably even while sleeping at night. The good news (or the bad news if you were flat-chested) is that your breasts will eventually shrink back almost to the pre-pregnancy size.

Being a Working Mother, How long can I continue working after I am pregnant ?

Pregnant women who have no complications can continue working until the ninth month. They must however, take certain precautions such as avoiding strenuous activity, stair-climbing, extreme temperatures and smoky areas. They must also take frequent breaks and leave early if they are feeling exhausted. If they have been standing for a prolonged period, they should sit down and put their feet up. Standing for extended periods, lifting heavy objects, stooping and bending should be avoided in the last three months. Pregnant women must eat regular meals. A sedentary job that is not particularly stressful may be less of a strain than staying at home.

I would prefer to be a stay-at-home mother?

any women around the world feel that having a baby is not just something you do and then move on. In fact, a baby that depends on you for its most basic needs and in many ways is completely helpless. Once you have a baby, you may find that it is not so easy to just get on with your life as you used to know it. Not only do you consider yourself solely responsible for the care of this child, but also you do not want to miss out on the pleasures of parenting, for which you feel you need to be a full-time mom. Experts in parenting and childcare have now given the role a new level of significance by calling it the stay-at-home mother, indicating that the decision of leaving your full-time job and career was a conscious choice made by the mother.

Should I go back to work ?

Resuming full-time work is not a black and white issue. There are a lot of factors that need to be considered while taking this decision, such as financial circumstances, the financial and emotional support from your partner, the availability of an alternate caretaker, etc.

All new mothers consider their babies as the most precious thing in the world. This is not to say that women should spend their entire lives looking after their children. Women are having babies all over the world and their lives are obviously not coming to an end. In fact, working mothers who are in the prime of their careers should definitely not give up their jobs for full-time motherhood. Although it may sound like a much-needed break for the first few months, it may lead to disappointment and resentment at one’s self, which in turn may get transferred onto the baby.

How soon can I go back to work ?

In most countries, women are granted three months of paid maternity leave. Many companies have a more liberal maternity policy where they even allow an extended leave of upto six months or more.

What are the alternatives to full-time work ?

Most women hesitate in asking their employers for working schedules where they can manage both their personal lives and professional lives. Women should take the initiative in discussing options such as flexible hours, part-time work, telecommuting or job-sharing. They may be surprised by the number of women who opted for one of these alternatives and achieved a successful balance.

Radical Lifestyle Changes, Will my pregnancy affect my relationship with my partner ?

You are worried that the coming of the baby is going to change your whole life. Your husband will cease to look at you as a desirable life partner and will now see you merely as the mother of his child. If marriage was a big change, involving a great deal of compromise, the birth of the baby may signal the end of your freedom. In the case of a father-to-be, he feels that the baby is not born yet and already all the attention is focussed on preparing for its arrival.

Will my life change after a baby ?

It is a definite that your lives will change drastically with the birth of your child. It is important that you accept this from the moment you decide to have a child and prepare yourselves. Do not romanticize the experience in your minds. While the birth of your baby will open the door on a wonderful new phase in your lives, it comes with a lot of adjustments and compromises.

What if my partner does not care for my pregnancy ?

When a woman finds out she is pregnant, she tends to completely wrap herself up in her pregnancy, tending to forget that there were two people who started on this journey together. It is important that you make your partner feel a part of the pregnancy, instead of making him feel that his part ended at the stage of conception. Similarly, after the baby is born, work hard at making time for yourselves. You must realize that the both of you share a relationship that is separate from being merely parents of your baby. This was the basis of your marriage and needs to be nurtured.

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Baby making Sex:

Baby making Love is generally no different from any other sex. However, the goal is to have semen deposited near the cervix. All things being equal, this is not usually a concern for the average couple trying to conceive a baby. There are certain positions that are more likely to help you achieve the goal of getting pregnant sooner, particularly if you are having certain fertility issues. Here are some positions for sex and their potential risks and benefits in the conception department.

1. Man on Top (Missionary Position) :

This is a pretty standard sexual position. This position will help with face-to-face intimacy, perhaps allowing for a greater possibility for orgasm. It also allows you to lay back and enjoy the show, so to speak. In this position, semen is deposited near the mouth of the cervix. The hard part of this position is that it may be more difficult for the woman to have an orgasm, which is quite important in the conception process.

Placing a pillow under your hips during intercourse and/or after your partner has an orgasm can help you get pregnant. By slightly tilting the position of the hips, you allow gravity to aid in the travel of the sperm to and through the cervix. You only need to do this for about 30 minutes to obtain the benefits.

2. Woman on Top :

This is generally thought as being counterproductive to getting pregnant because the sperm is deposited near the cervix, but immediately heads the opposite direction. This can be corrected if you lay down immediately after your partner has an orgasm. You can also use the pillow under your buttocks after this position. The good news about the woman on top is that the intercourse is deep penetrating and can help both you and your partner achieve orgasms, even if it is from manual stimulation which is easier in this position.

3. Hands and Knees Position (Doggie Style) :

Okay, before you laugh at the name, this position has a lot of conception benefits. Since there tends to be deeper penetration semen is placed closer to the cervix. While you lack the face-to-face intimacy of other positions, it is also easier to have manual stimulation of the clitoris, allowing for orgasms. Skip the post-coitus pillow if you maintain this position for a few minutes after having sex.

If you have a tilted uterus, you can use this position to make it easier to reach the cervix. If you also convert the position to a knee-chest position by bending your arms slightly to give you even more of an angle. This can be just what the doctor ordered! This is also true if your partner has low sperm counts or poor sperm motility. The sperm has to work less to get where it is going.

4. Side Lying :

Side lying sex is nice and slow and passionate. It can also be called spooning. Once your partner has his orgasm you can roll over and use your trusty pillow to help you keep sperm near your cervix. This is also good for manual stimulation of the clitoris. This position is also good for couples where one or more of the partners have a weight issue. This prevents either partner from having to either bear the weight or to hold themselves up. Back problems also fall into this category.

5. Standing :

This position is fairly counterproductive, but fun. Try this for times in your cycle when you’re not concerned with getting pregnant. Remember variety is a good thing and recreation sex is just as important as procreational sex.

Erectile Dysfunction (ED) & Ejaculatory Problems

These issues are common factors for some in infertility. Any position that helps your partner with these issues is the right position for you as a couple. Experiment and see what works best for you.

What's love got to do with it?

Many couples trying to get pregnant look at sexual intercourse as a means to an end. This means that sometimes the basics can get pushed aside or often ignored in favor of clocks, calendars and other schedules. Sometimes foreplay seems forced when you're making love to a calendar.

It's easy to see why the male orgasm is important. Obviously you need to have the man ejaculate to get the semen to find the sperm to hunt the egg to impregnate the woman. But why does it matter if she enjoys herself too?

The physiology behind the female orgasm is simple. When a woman has an orgasm her cervix, the mouth of the uterus, contracts as the uterus moves. This causes the uterus to dip or bob into the vagina. If the male has already had an orgasm, then this area is rich in semen (sperm). This motion of the cervix will actually draw the semen into the cervix and uterus to aid in it's passage towards the ripe egg.

If you usually include orgasm as a part of your foreplay, it still belongs there too. An orgasm prior to male ejaculation can help make the sex more pleasurable, the vagina more lubricated and make the whole scene much less clinical. However, for reasons stated above, if she does not have an orgasm after the male's then it is imperative for her to acheive one. It does not matter if this orgasm is via masturbation (self or partner lead). It simply needs to occur to improve the chances of pregnancy.

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The Male Orgasm:

Robert Kinsey, the scientist who first explored human sexuality in any detail, described an orgasm as, 'an explosive discharge of neuromuscular tension'! That was in 1950 and it seems that there is still a lot about the male orgasm that is not entirely understood.

The male orgasm is a complex experience and we all know that the male orgasm usually includes the ejaculation of sperm. The function of the female orgasm is less clear although there are many common features in the male and female orgasmic experience.

Ejaculation and orgasm :The male orgasm is not just about ejaculation. It is possible to have an orgasm without ejaculation.

· Some men do not have an ejaculation until several seconds after orgasm

· Adult males may experience several ejaculations and go on to have further orgasms without ejaculation.

· It seems that the way men experience ejaculation and orgasm differs from person to person.

Physical Experience of the Male orgasm
The male orgasm does have a psychological as well as a physical effect. Some men say that they have a more focal experience, feeling the orgasm in the scrotum and the genital area. Other men report their orgasm as a feeling that spreads over to some parts of the body and others that their orgasm is felt all over. How much of this is physical and how much psychological is difficult to judge.

The amount of conscious control a man has over his orgasm is variable too.

What's going on during a Male Orgasm?
During the male sex act a man's pelvic thrusts become less voluntary and other muscles of the body begin to contract rhythmically. As the orgasm begins you usually realize you are about to ejaculate. Heart rate, blood pressure and respiration all increase.

Some differences between male and female orgasm
Although many experiences have common ground there are differences too between the male and female orgasm.
The female orgasm has the effect of sucking sperm towards female's egg,(the ovum) in the fallopian tube.
Women can often experience an orgasm for a longer period of time than a man.
Women are, in general, more capable of rapidly returning to orgasm immediately after an orgasmic experience

Control over Ejaculation during Orgasm
Control over ejaculation during an orgasm can happen sooner than you may like. Ejaculation is disappointing if it happens too quickly. A disappointment that may also be felt by your sexual partner.

Kinsey reported nocturnal emissions in 85% of men, an obvious sign of sexual excitement and in most cases, orgasm. In men's early life this can happen once or twice a month. Women experienced this much less often than men.

Male multiple orgasm
Men report multiple orgasm more than women in the Kinsey report. 14% of women reported being multiple orgasmic and between 15-20% of men.

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Top Causes of Female Infertility

Fertility can be a complicated thing. The causes of infertility can be male, female or both parties. Here are the most common causes of female factor infertility:

· Structural Issues: These account for about 15% of female factors. Mechanical issues usually refer to issues with the anatomy of the woman. It may be a blockage in the fallopian tube, a fibroid in the uterus, or a problem with the opening of the cervix.

· Mechanical Issues: Some 25-40% of women will have fertility problems due to mechanical issues, such as scar tissue that block the fallopian tubes or the uterus.

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Top Causes of Male Infertility

· Blockage of Sperm:The vas deferens that carries sperm from the testicles to the penis can be blocked for a variety of reasons including prior vasectomy, injury, infection or physical anomaly.

· Chronic Disease
Diseases that can effect hormonal controls and sperm production, particularly when not controlled are also causes of infertility.

· Exposure to Harmful Substances
Environmental or work hazards can also lead to problems with fertility.

· Injury
If you have experienced injury to your testicles you may also have issues with sperm production.

· Varicocele
This is a varicosity, or varicose vein in the testicle. The varicosity damages the blood flow to the testes, making sperm production slowed or stopped.

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Diet before Conception

The old adage that "you are what you eat," has never held more relevance than in the case of fertility.

This works on two levels:

A balanced diet based on the five food groups will give you a greater sense of wellbeing and contribute to your ability to handle stress and the emotional ups and downs of infertility treatment.

Studies have also shown that maintaining a healthy weight, based on sensible choices from the five food groups, can help improve your chances to conceive, since weight is closely related to the hormonal balance needed for regular ovulation.

Here's a quick overview of the five food groups:

Protein foods (meat, poultry, fish, dry beans, eggs and nuts). An absolutely essential source of nutrients for you and the child you are trying to conceive.

Vegetables (especially leafy lettuce, broccoli, green peas, pumpkin, sweet potatoes and wax beans). Vital sources of vitamins and minerals as well as needed fibre in your diet.

Fruits (especially oranges, grapefruits, lemons and fresh fruit juices). Important sources of vitamin C and folic acid.

Grain products (rice, pasta, whole-grain or enriched breads, cereals and crackers). These foods provide carbohydrates, the body's main source of energy.

Dairy products (milk, cheese and yogurt). Sources of calcium, which are important for strong bones and teeth. Look for skim milk and other low-fat dairy products.

Contrary to popular belief, there is little scientific evidence to back up claims that certain foods can boost fertility. The one exception is zinc. Several studies have shown that zinc deficiencies can impair both male and female fertility. Maintaining the recommended daily allowance of zinc (15 mg per day) can help keep your reproductive system working properly. Zinc-rich foods include oysters, sardines, steak and chicken. Vegetarians can look to legumes (dried beans, black/eyed peas, lentils, peas, soy products and whole grains) as sources of zinc. Your doctor can best advise you on your specific nutritional needs during treatment.

Why diet matters
Nutrition has a direct impact on the potency of your sperm. Research shows that poor eating habits and regular consumption of alcohol, for instance, can lower the quality and quantity of sperm, making conception more difficult. And since infertility is nearly as much a man's issue as a woman's — up to 40 percent of fertility problems can be traced to men — eating healthfully now will boost your chances of conceiving a child.

Conception isn't the only reason to revamp your diet. Additional research shows that dads who drink heavily — the equivalent of two drinks a day — during the month prior to conception have babies who weigh on average 6.5 ounces less than other babies. Low birth weight is a serious medical condition that can affect your child's health and behavior for the rest of his life. Your diet should be every bit as balanced, varied, and nutritious as your partner's. Specifically, future dads should:

• Eat plenty of foods rich in vitamin C and other antioxidants: They help prevent sperm defects and boost its motility (movement). An eight-ounce glass of orange juice contains 124 milligrams. Aim for at least 60 mg of vitamin C daily, more — at least 100 mg — if you smoke.

• Get more zinc in your diet. Several studies show that even short-term zinc deficiencies can reduce semen volume and testosterone levels. Great sources to help you get the 15 mg you need a day include oysters (six medium oysters have a whopping 76.3 mg), extra-lean ground beef (a three-ounce serving has 4.5 mg), baked beans (a one-cup serving has 3.55 mg), and dark chicken meat (2.38 mg per three ounces).

• Fuel up on folic acid. Studies suggest that men with low levels of this key B vitamin — the same one women need to reduce the risk of neural tube birth defects — have low sperm counts. You may be able to get the amount you need (400 micrograms a day) from fortified breakfast cereals, leafy greens, legumes, and orange juice, but just to be sure, it can't hurt to take a folic acid supplement or a multivitamin.

• Increase your intake of calcium and vitamin D. Infertility researchers at the University of Wisconsin at Madison suggest that consuming 1,000 mg of calcium and 10 micrograms of vitamin D each day may improve men's fertility. Good sources of calcium include low-fat milk (an eight-ounce glass has 414 mg) and yogurt (one cup has 302 mg of calcium). You'll find vitamin D in milk (an eight-ounce glass has two mcg) and salmon (a three-ounce serving has eight mcg).

• Cut out or cut back on alcohol. While an occasional drink is generally considered safe, studies show that daily consumption of wine, beer, or hard liquor can decrease testosterone levels and sperm counts and increase the number of abnormal sperm in your ejaculate.

• B vitamins are very important for fertility - especially B6 and B12.Together with zinc, folic acid (B6) is essential for the formation and function of female sex hormones. It has also been shown to reduce the risk of an unborn baby developing spina bifida. Vitamin B12 maximises the absorption of folic acid and is essential for the synthesis of the RNA and DNA that form the basis of our genetic make-up.

Zinc helps to maintain a healthy menstrual cycle and is vitally important for growth and proper cell division in a developing foetus. A zinc deficiency can also slow down the production of good quality eggs prior to conception. Bottom of Form 1

Question: Can some foods increase our chances of conceiving?
Answer: Beliefs about the wondrous powers of so-called fertility foods such as shark's fin, camel's hump, ginseng, pine nuts, prunes, or even chocolate date to early civilizations. Unfortunately, most are pure fiction. Many are based on the simplistic notion that eating foods that look like sexual organs, such as figs or eggs, will help those organs function better. Also, no evidence proves the theory that eating spicy foods can increase sexual potency by raising your blood pressure and pulse rate.
There's some scientific proof that eating oysters can boost fertility. Oysters are packed with zinc, which plays a role in semen and testosterone production in men, and in ovulation and fertility in women. That doesn't mean you should down a plate of oysters on the half shell at every meal. Maintaining the recommended dietary allowance of zinc (9 mg a day) can help keep your reproductive system working properly, but excessive amounts of zinc (or any nutrient for that matter) will not turn either of you into a babymaking machine. In fact, super-high doses of vitamins and minerals may actually reduce your fertility.
Less meat, more carbs : Avoid eating large quantities of red meat, which can increase the amount of ammonia in our bodies. Too much ammonia can interfere with the implantation of the egg in the uterus. Too much rich protein may also increase the body's acidity and affect sperm activity. Sperm are at their most efficient in alkaline conditions. Realise, too, that a diet rich in healthy carbohydrates is important to maintain energy for couples trying to conceive. Reduce wheat and dairy consumption. Intolerance to wheat is very common for thousands of women, though you may not even be aware that you are affected by it.You can eat wheat in moderation, but try to substitute wheat with other grain foods, such as rye and sour dough, to maintain a balanced diet

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Trying to conceive? Five changes to make to your diet now

1. Improve your diet :
          The sooner you start eating well, the more likely you are to get pregnant. For both men and women, foods and fertility are linked; you need to stick to a balanced diet to boost your chances of conceiving and of having a healthy baby. Eat several servings of fruit, vegetables, grains such as whole wheat bread, and calcium-rich foods such as yogurt, cheese, and milk every day. Certain vitamins and nutrients — such as vitamins C and E, zinc, and folic acid — are important for making healthy sperm. Not getting enough nutrients can affect your periods, making it difficult to predict when you ovulate. And you may not ovulate at all if you've lost a drastic amount of weight or are extremely obese.
2. Break bad habits :
If your eating habits leave something to be desired — and many people's do — you'll have to make some adjustments. Some solid advice: Cut out or only occasionally drink alcohol (for non-alcoholic alternatives, see our list of the best virgin drinks). Stop using recreational drugs and if you smoke, quit. All these substances and habits can harm a developing fetus.
          You may also want to cut back on caffeine. The research on whether or not caffeine can affect fertility is mixed. Experts generally agree that low-to-moderate caffeine consumption (less than 300 mgs a day) won't affect your fertility, but your doctor may recommend you cut it out entirely to play it safe.3. Take a vitamin-mineral supplement.
Although you can meet almost all your nutritional needs through a balanced diet, many experts believe that even the healthiest eaters can use extra help. You may find it particularly hard to eat well when you're at work or parenting other children; taking a prenatal vitamin ensures that you're getting enough folic acid and other nutrients to boost your chances of conceiving.
Remember that a supplement is a safeguard, not a substitute for a sound diet. And since regular over-the-counter multivitamins may contain megadoses of vitamins and minerals that could be harmful to a developing baby, it's smart to switch to a pill formulated specifically for pregnant women. Talk with your caregiver about the right prenatal supplement for you.
4. Get lots of folic acid -- at least 400 micrograms a day.
This vitamin has been proven to reduce a baby's risk of neural-tube birth defects such as spina bifida and is linked to a lower incidence of heart attacks, strokes, cancer, and diabetes.
          Most women of childbearing age should get 400 micrograms (mcg) daily, which is the equivalent of 0.4 milligrams (mg), according to the U.S. Public Health Service (USPHS). If you have a family history of neural-tube birth defects, your doctor may suggest that you boost your daily intake to 4,000 mcg, or 4 mg, starting at least a month before you conceive and continuing throughout your first trimester.
          A good over-the-counter prenatal vitamin should contain more than the minimum recommendation of folic acid, between 600 and 800 mcg — what you'll need during pregnancy. In addition, you can eat folate-rich foods, such as dark green leafy vegetables (like spinach or kale), citrus fruits, nuts, legumes, whole grains, and fortified breads and cereals. Folic acid is a water-soluble vitamin, so your body will flush out the excess if you consume too much. But there's a downside to being water-soluble, too. You can lose a lot of this vitamin in cooking water, so steam or cook vegetables in a small amount of water to preserve the folate.
          For some women, there's an exception to this rule: Getting too much folate may hide a B-12 deficiency, sometimes a problem for vegetarians. Ask your doctor or midwife if you think you may be at risk.
5. Find your ideal body weight.
Shedding some pounds (or gaining a few if you're underweight) while you're attempting to get pregnant is a good idea, since you want to be as close as possible to your recommended weight when you conceive. Being over- or underweight can make it harder to get pregnant. Also, overweight women have more pregnancy and birth complications, and underweight women are more likely to have a low-birthweight baby.
          Use our calculator to figure out if you could stand to lose or gain weight.
          Devise a smart eating plan by choosing low-fat, high-fiber foods. Start or increase an exercise routine — and if you're overweight, aim to lose one to two pounds a week, a safe rate of weight loss. Extreme weight loss from crash dieting can deplete your body's nutritional stores, which isn't a good way to start a pregnancy.

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Baby Boy or Girl

If you want a boy...
> Lie down after sex and stay there for a while. Supposedly that gives the boy sperm a chance to beat the girl sperm to the egg.
> Make love standing up.
> Try the rear-entry position.
> Focus on his pleasure — if the male partner climaxes first, you're supposedly guaranteed a boy.
> Give in to seduction — if the man is the one to suggest some baby-making, you'll get a boy.
> Gals, sleep to the left of your partner.

If you want a girl...
> Give the missionary position a go.
> Make love with the woman on top.
> Focus on her pleasure — if the woman orgasms before her partner, you can decorate your nursery in pink.
> Take the lead — if the woman initiates sex, you'll get a girl.
It's all in the timing...or the direction
In a society where lots of people still rely on their daily horoscope for guidance, is it any surprise that superstition and folklore also dictate when to make love if you want to pick your baby's sex?
If you want a boy...
> Make love when there's a quarter moon in the sky.
> Have sex at night.
> Mark your calendar — more boys are conceived on odd days of the month.
> Follow the compass — one of our users swears that pointing the woman's head north while you make love guarantees a boy.
If you want a girl...
> Do the baby dance when the moon is full.
> Make a date for love in the afternoon.
> Get together on the even days of the month.
Keeping your cool
And we mean both literally and figuratively. According to some stories, being relaxed when you conceive means you'll have a girl; if you're a worrywart, a son's in your future. But actual temperature may play a role, too. Some old wives say a man's testicles should be cool before you have sex if you want a daughter; for a son, warm them up. That plays into the common belief about boxers versus briefs — go for the tighty-whities if you want a boy, but hang loose if you're aching for a girl. (FYI, research does suggest that boxers are best for baby-making in general.)
Just plain way out there...
Some sex selection folklore defies categorization. For instance, some say that if the hairline at the base of your last child's neck is a ducktail, your next baby will be a girl; if it's straight across, prepare for a boy. Another story says that the baby's sex is determined by which partner is dominant in the relationship at the time of conception.
Just predicting
Chinese conception chart
According to legend (and an awful lot of Web sites), the ancient Chinese came up with an almost foolproof way to predict the sex of your baby based on how old you are and what month it is when you conceive. Try it here.
The needle trick
More often used to predict what a baby's sex will be after conception, this technique is also one you can try before you conceive. Suspend a needle from some thread and have someone else hold it about an inch above your hand. If the needle swings back and forth, a girl is in your future; if it moves in a circle, count on a boy.
For a variation of this, hang your wedding ring from a strand of your hair (or use your spouse's ring and hair). Rub the ring up and down your index finger a couple of times and then hold it above the top of your outstretched right hand. The number of times the ring swings around in a circle before stopping will tell you how many children you'll have.

The Drano test
Some people believe that you can predict your baby's sex by mixing your urine with a little Drano. (The resulting color is supposed to be the key, but no one seems to be able to agree on which color means which sex.) Please don't try this. Not only is there nothing in Drano that would indicate a baby's gender, but mixing the chemicals in these two substances can produce dangerous fumes or even an explosion.

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