Getting Pregnant. Or Not

Pre-pregnancy planning and post-tubal pregnancy


A 26-year-old reader (who didn't include her name) is thinking about aiming for a pregnancy early next year. She has a lot of questions about how to go about this. I know what you're thinking: "have sex, duh—end of story." Not so fast. Unlike the gajillion of us who just plain ol' get pregnant, knocked up or caught by surprise in the family way, this reader is being very thoughtful about it. She wants to know what kind of vitamins she should take, when she should start trying if she wants to have her baby before the end of 2009, how often she and her husband should have sex and once she has a positive test, how long should she wait to see a doctor. Good questions, right? I like this reader. Her questions indicate she's a planner who wants to do the best she can. Sounds like she'll make a good Mama.

OK, here goes: What kind of vitamins should she take? Her doctor told her any old women's vitamin is fine and she doesn't need prenatal vitamins yet. She mentioned One a Day Women's Formula as her current brand. That's a good choice but many other brands (including generics) are just as good. In addition to all the nutrients your body needs normally, you want to make sure to take 400 mg of Folic Acid when you're trying to get pregnant and 600 mg once you are pregnant. Folic Acid helps prevent neural tube defects like spina bifida, the number one disabling birth defect in the US. It's not very common; only occurring in 7 out of 10,000 (.07%) pregnancies. Spina bifida and other neural tube defects occur when the spine fails to close during the first months of pregnancy. Babies born with spina bifida have incomplete development of the spinal cord or its coverings. While some babies born with this disorder have no outward signs/symptoms and minimal if any disability, others have extensive problems and require lots of medical care. It turns out that taking folic acid pre-pregnancy (400 mg) decreases incidence of spina bifida by 70%.

When should she start trying and how often should they have sex if she wants that baby in 2009? Since only 25% of women get pregnant the first month they start trying and somewhere around 60% get pregnant within 6 months; I'd say get going as soon as you feel ready. Start having sex every other day starting with the day your period is over. The most likely time for ovulation (when you pop out an egg that's ready to be fertilized by sperm) is around day 14 (more or less depending on your cycle). If you have sex more often than that, your husband may not have time to build up a burly sperm count. Less often and you might miss your window of opportunity if you happen to squirt out an egg early.

Once you've hit your target (or, er, your husband has) and you've got a positive pregnancy test, give your doctor a call and make an appointment. Some doctors want to get you in for a meet-and-greet, informative appointment within the first month but may not do a pelvic exam and lab tests until you're closer to 8 or 10 weeks. It varies with doctor preferences but some offices are busier than others. You'll have a better chance of getting an appointment with the doctor of your choice if you call early.

On the opposite end of the pregnancy spectrum, another reader (again, no name) said she'd gotten her tubes tied 11 years ago but now her doctor says there's a hole in the stitches. He wants to go back in for a re-do so she won't get pregnant. Our reader doesn't want another surgery but is understandably worried. Her question is, could she get pregnant? Well, honey, heck if I know. Anything's possible. We get patients in labor who've had their tubes tied; their husband's have had vasectomies and still they end up pregnant with triplets. The only 100% sure-fire way to not get pregnant is to not have sex. I know that's not very reassuring but what can I say? Once in a while we get patients who swear they've never had sex at all, even when the proof is staring them in the face. If you don't want to have another surgery but want more protection, talk to your doctor about other contraceptive options.

So readers, good luck getting pregnant. Or not. Whichever. I'll be rooting for you.

