High HCG Levels in Early Pregnancy

High HCG levels in early pregnancy can indicate several different factors. Everything from a miscalculation of pregnancy dating, you’re expecting twins, to even Down’s syndrome in the fetus. But before you begin worrying about your HCG levels, it is important to understand what exactly they are and how it factors into your pregnancy.
HCG levels are what the basic home pregnancy tests test for. The HCG levels can first be noticed by taking a urine test about two weeks after conception. The HCG hormone is measured in milli-international units per milliliter (mIU/ml).

HCG stands for the hormone human chorionic gonadotropin, which is produced during pregnancy. The HCG hormone is sent into your blood stream soon after the baby implants into the lining of your uterus, about eight to twelve days after conception. HCG is made by cells which form the placenta.
Usually, HCG levels will double every 48 to 72 hours, until they reach their peak during your first eight to eleven weeks of pregnancy. Afterwards, the HCG levels will decline and level off.
Normal HCG levels vary widely between different women and in different pregnancies for the same individual. Consequently, you should not be paranoid about trying to figure out what your HCG levels exactly are. What you should be watching is how much your levels are rising every couple to three days. This is what doctors are mainly concerned about, and what could signify any abnormalities in your pregnancy.

High increases in HCG levels could mean several things, including molar pregnancy, choriocarcinoma of the uterus, ectopic pregnancy, twins (or more), Down’s syndrome of the fetus, or simply a miscalculation of when your pregnancy started. A molar pregnancy is an abnormality of the placenta, caused by a problem when the egg and sperm join together at fertilization. Molar pregnancies rarely involve a developing embryo.

Choriocarcinoma of the uterus is a malignant variant of molar pregnancy which metastasizes early by the blood route and is treated by chemotherapy.

An ectopic pregnancy is a condition where the embryo grows outside the uterus. Usually this is noticeable by HCG level testing your HCG levels have been high but they do not double from your last take level.

Physical Recovery After an Abortion

Physical Recovery After an Abortion

These instructions are for recovery after a surgical abortion. Most of them apply to a chemical (medical) abortion as well. Okay, so you've just had an abortion? What physical warning signs should you look for? What can you do, to take care of yourself afterwards as you recover? What about fertility? How soon could you possibly get pregnant again?
On taking care of yourself - Basic things you can do:

• Drink lots of fluids
• Stay off work for a few days if you can
• Take vitamins, eat healthy food, and try to sleep
• Take the antibiotics prescribed by your doctor right away, and for the full amount of days prescribed!
• No exercise for two weeks
• No swimming or tub baths for 2 weeks
• Don't lift anything over 15 pounds for two weeks, don't use ANYTHING vaginally for 2-4 weeks - no sex, no tampons, no douches.
• You can ovulate as soon as two weeks after an abortion, which means yes, you could get pregnant again within two weeks after an abortion!
• After the 2-4 weeks is over, you should NOT have sex again unless you feel physically recovered, and have discussed with your partner what you want to do if an unplanned pregnancy occurs again. Do NOT let yourself be pressured into having sex again before you are physically and emotionally ready, and have had a serious discussion about the course of action for future unplanned pregnancies. You can get pregnant as soon as two weeks after an abortion! Your body normally will go back to it's regular cycle, and release an egg (ovulation) at 2 weeks post-ab. So once you decide you are ready to resume sexual intercourse again, make sure you are using birth control right away. As many of us know, birth control is NOT 100% effective. So it's very important that you don't have sex again until you are healed physically and emotionally, and you have a clear consensus on what will happen if you become unexpectedly pregnant again.
• For women who had an abortion for maternal health reasons, or for a poor prenatal diagnosis, consult your doctor about birth control and future pregnancies.
• If you were 9 or more weeks along in the pregnancy, it is possible that you may have trouble with milk, or a milky fluid leaking from your breasts after the abortion. The further along you were, the higher the chance of having your 'milk come in'. This can be upsetting, but it won't last for long. It's a normal effect of the hormones that your body releases when you are no longer pregnant. These hormones make your body start to produce milk, whenever a pregnancy is ended. Your breasts may feel sore, tight, swollen, and will leak out droplets of clear to whitish fluid. At times the milk may 'let down', and a substantial amount of liquid may come out. To help with this stage, wear a well-fitting/snug bra, and try avoid stimulation of your breasts or nipples. Wear the bra 24 hours a day until your milk dries up. It can take one to four weeks for the milk to dry up. It will not be as painful as it originally feels when the milk first comes in - as the milk is not 'used' the pressure on the milk ducts will cause the milk to 'dry up'. Keep wearing that snug-fitting bra, and take tylenol for the soreness, and this will subside. If you develop a fever, or extreme tenderness in either of your breasts, consult a doctor - there is also a condition where your milk glands can get infected, and this will need to be treated with antibiotics. (This is a rare complication).

What are the risks of an abortion?

An abortion is a surgical procedure, and, like all surgical procedures, it has risks. The most common risk of abortion is infection. Most doctors prescribe antibiotics before and after the abortion to lower the risk of infection.

There is always a small chance that some of the pregnancy tissue will be left behind after the abortion. If that happens, an infection can develop. If the person who had an abortion gets a fever or belly pain, she should see her health professional right away to be sure that she doesn't have an infection. If she does have one, an ultrasound will be done to check for any tissue that may have been left behind. If a lot of tissue was left behind, she may have to have another procedure.

If she gets an infection, the doctor will give her antibiotics to cure it. If she has a very serious infection, she may need to go to the hospital for a few days to receive antibiotics through an IV.

During an abortion, there is always a chance that the doctor could poke a hole in the wall of the uterus with the instruments. This isn't common, but it can happen. If it does happen, the doctor will want to keep a close watch on the person who had the abortion for signs of internal bleeding. If there is any chance of internal bleeding or that nearby organs (such as the bladder or intestine) were injured, the person may need surgery to repair the injury.

Who can I talk to if I decide to get an abortion?

Getting an abortion is a big life decision. If you are thinking about having an abortion, you will benefit from talking to someone about it. A trained medical counselor is a good person to hear your concerns and thoughts. Some girls and women feel very sad after having an abortion and really need a supportive adult to help them sort out their feelings. A doctor or another health professional can recommend a counselor to help you deal emotionally with the decision.

What is an abortion?

An abortion is a way to end a pregnancy because a girl or woman doesn't want to have a baby. There are a few different ways to do an abortion, depending on how far along the pregnancy is.

Medical Abortion

Medical Abortion What is it?
A medical abortion uses drugs to empty the contents of the uterus. Medical abortions can be done only early in pregnancy. There are two drug combinations used to cause abortions:

1. methotrexate and misoprostol
2. mifepristone (RU 486) and misoprostol

Only the first combination is currently available in Canada. The second combination mifepristone (RU 486) and misoprostol is not currently approved for sale in Canada.

Methotrexate is a drug used to treat psoriasis, and cancer. It also stops the growth of the pregnancy when given to a woman very early in pregnancy. Methotrexate is usually given by injection.

Misoprostol is a drug used to treat stomach ulcers. It causes the muscles of the uterus to contract, pushing out the contents. Tablets of misoprostol are placed in the vagina five to seven days after the methotrexate injection is given. In most cases the uterus will be emptied within 24 hours, but in about 35 percent of cases, it can take several days or weeks. Pain medication is used to ease the pain of the cramps, which occur when the pregnancy tissue comes out of the uterus.

The drugs that induce medical abortions cause birth defects. A woman who takes these drugs must be prepared to have a surgical abortion if the medical abortion is unsuccessful. A follow-up exam is done one or two weeks after the methotrexate injection to make sure that the abortion has happened.

When is the procedure done?
Most places will only do a medical abortion using methotrexate and misoprostol up to seven weeks or six weeks and six days by ultrasound. Where the mifepristone and misoprostol combination is available, it may be used slightly longer, up to nine weeks after your last period.

Advantages

• avoids surgery and the risk of damage to the uterus with surgical instruments

• can be done early before signs of pregnancy occur

• may feel less invasive than surgery

• may seem more private to some women since much of the procedure can occur at home

Disadvantages

• takes place over a week or more and involves several visits to the doctor

• ten percent risk that the procedure will be incomplete and a surgical abortion will need to be done

• sometimes causes heavy bleeding

• the drugs may have unpleasant side effects including nausea, diarrhea, abdominal cramping or pain, vomiting, hot flashes

Vaginal discharge - when the fertile days?

The menstrual cycle a woman is accompanied by other measures entering a vaginal discharge.

Menstruation is a woman accompanied by various physical symptoms - including a vaginal discharge. This vaginal discharge is normal and allows the woman in detail, careful observation even deduce their fertile days. In the days around ovulation, which is roughly in the chronological middle of the cycle, so far the clear, inconspicuous outflow stronger and changed its color and consistency to the onset of menstruation in a creamy white. What amount of mucus in a woman finds her panty liner or perceives is different from organism to organism.

Cervical mucus does not smell, reminiscent of egg white
The most important part of the cycle-related discharge of cervical mucus is the so-called cervical mucus. It gives women a reference to the fertile days. During the fertile period, the cervical mucus and liquid flows down to the vagina, a phenomenon that is used by some women even clearly perceived. The cervical mucus is reminiscent of consistency of egg whites and pulls strings, he also feels oily and slippery.
The cervical mucus is not accompanied by itching and burning and smells normal.

Sperm-cervical mucus need to survive
In the first days of menstrual bleeding is not yet drawn cervical mucus - the possibility of becoming pregnant is so extremely low, because the sperm need mucus to survive. Since the cervical mucus consistency and its optimal quantity but a few days before ovulation begins to build, is already the possibility of becoming pregnant. For several days in the cervical mucus sperm are viable and can wait for such a protected entry point.

If symptoms smelly discharge necessarily Doctors
Separates the vagina from a lot of unusual vaginal discharge, this can be annoying and uncomfortable for the woman, but need not necessarily mean that a disease is present.

It may be the cause of the increased discharge and irritation to the vaginal environment - caused by too much about personal hygiene, stress or too sugary diet. include a treatment with vaginal suppositories, the lactic acid bacteria, the vaginal environment can move back into balance. Does the discharge but associated with burning, itching and odor or has a greenish, brownish or red color, a gynecologist should be sought, since a strong suspicion of parasites, a fungal infection, bacterial infection or a sexually transmitted disease exists.

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Basal body temperature measuring method explained practically

A method to calculate the fertile days, which is so simple that it can be easily used by every woman at home, is the basal body temperature measurement method. It is used for natural family planning (and is not one hundred percent reliable), but may also wish to baby-planning can be used.

Under "basal" refers to the body temperature without physical stress, ie Sleep.
In the cycle of a woman has the typical basal body temperature fluctuations. From the end of menstruation until ovulation, the temperature is low, it falls back to ovulate again. After ovulation the basal body temperature rises, however, by up to 0.5 degree. Until the onset of the rules remains high temperature.
Through daily measurement of body temperature close to the time of ovulation. So you can see the optimum conception date.
Basal body temperature curve

The curve shows the course of a cycle from the first day without any bleeding until the end of the rule. Clearly visible is the temperature drop a few days ago and the rose-for ovulation.


How do I measure the basal body temperature?

writing for the recording of basal body temperature need something within reach on your nightstand, and a thermometer. To measure normal fever thermometers are unsuitable. Instead, you take a digital thermometer that displays two decimal places. Everything else is too vague.

You start a measurement cycle on the first Menstruationstag.

The measurement must be made after a long resting phase, at least five hours of sleep. Therefore, you measure the best in the morning, around the same time, the same body part and on as the same way (easiest oral) and still in bed, before you start your day, even before you speak. Every effort before getting up would distort the result.
The best thing is, you put your alarm clock so that you can measure your temperature at the same time.

The temperature reading is then recorded and entered as a point in a table. The individual items you are connecting with each other. Forget about you once a measurement, a gap remains in the table. The table also features should be noted about the use of alcohol, illness or taking medication. This can distort the temperature. Wear too, if you had sex with your partner.

The temperature chart evaluate
The analysis of the monthly table takes practice, as the temperature line, either before, during, or after ovulation proceeds evenly. Rather, it formed a zigzag pattern. This increases abruptly by up to 0.5 degrees and remains high for several days, ovulation has occurred. This higher temperature level is maintained until the onset of the new cycle. The day of ovulation is approximately 14 days prior to expected start of menstruation.

Since sperm are viable for up to three days, the fertile period begins four days before the temperature rise and ends two days later. Then the infertile period.

For many women - not all - the temperature drops during ovulation and lowest on the eve of a high temperature increases their level. If you notice a sudden drop to about 0.10 or 0.15 level, you should have safe transport. For you and your partner does the temperature drop, that you now have the best chance of conception.

The daily temperature variations are low and to evaluate properly the temperature table, must first help your doctor if necessary. It takes a little practice. The more regular your cycle is, the clearer it will emerge but a monthly recurring pattern. After two or three rounds can be distinguished from infertile phases and fertile well - important for the baby planning forecasts as well.

Condom

The condom is one of the mechanical contraceptives, which form a barrier to sperm, thus avoiding that they can reach a viable egg. Other well-known name for the condom are Präserativ, condoms or even rubber.
The designation as a rubber fits well with the material from which this contraceptive method is established. It is to thin rubber or latex.

The most important characteristics of a condom are that it is tear resistant and impermeable. These quality characteristics are reviewed regularly by the manufacturers of condoms.

The use of a condom is pretty simple, but requires some finesse. Already open the container caution should be exercised so that the condom is not damaged by a fingernail or a ring. be withdrawn before putting the condom on the rigid link, the foreskin, if the man is not already circumcised.

Bear in mind is that the front protrudes a small tip, which serves to hold the semen. This is once compressed, so that any air can escape from the condom.

After that the condoms will be unrolled, which is used at best the whole hand. If the condom is unrolled so that the rubber ring almost disappears in the pubic hair and it sits tight, no sperm come out of him, so that it is meeting its prevention function.

Caution is however necessary for the ejaculation. Since the limb relaxed after orgasm, and thus the safe seat of the condom is not guaranteed, it must be drawn very quickly from its sheath. This has the ring of Präserativs be recorded so that it is not stripped off in the vagina and no semen discharged into it.

Abortion During Pregnancy

How to Get Pregnant

Pregnancy is a memorable event in the life of every woman. It is during this event when a baby grows within her; a human being which needs her utmost care and attention. However, there are some women who are unfortunate enough to have abortion.

By definition, abortion is the termination of pregnancy by the removal or expulsion from the uterus of a fetus or embryo, resulting in its death. It can occur due to complications in pregnancy. Abortions results in 70,000 deaths and 5 million disabilities every year.

There are many causes of abortion. The causes are multitude and range from chromosomal abnormalities which are found in more than half of embryos miscarried in the first 13 weeks. A pregnancy with a genetic problem has a 95% probability of ending in miscarriage. Most chromosomal problems happen by chance, have nothing to do with the parents, and are unlikely to recur.

Another cause of abortion may be progesterone deficiency. In the second trimester, 15% of pregnancy losses may be due to uterine malformation, growths in the uterus or fibroids, or cervical problems. These conditions may also contribute to premature birth. Problems with the umbilical cord and placental problems may also be possible causes.

Whatever the causes are, it is best to avoid abortion during pregnancy as much as possible. But how are we going to go about it?

How to avoid abortion during pregnancy

You have a danger for abortion if you have had a miscarriage in the past or if the doctor claims you are in a high risk pregnancy. If you belong to these high risk groups, it is best to take precautions and follow these tips for better living.

First you should eat healthy. You should follow a diet that limits fat intake and makes you take in a lot of fruits and vegetables. You have to follow a diet plan that makes you eat the right number of calories and makes you get enough nutrients and needed supplementation.

Next is to drink lots of water. You should hydrate more often so that you will have plenty of amniotic fluid which serves as a cushion for your baby. A lack of amniotic fluid, termed as oligohydramnios, is detrimental to your baby and may even result to fetal death. You should replace sugary or caffeine beverages with several glasses of water each day. Occasional tea or coffee is acceptable with your doctor's consent, but don't overdo it. Avoid alcoholic beverages.

If you are being prescribed with multivitamins or any other medication as advised by your medical doctor, you should take it. Don't stop taking these medications because you may compromise your child's health.

Next, you should follow what your doctor says. You should rest well, avoid caffeine and tobacco and report any untoward signs and symptoms to your doctor. This makes you avoid all complications brought about by pregnancy as much as possible.

Next is that you should exercise in moderation. Your exercise should consist of a walking routine of 30 to 40 minutes a day in safe conditions may be beneficial if your doctor approves. Twenty minutes of daily fresh air, without tanning or sunburn, is good for you, too, preferably in the morning or evening.

Avoid stress and worries. Sleep well and rest well. Be aware of the changes in your body and welcome them freely. Do not hate being pregnant. It will soon pass, so enjoy the moment.

Ovulation symptoms

Once you start paying attention to your body, it's amazing how many hints it delivers about the various stages in your cycle - and ovulation symptoms are often quite noticeable and easy to detect once you know what to look for.

Don't forget that any form of birth control using synthetic hormones (such as birth control pills, implants or injections) will suppress normal ovulation symptoms and other indications of the different stages in your menstrual cycle.

Ovulation symptoms can be quite subtle. They involve your body's normal response to the natural changes in hormones that occur at different stages of the ovulation cycle.

These symptoms often precede ovulation and give you some really good hints that you are in your most fertile period, the four or five days in the lead-up to ovulation.

Some common ovulation symptoms are:

• increased libido (sexual desire)
• change in cervical mucus
• change in the position and firmness of cervix
• tender breasts
• heightened senses of smell and taste
• abdominal cramps (Mittelschmerz)
• rise in basal body temperature
  

Ovulation symptom: increased libido or sexual desire

Many women won't be surprised by this ovulation symptom - and it certainly makes good sense biologically.

The increase in certain hormones in the lead-up to ovulation often trigger higher-than-usual levels of sexual desire in women.

The hormones thought to affect desire in women at this time are oestrogen, testosterone and luteinising hormone.

If you're planning to fall pregnant, this pre-ovulation symptom of increased female libido is good news, because you're more likely to fall pregnant if you have sex as often as possible in the four to five days leading up to ovulation.

There are many anecdotal reports from women who believe that they look more sexually attractive in the lead-up to ovulation too; oestrogen can deliver plenty of side-effects that may contribute to this, including the inhibition of production of oil in the skin, which reduces the incidence of pimples.

And at least one study backs this up; a 2006 UCLA study found that women pay more attention to their appearance, grooming and dressing just prior to ovulation than at other times in their cycle.

Ovulation symptom: change in cervical mucus

The change in cervical mucus that occurs just prior to ovulation is one of the most consistent and reliable of ovulation symptoms in most women.

The volume of cervical mucus starts to increase as ovulation draws closer. Shortly after menstruation, cervical mucus may be sparse, but it will slowly increase in volume as the days progress. At first, it will usually have a slightly sticky consistency and be a white or cloudy colour.

In the days just before ovulation, the rise in oestrogen causes more cervical mucus to be produced. The mucus at this time is usually fairly clear and the texture becomes more slippery and stretchy - it is often compared to raw egg-white in colour and consistency.

The cervical mucus produced in the period before and during ovulation is designed to allow sperm to move freely through the cervix and into the fallopian tubes and to enable its survival until the release of the egg.

Ovulation symptom: a change in the position and firmness of the cervix

To spot this sign, you need to be familiar with the usual 'feel' of your cervix.

Proponents of this method suggest that you check your cervix once a day at around the same time. The cervix is usually smooth and round and slightly firmer than the vagina and is found at the top of the vagina. It is best checked with one or two clean fingers, while in a squatting position

When the time of ovulation approaches, the cervix will become higher (so is therefore more difficult to reach) and generally feels softer and more open.

Many women don't feel comfortable with assessing the state of their own cervix, so this is an ovulation symptom that is not commonly self-assessed.

Ovulation symptom: tender breasts

Only some women experience this ovulation symptom, and it's generally thought to be a side-effect of high oestrogen levels. Women who experience breast tenderness will usually find it occurs in a similar way each month.

The effects of the oestrogen diminish significantly after ovulation however they may recur in the lead-up to menstruation.

If you suffer from breast tenderness mid-cycle, it's worth taking note of this as an ovulation symptom, noting when it occurs and to what extent, so that you can use it in conjunction with a range of other ovulation symptoms to help you recognise your most fertile period.

Ovulation symptom: heightened senses of smell and taste

Some women report that they have a more intense experience of various smells and tastes at the time of ovulation.

Once again, this is an ovulation symptom commonly associated with raised levels of oestrogen.

When the egg has been released at the time of ovulation and oestrogen levels drop, this symptom generally fades.

Ovulation symptom: abdominal cramps (Mittelschmerz)

An estimated twenty percent of women feel a mild cramp-like abdominal pain or twinge at the time of ovulation.

This ovulation symptom has the clinical name of Mittelschmerz, which is a German phrase meaning 'middle pain.'

The pain can last from a few minutes to a few hours and is more common in the right side of the lower abdomen, although some women report pain on both sides of the abdomen and other women report that the pain moves from side to side each month.

Several possible explanations for the ovulation symptoms of mittleschmerz include:

- the growth of follicles in the ovaries prior to ovulation
- the rupture of the ovarian wall that occurs each month at ovulation
- muscular contractions of the fallopian tube and the ovaries that occur after ovulation

Ovulation symptom: rise in basal body temperature

Immediately after ovulation, a rise in the body's level of progesterone generates the almost universal ovulation symptom of ovulation temperature.

At this time, most women will experience a rise in their resting body temperature of around 0.5 degrees Celsius, and their temperature will remain at that level for the rest of the month.

Basal body temperature is best measured first thing in the morning, before you get out of bed, using an accurate thermometer and recording your temperature on a chart each day.

Your Pregnancy

Take care of yourself during pregnancy. Tiredness seems to contribute to morning sickness. Try to get to bed early. Nap during the day if you can, and if you feel tired. Eat healthy food. Eating small amounts frequently can help with morning sickness. Ginger can help, as can dry crackers or toast before you get out of bed in the morning. The best thing is to remember that morning sickness is a good sign, of a healthy pregnancy. Often a pregnancy which miscarries did not have much morning sickness (as was the case with my miscarriage). In the two pregnancies I have had since then I have welcomed the discomfort of morning sickness! After about 12 weeks it usually eases, or goes away altogether, and you can enjoy being pregnant without too many discomforts for a while. Generally in the last 3 months you start to feel tired again and various other problems may arise (such as varicose veins, heartburn, high blood pressure, etc. Consult your midwife about any problems, pains, etc you may experience).

Make sure you are well informed about any decisions you need to make, during your pregnancy, during birth, and soon after the birth. There are several controversial issues, and it is your responsibility to look at both sides and decide which makes the most sense to you. This process is often confusing, because both sides are convinced that they are right, and have statistics to back up their claims. You must sift through the evidence and look for errors in logic, contradictions, and straight out lies. Ask older people whom you trust what they think. Wisdom comes with years and experience. Some examples would be: Ultrasounds and tests during pregnancy – are they really necessary, and how safe are they? Pain management during birth – what are the pro's and con's of each method, what do you feel comfortable about using, and what would you not consider? Vitamin K for your newborn – what are the risks in giving it, versus the risks of not giving it? Is it better to be injected or given orally? Will you choose to circumcise if you have a boy? What are both sides of the immunisation debate? What are the risks of both, are vaccines safe and effective, what are vaccines made of, does anyone stand to gain anything from your decision?

It is important to keep fit during pregnancy. Walking 20 minutes a least 4 times a week is good exercise. Swimming and Pilates are also very good exercise during pregnancy.

Maternity clothes are sized the same as you would normally wear. If you are a size 12 normally, you will be size 12 in maternity wear. Get a maternity bra as close to the end of your pregnancy as possible. You may find you need a larger size bra earlier during the pregnancy. Do not wear under wire bras during pregnancy. When you buy maternity bras (you should need 2 or 3), you can get a professional to fit one for you at a lingerie shop. They are usually cheaper, however, from a department store. If you fit one yourself make sure there is at least room for two fingers to fit sideways under the diagonal side over your chest. This where your breasts will enlarge when they fill up with milk. You can buy disposable breast pads or washable breast pads to wear inside your bra to absorb leaking milk. I use mens' handkerchiefs, which work just as well.

The advice nowadays seems to be not to prepare your nipples for breastfeeding. However, I tried not preparing them for my third baby, and did not spend much time with it for my seventh, and both times I had cracks and sore nipples. For my other pregnancies I did prepare my nipples. During the last month or six weeks I would massage Vitamin E (wheatgerm oil) into the nipples and areola daily. I would also massage them between my finger and thumb often during the day to help prepare them for feeding. If you can get sun on them (without burning!!) that is good – an alternative is to blow a warm hairdryer on them for 10 minutes or so every day. A baby's suck is incredibly strong and I believe soft, tender nipples need some warning. After each feed in the first week or two I massage a thick lanolin into the nipple and areola. The one I have used is called “Lansinoh”. It helps protect the nipple and repair damage, and I have found it extremely effective.

When you pack your hospital bag put in some vaseline jelly or bee balm. This is to smother baby's bottom with. It will make the sticky, dark meconium (baby's first bowel motions) clean off easily. Without it, meconium can be quite difficult to get off baby's skin.

Causes of infertility

The causes of infertility are many and varied. They are classified as either absolute or relative. Absolute causes of infertility will, in the absence of treatment, totally prevent pregnancy. Relative causes reduce the chance of pregnancy but do not necessarily prevent it all together. An analogy is that absolute causes are like turning the pregnancy switch off and relative causes are similar to turning the dial down.

Over the last thirty years the impact of changing attitudes towards pregnancy, childbirth, work and family commitments has electively lead to a marked increase in the age of first pregnancy. As a result of these changes in western societies there is no doubt that increasing female age has become the single most important influence on a couples chance of achieving a pregnancy. For most couples it is a more important influence on the chance of successful pregnancy than any specific cause and it is becoming a more and more common problem as couples decide to start families later in life.

Among the specific causes of infertility there are however only four absolute causes of infertility that without treatment totally prevent pregnancy. They are:

• No sperm

• No eggs

• Blockage preventing egg and sperm meeting

• Prevention of embryo implantation

Often however a series of relative causes multiply together to reduce the chance of pregnancy by such an amount the realistic impact on couples is as severe as if they had an absolute cause.


Female factors

There are several main areas where fertility can be jeopardized in the female: the ovaries, the fallopian tubes, the uterus, and the hormones affecting these.

There will be a decrease in fertility if:

• ovulation is irregular or absent – this can be corrected with hormone treatment in most cases
• there is an obstruction between the vagina and the ovary, preventing the sperm and egg from meeting. These usually occur in the fallopian tubes, and it was for this condition that in vitro fertilization (IVF) was originally developed. Obstructions can often be treated surgically, but generally success rates are better with IVF
  
• there is an abnormality of the uterus, such as polyps or fibroids (obstructions can often be treated surgically, but can return) which impairs embryo implantation into the lining of the uterus
• endometriosis which is a common condition where tissue like the lining of the uterus grows outside the uterus, hampering a number of events leading to a pregnancy
  

Male factors

Male fertility seems less complicated than female fertility simply because the male is responsible for fewer stages in the process of creating a baby. Essentially, male fertility comes down to sperm.

There will be a decrease in fertility if the sperm are:

• not being produced in adequate numbers (or at all)
• being produced, but facing an obstruction that prevents them from reaching the outside world
• being produced, but not swimming very well
• stimulating antibody production in either partner by causing an allergic reaction.
  

Some of these problems can be treated surgically, but in most cases IVF is the best option.


Unexplained infertility

The cause of infertility is not always obvious. In many cases, both partners can appear to be fine, but they can’t seem to get pregnant. This is known as unexplained infertility. Having no identifiable cause does not mean that there is no available treatment. Indeed the prospect of spontaneous pregnancy is often higher than for those couples with a specific cause. Indeed IVF is highly effective for couples with female age under 40 years who have unexplained infertility.

NATURAL METHODS

There are four methods of natural birth control (also called fertility awareness) that are practiced. These methods may be used to either prevent or plan a pregnancy:

* Basal temperature method
* Cervical mucus monitoring (Billings) method
* Rhythm method
* Sympto-thermal method

The effectiveness of the above methods is approximately 80%. The degree of effectiveness may be higher or lower, and is highly dependent on the commitment level of the couple to practice the specific regimen.

Advantages
* Natural methods provide an effective means of contraception for women who are concerned about the risks associated with artificial birth control. By learning about your cycles, you can become more aware of the events that occur naturally in a woman's body. Natural methods can, in combination with other methods (example: barrier, IUD), offer a high degree of effectiveness and therefore reduce one's risk of becoming pregnant.
* There are also religious factors that play a role in women choosing a natural method as opposed to an artificial one, and these factors can aid in one's comfort level when it comes to dealing with an unplanned pregnancy.

Disadvantages
* Use of natural methods offers no protection from sexually transmitted diseases or infections.
* Both partners need to commit some time in order to learn the methods properly. Cooperation, compliance and patience are also a must for any couples considering these methods.
* Abstinence from intercourse during fertile periods may be very frustrating.
* Professional guidance is required in order to learn how to use these methods successfully, and therefore the couple needs to have an established comfort level with their health care provider.
* These methods are not suggested for women with irregular or unpredictable menstrual periods or for women who have persistent or frequent vaginal or cervical infections.
* If you have frequent illnesses, or you are unable to keep records, these methods might not be the right choice for you.


Basal Body Temperature Method
A basal thermometer is used to take an early morning temperature each day, prior to rising. The temperature is charted on a graph. A rise in basal body temperature by one degree indicates ovulation has occurred. Abstinence from intercourse must be from the start of the menstrual period until three days following the rise in basal body temperature.

Cervical Mucus Monitoring (Billings) Method
The amounts and consistency of cervical mucus changes throughout the fertility cycle. Observing these changes in vaginal/cervical mucus may help to determine the peak fertile days of your cycle. Mucus will become increasingly wet and slippery, leading up to ovulation. It will be clearer and stretchy, similar to egg whites. This type of mucus is produced by our bodies to enhance sperm mobility through the cervix, into the uterus and towards the egg. The dryer, thicker, stickier mucus is prevalent during non-fertile days, inhibiting the mobility of sperm through the cervix. Abstinence from intercourse must be up to four days following the peak of fertile mucus being observed.

Rhythm (Calendar) Method
Careful plotting of your menstrual period can give you an idea of your fertile days. An average menstrual cycle is twenty-eight days long. Ovulation occurs approximately fourteen days before the start of your next menstrual period, plus or minus one to two days. Day one of your menstrual cycle is the day that you begin your period. A day of light spotting is also considered day one. As sperm will live for upwards of five to seven days inside a woman's body, a pregnancy can arise from intercourse that occurs seven days prior to ovulation. The egg lives for up to twenty-four hours once released. This means that intercourse must not occur for the seven days prior to ovulation, as well as for the twenty-four hours past ovulation.

Sympto-Thermal Method
This is a combination of the Billings method and the Basal Body Temperature method. As temperature and mucus changes are noted on the chart, fertile days are easier to predict, as peaks and valleys are readily noticed on the graft.

Improve your chances for embryo implantation

Here are the factors that affect embryo implantation:

1. oocyte (egg) quality
Implantation is more likely to occur when a healthy embryo is present, and the best predictor for a healthy embryo is a healthy egg. Egg quality comes from a number of factors.

2. sperm quality
We now know that paternally imprinted DNA is disproportionately expressed in developing placental tissue. In other words, sperm quality matters a lot when it comes to implantation. For a successful pregnancy, sperm should have stable, well balanced DNA.

What you can do:
There are many ways that sperm quality can be maximized. Antioxidant vitamins are a popular intervention.

3. Embryo quality
Embryo quality is a reflection of both egg and sperm.
If you are doing an IVF cycle, embryo quality can be determined by grading systems. The embryos most likely to continue to develop will have 6, 7, or 8 cells by day 3 of development in the lab.

If you are considering a frozen embryo transfer (FET), embryo quality is also a reflection on the laboratory’s freezing-and-thawing success rates. In general, FET cycles have a pregnancy rate of one-quarter to one-half that of fresh cycles, but the rates vary by clinic. Embryos may be frozen with the traditional slow-freeze protocols, or with the new, flash-freeze vitrification methods. There is still some debate as to which is better.

What you can do:
Maximize egg and sperm quality before you start treatments.
Consider a repeat fresh IVF cycle instead of multiple frozen cycles.

4. The number of embryos transferred
There are some suggestions that embryos help each other to implant. In other words, the more embryos that you transfer, the greater the chance that each one will stick

What you can do
Be very careful with this one. The movement in our field is away from multiple-embryo-transfer, not towards it, because the risks associated with multiple pregnancy are very real. Some clinics even advocate for elective single embryo transfer.

But if there are other impediments to implantation -say, embryo quality is a known concern- then our standard of care is to transfer multiple embryos in the hope that one will take.

5. The woman’s overall health
Tests commonly ordered as part of the overall health screen include thyroid function and prolactin levels.

Depending on your situation and family history, you may also be screened for other systemic diseases that can affect implantation. For example, we might look to rule out diabetes, autoimmune conditions such as elevated Natural Killer cells, a pre-disposition to hypercoagulability, markers for celiac disease….and many more.
If you and your immediate family are otherwise healthy, many of these tests are not routinely offered.

What you can do:
Eat well, exercise moderately, don’t smoke, and continue seeing your family doctor for annual checkups even when under active fertility care.

If you have or suspect a specific medical condition, ask your doctor if further testing is warranted.

6. Shape of the uterus and fallopian tubes
Some women have an anterverted uterus, some women have a retroverted uterus. Both are fine: the terms simply refer to which direction your uterus tips. Of more importance, we need to confirm that the uterine cavity is a normal size and shape for implantation to be successful.

To confirm the structure of your uterine cavity, the gold standard of imaging is a 3-dimensional sonohysterogram. Hysteroscopy (surgery) may also be suggested when necessary. Indications for hysteroscopy include fundal polyps, impinging or submucosal fibroids, and/or a uterine septum extends 10mm or more.

The shape of your fallopian tubes should be confirmed by ultrasound, a hysterosalpingram, or (less often) surgery. I also screen for chlamydial antibodies, as a history of this infection can affect tubes. We know that dilated tubes (”hydrosalpinges”) may compromise implantation, and we sometimes suggest that they be surgically removed before IVF.

What you can do:
Make sure that you have had all the imaging tests available to you updated before starting your treatments.
If your doctor suggests uterine surgery, a second opinion may be warranted. But don’t be too hesitant: the surgery is often a day procedure, and the benefits can be profound.

7. Lining of the uterus
We look at the uterine lining itself, to judge whether or not implantation may be expected. The endometrial lining can be assessed in the following ways:

Appearance on transvaginal ultrasound
An ideal lining will be at least 7mm thick on day of ovulation trigger (HCG).
Ideally, it will also have a “triple line” appearance (an ultrasound finding that denotes a good response to estrogen).
After ovulation, the endometrium compresses somewhat, and the triple-line pattern will be less distinct. These are normal findings.
Luteal endometrial biopsy
An endometrial biopsy is not part of every cycle, but it may be done in the luteal phase of a cycle before IVF, in an effort to confirm that the implantation window exists.

This “window” describes the idea that the lining itself is only receptive to embryo implantation for a short period of time. Various markers for this implantation window have been identified, including histologic appearance & grading, specific findings seen only by electron microscopy, and the staining for various markers that are thought to be associated with implantation.

Probably the best tests for the markers of implantation are being run by Dr Harvey Kliman, associated with Yale. He calls his set of tests the “Endometrial Function Test (EFT)”. I offer the EFT through my office in partnership with Dr Kliman.

But even the EFT is less than ideal. We simply do not know what all the markers are for implantation. This causes great frustration for patients and clinicians alike, for sometimes we suspect a small, or even absent, implantation window yet cannot prove it. In the end, the EFT alone cannot predict implantation failure or success with 100% certainty.

What you can do:

When endometrial thickness is concerning low (the lining is never more than 6mm thick), you should talk to your fertility doctor, for management is highly individualized. Many authorities recommend a BMI of >18.5; a healthy lifestyle that involves no smoking and limited caffeine; and ask that you consider red meat to be part of your diet. Supplemental estrogen is regularly used and acupuncture may also be suggested. But as I said: you should really speak with your doctor.

If you have irregular cycles and a tendency towards a thick lining (>12mm), you might benefit from an endometrial biopsy to rule out hyperplasia.

Even if the EFT is limited, the very act of getting an endometrial biopsy may help with implantion. The proper studies have not yet been done to support this statement, but many smaller ones suggest that implantation may be boosted by as much as 20% in some cases. For more, see this Globe & Mail article.

8. Embryo transfer technique during IVF
In an IVF cycle, embryo(s) selected for transfer will be collected into about 0.020cc of fluid and inserted into the womb. The process of insertion is highly physician dependent: this means that it matters who does your embryo transfer. The following issues will be considered by your doctor:

(a) Transfer medications like progesterone, antibiotics, and steroids.
(b) Cervical preparation
(c) Use of a tenaculum
(d) Catheter type
(e) Ultrasound guidance
(f) Post transfer instructions

What you can do:

Work with a doctor, and a clinic that you trust implicitly. Embryo transfer is very important. Some physicians suggest a mock transfer prior to the IVF cycle itself. It has been my experience that the uterus is lying in a slightly different position every time. In other words, the mock transfer did not help as much as I would have hoped for. I now judge the value of a mock transfer on a case-by-base basis.

9. Luteal Support
We support the luteal (post ovulatory) uterine lining with progesterone whenever we are worried about natural progesterone levels. Progesterone may be taken orally, intramuscularly, vaginally, or rectally.

Other medications that you may read about for the luteal phase, and into early pregnancy, include estrogen, ASA, dexamethasone, Fragmin, Lovenox, IVIG, HCG, and others. We are very cautious here: some of these medications have side effects that, in some circumstances, could be of real concern to you 0r your baby.

What you can do:

Talk to your doctor. The medications that you take in the luteal phase, and into pregnancy, must be compatible with bringing a healthy child into this world. That said, the ideal balance will keep your endometrial lining stable. If you find that you consistently have your period before the planned pregnancy test day, your luteal support may need to be re-examined.

10. Lifestyle
You need to minimize caffeine, quit smoking, and avoid alcohol. Intercourse during the “two week wait”? I believe it to be fine, but I would ask your doctor, as everyone has a different opinion on this subject.

Conclusions

To be successful, your clinic must focus on implantation. Many protocols and techniques are well standardized across fertility clinics, but implantation standards are not. Consequently, there remain great differences in implantation rates between clinics, and between doctors.

Abortion Physical Side Effects

The physical side effects after an abortion will vary from woman to woman. It is important to talk with your Ob/Gyn as well as the doctor who preformed your abortion about possible side effects. Your period should return about 4-6 weeks after the abortion and you can get pregnant again soon after the abortion. If your doctor has prescribed antibiotics, it is important to take them as directed as this will help prevent infection. Call the Helpline toll-free at 1-866-942-6466 with question about abortion.

After an abortion, you may experience the following side effects for up to two weeks:

• Abdominal pain and cramping
• Nausea
• Vomiting
• Diarrhea
• Spotting and Bleeding

Call your doctor and seek medical attention immediately if your side effects become severe or if you experience any of the following:

• Severe abdominal and back pain that prohibits you from standing up
• Bleeding that is heavier than a normal menstrual period
• Foul-smelling discharge
• Fever above 100.4 F