REPOST: Pregnancy nausea drug won't harm fetus, study finds

A new study on the effects of a nausea drug to pregnant women has been released in Denmark. Marilynn Marchione shares the details in this NBCNews.com article.

There's reassuring news for pregnant women miserable with morning sickness: A very large study in Denmark finds no evidence that using a popular anti-nausea drug will harm their babies. 

One in 10 pregnant women has nausea and vomiting bad enough to need medicine but many forgo it out of fear of side effects. No drugs are currently approved for morning sickness in the United States although doctors are free to prescribe whatever they believe is best.

Zofran, sold by GlaxoSmithKline and in generic form for treating nausea from cancer treatments and other causes, has been the top choice. Yet women and doctors have been leery of it because a small study previously suggested it might raise the risk of a birth defect — cleft palate.

The new study of more than 600,000 pregnancies in Denmark found no evidence of major birth-related problems, so women should not be afraid to use Zofran if they need it, said Dr. Iffath Hoskins, a high-risk pregnancy specialist at NYU Langone Medical Center and a spokeswoman for the American College of Obstetricians and Gynecologists.

"It's effective and it's safe," she said. "Nobody is giving you a gold star for suffering through this."

Poor nutrition because of excessive vomiting can harm the woman and the fetus, she said.

Hoskins had no role in the study, which was led by Dr. Bjorn Pasternak of the State Serum Institute in Copenhagen. Results appear in Thursday's New England Journal of Medicine.

Researchers used nationwide health registries to compare rates of miscarriage, stillbirth, birth defects, preterm delivery and having a baby that weighed too little among women who used Zofran during pregnancy and others who did not. They also looked separately at use during the first trimester of pregnancy, when risks to the developing fetus are highest.

No harms were seen from Zofran use, which occurred in 1,970 of the 608,385 pregnancies. The study looked at birth defects collectively, and cannot rule out a higher risk of specific ones, although the incidence of those is very small, researchers noted. The Danish Medical Research Council paid for the study.

As a first step, women should try treating morning sickness with crackers, ginger ale and certain B vitamins and use Zofran or one of the other prescription anti-nausea medicines as a last resort, Hoskins said. 

"Whenever possible, nothing or simple is better" than a drug, especially in the first three months of pregnancy, she said.

More news and articles on pregnancy can be read in this Cristian Andronic blog site.

REPOST: Preeclampsia And Eclampsia

This Prevention.com article shares the things that women should know about preeclampsia and eclampsia.

What Is It?

Preeclampsia is a condition that occurs only during pregnancy, and usually only after the 20th week. A woman with preeclampsia develops high blood pressure and protein in her urine, and she often has swelling (edema) of the legs, hands, face, or entire body. When preeclampsia becomes severe, it can cause dangerous complications for the mother and the fetus. One of these complications is eclampsia, the name for seizures that are associated with severe preeclampsia.

Experts are still not entirely sure what causes preeclampsia, but recent research has provided some good clues. The best hypothesis is that preeclampsia occurs when the placenta does not anchor itself as deeply as expected within the wall of the uterus during the first trimester. What causes this abnormal anchoring is unclear, but it may be influenced by the mother's or father's genes or the mother's immune system, and medical conditions the mother may have, such as diabetes or high blood pressure.

Regardless of its cause, early abnormalities in placental formation lead to changes that later affect blood vessels and other organs. Arteries throughout the body can tighten (become narrower), raising blood pressure. They can also become "leaky," allowing protein or fluid to seep through their walls, which causes tissues to swell. In preeclampsia, changes in arteries decrease the blood supply to the fetus and placenta, and to the woman's kidneys, liver, eyes, brain, and other organs.

In parts of the world with more limited medical care, preeclampsia and eclampsia cause many women to die during pregnancy. Fortunately, with appropriate prenatal care and monitoring, most women with preeclampsia and eclampsia and their babies survive just fine.

Eclampsia and, especially, death from preeclampsia are very rare in well-resourced countries like the United States. However, even with the best care, preeclampsia is a leading cause of illness for mothers and newborns. The following conditions increase the chance that a woman will develop preeclampsia:

• Chronic (long-lasting) high blood pressure 
• Obesity 
• Diabetes 
• Kidney disease 
• Being under 15 years old or over 35 years old 
• It being the woman's first pregnancy 
• Having had preeclampsia in a previous pregnancy
• Multiple gestations: twins, triplets, or a greater number of multiples (These pregnancies have more placental tissue. This suggests that the placenta or things it produces may play a role.) 
• Certain autoimmune conditions, including antiphospholipid antibody syndrome and some autoimmune arthritis conditions 
• African-American or Hispanic ethnicity 
• Having a sister, mother, or daughter who had preeclampsia or high blood pressure during pregnancy
• Having a male partner whose previous partner had preeclampsia (this suggests that the father's genetic material, passed to the fetus and its placenta, may play a role) 
• Having a male partner with whom you were sexually active for only a short length of time prior to becoming pregnant (this may be due to a change in the way a woman's immune system reacts to genes from the father after repeated exposure to his semen)

Symptoms

A woman with mild preeclampsia may not notice any symptoms, or she may have only mild swelling of the hands or feet. However, most pregnant women have some degree of swelling of the feet. So not all swelling indicates preeclampsia.

Symptoms of severe preeclampsia can include:

• Headache 
• Visual changes 
• Nausea and abdominal pain, usually in the upper abdomen 
• Difficulty breathing 

Eclampsia causes seizures, which are jerking movements of the arms and legs. During a seizure, a woman is likely to lose consciousness, and she may lose control of her bladder or bowels.

Diagnosis

Because preeclampsia doesn't always cause noticeable symptoms, it is crucial that all pregnant women see a health care professional regularly during pregnancy for prenatal care. This gives you the best chance of having preeclampsia diagnosed and managed before it becomes severe. Your doctor or midwife will measure your blood pressure and test your urine for protein at each prenatal visit because abnormal results are the earliest, most common signs of preeclampsia.

Preeclampsia can be especially difficult to detect in women who have a history of high blood pressure (hypertension) before pregnancy. One in four women with high blood pressure develops preeclampsia during pregnancy, so it is essential that these women be monitored closely for changes in blood pressure and for protein in the urine.

Your doctor or midwife will diagnose preeclampsia depending on your symptoms and the results of certain tests. There is no one blood test currently available to determine if someone does or does not have preeclampsia. Since a simple blood test is not available, here is how the diagnosis is determined:

• Mild preeclampsia is characterized by the following: Blood pressure of 140/90 or above Swelling, particularly of the arms, hands, or face that is reflected in greater than expected weight gain, which is a result of retaining fluid. (Swelling in the ankle area is considered normal during pregnancy.)Protein in the urine 
• Severe preeclampsia is characterized by: Blood pressure of 160/110 or higher in more than one reading separated by at least six hours A 24 hour urine collection that has more than 5 grams of protein Symptoms such as severe headache, changes in vision, reduced urine output, abdominal pain, fluid in the lungs and pelvic painSigns of the "HELLP" syndrome, which means the liver and blood-clotting systems are not functioning properly. HELLP stands for Hemolysis (damaged red blood cells), Elevated Liver enzymes (indicating ongoing liver cell damage) and Low Platelets (cells that help the blood to clot). It occurs in about 10% of patients with severe preeclampsia. 
• Eclampsia is diagnosed when a woman with preeclampsia has seizures. These seizures usually happen in women who have severe preeclampsia, though they can occur with preeclampsia. Eclampsia also can happen soon after a woman gives birth. Approximately 30% to 50% of patients with eclampsia also have the HELLP syndrome.

Expected Duration

Preeclampsia can begin as early as the 20th week of pregnancy, or very rarely even earlier. But it is more likely to develop during the last three months of pregnancy. In fact, the majority of cases are diagnosed in the last weeks of pregnancy. When a diagnosis of preeclampsia is made long before delivery, the pregnancy usually can be managed with a combination of bedrest and careful observation. Because preeclampsia can quickly worsen, doctors will often recommend that women with preeclampsia be admitted to the hospital for such rest and observation. If the condition worsens and threatens the health of the mother, delivery is usually recommended. Delivery will also be recommended as a pregnancy approaches its due date, to prevent worsening preeclampsia. In most cases preeclampsia goes away after delivery, although, as noted above, for reasons that are poorly understood, some cases of preeclampsia occur after delivery.

Prevention

Currently there are few recommendations that can be made to prevent preeclampsia. Because certain health problems (diabetes, high blood pressure, lupus) are associated with preeclampsia, women should be in the best health possible before becoming pregnant. This includes not being overweight and gaining the appropriate weight once pregnant. Some experts suspect that low-dose aspirin may provide slight protection to women who are at especially high risk of preeclampsia (for example, women who have had severe or early preeclampsia with a previous pregnancy. However, any benefit of aspirin treatment is small, and it has not been shown to work for women at average risk.

Getting prenatal care is one of the most important things you can do to keep yourself health during pregnancy. Preeclampsia is one of the many things your doctor or midwife will be on the lookout for.

In women whose preeclampsia is getting markedly worse, magnesium sulfate is given to prevent eclamptic seizures. Magnesium sulfate may be given either through an intravenous line or as an injection.

Treatment

The only cure for preeclampsia and eclampsia is to deliver the baby. (Actually, the cure is the delivery of the placenta, but one can't deliver the placenta without delivering the baby.) How you proceed depends on the severity of your preeclampsia.

• Mild preeclampsia. The goal of treating mild preeclampsia is to delay delivery until the fetus is mature enough to live outside the womb. You most likely will be put on bedrest and your doctor or midwife will monitor your blood pressure, weight, urine protein, liver enzymes, kidney function, and the clotting factors in your blood. Your provider also will monitor the well-being and growth of your fetus. Some women need to be hospitalized for adequate treatment and monitoring, while others can remain in bed at home. If you are not hospitalized, you will need to be seen by your health care professional frequently.
• Severe preeclampsia. The overall goal is to prevent serious consequences to the mother's and fetus' health, including eclampsia, stillbirth, and liver and kidney failure. Women with severe preeclampsia are carefully monitored, and high blood pressure is treated with medication. If the condition of the mother or baby gets worse, the baby may need to be delivered early. If the pregnancy reaches a gestational age at which the consequences of premature delivery are outweighed by the risks of continuing the pregnancy (generally about 32 to 34 weeks of gestation), an obstetrician may also recommend delivery. Your physical health and well-being will begin returning to normal after the baby is delivered.
• Eclampsia. Magnesium sulfate is used to prevent eclamptic seizures in women with preeclampsia at highest risk for them. When eclamptic seizures occur, magnesium sulfate will be started (for those not on it already) or given again (for those in whom seizures have occurred in spite of initial treatment) in an effort to prevent recurrent seizures. Other medications, such as lorazepam (Ativan), may be used to stop ("break") a seizure in progress.

When To Call a Professional 

You should schedule your first prenatal care visit with a health care professional as soon as you know you are pregnant. If you have swelling, severe headache, changes in vision, or other symptoms of preeclampsia, contact your doctor or midwife immediately.

Prognosis

The outlook for full recovery from preeclampsia is very good. Most women begin to improve within one to two days after delivery, and blood pressure returns to their normal pre-pregnancy range within the next one to six weeks in almost all cases.

About one of every five women with preeclampsia during a first pregnancy will have preeclampsia during a second pregnancy. Those with early or severe preeclampsia, or who have other medical conditions such as high blood pressure or diabetes, are at greatest risk for recurrence.

Women who have had preeclampsia are at risk for developing high blood pressure and other cardiovascular diseases later in life. You should let your primary care provider know if you have had preeclampsia. Although at present no specific treatments are recommended for women who have had preeclampsia to prevent later problems, it is prudent to adopt a healthy lifestyle. This includes:

• Maintaining a healthy weight 
• Exercising regularly and being physically active 
• Eating a well-balanced diet 
• Not smoking 
• Using alcohol in moderation

High-risk pregnancies is one of the expertise of Dr. Cristian Andronic. Follow this Twitter page for more updates.

Standardizing home delivery

Homebirth is generally frowned upon by physicians. Considered crude and outdated in a time when obstetric care is almost universally accessible, homebirth has been discouraged by many obstetricians and pediatricians. Despite this medical warning, it is still being performed in rare instances, comprising less than 1 percent of all deliveries in the country, and a majority of them aren’t attended by doctors but by midwives.

Image Source:  sheknows.com

To help standardize and regulate the process of home delivery, the American Academy of Pediatrics (AAP) formulated the following guidelines and published it in its official journal, Pediatrics:

• There should be at least one person who will be held accountable for tending to the newborn.

• A phone line should be kept handy to provide for immediate communication in cases of untoward emergency.

• The healthcare professional in charge should also check the weather situation, just in case delivery complications may arise and the mother and newborn need to be transferred to a hospital.

• Standard post-delivery procedures routinely done in hospitals should also be performed in home deliveries, such as temperature monitoring and regulation, vitamin K administration, and heel-prick newborn screening tests, among others.

Image Source: scienceandsensibility.org

For the AAP, it is important to ensure that the delivery care being given is the same regardless of the setting. “No matter where a baby is born, they deserve the same standard of care,” said Dr. Kristi Watterberg, lead author of the revised AAP guidelines. “It’s our best shot for the best outcomes for babies and moms.”

Image Source: ecochildsplay.com

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REPOST: Acupuncture and moxibustion greatly improve chances of pregnancy when IVF has failed: Study

How can acupuncture and moxibustion help in improving one's chances of getting pregnant? Read this Natural New.com article.

Image Source: naturalnews.com

(NaturalNews) Most NaturalNews readers have anywhere from a vague understanding to a first-hand experience of acupuncture. But moxibustion needs to be explained a little.

With moxibustion, heat is applied to acupuncture points instead of needles. The purpose is to move Qi or chi as needle stimulations do, but also to remove cold from one's system. More details are available from source (1) below.

In vitro fertilization is codified as IVF. In vitro refers to lab glass containers, usually petri dishes; in vivo is a reference to live whole organisms, from rats to humans.

IVF takes an ova or ovum (egg or eggs) from an infertile woman's ovaries, fertilizing it or them into a petri dish (in vitro), then removing the zygote (fertilized egg or eggs) from the lab environment and inserting into the woman's uterus. (2)

In vivo procedures to circumvent infertility involve a real human donor who is impregnated with the injected sperm of the infertile woman's husband or another donor's sperm. As the embryo begins to form in the donor's ovaries, it is removed and inserted into the infertile woman.

The embryo in vivo technique was accomplished a few years before IVF was created in 1978. IVF became the preferred infertility intervention because lab controls minimized infections, the biological status of the newborn was less questionable, and the occasional donor pregnancy was eliminated. (3)

But the success rate of IVF alone is not so great, around 20 percent. And it is expensive. Most health insurance plans won't even go there. (4)

However, TCM (Traditional Chinese Medicine) has quietly been establishing efficacy at increasing fertility in both men and women. This has come to the attention of the western medical scientific community, which must "prove" empirically established procedures by randomized double blind testing.

IVF needs a boost and seeks TCM as an adjuvent (support) 

A San Paulo, Brazil randomized clinical study, "Influence of acupuncture on the outcomes of in vitro fertilisation (sic) when embryo implantation has failed: ..." was recorded by PubMed March 19, 2013.

They used 84 women on whom IVF had failed at least twice and divided them into three groups of 28 each. The rates of pregnancy were 35.7 percent among those who were administered correctly-applied acupuncture/moxibustion with IVF, 10.7 percent among the sham (false) TCM applications, and 7.1 percent within the control group receiving only IVF.

Their conclusion: "In this study, acupuncture and moxibustion increased pregnancy rates when used as an adjuvant treatment in women undergoing IVF, when embryo implantation had failed." (5 - 5a)

Is IVF necessary? 

This Brazilian study was formed because of IVF's low rate of success and word on the medical street that TCM was working better without either in vitro fertilization (IVF) or in vivo embryo transfer.

So the study does enable Western medical practitioners to still get bucks for their IVF while boosting their success with TCM as an adjuvant. It could be considered a win-win for both sides.

But either Brazilians have universal health coverage or many are well off. Here in the USA, that 10 grand or more for IVF comes from private piggy banks. So what if TCM alone works well with much less expense? Short answer - it does.

An interesting example is Dr. Randine Lewis, who ditched Western medicine and went fully TCM to form The Fertile Soil group after her own infertility issues had led her to TCM for solutions.

Again, TCM performs without invasive treatments or pharmaceutical drugs with less costs and often achieves fertility goals with side effects of overall health improvements.

Dr. Lewis and others are listed below with more information under the heading Sources below are TCM for infertility options. If you or your partner have fertility concerns, find your local area TCM clinics and inquire.


Dr. Cristian Andronic can help you deal with problems in fertility and early signs of pregnancy. See this Twitter page for more updates.

REPOST: Some Morning-After Pills Are Now Allowed For Everyone

This article from Time.com shares an order issued by the 2nd U.S. Circuit Court of Appeals in Manhattan which allowed some emergency contraception pills to be sold without restrictions. Read the full details below:



Generic versions of emergency contraception can be sold without a prescription or age restrictions while the federal government appeals a judge’s ruling allowing the sales, an appeals court said Wednesday.

The brief order issued by the 2nd U.S. Circuit Court of Appeals in Manhattan permitted two-pill versions of emergency contraception to immediately be sold without restrictions, but the court refused to allow unrestricted sales of Plan B One-Step until it decides the merits of the government’s appeal. It did not specify why the two-pill versions were being allowed now, though it said the government failed to meet the requirements necessary to block the lower-court decision.

The order was welcomed by the Center for Reproductive Rights, where President Nancy Northup called it a “historic day for women’s health.”

“Finally, after more than a decade of politically motivated delays, women will no longer have to endure intrusive, onerous and medically unnecessary restrictions to get emergency contraception,” she said in a statement.

The center’s litigation director, Julie Rickelman, said the government has two weeks to decide whether to appeal the 2nd Circuit’s decision on the stay to the full appeals court or the Supreme Court. Even if there is no appeal of the stay ruling, it was unclear how soon drugstores would move the two-pill emergency contraception from behind the counter. She said she hoped the pills would be available without restriction within a month.

“What it does mean is that generic two-pill products are going to be readily available to women without age restrictions, on any drugstore shelf,” Rickelman said. “It’ll be like buying Tylenol. You’ll be able to go get it off the drugstore shelf, no ID, at the regular counter.”

Justice Department spokeswoman Allison Price said the government was reviewing the court’s order.

The government has appealed U.S. District Judge Edward Korman’s underlying April 5 ruling, which ordered levonorgestrel-based emergency contraceptives be made available without a prescription, over-the-counter and without point-of-sale or age restrictions.

The government asked Korman to suspend the effect of that ruling until the appeals court could decide the case, but the judge declined, saying the government’s decision to restrict sales was “politically motivated, scientifically unjustified and contrary to agency precedent.” He also said there was no basis to deny the request to make the drugs widely available.

The government had argued that “substantial market confusion” could result if Korman’s ruling was enforced while appeals were pending, only to be later overturned.

The Food and Drug Administration was preparing in 2011 to allow over-the-counter sales of the morning-after pill with no limits when Health and Human Services Secretary Kathleen Sebelius overruled her own scientists in an unprecedented move.

The FDA announced in early May that Plan B One-Step could be sold without a prescription to those 15 and older. Its maker, Teva Women’s Health, plans to begin those sales soon. Sales had previously been limited to those who were at least 17.

Korman later ridiculed the FDA changes, saying they established “nonsensical rules” that favored sales of the Plan B One-Step morning-after pill and were made “to sugarcoat” the government’s appeal.

He also said they place a disproportionate burden on blacks and the poor by requiring a prescription for less expensive generic versions of the drug bought by those under age 17 and by requiring those over age 17 to show proof-of-age identification at a pharmacy.

Plan B One-Step is the newer version of emergency contraception – the same drug, but combined into one pill instead of two.



Find more news on issues affecting women's fertility and pregnancy on this Twitter page for Dr. Cristian Andronic.

Pregnant women, beware: Migraine medication might reduce your child's intelligence

As a general rule, pregnant women aren’t supposed to be taking in medications, as it is still not certain if these substances can affect the fetus that they are carrying. There have been many cases where some drugs and substances exhibited teratogenicity (a drug’s ability to cause fetal malformation), hence bringing it to become a matter of medical concern.

Image Source: pharmacytechnician.org

Adding to the long list of fetus-damaging drugs are anti-migraine medications Depakote and Depacon, both of which have been noted by the Food and Drug Administration for potentially causing mental retardation to children. This came after a study showing a pattern of reduced IQ scores among children whose mothers used the abovementioned drugs during pregnancy.

The culprit: a sodium salt called valproate sodium—originally an anticonvulsant which is also being used as a prophylaxis for migraines. Drugs containing this ingredient already come with FDA warnings that tell of its teratogenic effects. Apparently, some uninformed pregnant women would still take these drugs to ease the pain which is brought about the migraines.

Image Source: foxnews.com

When stuck in such quandary, mothers are advised to consider all the potential risks which might come from taking these drugs.

Dr. Russell Katz, FDA’s director for neurology drugs, recognizes the likely damage incurred by the medication. “We have even more data now that show the risks to the children outweigh any treatment benefits for this use,” he said. The FDA also said in a statement: “Women who can become pregnant should not use valproate unless it is essential to managing their medical condition.”

Image Source: bu.edu

There are many ways by which prospective mothers can keep their pregnancies healthy. Keep abreast with pregnancy-related updates by visiting this Facebook page for Dr. Cristian Andronic.

REPOST: Will You Still Be Fertile in 5 Years?

Are you beginning to wonder if you can still get pregnant? This Parenting.com article will help you detect your fertility rate, which can boost your chances of getting pregnant.

Image Source: parenting.com

Thinking of having another child? You may have less time than you imagine to conceive without difficulty. Still, you may be able to take steps now to improve your chances.

To help judge the state of your fertility, consider these questions:

1. How old are you? 

Age is by far the biggest factor in fertility, and even the most advanced infertility treatments aren't always able to turn back the clock. "Women are postponing childbearing until later in life - that's the very reason we see more problems today," says Pamela Madsen, executive director of the American Infertility Association.

Some researchers believe that fertility peaks as early as a woman's late 20s, and there's a consensus that by her early 30s, both the quantity and the quality of her eggs have begun to decline.

It's a gradual process, so there's certainly no need to panic. But if you're 30, you may not want to wait ten years to start trying to get pregnant again. At age 35 about three-quarters of women will be able to conceive without treatment, but by age 40 only half will, says Owen Davis, M.D., director of the IVF Program at Cornell Medical Center in New York City. By age 45 it's under 10 percent.

The risk of miscarriage also goes up with age. At 35, about one in five pregnancies doesn't result in a live birth; by age 42 more than half fail, according to a study of over 500,000 women million women in Denmark. An older egg becomes an embryo that's more prone to genetic damage, researchers believe.

Infertility is traditionally defined as the inability to conceive after one year of unprotected sex. "In my opinion, a woman under thirty-five should try to conceive for that amount of time before she seeks medical help to find out why she's not getting pregnant," says Magdy Milad, M.D., a reproductive endocrinologist and an associate professor of obstetrics/gynecology at Northwestern University Medical School, in Chicago. "Between the ages of thirty-five and thirty-nine, she should try for six months. And after the age of forty, she should try for three months and then see a doctor for an evaluation, just to make sure that nothing's wrong and she doesn't run out of time to try treatment."

2. Do you smoke? 

If so, you're hurting your chances of getting pregnant at any age. Exposing your eggs to nicotine will not only affect the quality of your eggs but decrease your ovaries' supply. The more cigarettes a woman smokes daily, the lower her chances of conceiving. Smoking can also speed up the age at which menopause begins, prematurely closing your lifetime window of fertility.

The good news is that quitting now can restore much of your fertility. It's not immediate, though. "Once a woman quits, it can take several months for smoking-related toxins to be cleared from the body," says Dr. Milad.

Passive smoking interferes too: In one study, women exposed to smoke at work or at home were less likely to conceive within a year than peers who were exposed to little or none.

3. Are you at a healthy weight? 

Being seriously over- or underweight - for a woman who's 5 foot 4, for instance, being heavier than 175 pounds (a body mass index of 30) or lighter than 105 pounds (a body mass index of 18) - may have a bearing on fertility, but only if it affects ovulation.

If your periods are normal, your weight is unlikely to impact your ability to get pregnant, says Bryan Cowan, M.D., chairman of the department of obstetrics and gynecology at the University of Mississippi Medical Center, in Jackson. But if you're overweight and your periods are irregular, talk to your doctor. On the other hand, if you're very thin or have recently lost a lot of weight and your periods have become irregular or have stopped, gaining weight may be the first step toward fertility.

4. What medications or remedies are you taking? 

Thousands of prescription and over-the-counter medications - as well as herbal remedies - can have an effect on fertility. But the main concern is a class of drugs that affect your body's production of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) - key players in your ovulatory cycle. These include steroids (for asthma and rheumatoid arthritis), as well as prescription medicines that contain metoclopramide (for gastrointestinal upset) or phenothiazines (for anxiety.) It's always a good idea to talk with your doctor about which medications you are taking - or have taken - that might have an impact on fertility.

Contraceptives may also have an effect. If you've been on the Pill for a long time, it may take two to five months for your body to start ovulating normally once you go off it; that's also true for the newer hormone-based contraceptives like the Mirena IUD or the Nuva ring. "It's a myth that taking the Pill will prevent you from getting pregnant in the future," says Helane Rosenberg, Ph.D., egg donor coordinator at IVF New Jersey, in Somerset "But if you've been taking it for a long time, it could be masking a problem that would make you ovulate irregularly if you weren't taking the contraceptive."

The exception is if you've been treated with Depo Provera - in that case, the wait could be much longer. "Since the drug is injected into muscle, the hormone absorption may be so slow that it could take as long as a year for your fertility to return to normal," says William Gibbons, M.D., chairman of the department of obstetrics/gynecology at Eastern Virginia Medical School, in Norfolk. Norplant, though, has no adverse effect on fertility once it's removed.

If you're using herbal remedies, be wary: They're not regulated, so there's no requirement that their effects on conception and pregnancy be properly researched. Some reports have suggested that popular supplements - Saint-John's-wort, ginkgo, Echinacea - may negatively affect fertility, but other studies have found no effect, so there's no way to tell yet. "If you're having trouble conceiving and you're taking herbal supplements, you might want to stop, just in case," says registered dietitian Paul Thomas, editor of The Dietary Supplement, a newsletter for health professionals and consumers.

5. Have you ever had a sexually transmitted disease (STD)? 

If it was caught early and treated, an STD will probably not affect your ability to get pregnant. But one that was untreated for a long period of time may cause problems; untreated chlamydia, for instance, can lead to pelvic inflammatory disease, which may make you infertile. Chlamydia and gonorrhea can also cause scarring of the fallopian tubes or low-grade infections that can change how receptive your uterine lining is, says Carolyn Salafia, M.D., director of EarlyPath Diagnostics, a research facility in Larchmont, NY.

That's why it's important to be checked for STDs by your doctor before you try to get pregnant. Your partner should get checked too: STDS can also block production of sperm.

6. Was your last delivery difficult? 

Even if you've had a c-section, you won't necessarily find it harder to conceive your next child, unless there was tissue scarring, which can potentially impair fertility. (Nor do the vast majority of abortions affect conception.)

On the other hand, even a problem-free pregnancy doesn't mean it'll be easy to get pregnant the next time. "If your first pregnancy was uneventful, it excludes certain problems in the future, such as specific congenital abnormalities, but it's not a guarantee - other factors, like age, can affect your chances," says Dr. Davis.

7. Is your period regular? 

If you have an irregular cycle that is very long (more than 36 days) or short (less than 22 days), it's possible that your ovaries aren't functioning normally, and that could have an impact on the viability of your eggs when you try to get pregnant. Every woman's cycle is different, but see your doctor to rule out possible medical causes, such as thyroid disease or polycystic ovarian syndrome; both can be detected by blood tests and treated. Fibroids, which can cause heavy periods, may also interfere with fertility and are also easily treated. Fortunately, if you are not ovulating normally when you want to conceive, there are a number of medications that can correct the problem.

8. Are you under a lot of stress? 

It isn't clear whether daily stress has an effect on one's chances of getting pregnant. Some experts think it may decrease the production of estrogen, but others find no link. It's a bit of a chicken-and-egg issue: Infertility itself is stressful, so it's not surprising that women who seek help may report feeling tense.

Depression is another matter: "A number of studies link depression and trouble conceiving," says Alice Domar, Ph.D., director of the Mind/Body Center for Women's Health at Boston IVF, Harvard Medical School, and coauthor of Conquering Infertility. "If you want to conceive in the future and you're having emotional problems, try to see a mental health professional," says Dr. Domar. But if you're sure that your emotional stress is related to pregnancy worries, you may want to join a fertility support group. It will not only give you a place to talk about your experiences but also teach you coping techniques for stress management and relaxation. To find a group in your area, visit, the website of the National Infertility Association, and click on Local Chapters.

9. Are you a healthy eater? 

A well-balanced diet with plenty of fruits and vegetables is always a good idea, but the average American diet provides the necessary vitamins and minerals for fertility, says Dr. Cowan. Of course, every woman of childbearing age should take a multivitamin with at least 400 micrograms of folic acid - it helps prevent neural tube defects only if you take it before you get pregnant.

Caffeine remains controversial. Some studies indicate that it can delay conception, but others show - you guessed it - no effect. Once you do become pregnant, though, caffeine matters: As little as two cups a day can double your risk of miscarriage. Says Dr. Milad, "I give my patients who are trying to get pregnant the same advice I give those who are pregnant - keep caffeine intake in check and take your vitamins."

So, will you be fertile in five years? There's no way to be absolutely sure, of course. The more you know, the easier it is to plan your future. And the healthier your lifestyle, the better your chances will be.

Kristyn Kusek writes about women's health issues for a number of magazines. This is her first feature for PARENTING.

The Dad Factor 

The male contribution to infertility has only recently received the scientific attention it deserves. Here are some questions worth asking about the aspiring father:

Does he smoke? 

Infertility rates are three times higher in men who smoke compared with those who don't. Just as tobacco use affects a woman's eggs, it can also cause a reduction in the number of sperm as well as damage those being formed. After a man quits, it takes about three months for his sperm to return to normal, says Dr. Davis. If he was a heavy smoker, it can take longer. What's his health history? Mumps can cause sterility, according to Dr. Davis. Also, about 1 in 500 men have Klinefelter's syndrome, a genetic disorder that causes them to be born sterile.

How old is he? Although a man can impregnate a woman into his 70s and older, new studies make it clear that a man's fertility declines with age, beginning around 35. Both the quality and the quantity of sperm are affected.

Is he okay "down there"? One of the biggest causes of male infertility is varicoceles - varicose veins in the scrotum. These affect one in ten men. Some get them around their testicles, which can reduce sperm production. Have him see a urologist for treatment options.

How's his diet? Men who get enough folic acid, vitamin C, and zinc produce more sperm, studies show. The amounts for each in a healthy diet - or a standard multivitamin - are fine.

Is he regularly exposed to heat? For men who use hot tubs often - or truck drivers who spend a lot of time sitting above a vehicle's engine - there may be a reduction in the number of sperm produced.

Does he drink a lot or smoke pot? In some men, even moderate drinking affects fertility; some researchers believe men should limit themselves to one drink a day for optimal fertility. Marijuana use can reduce the production of sperm, and heavy use is associated with infertility, says Dr. Davis.

Timing the Test for Pregnancy 

If you're using a home pregnancy test, wait at least ten days after your period is due to try it. If you test too soon, the result may signal that you're not pregnant when you really are, says epidemiologist Donna Day Baird, Ph.D. "The fertilized egg may not yet be implanted in the uterus by the time a woman expects her period," she says, "so the test can't detect the pregnancy." - Rachelle Vander Schaaf

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