STACEY: I'm Stacey Tisdale for howdini. Getting pregnant is the most natural thing in the world unless of course you can't. More and more women are struggling to get pregnant, especially if they wait to have children when they're older. Joining us to discuss ways to improve your odds is Dr. Keith Eddleman. He's the Director of Obstetrics at Mount Sinai Hospital in New York and the author of two books including Pregnancy for Dummies. Thanks for joining us Dr. Eddleman.
DR. EDDLEMAN: Thanks for having me.
STACEY: People think about pregnancy issues and the first thing that comes to mind is age. How old is too old?
DR. EDDLEMAN: Well there's really no absolute 'how old is too old'--it really depends on a lot of different things. Are you still producing eggs--are you still ovulating regularly? Are you still having normal cycles? Is your general health good? You know if you're still ovulating at 45 and your health is good there's really no reason why you can't conceive at 45. Some women, however, at age 38 stop ovulating or decrease the number of times they ovulate per year. So it really is an individual answer to that; each woman is different.
STACEY: There's a lot of information out there though that okay after 35 your risks go up exponentially, after 40 your risks go up exponentially. Talk a little bit about that.
DR. EDDLEMAN: Well they're several different issues. You know after 35 the chances of conceiving go down. It becomes more difficult after you reach the age of 35 and also the chances of conceiving a fetus that's chromosomally abnormal goes up. So it's not just being able to get pregnant, but it's being able to have a fetus that's healthy and chromosomally normal. So the risk of chromosome abnormalities goes up after the age of 35 and then the chances of conception after the age of 35 goes down.
STACEY: Conception: how can women know exactly where they are in their cycles. Do those ovulation kits and things on the market really work?
DR. EDDLEMAN: Well the first thing you can do is pay attention to your cycles. You know, like pay attention to the first day of your last period and record it. If you have a typical 28 day cycle, then most women ovulate on day 14 of a 28 day cycle. If on the other hand your cycles are irregular, you're not sure, you can get the ovulation prediction kits from the drugstore. And those are actually pretty precise and pretty accurate.
STACEY: Let's talk about lifestyle and then let's talk about some of the ways medicine can help. What can people do in their lifestyle to improve their chances of getting pregnant?
DR. EDDLEMAN: Number one is try to get as close to your ideal body weight as possible. If you have a few extra pounds try to lose them because that can a) help increase the chances of conceiving, but also it can make the pregnancy itself less complicated. So that's probably rule number one. Any chronic diseases that you have you want to get under control. For instance if you have diabetes, you have high blood pressure--you want to get those under control before you're pregnant to maximize the chances that you'll have a healthy pregnancy. Also, oftentimes women who have those disorders, if they're not well controlled, those are harder--those patients find it harder to get pregnant as well too. So those are probably two of the biggest things. The other thing is make sure all your vaccinations are up to date. General health--just make sure general health is good. And finally one thing that's very important for women to understand when they're contemplating pregnancy, you want to make sure that you're taking extra folic acid around the time that you conceive. Ideally one to three months before you conceive because that has been shown in numerous studies to reduce the risk of having a birth defect known as Spina bifida or a neural tube defect. So it's something that's a severe disorder that you can actually help prevent if you're taking extra folic acid around the time you conceive.
STACEY: So I'm doing all those things and I still can't get pregnant. Talk to me about some of the ways medicine can help.
DR. EDDLEMAN: If you're 26 obviously you don't need to run to the infertility specialist if you don't get pregnant in three months. But if you're 45 and you're trying to get pregnant and you've tried really, really diligently for six months then that might be time to go see an infertility doctor. As far as increasing your chances on your own, some things that you and your partner can do-- around the time of ovulation is actually the best time to have intercourse to maximize the chance that the egg and the sperm will come together. And the other thing that men should do is to decrease the frequency of intercourse before that time of ovulation because their sperm counts will be higher then and that will also increase the chances of conception when the egg is ovulating.
STACEY: Talking about getting people to ovulate, inseminating the partner, how many times is enough? After how many times do you have to move on to something else?
DR. EDDLEMAN: Most doctors will wait for two to four cycles with what we call ovulation induction and in utero insemination, but after that they'll probably move towards something called in vitro fertilization, commonly known as IVF.
STACEY: What kind of toll does in vitro fertilization and some of these other methods taking on a woman's body?
DR. EDDLEMAN: It's a great question. First of all, there's the emotional toll of not being able to get pregnant and the emotional stigma that goes along with that. And that's not insignificant for a lot of women. The second thing is that there's some data to show that going through multiple IVF cycles, taking the medications that cause you to ovulate more than one egg, may lead to an increased risk of ovarian cancer later down the road. The data's a little shakey on that, but there's some emerging data to show that that might be a real issue.
STACEY: Do any of these options increase the risk to the fetus?
DR. EDDLEMAN: The garden variety IVF, the type that most people use, has not been associated with an increased risk of fetal abnormalities.
STACEY: Great information. Dr. Eddleman thank you so much for joining howdini.
DR. EDDLEMAN: Thanks for having me.