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Friday, September 30, 2005

How long is a normal pregnancy?

Hello,

My daughter was born 'exactly' 42 wks from when her mother was last with me sexually. Is this likely to be? If not it's not, then its not my daughter. I believe its only 38 wks/266 dys from becoming pregnant to delivery?

Regards,
Ciaran

Dear Ciaran,

The average pregnancy lasts 38 weeks from conception, but it is not uncommon for a particular pregnancy to last 40 weeks from conception. In addition, you have to consider the fact that conception takes place when the egg is released, not when you have sex. Sperm can live inside a woman's body for 5 days or more after intercourse and be available to fertilize an egg when it is released.

There is an easy way to settle the issue. Ask for a paternity test. That will give you a definite answer.

Sincerely,
Amy

Supplements in pregnancy

If you search the internet for information re: flaxseed (ground meal) and pregnancy, you get very confusing results. Some sites (medical ones) say the Omega-3 oils and fatty acids are a great supplement to a pregnancy diet and that it can also help with constipation among other things. Yet, one of your responses said NOT to take flax seed when pregnant, and I've read sites (medical ones) that say flax seed taken during pregnancy can increase the chance of miscarriage. How can a mother to be know what to believe? My own OB-GYN said ground flax meal was fine. So if not your own doctor, than who??

Mary

Dear Mary,

There is no reason to take supplements of any kind during pregnancy once you are taking prenatal vitamins. There is absolutely no evidence to suggest that any supplements improve pregnancy outcome. Furthermore, supplements are an unregulated industry and you cannot be sure that what it says on the label is what is actually in the bottle.

Supplements often contain many times the recommended daily dose of vitamins and minerals and no studies are done on their safety in pregnancy. We know from tragic experience that excess vitamin A leads to severe birth defects. There is always a possibility that excesses of other vitamins and minerals can lead to birth defects.

Finally, to the extent that any substance works, it is only because of the chemicals that are in it. Chemicals made by living things are no better than those made in a lab. Natural substances can be very toxic; tobacco, cocaine and heroin are just the best known examples.

Of course, your most important source of information should be your own doctor. However, to the extent that there is any controversy about a substance, I would avoid it during pregnancy. There is no scientifically established benefit, and there could be substantial risk.

Sincerely,
Amy

Second trimester miscarriage

I had a miscarriage at 8wks in Sept.04 (determined to be a blighted ovum) at age 31 and was pregnant again in Feb.05 with an early scare of a subchorionic hemorrhage, which resolved after 3wks. I had no problems or complaints until 19.5wks.

The very same day we'd heard a healthy heartbeat (after I'd complained to the doctor of slight cramping and staining), my water broke that evening and I went into labor. At the hospital, there was no heartbeat and we delivered a deceased baby boy. Tissue and blood samples from me and the baby were taken and various tests performed. There was nothing found to explain why my water broke and I miscarried.

The "best guess" from my OB-GYN is that I had some kind of bacterial infection (with no symptoms) that caused my membranes to rupture. Two suggestions if/when we should become pregnant again is to 1) be tested for bacterial infections and treated right away if necessary, and 2) be seen by a genetic counselor early in the pregnancy. Can you tell me what this kind of testing might reveal, if anything?

The thought is that these 2 miscarriages are not related, but to miscarry as late as 19.5 weeks when things seemed to be going so well, is obviously disconcerting. I have read about Factor 5 and Antiphospolipid Syndrome, but tests have not indicated that either applies to me. Just hoping to hear another medical opinion and to try and do whatever I can with a subsequent pregnancy.

Mary

Dear Mary,

I am very sorry to hear about the loss of your son.

The first miscarriage was probably the common kind of miscarriage which occurs in 1 in 5 pregnancies. This is almost always due to a one time non-repeating genetic defect in the embryo.

A second trimester miscarriage is unusual and should prompt an investigation for possible causes. One cause that has not been considered is incompetent cervix. An incompetent cervix is a cervix that does not stay closed as the uterus enlarges. When the cervix opens, the membranes bulge through and may rupture. Once the membranes rupture, there is no way to save the pregnancy.

You can be monitored for incompetent cervix in a future pregnancy by having routine ultrasounds and exams to be sure that the cervix remains closed. The treatment for incompetent cervix is cerclage, a surgical procedure in which is large suture (a ribbon, really) is placed around the cervix to hold it closed. At the end of pregnancy, the stitch is removed (in the office) and you can have a vaginal delivery.

Factor V and antiphospholipid antibodies are rare causes of recurrent first trimester miscarriages, and are unlikely to be involved in your case, but you can be tested for them anyway, if you'd like.

You may wish to consult a perinatologist (a specialist in high risk pregnancy) for additional suggestions based on your complete medical history.

Sincerely,
Amy

Sperm life

How long does sperm live outside the body? Is it possible to get pregnant if the man ejaculates outside the body?

MO

Dear MO,

It all depends on how the sperm is treated. If the sperm is preserved carefully it can live for hours to be examined in the lab, or it can be frozen to be used for artificial insemination. However, if the sperm is allowed to dry out, it will die within minutes.

Sincerely,
Amy

Cornual ectopic

Dear Dr Amy,

I had an ectopic pregnancy in the horn, not in the tube and was treated with methotroxate for one week until my hcg level dropped to 25.

I have had two periods since that were normal but two days ago I bled for a couple of hours and then it stopped. My period is not due until this week. I am having mild cramping but no bleeding. Is there something wrong?

T

Dear T,

An ectopic pregnancy in the horn of the uterus (the area where the uterus connects to the fallopian tube) is called a cornual ectopic. It is very difficult to operate on that area of the uterus, so it is fortunate that you could be treated with methotrexate.

It is very important to be sure that your HCG level returned to non-pregnant levels. You should call your doctor about the bleeding. He or she may want to check your HCG level.

Sincerely,
Amy

Bleeding after intercourse

While making love to my boyfriend last week I started to bleed very heavily. The blood was very thin and bright red with what I can only explain as "stringy bits". It took a good 2 hours before the bleeding stopped and i am still spotting now. My friend said it sounds like a miscarrage however I have had an iud coil fitted for 2yrs. Could this be the case?

Thank you,
Kathryn

Dear Kathryn,

I'm not sure what caused the bleeding. You should make an appointment with your doctor to get this checked out.

Sincerely,
Amy

X-rays in early pregnancy

Hi Doctor,


3.5 weeks ago, I was involved in a car accident. On the 12th of September I was sent for neck x-rays I did a pregnancy test before I went. It was negative.


My period was due today, and for some reason, even though I felt like my period was coming, I did a pregnancy test and it was POSITIVE. I'm petrified that I could have harmed my baby. This was supposed to be the most exciting time of my life and yet I'm a mess!

EH

Dear EH,

You can stop worrying. The risk of X-rays during pregnancy is purely theoretical. There are no documented cases in which x-rays led to birth defects. Furthermore, pregnancy is not a reason to postpone necessary X-rays, such as those you had after your accident.

Sincerely,

Amy

Acid reflux

I am 9 1/2 weeks pregnant and have had horrible morning sickness since the beginning of my 6th week. At first it was nausea all day and night. Now I'm not continually nauseous but I've been vomiting a few times a day. It seems as if I've now developed acid reflux which is causing me to cough and makes it hard for me to catch my breath at times. My internist said he didn't feel comfortable prescribing anything besides TUMS but they don't seem to be working. Is there anything you know of that's safe to take? Its keeping me up at night so now I'm even more tired.

Thank you,
Allison

Dear Allison,

You might try a liquid antacid like Mylanta. Liquid antacids often work better than tablets for severe heartburn and acid reflux.

You should make an appointment with an obstetrician for prenatal care, instead of relying on an internist. Women who start prenatal care during the first trimester have better pregnancy outcomes.

Sincerely,

Amy

Thursday, September 29, 2005

Ultrasound shows different results for each twin

I am just looking for an explanation. I have a 7 week 2 day yoke sac age and two fetuses. One is measuring 6 weeks 5 days and one 6 weeks 2 days. My doctor is saying that can be normal. Right now there are no fetal pulses. My doctor is saying that the fetal poles can lag behind almost a week and it is not considered unusual. I am just looking for an explanation of whether this is possible, and if it is possible for twins to have different fetal pole measurements or is one of them dead?

Thank you,
Sarah

Dear Sarah,

Ultrasound in the first trimester is accurate within 1 week either way. Therefore a baby who measures 6 weeks 2 days is anywhere from 5 weeks 2 days to 7 weeks 2 days. The gestational ages of the yolk sac and of each twin, although different, are all consistent.

The discrepancy is due to limitations of ultrasound (afterall, the babies are less than 1/4 inch long) and individual variation. Just as the babies may have different weights at the time of birth, they can be slightly different sizes now.

The most accurate measure of gestational age is obtained by calculating from the last menstrual period.

The fetal heartbeat is first seen between 6-7 weeks. By next week you should be able to see both heartbeats.

Sincerely,
Amy

Risk of repeat miscarriage

If you have had one miscariage, are you more likelyto have another one?

NC

Dear NC,

No, you are not more likely to have a miscarriage if you have had one before. That's because almost all miscarriages are caused by one time, non-repeating genetic defects in the embryo. The risk of miscarriage in any pregnancy is 20%.

Sincerely,
Amy

Constipation

I’m suffering from constipation so I’m using an over the counter women laxative, but I just found out that I’m pregnant, can I still use it and do you think that the period I have using it can hurt the baby?

Thank you,
Christine

Dear Christine,

It is better to use a stool softener during pregnancy instead of a laxative. Most doctors recommend Colace which you can buy over the counter. The fact that you have used a laxative up until now should not cause a problem.

Sincerely,
Amy

Vaginal delivery after 2 C-sections

Hi,

I've had two children. My sone was quite large and sunnyside up, so I had to have an emergency C-section. My daughter was small enough for me to have a vaginal birth, but she was breech so I had another C-section. We want another baby. What are my chances of having a vaginal delivery?

Anonymous

Dear Anonymous,

You could try for a vaginal delivery but the chances that your doctor will agree are small. That's because there is a slight risk of rupturing the scar on your uterus during labor. That's why there it is recommended that the doctor be there during your entire labor and that the hospital have an anesthesiologist available for an immediate C-section if necessary. Many doctors and hospitals do not want to comply with these recommendations and advise a repeat C-section instead.

Sincerely,
Amy

Wednesday, September 28, 2005

Spina bifida

I took an afp test and it came back abnormal, then I had a sonogram today and they said the baby has spina bifida. Can the blood test and sonogram be wrong? I was afraid to take the amniocentesis, because I was told that it could cause birth defects.

Anonymous

Dear Anonymous,

The AFP test is a screening test. It identifies babies who might have a problem. The ultrasound test actually shows the baby and can see if the baby really has spina bifida.

Spina bifida is a neural tube defect. Very early in pregnancy the tube that eventually becomes the spine begins to develop. If the tube does not close at the top and at the bottom, the baby will have an opening in the spine. That's called spina bifida. Spina bifida can range from mild to severe depending on how large the opening is and how high up toward the head it is. Often the baby is paralyzed from the point below the opening of the spine.

Your doctor needs to arrange for you to speak to a pediatric neurologist to find out what to expect when your baby is born.

Spina bifida is sometimes associated with other birth defects. That's why your doctor recommended an amniocentesis, to check the baby's chromosomes. An amniocentesis does not cause birth defects, it finds them. There is a small risk of miscarriage after amniocentesis (less that 1%).

Sincerely,
Amy

42 weeks pregnant

My wife is at 42 weeks and I was wondering how long the baby can stay in there before it can hurt the baby?

Thanks,
John

Dear John,

Most doctors feel pretty strongly that 42 weeks is the maximum amount of time that the baby can stay inside before the risks to the baby begin to rise. Almost all doctors would schedule an induction (giving pitocin to start labor) at 42 weeks. Talk to your doctor about scheduling an induction as soon as possible.

Sincerely,
Amy

Predicting a uterine rupture

Dr. Amy,

I have written you a few times in the past concerning pregnancy after a uterine rupture. Since then, I have miscarried and am wondering what your thoughts are regarding an OB GYN who advises me that I am anatomically sound with no troubling scars after doing an ultrasound. Can the OB GYN see enough on a standard ultrasound to say that I am anatomically good to go? I very much want one more child but my mind goes to the possibility that my uterus and uterine artery(which burst during the rupture) are not up to the task. My rupture was back in 2000 and since then we have miscarried twice and I assume both were due to not supplementing the progesterone early enough. Also, will starting progesterone right after ovulation help if the surface of my uterus is uneven from the rupture? We intend to give my body a break before trying again, but I would love your opinion regarding the validity of an opinion after a simple sonogram. Thanks.

Teresa

Dear Teresa,

There is no way to know for sure whether you will have another uterine rupture. An ultrasound can show an obvious uterine malformation, but I would not expect to see an obvious malformation. If there was a significant defect, it would increase the chances of a problem, but the fact that there is no significant defect does not mean that it can't happen again. That's because a rupture is not caused by an anatomic defect; it is usually a problem with tissue strength, or, less likely, a poor repair in an earlier surgery.

There is not enough experience with pregnancy after uterine rupture since many cases of uterine rupture require hysterectomy at the time of C-section. There are small studies that show no recurrence in women who have scheduled C-sections before the onset of labor, but the studies are really too small to draw any conclusions.

Unfortunately, you will have to make a decision about a future pregnancy without reliable statistics to guide you.

It may be that your recent miscarriages were due to lack of progesterone, but it is equally likely that they were due to genetic defects. It is extremely unlikely that they were due to any irregularity on the internal surface of the uterus, since the surface is probably normal, and the odds that the embryo implanted on the scar are small.

Sincerely,
Amy

Tuesday, September 27, 2005

Getting pregnant at age 41

Hi,

I am 41 and trying for a baby. My partner and I have a little girl of 2 and are trying again but with no luck. We have been trying since February of this year. Do I need help or am I too old to try?

RA

Dear RA,

You may need help. If you are over age 35 and you have been trying for more than 6 months, it is time to see a gynecologist. You may need medication in order to get pregnant.

Sincerely,
Amy

Birth control after 50

Dear Dr. Amy,

I will turn 52 next month. I stopped taking the pill two weeks ago. What are my chances of getting pregnant? Should I be using another form of birth control?

Thank you,
Marie

Dear Marie,

Some women ovulate (and can get pregnant) right up until they start menopause. If you are still having periods, you will need to use some form of birth control. The Pill is usually not recommended for women over age 40.

Sincerely,
Amy

HCG level not rising

Dr. Amy,

I am so confused right now. I tested on 9/18 at home and got a +, repeated the test on 9/20 +, DH and I had intercourse on the 21st then had some spotting. Went to a new Dr. on the 22nd, did sonogram and did not see anything and the blood test showed a level of 75, had blood work again on Saturday and the level was 71. Had some bleeding w/ clots on Sunday when went to the bathroom and have some residual dark spotting. Felt a little crampy like normal period stuff but no major cramps.

Went to my "old" dr yesterday and had more blood work. I am really confused as to what is going on. Am I pregnant or not? If I am, is there a problem? Could there be another explanation? Doc, said she does not think that I have had a miscarriage at this point and ordered another blood test. I am waiting for the results today. I am scared, confused and anxious. We want to be pregnant and we want a healthy baby, but all of this is not looking good.
Thanks for your help!

Magi

Dear Magi,

It sounds like you are pregnant and you are having a very early miscarriage. This is extremely common.

In a normal pregnancy, the HCG level will double approximately every 48 hours. If it does not risk appropriately, it is unlikely to be a normal pregnancy. If it drops, it is almost certainly a miscarriage. The only other possibility is that it is an ectopic (tubal) pregnancy, but that is less common, and usually produces one sided lower abdominal pain.

Early miscarriages are almost always caused by one time non-repeating genetic defects in the embryo. An early miscarriage does not increase the risk of having another miscarriage in the future.

Sincerely,
Amy

High prolactin and infertility

Hi Dr. Amy,

I am 26yrs. old. I'm trying to have a baby-with no luck of course. I know my prolactin levels are high. I've taken Bromocriptine and Parlodel without success.

I do have irregular menstration. I am not even sure if I ovulate or not. I am almost to the point of giving up and accepting that having a child is not meant for me. But something inside of me won't let me. I am my mothers only child and I would loveto make her a grandmother. Right now I am taking Ovulex, but someone from your website said that you said its a waste of time. Is this true? If it is, what should I do? Thank you for your time.

Nikia

Dear Nikia,

It sounds like you have a hormone problem that is preventing ovulation and therefore, you cannot get pregnant. The best thing to do would be to see an infertility specialist for a complete evaluation. Your situation is more complicated than most, and it will take a specialist to figure out the best treatment for you. I would not give up on pregnancy until an infertility specialist tells you that there are no more treatments to try.

Ovulex does not treat infertility problems. There is nothing you can buy over the counter that will treat infertility.

Sincerely,
Amy

How late can you have an abortion?

What is the latest you can abort a baby?

G

Dear G,

The date varies from state to state. In general, it is somewhere from 20-24 weeks.

Sincerely,
Amy

CIN II

Hi,

I received my biopsy results from my colposcopy last week and it showed that I have CIN2. I found out at the weekend that I am pregnant. Does having CIN2 carry any risks for myself or the baby?

Thanks,
C

Dear C,

CIN II stands for cervical intra-epithelial neoplasia or precancerous cells. It is grade 2 on a scale of 1-3. CIN II needs to be treated to prevent it from progressing to cervical cancer, but treatment should be postponed until after delivery if possible.

CIN poses no risk to the pregnancy or to the baby. Talk to your doctor about your treatment options; be sure to tell him or her that you are pregnant.

Sincerely,
Amy

Home birth after C-section

Hi,

I am 12 weeks pregnant with my second child. My first delivery was by emergency ceserean. Can I have a natural birth at home for this pregnancy?

Gina-Lee

Dear Gina-Lee,

I would not recommend it. The odds of something going wrong are low, but they are not zero. In addition to the usual risks of delivery, there is the increased risk of rupture of the uterine scar from the first C-section.

Sincerely,
Amy

Is this premature labor?

Hi,

I am thirty five weeks and have been having lots of cramps and low backache. Could this be a sign of early labour? If so, is it too early?

S

Dear S,

It could be a sign of premature labor, so you should be sure to talk it over with your doctor. If it is labor, it is too early and an attempt should be made to stop labor to give your baby a few more weeks before birth.

Sincerely,
Amy

Risk of recurrent Down's Syndrome

Dr. Amy,

I turned 41 last month and my husband is 32. We want a baby. I had a previous pregnancy earlier this year but decided to terminate due to trisomy 21 & dandy-walker variant. My dr. said there wasn't really any increased odds of having another down's syndrome pregnancy, but I'm not sure that is correct. I realize the chances of chromosmal defects increase with age, expecially over age 40. Also, what are the chances of having another pregnancy with dandy-walker variant? Where can I find some information? Thanks so much.

Annette

Dear Annette,

The risk of Down's Syndrome rises with maternal age, and it is also increased in women who have had a previous child with Down's Syndrome. The risk of Dandy Walker may also be increased in women who have had a previous child with Dandy Walker, but that is not clear. The best thing to do would be to arrange a consultation with a genetic counselor (your doctor can arrange this for you). A genetic counselor can give you the best estimate of recurrence rates in your specific case.

Sincerely,
Amy

Monday, September 26, 2005

Stopping the Pill in mid cycle

Hi,

Is it safe to stop my pill mid cycle to start trying for a baby?

Many thanks,
K

Dear K,

It is not harmful to stop in mid cycle, but it makes more sense to finish out the pack. That's because stopping in mid cycle will often lead to irregular bleeding.

Sincerely,
Amy

Incompetent cervix

My husband and I have lost three pregnancies to incompetent cervix. The first pregnancy was lost at 16 weeks, and my ob suggested that I may have incompetent cervix. With my next pregnancy, I was sent to a perinatologist to monitor my cervical change, and at 15 weeks, I recieved a rescue cerclage, but the pregnancy was still lost at exactly 21 weeks. With my most recent pregnancy, I recieved a cerclage at 12 weeks, and all was going well until my appointment with the perinatologist at 19 weeks. My cerclage was no longer holding, and I needed another rescue cerclage. I remained in the hospital, and again at exactly 21 weeks I delivered my third son who died shortly after.

I have never had a STD, or trama to my cervix, and I am not a DES baby. Could my cervical incompetence be hormonal, and what tests should be done to find this out? My Ob said that I will need a transabdominal cerclage with my next pregnancy. Is there anything that I can do to strengthen my cervix in addition to the surgery? What is the healing time after the transabdominal cerclage is placed, and how long after that should my husband and I wait to try and conceive? How long should I wait to have the surgery?

Anonymous

Dear Anonymous,

I am so sorry to hear about the loss of your babies. I can only begin to imagine how devastating it must be.

My first concern would be that you have a defect inside the uterus or an abnormal uterus. For example, some women have a septum (wall of tissue) inside the uterus. This restricts the space available for the baby and when the baby gets to a certain size, it is expelled. You may have already been tested for this possibility. The test is a hysterosalpingogram; radio-opaque dye is injected into the uterus and X-rays taken to investigate the uterine cavity.

If you were to have a uterine defect, no cerclage could hold the baby in. A uterine defect would be fixed by surgery before another pregnancy.

If all other possibilities have been ruled out, and the only problem is incompetent cervix, there is not much that you can do about it beyond a cerclage. No one knows what causes incompetence in an undamaged cervix.

I'm not sure what you mean when you say that the cerclage was not holding. A cerclage should not come undone. When a cerclage fails, it is usually because the stitch tears through the cervix.

A transabdominal cerclage is an unusual procedure and there is some controversy about whether it is truly beneficial. You may want to seek a second opinion before trying that procedure.

Good luck.

Sincerely,
Amy

Transverse lie

Dear Dr. Amy,

I had my 33 week check today with my midwife and was told that my baby is lying in a transverse position and that she recommends that I see aconsultant at 35 weeks (2 weeks time). I looked back over my notes and noticed that the baby has been in transverse lie since mid-July. This is my third pregnancy and I am a little worried that the baby has not turned and seems to be nicely settled across my tummy for some time now.This alone does cause some discomfort for me as my tummy is very tight and the movements of the baby feel quite un-comfortable. Can you offer any advice on what I can do to help my baby turn? Will this mean I will have to have a C-section if baby doesn't turn soon?

Joanna

Dear Joanna,

There is still plenty of time for the baby to turn to the head down position. Some obstetricians would also be willing to do a version, which is an attempt to turn the baby under ultrasound guidance. If the baby does not turn, you will need to have a C-section. A baby in a transverse lie cannot be delivered vaginally.

Sincerely,
Amy

Pregnancy after tubal ligation

Dear Dr Amy.

I was sterilised 2 years ago now, but I fear I am pregnant. I took a test on Sunday and it was positive but today was negative. Do you think I could be?

Thanks,
Lesley

Dear Lesley,

A positive pregnancy is quite reliable, and having a positive and then a negative test suggests either that you had a very early miscarriage or that the level of HCG is very low.

You should not be able to get pregnant after a tubal ligation, so you should see a doctor about this as soon possible. Women who get pregnant after a tubal ligation have a much higher risk of having an ectopic (tubal) pregnancy.

Sincerely,

Amy

Hand, foot and mouth disease

Hi Dr Amy,

My son is showing symptoms of hand, foot and mouth disease. I am 15 weeks pregnant. Should I be concerned about my health and the baby's health?

Jodie

Dear Jodie,

Hand, foot and mouth disease is caused by coxsackie viruses. Most adults are immune to them, having been exposed in childhood. Thusfar, there is no evidence that hand, foot and mouth disease causes problems in pregnancy, even in women who are not immune.

Sincerely,
Amy

No more periods after baby was born

Can having a baby at 43 stop my periods completely? My baby is 7 months old , and this has happened to me.

Regards,
Karen

Dear Karen,

If you are breastfeeding, your periods may not return until after you wean the baby. If you are not breastfeeding, it is possible that you are going through menopause. You should talk this over with your doctor.

Sincerely,
Amy

Herbal supplements for anxiety

Dr Amy,

I suffer from some anxiety issues, but am reluctant to take prescription medicines. I grew up with a case of selective mutism, and I did get over it, but i still have anxiety about certain things. I know that you cant tell me whether I should or should not take an herbal supplement, but i was just wondering what you think of the ingredients of one that i am considering. The testimonials on the product seems promising. I know it wont give me an instant cure but if it helps even a little bit, that would be a good thing. The following ingredients are: Melissa Officinalis, Lavandula Augustifolia, and Passiflora Incarnata. Do you know anything about these? Are there any side effects? Do they interefere with birth control medicines? Just curious. I just am wondering about general info. I know for specific info i need to talk to my doc but i was just wondering about your thoughts on this.

Thank You,
Nia

Dear Nia,

Herbal supplements do not work. I am not aware of a single supplement that does what it claims to do. You will be wasting your money if you buy this since it definitely won't work and it may even hurt you.

Most people don't realize that supplements are big business: over $40 billion dollars a year. The supplement manufacturers successfully lobbied Congress to have supplements excluded from the category of medication. Therefore, there is no oversight at all.

Manufacturers of prescription drugs are required to provide data that a medication does what they say it does, that the bottle contains what they say it contains, and that it has been demonstrated to be safe for human consumption. There are no requirements for supplements.
That means that you cannot be sure what is in the bottle; you don't know if it has ever worked for anyone, and you don't know if it safe or what side effects it has.

To the extent that medication works, it is because of the chemicals that are in it. Natural chemicals are no better or safer than chemicals made in a lab. If you think about it, you already know that this is true; some of the most dangerous substances around are "natural", like tobacco, heroin and cocaine. All of them come from plants and probably kill more people combined than any other substances.

There are a variety of very effective prescription medications available for anxiety. Unfortunately, there is no way to predict in advance what medication is best for an individual. That's why there's often a certain amount of trial and error in finding a medication that works and does not have unacceptable side effects.

I wish supplements worked for anxiety, but they don't, and they don't work for any other conditions, either.

Sincerely,
Amy

Pap smears after hysterectomy

Dear Dr. Amy,

I am a 56 year lady who had a Hysterectomy (all except one ovary) at the age of 32 due to Endometriosis. At the age of 40 I under went removal of the remaining ovary due to the presence of endometrial tissue again. Since then I have been on HRT patches with regular checks and no problems.

Question: Do I need a PAP Test done? I had one done last year and nothing abnormal was detected. My Doctor seems to think I need one doing every year. If this is so, perhaps your would be kind enough to explain why?
I look forward to your reply.

Kind regards,
Eileen

Dear Eileen,

The current recommendation is that women who have had their cervix removed and have had 3 normal Pap smears in a row, do not need further Pap smears. The exception to this is women who have had cervical cancer or precancerous cells. That's because cervical cancer can recur at the top of the vagina.

Sincerely,
Amy

Prilosec (omeprazole)

If I am taking omeprazole can this stop me from getting pregnant? If not, can it harm the baby?

JS

Dear JS,

Omeprozole (Prilosec) should not affect your fertility. It is a pregnancy Category C drug, which means that there is not a lot of information available about it. It can be used if the medical benefits outweigh any potential risks. You should talk to your doctor about whether it is necessary to continue this medication while trying to get pregnant or if another medication might be better for you.

Sincerely,
Amy

Acrylic nails during pregnancy

I have acrylic nails and just found out I about 5 weeks pregnant. Is it safe to continue getting "fill-ins" or could this pose some kind of hazard to my baby? I go to a reputible nail tech. who is very compulsive about sterilizing everything.

Thanks,
Sissy

Dear Sissy,

The danger of acrylic nails for the baby is not because of bacteria, but it is the threat posed by inhaling the chemicals used to apply and care for the nails.

No one knows what the risks are, but most doctors advise forgoing acrylic nails during pregnancy. Many women find that their nails become stronger during pregnancy, and they don't need the acrylic nails.

Sincerely,
Amy

Does a woman need to have an orgasm in order to conceive?

If a female has an orgasm at the same time a male does that mean that it is the point of conception?

TJ

Dear TJ,

In order to get pregnant, the man has to have an orgasm during intercourse, because that is the way that the sperm gets inside the woman. After sex, you might or might not get pregnant. That depends on whether there is an egg ready to be fertilized which, in turn, depends on where you are in your cycle.

A woman does not have to have an orgasm to get pregnant.

Sincerely,
Amy

Fibroid

Hi,

My doctor called me yesterday and told me about fibroid. I don't know what this means, but she told me this is related to fetus and cervix. Usually black woman have this when they are pregnant. I am Pakistani and this my second child. I am worried about this because my doctor told me some time this can grow to be very large and I might need surgery.

Thanks,
KA

Dear KA,

I'm not sure I understood your question completely, but what I wrote above is what I think you meant.

A fibroid is a benign growth of the uterus. It is not cancer and it does not turn into cancer. Fibroids are not harmful. The can grow to be large and causes heavy menstrual periods. If a non-pregnant woman has large fibroids, her doctor might recommend surgery to remove them.

Fibroids are stimulated by estrogen. Since there is a lot of estrogen during pregnancy, fibroids can grow much bigger. Usually this does not cause a problem. Occasionally, they can become painful. Rarely, they can block the baby's head from coming down and you would need to have a C-section.

Fibroids should not be removed from the uterus during pregnancy. The surgery could cause severe bleeding and lead to the loss of the pregnancy.

Sincerely,
Amy

Sunday, September 25, 2005

Dose of folic acid

I have recently had a miscarriage. I want to try as soon as I have my first period. My doctor prescribed 5mg of Folic Acid but I am worried this will be too much and may affect the baby if I get pregnant soon. Is 5mg to much?

Thanks,
Jo

Dear Jo,

The recommended dose of folic acid is 0.4-1 mg per day. The only time more folic acid is recommended is for women who have given birth to a child with a neural tube defect like spina bifida. In that case, the recommend dose is 4 mg per day.

Sincerely,
Amy

Evening primrose oil

Dr. Amy,

I am pregnant with my 5th baby and am 39 weeks,tired and very uncomfortable and want the baby to be born. I have heard that evening primrose oil can help ripen and efface your cervix to help you to go into labor along with walking. Would you say this is a safe way to naturally help get labor underway?

Desperate

Dear Desperate,

As far as I know, there is no scientific evidence that evening primrose oil works to ripen the cervix or induce labor.

It is also important to keep in mind that inducing labor is not "natural", no matter what substance you use to do it. To the extent that any substance works, it is because of the chemicals that are in it. Chemicals that are created by living things are no safer than chemicals created in the lab. Some of the most dangerous chemicals known are created by living things: tobacco, heroin, cocaine, etc.

Sincerely,
Amy

Irregular bleeding

Dr. Amy,

I was so thankful to find your web site and wanted to ask a question. I had laparoscopic surgery in January of this year, in which both my gallbladder and right kidney were removed. I was born with the nonfunctioning right kidney, and after much discussion when it appeared to be aggravating my gallbladder, my doctor decided it was best to take both of them out.

I am 29 years old, and my husband and I are trying to conceive at this time. I was told to wait a few months before trying for a baby after my surgery. The problem is that I never know when I am ovulating, because I have frequent bleeding.

I had what I think was a "true" period on September 3rd through the 5th, the blood was bright red. Then on September 19th, I noticed I was spotting dark brown blood, enough of it that I had to use a pantyliner, this went on for 3 days. Today on the 24th, I am having the dark brown blood mixed with bright red and again wearing a pantyliner. I have been off of birth control for 2 years. Even while on the pill I had breakthrough bleeding between periods. My OB doctor did not seem overly concerned when I mentioned it to him a couple of years ago, saying "Some women just have breakthrough bleeding and that is normal for them."

This type of bleeding between periods has been going on for at least 3 years, but it seems to be worse since I've been off of the pill. I had a routine physical done in August and all my bloodwork was normal. Should I be concerned at all? I am never sure when my husband and I should try! Any advice you might have, I would appreciate! Thank you for your time.

Sincerely,
Angie

Dear Angie,

Women who are not on the Pill do not usually have breakthrough bleeding. The pattern of bleeding that you describe suggests that you might not be ovulating and may have polycystic ovary syndrome (PCOS), a hormonal problem that causes irregular bleeding. You can ask your doctor for blood tests of hormone levels to see if you do have PCOS.

You can also buy ovulation predictor kits to find out if you are ovulating. There is no harm in trying to get pregnant in the meantime. If you are ovulating, and you have sex on a regular basis, you will get pregnant. You don't need to time sex to ovulation in order to conceive.

Sincerely,
Amy

Sex at the end of pregnancy

Dear Dr Amy,

My wife is 20 years old and is in the 9th month of pregnancy. Is sex is safe during this period of pregnancy? Are orgasms for women safe during pregnancy? Plus , what about fingering (masturbating) her , is it safe for her and our baby?

AY

Dear AY,

Sex, orgasm and masturbation are all safe at the end of pregnancy, as long as there is no bleeding and the membranes have not ruptured.

Sincerely,
Amy

Worried about pre-eclampsia

Hi,

I am 21 years old i am 16 weeks into my second pregnancy. This time it is totally different. I had pre eclampsia at the end of my pregnancy with my little boy and I was in a bad way. I am scared that I will get it again and find it hard to sleep, worrying that this time I won't be so lucky and I've got too much too leave behind. If you have had it once, what are the chances of getting it in the second pregnancy. I panic when I get a headache, worrying that it is my blood pressure, which is fine at the moment. Thank you for listening and if you would get back to me maybe I could get a decent night's sleep.

Thank you,
Rebbecca

Dear Rebbecca,

There is a chance that you could get pre-eclampsia again, but it is in the range of 20%. The key, this time, is close monitoring.

You don't need to worry now, because it is too early to develop symptoms. At the earliest, you could start getting symptoms after 22 weeks or so. At that point, you can be monitored with weekly visits to check your blood pressure, reflexes and urine protein. You can also have blood tests to detect more subtle signs of pre-eclampsia. With careful monitoring, you can be hospitalize and delivered before you get severe pre-eclampsia.

You might consider asking to be switched to a perinatologist (a specialist in high risk pregnancy) for your care. Perinatologists have a great deal of experience with pre-eclampsia.

Sincerely,
Amy

Bleeding every 14 days

Dear Dr. Amy,

I am 17 years old and have had a regular cycle up till now. I am now getting my period every 14-17 days, whereas before they were every 28 days since I was twelve. They are also now much lighter. I am concerned!

I have also never been able to use tampons and feel defective.

Thank you,
E

Dear E,

It sounds like you may not be ovulating regularly. The best thing to do is to make an appointment with a gynecologist (or your regular doctor) to figure it out.

Being unable to use tampons does not mean that you are defective. You can try small tampons (junior size) and lubricate them with a water soluble product like K-Y Jelly (don't use vaseline). If you practice trying different angles, you'll probably get the hang of it.

The most common reason for difficulty is that many women don't realize how the vagina is angled. For example, when you are standing up, the vagina is not straight up. it is actually pointing toward your back. So if you try to insert a tampon straight up, it won't go in; you need to point it toward your back.

Sincerely,
Amy

PCOS

Dear Dr. Amy,

My 19 year old daughter has extremely irregular periods. They have been that way since she first got her period and now it is becoming increasingly worse. In the beginning she would get it every 2 to 3 months or sometimes 4. It then went to twice a year and so far she has only had it once this year. She did have brain surgery back in 2000 and was briefly on anti-seizure medication. She has no other pertinent medical history. What do you suggest?

Karen

Dear Karen,

It sounds like she very well may have PCOS. The best thing to do would be to make an appointment with a gynecologist for an exam and blood tests to find out. There is also a small possibility that her pituitary gland was injured during her brain surgery (it depends on the specific type of surgery). This would be treated differently than PCOS.

Sincerely,
Amy

Paxil during pregnancy

Hi Dr. Amy,

My daughter is 32 yrs. old and pregnant. She has been on Paxil for a couple of years and she asked a pharmacist whether she should get off the rx, she said to wean herself off. Then she saw a Dr. and she told her to stay on. What do you think? My daughter has decreased her dose to 15mg daily.

Thanks,
Dawn

Dear Dawn,

There is some question about whether medications like Paxil are harmful in pregnancy. However, there is no question that women with severe symptoms of depression or anxiety should stay on the medication throughout pregnancy.

An excellent source of information is the Reproductive Psychiatry department at Mass General Hospital. Their website is www.womensmentalhealth.org. You can visit the site for an extensive discussion of the risks and benefits of psychiatric medications. In addition, your daughter, or her doctor, can call them for a phone consultation about her specific situation.

Sincerely,
Amy

ASCUS Pap and colposcopy

My 21 year old daughter just got her Pap results that were ASCUS and positive for HPV. They have recommended colposcopy. She is studying abroad and won't be home until Dec. Is it safe to wait unti then to do the test? Also does it mean that she has a high risk strain of HPV because they want her to do colposcopy?

Nina

Dear Nina,

ASCUS stands for atypcial squamous cells of undertermine significance. In other words, there are some slightly abnormal cells, but it is not clear if they are precursors of precancerous cells.

The current recommendation is that women with ASCUS Pap smears need colposcopy only if they have a high risk strain of HPV. However, some doctors will recommend colposcopy for any strain of HPV.

Sincerely,
Amy

Nicotine gum during pregnancy

Can I use nicotine gum while in early stages of pregnancy? If not, is anything I can use to stop smoking?

P

Dear P,

This is controversial. Smoking during pregnancy is clearly bad for the baby. However, nicotine is bad for the baby, too. Some doctors feel that the danger from smoking is higher, but others believe that they should not prescribe a medication that is, in itself, bad for the baby, even if smoking is worse.

Sincerely,
Amy

Baby is late

Hi, dr..

My expected due date was on 9/20/05 and there is no baby yet. I had an appointment on 9/22 andmy doctor checked my cervix and told me that my cervix was still long and closed, and that it was high. I was just wondering what that meant.

I am scheduled for an induction on 9/29 if by then i do not go naturally. I am worried and scared to be induced because I have heard that it is more painful as opposed to letting your body go naturally. On the other hand I am scared that I may have to have a c-section, not that they have told me, but just in case. My plans from thebeginning were not to have an epidural and I don't know what other choices I have for pain. Any advice on that please?

I was told that there is a pill that the doctor can give or put in my vagina to ripen the cervix (i do not quite understand what that meant), I was just hoping you can also answer that for me.

Thank you so much!
YR

Dear YR,

It is important to keep in mind that the due date is really an estimate. The due date is placed at 40 weeks because that is the average length of a pregnancy, not because the baby is officially "done" on that date. So, being late, in and of itself, is not a problem.

We know from experience that if a pregnancy lasts more than two weeks longer than an official due date, the baby can begin to outgrow the supply of oxygen and nutrients supplied by the placenta. That's why inductions are usually scheduled for approximately 1 1/2-2 weeks after the due date. At that point, the risks of being late begin to outweight the risks of induction (the chance that it won't work and the increased risk of a C-section). As far as pain is concerned, the pain of labor is very, very intense. It does not make a lot of difference if you are induced.

Before labor begins, the cervix starts to thin and stretch in preparation and the baby's head drops lower in the pelvis. Your exam showed that none of these things have happened yet, so natural labor is probably not very close. There is medication that can be applied to the cervix before an induction to soften and thin (ripen) the cervix. If you have an induction, and your cervix isn't ready, you will receive this medication first.

The best advice I can give you about pain medication is to make your decision based on your experience. Don't decide in advance what you will or won't do, because you don't know how you will feel. If you don't need pain medication, that's great. If you do, you can choose between injections of medication that will dull the pain and an epidural (an injection of anesthetic around the nerves of the lower spine) that will take the pain away.

Good luck!

Sincerely,
Amy

Saturday, September 24, 2005

Airplane flight in pregnancy

Can you fly abroad at 16 weeks pregnant?

KPU

Dear KPU,

It is safe to fly on an airplane during pregnancy unless you have specific medical problems. The airlines will not let you fly after 36 weeks because of the risk of delivering on the plane.

Sincerely,
Amy

Ultrasound to check for Down's Syndrome

I'm 17 weeks pregnant and I have gestational diabetes. My doctor wants to do a special ultrasound to check for Down's syndrome in my baby. I'm very scared. Is this a normal test? I have a daughter, age 5. When i was pregnant with her I had gestational diabetes, but never had this test.

Thank you,
Victoria

Dear Victoria,

As you get older, the risk of having a baby with Down's Syndrome goes up, whether or not you have gestational diabetes. Women over 35 are advised to have an amniocentesis (inserting a needle through the skin of the abdomen into the uterus to remove amniotic fluid and analyze it). It turns out that there are signs of Down's Syndrome that can be seen on ultrasound. Many doctors are now offering all their patients an ultrasound at around 18 weeks to be sure that there are no birth defects of any kind. There is no need to be worried about this; it is routine.

Sincerely,
Amy

What is a D&C?

My recent hcg results show that I've miscarried. I haven't lost anything and only had light bleeding during normal period time. My doctor wants to see me on the 5th of Oct. to determine whether I need a D&C or not. What's a D&C and what are the side effects. Also a pregnancy out of the uterus can that still be detected by blood work?

Becki

Dear Becki,

In a normal pregnancy, the HCG level doubles approximately every 48 hours. If the HCG level is not rising appropriately, it is not likely to be a normal pregnancy. It could be an impending miscarriage or an ectopic (tubal) pregnancy. An ultrasound can sometimes be helpful in telling the difference. If the ultrasound shows pregnancy tissue in the uterus, it is not an ectopic pregnancy.

D&C stands for dilatation (opening the cervix) and curretage (scraping or suctioning out the contents of the uterus). That can be necessary if your body does not expel the pregnancy tissue on its own, or if it expels only part of the tissue, you will continue to have heavy bleeding until the rest of it is removed.

A D&C is a minor surgical procedure and the risks include infection, bleeding and a very small chance of damage to the uterus. If you can avoid a D&C, that would be great, but in many cases of miscarriage, it cannot be avoided.

Sincerely,
Amy

Flaxseed oil and wheatgrass in pregnancy

I was wondering if it is safe to take flaxseed oil (1000 mg) daily and also drink wheatgrass during pregnancy? I only drink 1 tsp wheatgrass powder diluted in a glass of juice. Both the flaxseed oil and wheatgrass I take have no other herbal additives.

Thanks,
Leigh

Dear Leigh,

Flaxseed oil should not be used during pregnancy because there is potential to cause birth defects. I could find no scientific information about wheatgrass.

Sincerely,
Amy

Friday, September 23, 2005

Birth control pills at 49

Dear Dr Amy,

I am 49 years old and began birth control pills for the first time ever in July. My Dr recommended the 3 month without a break routine so I woulld have periods just 4 times a year. Last Sunday, Sept 18th, I began my weeklong placebos but I have only had some light spotting and no real period. I did have unprotected intercourse on that Sunday but I can't see that I would be ovulating that quickly to become pregnant the day after I stop the pills. Anyway, what is your take on this?

Thank you for your help,

Angie

Dear Angie,

In general, the birth control pill is not given to women over age 40 because of the increased risk of heart attacks and strokes in older women.

Many women in their 40s have problems with their periods because they are approaching menopause. These problems are usually treated with progesterone alone, not birth control pills.

If you are close to menopause, or in menopause, you will not have a normal period on the Pill.

Talk to your doctor about these issues, particularly the risks and benefits of the Pill at age 49.

Sincerely,
Amy

Small pelvis

Hi Dr. Amy,

At my last appointment, I was told that I have a very narrow pelvis. I am not scarred of having a c-section, but I was wondering what my chances are of having one versus a vaginal birth. Thank you.

Alicia

Dear Alicia,

Whether or not the baby will fit depends on 3 "P"s: pelvis, passenger and power. The pelvis refers to the size of your pelvis. If it is narrow, it may not be able to fit a large baby, but it is very possible that a small baby will come through easily.

The passenger is the baby. Of course, the baby's size matters, but it's position does, too. The ideal position for a baby at the beginning of labor is head down and facing the mother's back. If the baby is in a different position, it may not fit nearly as well.

Power is the strength of the uterine contractions. Some women have contractions that are not powerful enough to push the baby out. The contractions can be strengthened with medication (pitocin), and that is often enough to push the baby through. If pitocin doesn't work, it is a sign that a C-section is needed.

It's not possible to tell in advance whether you will need a C-section. It all depends on what happens with these 3 factors when you are in labor.

Sincerely,
Amy

Polycystic ovary syndrome

I have just recently been diagnosed with polycystic ovaries, and not long after found out I am pregnant. Will this affect my pregnancy or unborn baby?

DC

Dear DC,

Polycystic ovary syndrome can affect your ability to get pregnant, but once you are pregnant, it should have no effect on the pregnancy or the baby.

Sincerely,
Amy

Pregnancy after 2 ectopics

Hi Dr. Amy,

I am 24 and my man is 32 and we are so happy toghter. We both want to know if after 2 ectopic pregnancies, can we still kave kids? We were talking about IVF, but it cost so much and we dont have that much. We have tried all the things you can buy that say they help, but nothing works. Can you tell use the best thing we can try?

Thank you,
Kay

Dear Kay,

You need to find out how your ectopic pregnancies were treated. If you had surgery, you need to know if they removed your fallopian tube, or simply repaired it. If both fallopian tubes were removed, you cannot get pregnant without IVF. That's because there is no way for the sperm to reach the egg and there is no way for the egg to reach the uterus.

If you have at least one fallopian tube, you can get pregnant naturally. However, it is possible that the tube is blocked. Ectopic pregnancies often happen because the tubes have been damaged by infection. The ectopic pregnancy can further damage the tube. If you have at least one tube, you can ask a gynecologist for a test to see if the tube is open. If it is open, you could get pregnant. If it is blocked, you would need surgery to fix it.

Nothing you can by over the counter can increase your chances of getting pregnant.

Good luck.

Sincerely,
Amy

Organic yogurt

Dear Dr. Amy,

Is it safe to eat organic yogurt and milk while pregnant? The ingredients in the organie yogurt I've been eating are cultured pasteurized nonfat milk, naturally milled sugar, inulin, natural vanilla flavor, pectin, turmeric. And it contains six live active cultures including L. Acidophilus, bifidus, L. Casei and L. Reuteri.

Thank you,
Samantha

Dear Samantha,

As long as the milk is pasteurized, it should be okay.

Sincerely,
Amy

Spa use in pregnancy

Dear Dr Amy,

I am a regular user of my own outdoor spa. I have recently fell pregnant (4 weeks) and I would like to continue using the spa for relaxation etc. The average use of the spa would be twice a weekend for about an hour and the temperature is 37 degrees C. Is there some way to still use the spa? ie maybe only for one hour at 37C once a week?

Kind Regards,
Claire

Dear Claire,

The important thing to keep in mind is that raising your body temperature above normal increases the risk of birth defects. At 37C, your spa is at body temperature, and is probably okay.

Sincerely,
Amy

Thursday, September 22, 2005

Pet rats

Dear Dr. Amy,

I wondered if there were any problems or dangers with handling pet rats whilst pregnant?

Thanks,
Ally

Dear Ally,

I've never had that question before!

I don't know the answer. You might try asking a veterinarian what illnesses are common in pet rats and then we can figure out if those illnesses pose a danger to pregnancy women.

Sincerely,
Amy

Sleeping medication

Hi Dr. Amy,

I have been dependent on sleep aids for three years now. I am three weeks pregnant now and have tried to stop taking them. I have not slept for a while and it is affecting my work performance. I am a single parent and I need my job and I do not want my lack of sleep to affect my son or job, is it safe to take sleep aids while pregnant? The ones I take now are called Simply Sleep by Tylenol.

Thank you for your help!
Chantal

Dear Chantal,

Simply sleep is just the anti-histamine benadryl. It is considered safe for occasional use in pregnancy. You should talk to your doctor about continuous use to see what he or she suggests.

Sincerely,
Amy

Malaria tablets

Is it safe to take malaria and hepatitis A tablets whilst pregnant? I am going on holiday to the Caribbean and would like to know whether these tablets are safe.

Thank you,
Caroline

Dear Caroline,

Do not take any medication without first discussing it with your obstetrician or midwife. Some anti-malaria medications are acceptable, others are not. There are no pills to prevent hepatitis A. You would need a vaccination.

Sincerely,
Amy

In Iraq, possible ectopic

Hello Dr. Amy,

I have a very overwhelming situation. About a month ago I went to the doctor because I was having really bad cramps with my period . I found out I was pregnant. The doc said that i was having a miscarriage and that it should get rid of itself.

Forthis whole month I was bleeding, some days heavier than others. About three weeks into it I was still having cramping and bleeding so I emailed him and he told me to come in after the weekend was over but I never did . Last week the bleeding let up and I thought the bleeding was going to end. To my surprise just one day out of the blue I had pain in my right lower abdomen. It hurt so bad I was in tears. It lasted for about three hours and then I felt fine but when it initially started I had passed a blood clot and I was bleeding.

I went to the hospital and the doc says that he believes that I had a ectopic pregnancy. I have not been in any pain since than but when he did the ultrasound we found out that I have a huge blood clot in my uterus or behind it. He said that the hemorraging has stopped

Because of where I am (Iraq) we are waiting for the HCG levels to see what they are doing. He said it is too risky to send me to where I need to go because if I rupture than I could bleed to death on the flight.

Should I assume that I had a etopic pregnancy and it ruptured and my tube is okay? He said there is nothing in my uterus but that big blood clot. Do you think the big blood clot
could have came from hemorrhaging from a ectopic pregnancy? If it ruptured, could it rupture more if it was just a little bit?

GM

Dear GM,

The blood test will tell you what is going on. If the HCG level is dropping, you may have had a miscarriage. If the HCG level is is steady or rising slightly, you probably have an ectopic pregnancy. In that case, you need to be transferred to a facility that can treat you with medication (methotrexate) or surgery. The risk of rupturing on the flight is no greater than the risk of rupturing in Iraq, so it makes sense to get to a place where you can be treated.

Sincerely,
Amy

Penis size

Dear Dr Amy,

I have been with my fiancé for a year now. He lives with me now and we get along great! Well he is a little smaller then most guys in that area and it bugs me because I dont know if I could get pregnant from him or if that is even why I'm not pregnant yet. We have unprotected sex all the time and I'm still not pregnant . I dont know if something is wrong, and it scares me.

I want to tell my fiancé that I would love for him to get bigger down there but he can be a stubborn guy about that kinda stuff. I dont know how to tell him that I think that and wish he would do something about it. Plus, I dont understand why I haven't got pregnant.

Thank you,
M

Dear M,

Penis size has absolutely nothing to do with the ability to get pregnant. It also has nothing to do with sexual satisfaction.

I'm not sure what you expect him to do about it anyway. There is no way to change the size of your penis. There are plenty of things on the market that claim to enlarge it, but none of them work.

If you have been having unprotected intercourse for more than a year without getting pregnant, it is possible that there is an infertility problem, but the problem may be with you, not him. You can make an appointment with a gynecologist for a complete infertility evaluation. As part of the evaluation, your partner will be asked to have his sperm count checked, so you can find out if that is a factor.

Sincerely,
Amy

Pregnancy induced hypertension

Dr. Amy,

Please help! I am five months pregnant. I have been going to the doctor regularly, and my BP has been high. I had PIH with my first pregnancy. One doctor that I saw was concerned that I was developing it again, because of my BP, protein in my urine, visual spots, and headaches. They then put me on BP meds, and I went back today for a check-up. Today, the doctor I had says my BP is fine even though it was higher than the last time (when they were concerned). So, today it was higher and I am on the medication for it, but now it doesn't seem to be an issue.

Also, they told me that you can't develop PIH with the second pregnancy to the same man, yet, everything I have read says that you can. I even went as far as to join the preeclampsia foundation, and have spoke with several women on there who also have it, or have had it, and they have all had it with all pregnancies. The one woman I spoke with said that her blood work always came back good yet she was diagnosed with it. My blood work is fine yet my BP is high and they say I can't have it. I am so confused.

JW

Dear JW,

It's difficult for me to know what is going on because you didn't mention what your blood pressure is, how much protein is in your urine and what medication you are taking.

There are a number of things to keep in mind, though. PIH (pre-eclampsia) usually involves an increased diastolic blood pressure. That's the bottom number. So if your previous blood pressure was 120/88, but today's blood pressure was 130/78, things would be better.

Second, PIH usually occurs in the third trimester, most often in the last month of pregnancy. Elevated blood pressure before that may be due to pre-existing high blood pressure unrelated to pregnancy. Medication can control pre-existing high blood pressure, but usually doesn't do much for PIH. The fact that you were started on medication suggests that the doctor was worried about pre-existing high blood pressure.

There are a number of blood tests that can give more information about whether or not you have PIH. You can request these blood tests if you haven't had them already.

Women who did not have PIH in a first pregnancy, are unlikely to get it in a subsequent pregnancy. It's not impossible, of course, but it doesn't happen very often.

If you are concerned, you can always get a second opinion or ask for a referral to a perinatologist (a specialist in high risk pregnancy) for an evaluation.

Sincerely,
Amy

Pregnancy and the coil (IUD)

Can you get pregnant on the coil?

Anonymous

Dear Anonymous,

It is unusual, but you can get pregnant with a coil (IUD) in place. If you do get pregnant, it is more likely than average to be an ectopic (tubal) pregnancy.

Sincerely,
Amy

Honey during pregnancy

Hi there,

My girlfriend has a virus and wanted to drink some honey and lemon, but didnt know if it was ok.

Many thanks,
Dan

Dear Dan,

Both honey and lemon are safe in pregnancy. Honey should not be given to babies under the age of one, because it can contain a certain kind of bacteria that can harm babies.

Sincerely,
Amy

Prolapsed uterus and pregnancy

Dear Doctor,

My GYN told me that I have a prolapsed uterus. He instructed me todo the kegel exercises. My questions is: can I still get pregnant?

Thank you,
MY

Dear MY,

You should be able to get pregnant if you have a prolapsed uterus. If you have a severely prolapsed uterus, falling deep into the vagina, you may be uncomfortable in the early months of pregnancy. Once the baby gets big enough, it will hold the uterus up because the baby will be too big to drop through the pelvic opening.

Prolapse is usually caused by stretched ligaments, and Kegel exercises strengthen the muscles, so I am not sure they will help.

Sincerely,
Amy

Wednesday, September 21, 2005

Fetal arrhythmia

Dear Dr. Amy,

What is a heart arrhythmia in a fetus still three months from due date? What are possible consequences and treatments?

SJH

Dear SJH,

It depends on the type of arrhythmia. Some arrhythmias are mild and temporary and do not cause problems. Other arrythmias are associated with heart defects and may have serious consequences. Fetal arryhthmias are usually evaluated by ultrasound initially. At that time, recordings of fetal heart motion can be made and the structure of the heart is evaluated. If there is a problem, you should see a pediatric cardiologist who can perform additional investigations to figure out what (if anything) needs to be done.

Sincerely,
Amy

High cholesterol and pregnancy

I am 33 years old and have a 4 year old and a 7 year old. I have a cholesterol level of 233 with the LDL level of 155 and the VLDL of 21. I am wondering if it is safe to try and become pregnant again. High cholesterol is HIGHLY seen in my entire family history. My cholesterol has only been tested the last two years....so I may have even had high levels when I was pregnant with my first two , both being good pregnancies/no complications. Please tell me that it is okay!

Thank you,
Amy

Dear Amy,

As far as I know, high cholesterol does not have adverse effects on pregnancy. Cholesterol can increase during pregnancy, but it not associated with problems. The best thing to do would be to discuss your specific situation with your internist and your obstetrician.

Sincerely,
Amy

Yeast infection and conception

Dear Dr. Amy,

I am 32 years old and have a 2 year old son. My husband and I are eager to conceive again now. Although I conceived my son the first time we tried, we are on our second "go-round" and the home pregnancy test result, taken yesterday (day 29 of my cycle), was negative. I took the test on day 29 because I now have a yeast infection and didn't want to treat it without knowing whether or not I am pregnant. So, here are a few questions I have for you:

1. Will a yeast infection delay my period?
2. Can a yeast infection affect the results of a pregnancy test?
3. If I treat the infection with Monistat and then get my period, will the medication affect my ability to conceive?
4. If I treat the infection with Monistat and find out I am pregnant, is that harmful to the fetus?

Also, my cycle is typically 27-28 days long. Today I am on day 30 and no period. Therefore, unless the yeast infection plays a factor in delaying menstruation, other than using an OPK kit and monitoring cervical mucus, how can I predict ovulation? I am very eager to be pregnant again now. Any helpful suggestions are greatly appreciated.

I thank you in advance for your response.

Sincerely,
Anonymous

Dear Anonymous,

1. A yeast infection will not delay your period.
2. A yeast infection will not affect a pregnancy test.
3. Monistat does not affect fertility.
4. Monistat is not considered harmful in pregnancy. The manufacturer advises against using it in the first trimester, but there is currently no evidence that it causes any problems.

If you are concerned about a possible pregnancy, you can always wait a few days before treating the infection.

Sincerely,
Amy

Fetal movement

Dear Dr. Amy,

I am 25 weeks pregnant and up till now have had obvious signs of the baby moving, but over the past couple of days this has settled down a bit. Some of my friends say that it's normal but please can you put my mind at rest?

Many thanks,
Fiona

Dear Fiona,

It is always reassuring to feel the baby move and women become concerned when the pattern of movement changes. The most common reason is that you are distracted and don't notice all the movements. If you sit quietly for awhile, you may find that the baby is moving just as much as usual.

If you are still concerned, don't hesitate to talk it over with your doctor. He or she may recommend coming in to evaluate the baby on the fetal monitor.

Sincerely,
Amy

Genital warts during pregnancy

Dear Amy,

Quite an embarrasing issue really, I had gential warts when i was pregnant with my son. We want to have another baby now but i am worried the warts will return. Is there a chance they will? What can i do to keep them at bay?

Thank you,
Anon

Dear Anon,

Human papilloma virus (HPV), the virus that causes genital warts, can remain dormant in the body for years at a time, but the warts may appear only at certain times. Pregnancy is a state of altered immunity and women with HPV may notice more warts, and larger warts at that time. As yet, there is nothing that you can do to prevent this.

The warts themselves are not harmful to the baby. As far as we know, the risk of passing the virus is the same whether you have warts at the time of delivery or not. If you do develop warts during pregnancy, they may go away spontaneous after the baby is born, or they can be treated at that time.

Sincerely,
Amy

Spina bifida

Dr Amy,

I had an ectopic pregnancy in April, and we plan in the future to try again. I am concerned because niece was born 6 years ago with spina bifida. My sister's doctor wanted them to go thru genetic testing to see whose side it came from; they said her spina bifida could have been hereditary. They opted not to go through the testing to avoid feelings of blaming each other. She was on Clomid and her doctor never told her to take prenatal vitamins.

We know that sb is likely to be caused by folic acid deficiency. I am taking prenatals but should I also be taking folic acid supplements also? I am worried that when and if we conceive, our baby with be born with SB also. What extra steps can we take to be the safest and have the healthiest baby?

Thank you,
Denise

Dear Denise,

It seems that spina bifida is caused by both genetic and environmental factors. As far as I know, the genes involved in spina bifida have not been identified, so there is no way to predict who is carrying it.

Taking folic acid in the month before conception and in the early months of pregnancy can decrease the incidence of spina bifida by 75%, but it will not prevent all cases of spina bifida. If your prenatal vitamins have 1mg of folic acid (and most prenatal vitamins do), you do not need to take additional supplements.

The Spina Bifida Association of America has a fact sheet about spina bifida and genetics. You can find it at: http://www.sbaa.org/site/DocServer/genetics.pdf?docID=868.

Sincerely,
Amy

Tuesday, September 20, 2005

Severe morning sickness

Dear Dr. Amy,

I am 20 years old and have been pregnant 5 times. I terminated all pregnancies due to my state of health starting from 4 weeks on. I get extremely sick. I vomit about 30 times a day, and get sent to the hospital for re-hydration.

None of the pregnancies were planned, so I was wondering if there were any vitamins I could take before I get pregnant to ease the amount of nausea I get during that time. Thus far, the only nausea medication that has worked is not safe for the baby; it is used to treat patients with cancer who are going through radiation therapy.

I did try to go through my 1st trimester the last time, but the sickness was unbearable and showed no signs of easing by the time I reached 11 weeks. Is there something I can do or should I continue to consider having another woman carry my baby?

Please help,
SN

Dear SN,

Severe morning sickness is called hyperemesis, which means excessive vomiting. There are no vitamins or other medications that you can take to prevent hyperemesis. There are a number of medications that you can take during pregnancy that can help with the nausea and vomiting, there is no guarantee that they will work for you. You can talk to your doctor about it in advance.

Hyermesis, while very uncomfortable, is not harmful to you or the baby.

Sincerely,
Amy

Ovulation predictor tests

Hi, Dr. Amy!

After coming off the Pill in May, my periods have been around 40-45 apart and my doctor told me that because of this length, I am not ovulating. She suggested using an ovulation predictor test to see if and when I ovulate. How accurate are these tests. It was very obvious when I had my LH surge according to the test strips, so I just want to know that if you have an LH surge, will you definitely ovulate? My last period was on August 19th and lasted about 6 days. I began using the ovulation test, and on September 8 it showed an obvious surge. We had sex on September 9th and 11th so I will wait until around the 23rd or 24th to take a HPT. Thanks for your opinion.

Sincerely,
Haylee

Dear Haylee,

The ovulation predictor kits are quite accurate, so you probably did ovulate. However, just because you had sex around the time you ovulated does not guarantee that you will get pregnant. The chance of pregnancy in any given cycle is only 20%. That's normal. It usually takes several months of trying before you get pregnant.

Sincerely,
Amy

Abnormal periods

Dear Dr. Amy,

My period is not normal. Sometime it lasts a month or more, sometime it lasts only 3 days and sometime there no period for a few months. When i go to the doctor to see if I'm pregnant the test was negative. Right now I'm having a very light spotting. Is there a chance I might be pregnant? I had a miscarriage in 2002, and I've been trying to have a baby. I went to see a gyn who said everything is normal. Do you know what are the best things to do to get pregnant? Should I start any medication?

A

Dear A,

It does not sound like everything is normal. Very irregular periods, some long, and some short are often a sign of a hormone problem called polycystic ovary syndrome (PCOS). This hormonal problem can also make it very difficult to get pregnant. You should see another gynecologist or an infertility specialist. He or she can order tests to find out what is wrong and figure out the appropriate treatment.

As far as the spotting is concerned, spotting is not usually a sign of pregnancy. The only way to know if you are pregnant is to check a pregnancy test.

Sincerely,
Amy

Symptoms of ectopic pregnancy

My daughter has just found out she is 5 weeks pregnant. She is 24, when she was 16 she had a pelvic inflammatory infection ( I think that's what is was called ) and was told this could effect her getting pregnant or she could have an ectopic pregnancy. How soon will she have her first scan done to find out if its in the right place? She is very worried at the moment.

Liz

Dear Liz,

Although women who have had a previous episode of PID (pelvic inflammatory disease) are at increased risk of having an ectopic pregnancy, most pregnancies will be normal. Only about 10% or pregnancies will get stuck in the tube.

The classic symptoms of an ectopic pregnancy include one sided lower abdominal pain and vaginal bleeding. Your daughter can have an ultrasound as early as 6 weeks after her last menstrual period to be sure that the sac is in the uterus and not in the tube.

Sincerely,
Amy

Ectopic pregnancy

I am 41 years old and I have 4 children. I was 8 weeks pregnant and my doctor did an ultrasound and there was no baby, just the sac. My doctor said that it could be an ectopic pregnancy and she did a D&C.

She sent tissue to the lab and said that the pregnancy was probably in the tube. She gave me two shots of methotrexate and sent me home. After that, I have had blood tests every two weeks to check the level of pregnancy hormone. I had my period for two week, then I had my period again two weeks later for another two weeks. Now I have my period again only three days after the last one. Is this normal? My last blood test was on Friday and the level was 50.

Thank you,
Adriana

Dear Adriana,

It sounds like you did indeed have an ectopic (tubal) pregnancy and your doctor treated you appropriately. The three episodes of bleeding that you describe are probably not all periods. I'm not sure why you are continuing to have irregular vaginal bleeding. You should talk it over with your doctor.

Sincerely,
Amy

Monday, September 19, 2005

Buserelin

Dear Dr. Amy,

I am currently taking buserelin prior to ICSI and wondered if can you get pregnant whilst on this drug. I have injecting for 5 weeks now and have not yet had a bleed. I will go back to the clinic shortly.

Thank you,
Lu

Dear Lu,

Buserelin is used to suppress the ovaries, so you should not be able to get pregnant while you are taking it. It is the first step in preparing the ovaries to produce multiple eggs for assisted reproductive procedures.

Sincerely,
Amy

PPD in pregnancy

Dear Dr. Amy,

I had a PPD test done for a job. 3 weeks later I'm pregnant with twins. Are my babies at risk?

Very Nervous

Dear Very Nervous,

PPD tests for tuberculosis are considered safe in pregnancy.

Sincerely,
Amy

Celiac disease

Dear Amy,

I am 38 years old and was diagnosed with coeliacs disease 12 months ago. I have one 10 yr. old daughter and am thinking of getting pregnant. Would celiac disease affect the baby during pregnancy? Would the baby have celiac disease as well?

Y

Dear Y,

Celiac disease does not seem to affect fertility or pregnancy. Celiac disease appears to be genetic, and 10%or more of the children of celiac parents will have the disease. You should talk this over with your daughter's doctor. He or she may recommend testing her and any children you have in the future.

Sincerely,
Amy

Baby has abdominal defect

Hi,

I am 22 weeks pregnant and after my 18 week scan they discovered that my baby's bowels are on the outside of the stomach, due to the baby's tummy not closing, leaving a hole at the tummy button. I had an amnio to rule out any other problems and all my chromosomes are normal, but I am wondering what will happen when the baby is born and will it be ok?

Anonymous

Dear Anonymous,

This is a very serious, even life threatening problem, and it is possible that the baby will be very sick.

There are two major kinds of abdominal wall defects: omphalocele, where the intestines come through the abdominal wall, but are contained by a sac, and gastroschisis, where the intestines are floating freely in the amniotic fluid.

Both defects require major surgery to repair. Although the baby's chromosomes are normal, it is possible that the baby has other defects as well, and these may also need to be repaired. The more intestine that is outside the body, the greater the chance that the defect cannot be successfully repaired. Approximately 1 in 3 babies with this problem will not survive.

It is very important for your doctor to send you to a perinatologist, a specialist in high risk pregnancy, so you can have the best possible care. You will need to deliver the baby at a hospital where they can operate on the baby right away, and you should meet with the surgeons who will care for the baby before the baby is born.

Your doctor should also discuss with you the option of terminating the pregnancy (abortion). It is possible that this is something you would never do, but it is important for you to understand that you have the option.

I am sorry that I have such bad news. Your doctor should have told you this already, and made the proper arrangements for the baby's care.

Good luck.

Sincerely,
Amy

Ballet and no period

Hello Amy,

My daughter is a ballet school student and has been since the age of 11. She is 16 next month (October) and has not started her periods. She is very petite, 5ft 2 inches, size 6 and weighs around 6 and a half stones. She is very healthy and eats wells and is not anorexic. Should I be worried? Do I need to see a doctor about this?

Thank you,
Kim

Dear Kim,

A girl should start her period by age 16, so you should take your daughter to the doctor to get this checked. It is true that female atheletes and ballerinas may lose their periods (or not start) because of their weight and the strenuous exercise. However, it is also possible that your daughter may have a hormone problem that needs to be treated.

Typically, a girl will get her first period approximately 2 years after beginning puberty (growing underarm and pubic hair). If the regular events of puberty are happening, it is less likely that there is a problem.

Sincerely,
Amy

Sauna or jacuzzi in pregnancy

Hi,

Can I use the sauna and jacuzzi whilst pregnant?

Gemma

Dear Gemma,

The sauna should be avoided during pregnancy. That's because raising your core body temperature can increase the risk of birth defects. A jacuzzi is fine as long as the water is not too hot.

Sincerely,
Amy

Urinary tract infection

My sister in law lost a baby last year because of her placenta breaking. She has just had an water infection and the hospital prescibed cephalexin capsules 250mg. Shes 24 weeks pregnant what affect can this have on her child?

MP

Dear MP,

Cephalexin (Keflex) is safe to take during pregnancy. It is very important to treat a urinary tract infection in pregnancy because there is an increased risk of getting a kidney infection. A urinary tract infection or a kidney infection also increases the risk of premature labor. She should be sure to finish the full prescription and return to the doctor if she still has symptoms.

Sincerely,
Amy

Postpartum bleeding

Hi,

I had my daughter on July 8th. It was a normal vaginal delivery and my third child. I am very worried because I am still bleeding. On Sept. 7th and 8th it went down to a barely spotting status and then on the 9th through now its like a light period, but it is weird. For example, today I had soaked through a tampon in barely an hour and then barely spotting, and then soaking again. It looks like fire engine red and bright.

I am also on the minipill and I have been since I delivered. Do I have any reason to be worried or is this normal? Ive had sex only one time and that was on the 8th of september. Please ease my mind. Thanks! (BTW I am not breastfeeding anymore...I only breastfed for two weeks in case you need to know)

MG

Dear MG,

I'm not sure what is causing the bleeding, but you should make an appointment with your gynecologist to get it checked out. You should not be having postpartum bleeding so long after the birth of your daughter. It raises the possibility that there is some tissue left behind.

It is possible for the minipill to cause irregular vaginal bleeding, but it is usually not heavy and not bright red. In any case, your doctor may recommend switching to a regular birth control pill as long as you are able to take estrogen. You shouldn't take estrogen containing birth control pills while nursing, but now that you've stopped, you can switch. Estrogen containing pills are more reliable and are less likely to cause irregular bleeding.

Sincerely,
Amy

Lubricant during a Pap smear

Dr. Amy,

My internist says that lubricants shouldn't be used during a Pap smear. I am post menopausal and I'm dry, so it is very uncomfortable. If I remember correctly, my previous doctors have used lubricants.

What is your opinion.

Thank you,
Nancy


Dear Nancy,

I was taught, like everyone else, that you shouldn't use lubricant during a Pap smear, but recent research does not support that teaching. There are studies that suggest that water soluble lubricant has no effect on Pap smears.

It is very difficult for a doctor to go against established practice, however, so we may have to wait for a professional organization to sanction the use of lubricants during Pap smears.

Sincerely,
Amy

Cerclage

Dear Dr. Amy,

I just found out about 4 days ago that I have an incompetent cervix and it is starting to funnel. I am 22 weeks into my pregnancy. I have had 2 miscarriages and 1 live birth.

I am terrified after finding this out I have been reading books and articles about late miscarriage and premie babies dying at this gestation. I was asked by my obgyn if I wanted to do the cerclage to keep the baby in but I am terrified of anesthesia. Now I am on bed rest for the next 3 weeks until my next routine check up.

What would be the wise thing to do, stay on bed rest and ride it out with the possibility of losing this precious little baby girl's life, or doing the cerclage and still having the possibility of late miscarriage?

Helpless and Terrified,
Megan

Dear Megan,

It's very difficult to determine the odds of the various outcomes, and neither course of action is without risk, since there is always the possibility that the cerclage to lead to ruptured membranes and loss of the baby.

Figuring out the right answer depends on what kind of person you are and how you would feel about the various outcomes. Some women are more comfortable doing "everything", whatever everything might be. They reason that if the baby is born prematurely, it won't be for lack of trying on their part. They would feel guilty if they didn't have the surgery and they would be accepting of any surgical complications, figuring that action is better than inaction.

Other women are more comfortable with minimal intervention. They are willing to lie in bed for as long as necessary, and they are accepting of the fact that it might not work. They would be angry with themselves if they submitted to surgery that resulted in complications.

It is very difficult to read between the lines of an e-mail, but the impression your e-mail gives is that you want to have the cerclage, but are afraid due to personal fears. If that's the case, you would probably be happier having the surgery, even though it is frightening. You might feel guilty if you didn't have the surgery and the baby was born prematurely. I'm just guessing, though, and you might feel very differently.

Good luck with whatever decision you reach.

Sincerely,
Amy



VBAC

I have 2 boys, one born vaginally and one by emergency c-section (due to placenta previa and bleeding). I am pregnant with my third. I am 36 weeks, hoping to have VBAC, and have been told that I will not be induced if I go overdue, that I will have another c-section. Why is this and if so will I be booked in for a c-section before my due date?

Robyn

Dear Robyn,

It's a safety issue. There is always a risk that the previous C-section scar will rupture during labor and cause internal bleeding that can be life threatening for baby and mother. The risk is very small, but it is dramatically increased in the case of pitocin induction. Most obstetricians will not induce a woman who has had a previous C-section.

Sincerely,
Amy

Provera

Dear Dr. Amy,

I went to the doctor last week for my yearly checkup. I have been experiencing some spotting a few days before my period starts. My doctor gave me a prescription called Peurera (I think that is what I am reading on the paper). She told me it would help clean out my uterus. My husband and I are trying to have a baby. There is a good chance I could be pregnant. Should I have the prescription filled and take it and if I am pregnant will it hurt the pregnancy?

Thanks,
April

Dear April,

If you are trying to get pregnant, or think you might be pregnant, you should not take the Provera (progesterone).

Many women have spotting before their periods and it is not a sign that anything is wrong. Provera will cause a very heavy period, and "clean out" the uterus, but it may have no effect on the spotting.

Sincerely,
Amy

Endometriosis

Dear Dr. Amy,

How soon can endometriosis pain come back after getting surgery 2 months ago. Would it be as soon as the 1st cycle? Are there any reports that endometriosis could turn to cancer? Does BC slow it down? Lastly, should women that are diagnosis with this give up hope for a pregnancy?

Thank you,
Rachel

Dear Rachel,

How quickly the endometriosis will come back depends on what was seen and done at the time of surgery. Your doctor owes you a complete explanation of the findings, what was done, and what he or she expects will happen.

In general, endometriosis will begin to return around 6 months after surgery. Continuous birth control pills (skipping the inactive pills so you do not get your period) will supress endometriosis.

Endometriosis is not related to cancer and does not turn into cancer.

Endometriosis can affect fertility, but we do not understand how it works. Some women with mild endometriosis will have difficulty getting pregnant, while other women with a lot of endometriosis can get pregnant easily.

Sincerely,
Amy

Sunday, September 18, 2005

Pregnancy at 46

Dear Dr. Amy,

I am very interested in becoming pregnant again. I would appreciate it if you could provide me with statistical information regarding birth defects? Currently I am 46 years old. I have a beautiful 6year old boy and would like very much to have another child. I should add that twins do run in the family for second pregnancies. My previous pregnancy was a "C section" since the baby was in breech position. I have had my appendix removed as well so there is scar tissue.
I understand that a woman is more likely to have a miscarriage at my age. What are your suggestions to ensure the best possible pregnancy?

Sincerely,
Carol

Dear Carol,

The first thing to keep in mind is that it may be difficult or impossible to become pregnant. Fertility drops dramatically at age 40, and very few women who are 46 can become pregnant without fertility treatment, or even with fertility treatment.

The miscarriage rate rises dramatically also, as well as the risk of chromosomal problems such as Down's syndrome. For example, the risk of Down's syndrome rises from 1 in 200 at age 35 to 1 in 20 at age 45.

Many women have developed medical issues by age 46, such as high blood pressure, and these can affect the pregnancy. In addition, there is a much higher risk of developing pre-eclampsia.

Most of these problems are factors beyond your control. There is nothing that you can do specifically to counteract these issues. That doesn't mean that you can't have a healthy baby at age 46, but the chances are much lower than at age 35 or age 40.

Sincerely,
Amy
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