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Pregnancy after IVF treatment

Many infertile couples need treatment in different forms including Assisted Reproductive Techniques. In Vitro Fertilization and Embryo Transfer is the most advanced method of infertility treatment. Management of these pregnancies is difficult as the couples and treating doctors have undue concern and apprehension and worry about outcome of such pregnancies.

IVF Pregnancy Test

When can you take a pregnancy test during an IVF treatment cycle? Your doctor will likely schedule a blood test 10 to 14 days after the egg retrieval. The blood test will detect and measure the hormone beta hcg.

You should not take a urine pregnancy test during IVF treatment. Taking multiple early pregnancy tests is a bad habit many fertility-challenged women struggle with, and it’s one you should try your best to resist if you’re getting fertility treatments. The reason is that one of the fertility drugs used is the hormone hcg. If you take a pregnancy test the day after receiving this injection, you may get a positive pregnancy test, not because you’re pregnant, but because the test is picking up the hormones from the fertility treatment.

Continued Progesterone Support

Treatment isn’t over the moment you get a positive pregnancy test result. Your doctor may keep you on progesterone hormone support. How long he will continue progesterone treatment will be dependent on your particular situation.

If you’re taking progesterone in oil through injections, you may be able to switch to vaginal suppositories or gel. Ask your Gynecologist about your options.

Continued Blood Tests for Monitoring

Your fertility doctor will also likely continue to check your hormone levels for at least a few weeks following a positive pregnancy test. There are a few reasons for this:

  • to look for rising hcg hormone levels (pregnancy hormones), in order to ensure the pregnancy is healthy and to look out for very high levels (which may indicate a multiple pregnancy)
  • to monitor estrogen levels, especially if symptoms of ovarian hyperstimulation syndrome (OHSS) are present
  • to monitor progesterone levels

Getting Good News: Feeling Excited- But Also Scared

You’ve most likely been trying to get pregnant for years. You may have even gone through many cycles of fertility treatments. Finally, you’ve achieved a pregnancy. You’re likely really excited and happy. But you may also feel anxious. You may even wonder if it’s all really happening. If you have friends who are still trying to get pregnant, you may experience some emotional guilt. All of this is completely normal.

Feeling nervous and not too hopeful about the pregnancy is understandable. If you’ve experienced miscarriages in the past, this is especially true. Don’t feel guilty for feeling the way you do. Do try to find someone, whether a friend or a therapist, to talk to about your feelings. It will help.

Women who have experienced infertility are at-risk for developing pregnancy and post partum depression. The sooner you talk to someone, the more likely it is you’ll feel better.

Feeling Unsure of When to Tell People

This is a big moment! However, you may or may not be ready to share the news with the world.

If you’ve shared your treatment progress with friends and family, especially if you’ve shared details of this particular cycle, you may be expected to tell them sooner than later. If they knew when you had your embryo transfer, they are naturally going to want to know if the cycle worked!

However, for those who weren’t in the loop, you can choose to wait.

When should you tell? When you see your hCG doubling? After ultrasound confirmation? After you see the heartbeat? After the first trimester? It’s entirely up to you. There is no right or wrong answer.

Pregnancy Risks After IVF

Pregnancy after IVF conception is associated with some increased risks and complications. These risks don’t seem to be directly caused by the use of fertility treatment. Instead, they are more likely associated with the original reason IVF was needed in the first place—infertility or advanced age.

Some pregnancy risks and complications that are higher after IVF conception include…

  • Pregnancy induced hypertension
  • Gestational diabetes
  • Preeclampsia
  • Abnormal bleeding
  • Intrauterine growth restriction
  • Premature labour (even with a singleton pregnancy)
  • Congenital defects

Pregnancy after IVF is also more likely to require induction of labor and have a higher risk of cesarean birth.

Prenatal care is always important, but it’s especially important after IVF to hopefully catch these complications early and treat (or prevent) them as soon as possible.

Release to a Regular Obstetrician

Usually, an IVF pregnancy is handled by a regular obstetrician (OB) and not a high-risk obstetrician. Your fertility doctor will transfer you over to the regular OB at about the 8-week mark.

You may be excited to see a “regular” doctor—finally! You may also feel nervous. It can be quite a shock to go from the intense monitoring of IVF to the more laid back, once-a-month visits of a regular OB/GYN. Don’t hesitate to talk to your doctor.

Dr. Ruchi Tandon, specialises in infertility conceived and IVF pregnancies. She has over 13 years experience in handling pregnancies in leading South Delhi hospitals, including Max smart superspeciality hospital, saket and Apollo cradle Royale, nehru place.

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Second opinion in your High risk pregnancy- choose the best Gynecologist

What conditions may lead to a high-risk pregnancy?

The following list represents the most common conditions that can lead to a high-risk pregnancy, but note that not all women with these conditions will have a high-risk pregnancy.

  • If you have diabetes before you become pregnant, you will likely be referred to a maternal-fetal medicine specialist to monitor your condition and determine the proper medications. Preconception counseling is ideal. Developing diabetes during pregnancy (gestational diabetes) is very common, and your obstetric provider will likely be able to care for you without a maternal-fetal medicine consult. If a maternal-fetal medicine specialist is consulted for gestational diabetes, he or she will follow your baby’s growth and well-being, and manage your health with nutrition counseling, glucose monitoring and, possibly, medications.
  • Pre-eclampsia is a condition unique to pregnancy where you have high blood pressure in conjunction with protein in your urine and edema (swelling of the skin). In some women with pre-eclampsia, liver or platelet abnormalities are present. You may be referred to a maternal-fetal medicine specialist depending on the severity of your disease or if you are preterm. “The only treatment for pre-eclampsia is delivering your baby,” explains Henderson, “so this is a condition that requires very close monitoring to balance maternal complications against the risks of delivering your baby early.”
  • If you have hypertension before pregnancy, a maternal-fetal medicine specialist will monitor your baby’s growth and may be consulted if problems arise. Some medications commonly used outside of pregnancy to treat hypertension are contraindicated in pregnancy.
  • Multiples Pregnancies with twins or higher order pregnancies have a greater risk of complications. Women with multiple pregnancies are more likely to develop pre-eclampsia or go into preterm labor. Twin pregnancies have a higher risk of fetal anomalies and growth problems, especially if they share a placenta. If you have a multiple pregnancy, a maternal-fetal medicine specialist will closely monitor the pregnancy by performing additional ultrasounds. The maternal-fetal medicine specialist will recommend how and when your babies should be delivered. “If you remain healthy and the growth of your babies is normal and without complications, you may continue to see your Ob/Gyn,” says Henderson, “or you may prefer to be seen in a specialty multiples clinic.”
  • Sexually transmitted diseases (STD’s) In general, your obstetric provider can treat you for sexually transmitted diseases that may occur during pregnancy or if there is a pre-existing STD, such as herpes. In certain cases, consultation with a maternal-fetal medicine specialist will be required. For example, if you are being treated for syphilis and an ultrasound shows that your fetus may be affected, a maternal-fetal medicine specialist will provide further care and management. Women with HIV are also generally cared for by maternal-fetal medicine specialists because the medication regimens are complex.
  • Women who are obese have a greater risk of developing diabetes, hypertension and pre-eclampsia during pregnancy. “Obesity is the one of the only health conditions affecting pregnant women that can be changed before pregnancy, which is why maternal-fetal medicine specialists encourage women to lose weight through healthy strategies,” explains Henderson. “The Johns Hopkins Nutrition in Pregnancy Clinic works with obese women during pregnancy to optimize the health of mothers and their babies.”

Q: Will all my future pregnancies be high risk?

A: Having one high-risk pregnancy does not mean that all your future pregnancies will be deemed high risk as well. You may have a fetal complication occur in one pregnancy that wouldn’t in another, and certain health conditions may change over time.

However, if you have had a pregnancy that ended in preterm delivery, you are at greater risk of having preterm labor during your next pregnancy. If this occurs, your obstetric provider will manage your pregnancy using medication, and a maternal-fetal medicine specialist will monitor your cervical length with ultrasound surveillance.

Ultimately, the most important thing to remember about having a high-risk pregnancy is that your maternal-fetal medicine specialist and Ob/Gyn have the knowledge and experience required to keep you and your baby as healthy as possible.

Dr.Ruchi Tandon is a Gynecologist practicing in leading maternity hospitals of South Delhi namely, Max Smart superspeciality hospital, saket, Apollo cradle Royale to name a few. She is well versed, amicable and approachable. High risk pregnancy management is her forte.

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First trimester in your first time pregnancy- what to expect

You have just gotten the big news!  You are pregnant! The feeling when you get confirmation from your Gynecologist doctor, is amazing! Having a child is the most precious, amazing and scariest thing ever!

Don’t worry though, I know it seems as if there is so much to do before the baby comes and there is, but relax, it’ll be okay and you’ll have help to get these things taken care of.  Here are some tips for you for first time pregnancy. These will help you get through your first time being pregnant with little worrying. Let’s face it, we’re women and we worry but don’t get so worked up, it will upset the baby. Good luck and congratulations.

Take Care of yourself during your pregnancy

The basic premise here is to be healthy and stay healthy for you and your baby.  Don’t smoke or be around second hand smoking or be around heavy smokers. You should not drink either.  You should sleep and rest as much as possible because you will NEED it! If you’re not, start taking prenatal vitamins, with folic acid.  When you buy these, always make sure they contain folic acid. It is vital to your pregnancy. Taking care of yourself will ensure that you have a healthy baby growing inside of you.  Your baby’s neural cord turns into the brain and spinal cord, developing in the 1st month you’re pregnant. Therefore, essential vitamins and minerals are very important from day one.

Exercise

If you don’t know this, it is very important that you exercise in some way to help with stress, weight control, help your circulation, keep your mood stable and you’ll sleep better if you exercise.  You should take a walk for at least 15-20 minutes each day. Swimming is a really good exercise when you are pregnant, especially if it’s summer time! Try to get at least 30 minutes of exercise a day.

Get to know more about your baby

Educate yourself and learn about what was going on with your body.  Learn the pains and what happens each week as your baby grows inside. If you read up on the baby, it will get you thinking about certain questions to ask your doctor.  Also, find out your family history, you’re going to need to know everything about everyone.

Keep track of your weight gains

During your pregnancy, it’s okay to gain weight, you’re eating for two, however, gaining too much weight can be unhealthy for you.  Also, you’ll have a hard time losing the weight if you gain too much. If you don’t gain enough weight, your baby’s birth weight and health could be in jeopardy.  This is what Gynecologist doctors recommend that you gain for your pregnancy:

  • Underweight: Gain 28-40 Pounds
  • Normal Weight: Gain 25-35 Pounds
  • OverWeight: Gain: 15-25 Pounds
  • Obese: Gain 11-20 Pounds

Eating Healthy will pay off! Trust me!

You definitely should drink about 8-10 glasses of water a day.  My doctor told me that I should eat about five or six well-balanced meals each day. When you eat, you need to make sure that you are eating foods that are folate-rich.  These foods include: cereals, lentils, oranges, orange juice and asparagus. Again, folic acid is extremely important in the development of your baby’s neural tube. Folic Acid also is vital for red blood cells to be created.  Natural sugars in bananas and apples can lift your energy levels, which is close to a cup of coffee.

Nausea with or without vomiting

Morning sickness or nausea, which can strike at any time of the day or night, is one of the classic symptoms of pregnancy. For some women, the queasiness begins as early as two weeks after conception. Nausea seems to stem at least in part from rapidly rising levels of estrogen, which causes the stomach to empty more slowly. Pregnant women also have a heightened sense of smell, so various odors – such as foods cooking, perfume or cigarette smoke – may cause waves of nausea in early pregnancy. There are some hints and tips to help combat the effects of morning sickness.

It’s important to take care of your baby, even before he or she is born. You can do this by living a healthy lifestyle and keeping doctor’s appointments while you’re pregnant. This is called prenatal care. You’re more likely to have a healthy birth if you maintain a healthy pregnancy.

Path to improved health

Schedule an appointment with your Gynecologist doctor as soon as you find out you’re pregnant. Your doctor will start by reviewing your medical history. He or she also will want to know about your symptoms. During this first appointment, urine and blood samples will be taken. (These will also be taken again on later visits.) Urine tests check for bacteria, high sugar levels (which can be a sign of diabetes), and high protein levels (which can be a sign for preeclampsia, a type of high blood pressure during pregnancy). Blood tests check for blood cell count, blood type, low iron levels (anemia) and infectious diseases (such as syphilis, HIV, and hepatitis).

The doctor also may do other tests at your first visit. These may vary based on your background and risk for problems. Tests can include:

  • A pelvic exam to check the size and shape of your uterus (womb).
  • An ultrasound to view your baby’s growth and position. An ultrasound uses sound waves to create an image of your baby on a video screen.

After your first visit, you will have a prenatal visit every 4 weeks. In months 7 and 8, you will have a visit every 2 weeks. In your last month of pregnancy, the visits will occur weekly until you deliver your baby. At each visit, the doctor will check your weight and blood pressure and test your urine. The doctor will listen to your baby’s heartbeat and measure the height of your uterus after the 20th week. You should always discuss any issues or concerns you have with your doctor.

Here are some other guidelines to follow during your pregnancy.

How much weight should I gain during pregnancy?

Talk to your doctor about this. It’s different for everyone, but most women should gain about 25 to 30 pounds. If you’re underweight when you get pregnant, you may need to gain more. If you are overweight, you may need to gain less.

What should I eat?

Eating a balanced diet is one of the best things you can do for yourself and your baby. Be careful of the following foods and drinks during pregnancy.

  • Raw meat, eggs and fish. Food that isn’t fully cooked can put you at risk for food poisoning. Don’t eat more than 2 or 3 servings of fish per week (including canned fish). Don’t eat shark, swordfish, king mackerel, or tilefish. These fish have high levels of mercury, which can harm your baby. If you eat tuna, make sure it’s light tuna. Don’t eat more than 6 ounces of albacore tuna and tuna steaks per week. It’s safe to have 12 ounces of canned light tuna per week.
  • Fruit and vegetables. Wash all produce before eating it. Keep cutting boards and dishes clean.
  • Eat 4 or more servings of dairy each day. This will give you enough calcium for you and your baby. Don’t drink unpasteurized milk or eat unpasteurized milk products. These may have bacteria that can cause infections. This includes soft cheeses such as Brie, feta, Camembert, and blue cheese, or Mexican-style cheeses, such as queso fresco.
  • Sugar substitutes. Some artificial sweeteners are okay in moderation. These include aspartame (brand names: Equal or NutraSweet) and sucralose (brand name: Splenda). However, if you have phenylketonuria (PKU), avoid aspartame.
  • Don’t drink more than 1 or 2 cups of coffee or other drinks with caffeine each day.

Can I take medicine?

Check with your doctor before taking any medicine. This includes prescriptions, pain relievers, and over-the-counter medicines. Some medicines can cause birth defects, especially if taken during the first 3 months of pregnancy.

Dr.Ruchi Tandon is a Gynecologist practicing in leading hospitals in South Delhi, with over 13 years of clinical experience. At present she is practicing in Max Smart super specialty hospital, Saket, Apollo cradle Royale, Nehru place and her clinic in Greater Kailash part 2, Delhi.