Pregnancy After Infertility: What To Consider, What Not To Worry About

Congratulations! You’re pregnant after months, or maybe years of trying and struggling with infertility or recurrent loss. What do you need to know now?

1. You don’t necessarily have to see a high-risk obstetrician. Just because you had to undergo fertility treatments (IUI or IVF or donor egg IVF) to get pregnant, doesn’t mean you’re automatically a high-risk pregnancy patient. Your general OB/GYN should be able to monitor and care for you during the course of your pregnancy. However, if you’ve had a history of recurrent miscarriages or preterm labor or medical problems (i.e. diabetes, hypertension), your OB/GYN may work in consultation with a high-risk obstetrician (aka a maternal-fetal medicine specialist).

a. Also, be prepared for far fewer doctor visits. If you had to go through fertility treatments to conceive, you’re probably used to having to see the doctor weekly, sometimes even daily. For an uncomplicated pregnancy, many women are shocked to learn they only need to see their obstetrician once or twice each trimester until the third one.

2. Your doctor will monitor you closely for pregnancy-related complications such as gestational diabetes and preeclampsia. Studies do suggest that women who conceive using ART (assisted reproductive technology) are at slightly (emphasis on the slightly) higher risk of certain pregnancy complications such as bleeding, preeclampsia, gestational diabetes, as well as higher risk for a Cesarean delivery. Again, a good general obstetrician will be used to dealing with this and can monitor you.

3. Try to stay healthy. A prenatal vitamin with at least 400mcg (up to 1 mg) of folic acid along with an omega 3 supplements help promote fetal health. There’s no safe level of alcohol consumption during pregnancy so try to avoid it altogether. And, stop smoking. If your doctor gives you the green light, try to exercise a few times a week (walking, jogging, yoga, spinning) to maintain a healthy level of weight gain during pregnancy-both too little and too much weight gain can compromise pregnancy health.

4. Before booking a babymoon, check the CDC Zika map. Unfortunately, Zika is a very real cause of serious pregnancy complications. So, I’ve been advising my patients both while they’re trying to conceive and when pregnant to try and avoid areas where Zika is actively spread. For women living in areas of active Zika transmission, try to avoid getting mosquito bites (liberal repellent use and long sleeves/pants, if possible) and talk to your doctor about periodic screening for Zika infection. If your (male) partner gets infected with Zika (or if he’s traveled to a high risk area), you should avoid any unprotected intercourse with him for the entire pregnancy.

a. Keep in mind that a more ubiquitous cause of microcephaly is CMV (cytomegalovirus). This super common virus is mostly found in young children and can be spread through secretions (saliva, mucus). The best prevention? Hand-hygiene (Purell/hand washing) and try to avoid sharing foods and drinks with the little ones.

5. Remind yourself that it’s normal—after everything you’ve been through—to still feel ambivalent/anxious about the pregnancy. Often times, the pregnancy doesn’t “even feel entirely real for sometime” according to Nora Spielman, LCSW, a private psychotherapist in New York City. She advises her clients to try and “rely on data/evidence/facts”—so if the ultrasounds and tests and your doctor are all telling you the pregnancy is progressing smoothly, try to allow yourself to hear that and understand that “the rest is your anxiety and a story you’re telling yourself.” Give yourself room to do things that help relieve stress and give you pleasure—whether it’s a few hours to see a movie with your friend/partner or some quiet time to take a nap or a pass to devour that brownie hot fudge sundae you’ve been craving for so long. If you find the anxiety still hard to bear, seek emotional support through a professional therapist.

6. Lastly, sex during pregnancy is okay! If you’re not at risk of a miscarriage or preterm labor (i.e. no bleeding or cramping or shortened cervix), go ahead and share some intimate moments with your partner. I’ll usually advise my patients to try and hold off on having sex until their first ultrasound confirms a pregnancy with a heart beat (usually around 7 weeks or so) but then, if, there aren’t any complications, I’ll reassure them that intimacy/sex is fine and won’t harm the pregnancy. In fact, because infertility treatments and dealing with recurrent losses can be such a lonely and isolating process, sex during pregnancy may be a great way to help you re-connect with your partner.