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There is growing evidence to show that exposure to metabolic health risk factors in the womb can affect the child even long after birth.
Preconception or pre-pregnancy care with early interventions to set the right habits and conditions can improve one's chances of getting pregnant and minimise the risk of pregnancy complications.
With sustainable nutritional and lifestyle changes, you can give your child the best start in life and make a difference to the health of your future generations.
In this 'Ask the Specialist' Q&A forum, Dr Serene Thain, Consultant from the Department of Maternal Fetal Medicine at KK Women's and Children's Hospital (KKH), answers your questions on what to do to improve your chances of getting pregnant and minimise the risk of pregnancy complications. Dr Thain is also the lead of the one-STop Obstetric high RisK (STORK) Centre which helps women with high risk medical conditions optimise their preconception health and support them in minimising the risk of pregnancy complications.
KKH is a member of the SingHealth group.
This Q&A forum is open from 1 July to 27 July 2022.
To post your question, please log in as a member. If you are not a member, you can register for a FREE membership here.
If you have problems posting your questions, please email your questions to marcom@healthxchange.com.sg
Kindly note: Your question will only go live / appear on this page after the doctor answers it
Hi, may I ask if there are any foods or lifestyle habits that can improve chances of getting pregnant? Does late nights have an impact on getting pregnant?
Answered by Dr Serene Thain, Consultant, Department of Maternal Fetal Medicine, KK Women's and Children's Hospital (KKH)
Couples who are planning to conceive should adopt a healthy balanced diet and lifestyle to improve their chances of not just getting pregnant, but having a healthy pregnancy. This would include:
Having sufficient amount of sleep can also help one maintain good health and well-being.
How do I improve my sperm quality? Should I keep my wife's legs and pelvis elevated after ejaculation?
Poor sperm quality can be due to various factors such as obesity, chronic diseases (e.g. diabetes, hypertension, heart disease) especially if poorly controlled, smoking or alcohol intake. Optimising any underlying chronic conditions and smoking/alcohol cessation can therefore help in improving your sperm quality. However, there can be other causes as well which may not be reversible. Men with persistently poor sperm quality may be recommended to look towards in-vitro fertilisation (IVF) for their best chance at conception.
There are no published studies or conclusive scientific evidence to suggest that sexual position makes a significant difference when trying to conceive. Despite this fact, some suggest positions which allow for deep penetration that may provide the best chance of conception, based on the fact that deep penetration allows the sperm to be ejaculated as close to the cervix as possible. Also, as sperm can take up to 15 minutes to reach the cervix, this is why some suggest to lie down briefly after sex, even propping up the female partner’s pelvis with a cushion in attempts to help sperm along the way. As there is no concrete evidence to show that these measures help, these are just suggestions for you to try if you are struggling – they are not a must. It is more important to stick to what is comfortable for you and your partner, so as to be as stress-free as possible, as stress can reduce one’s chances of conception.
To optimise chances of pregnancy, couples may wish to get a preconception assessment at specialist centres like KKH.
What would be the general guidelines and most important principles for trying for a baby immediately post a miscarriage? Tips on mental health for coping with miscarriage?
In most pregnancies, a miscarriage is a sporadic (one-off) event and will not affect the chances of success in subsequent pregnancies. In these cases, you can try for a baby as soon as your menstrual periods have returned to normal and when you feel emotionally ready to do so. However, in certain scenarios, for example, recurrent miscarriages (three or more consecutive miscarriages) or second trimester miscarriages, further investigations may be helpful in looking for an underlying cause. I would therefore encourage you to follow up with your obstetrician and gynaecologist after the miscarriage to ascertain if any further assessment/investigations may be required before trying for a baby again.
Tips on mental health for coping with miscarriage
Losing your baby at any point in time in pregnancy can have potential immense psychological impact on you and your partner’s life. It is perfectly normal to grieve over your pregnancy loss. Do seek professional help if you are finding great difficulty in overcoming the grief and are not able to cope with everyday life.
The KKH recurrent pregnancy loss clinic provides comprehensive assessment, treatment recommendations and psycho-social counselling for affected couples.
I'm going to be 41 in November and I'm planning to start a family next year. Is it too late to try to get pregnant at my age?
It is still possible to get pregnant at the age of 41. However, advanced maternal age (age > 35 years old) pregnancies are associated with an increased risk of pregnancy complications such as miscarriages, genetic problems in the baby (e.g. Down Syndrome), gestational diabetes and gestational hypertension. Also, issues with fertility are more common with increasing age. Preconception counselling and optimisation of your health may help reduce some of these risks. I would therefore recommend that you consult an obstetrician and gynaecologist prior to trying to conceive so as to access optimal preconception care to improve your chances of a healthy pregnancy.
The KKH one-STop Obstetric high RisK (STORK) preconception clinic caters to women with pre-existing chronic medical conditions (e.g. diabetes mellitus, hypertension, autoimmune conditions). It provides preconception counselling and optimises the health of these women prior to trying for a baby, so as to improve outcomes for both mother and baby.
What should I do to improve my chances of getting pregnant?
The highest pregnancy rates occur in couples who have sex every day or every other day. If this is not possible, try having sex every two to three days a week, soon after the end of your period.
If you have not become successfully pregnant after a year of active trying; or if you have other risk factors such as age above 35 years, irregular periods, other known gynaecological conditions (e.g. endometriosis), and have been unsuccessful at conceiving after six months of active trying, you should consider consulting a fertility specialist, or getting a preconception health assessment at specialist centres like KKH.
Aside from the above, measures you can take to improve your chances of getting pregnant and having a healthy pregnancy include:
When I was teenager, the doctor said the lining of my uterus is not stable - I would bleed mid-cycle whenever I exercised. She gave me some hormonal medicine to stabilize the lining but I have stopped taking them.
What are the things I can do / consume if I am planning to conceive?
I am worried that my unstable uterus lining might not hold a fertilized egg.
Thank you doctor!
Bleeding after exercise can be due to various causes, e.g. hormonal changes, endometrial polyps, cervical polyps, etc. If you are still experiencing these symptoms, I would recommend you to see an obstetrician and gynaecologist for an assessment prior to trying for a baby.
For some one starting first ivf, what are some things to do prior to better prepare for it? And what to do and avoid to do during and after it?
Measures you can take to improve your chances of getting pregnant and having a healthy pregnancy include:
What should i eat if im a lacto ovo vegetarian to try to concieve?
You should ensure that your lacto-ovo vegetarian diet is a well-balanced one. A vegetarian diet can sometimes lead to lower amounts of some important nutrients, e.g. protein, iron, folic acid, iodine, vitamin B12, calcium, zinc, vitamin D and omega-3 fatty acids. Do ensure you eat foods that give you enough of these nutrients. You can also take a multivitamin pill that has iodine, iron, folic acid, vitamin B12, calcium and/or vitamin D to ensure that you get enough of these nutrients.
Hi Dr Serene, may I ask if a female with secondary hypothyroidism has less chances to get pregnant if shes under thyroid medication? What can be done to increase the chances of getting pregnant?
Will intermittent fasting reduces chances to get pregnant?
In general, women with hypothyroidism on thyroid medications have good chances of pregnancy if the thyroid function is maintained within the normal range. However, women with secondary hypothyroidism due to disorders of the pituitary gland or hypothalamus may have associated excess or deficiency of other hormones that control the menstrual cycle. I would suggest for you to inform your endocrinologist that you are trying to conceive, so that he/she can ensure that you are in the best health state possible prior to conception.
There are many types and regimes of intermittent fasting that are currently being practised. In general, intermittent fasting is a form of restrictive eating, which has potential negative effects on the menstrual cycle, especially if done in an extreme form. For women to have regular ovulation and therefore regular periods, they need to consume enough calories and have adequate body fat. In cases of excessive restriction in food intake, excessive exercise and/or significant and rapid weight loss, hormonal changes can occur as a result of that and lead to irregular periods and anovulation (lack of ovulation). You should therefore ensure that you adopt a well-balanced diet that includes high protein foods, fruits and vegetables and omega-3 fatty acids when trying to conceive.
What kind of interventions are available for a couple who are interested to try for a baby naturally instead of going through IUI / IVF? eg., medication, injections, supplements?
The highest pregnancy rates occur in couples who have sex every day or every other day. If this is not possible, try having sex every two to three days a week, soon after the end of your period. This may help increase your chances of success of a naturally conceived pregnancy.
However, if you have not become successfully pregnant after a year of active trying, or if you have other risk factors such as age above 35 years, irregular periods, other known gynaecological conditions (e.g. endometriosis), and have been unsuccessful at conceiving after six months of active trying, you should consider consulting a fertility specialist, or getting a preconception health assessment at specialist centres like KKH.
The type of intervention prescribed is largely based on the underlying cause for the subfertility. For example, in cases where subfertility is due to a lack of ovulation, ovulation induction medications may be prescribed to increase the chances of ovulation within each menstrual cycle and therefore increase pregnancy rates. In other cases where the cause of subfertility is due to male factors (e.g. low sperm counts) or blocked fallopian tubes, in-vitro fertilisation (IVF) procedures may be advised to increase one’s chances of conception.
I've tried one IVF cycle at KKH and it resulted in three blastocysts. Tried two transfers already both failed, but realised the doctors were not able to properly identify the root causes of the failures. Is there any reason why this were the case? I tried googling and some said most failures were likely due to embryonic arrest. What does this mean? Is there anything we can do to increase the chances of successful implantation at this stage?
Thank you for your question. Unfortunately, this question will need to be addressed by an IVF Specialist hence Dr Thain will not be replying.
im 42 and what can I do to improve chances in getting pregnant naturally and minmise the risk of complications or should i go straight to try IVF or impossible to get pregnant? thx
It is still possible to get pregnant at the age of 42. However, advanced maternal age (age > 35 years old) pregnancies are associated with an increased risk of pregnancy complications such as miscarriages, genetic problems in the baby (e.g. Down Syndrome), gestational diabetes and gestational hypertension. Also, issues with fertility are more common with increasing age.
Preconception counselling and optimisation of your health may help reduce some of these risks. I would therefore recommend that you consult an obstetrician and gynaecologist prior to trying to conceive so as to access optimal preconception care to improve your chances of a healthy pregnancy. Also, the obstetrician and gynaecologist would be able to assess if fertility treatment may be required in your situation.
Question posted by Wenqi
Hi Dr Thain,
Could long hours of standing eg 9h a day at work cause implantation failure or fertilisation failure?
Question posted by DataStar
Hi Dr Serene,
I have given birth to my number one Jan 2021, and planning for second one now. Back then, I wasn't able to deliver natually and ended up C-section. The scarring has keloids and itchy at times. About 9 months after the delivery, I feel tingling sensation on and off, Sometiems once every few weeks, sometimes consecutive days. It last within seconds each time. Will this be a concern especially when I am planning for second pregnancy? Is there anything that I should take note? I am 39 years this year.
Thank you.
Some women do continue to experience numbness, tingling and odd shooting pains around their scar for months after delivery, but experiencing these symptoms should not affect your planning for a second pregnancy.
Advanced maternal age (age > 35 years old) pregnancies are associated with an increased risk of pregnancy complications such as miscarriages, genetic problems in the baby (e.g. Down Syndrome), gestational diabetes and gestational hypertension.
Preconception counselling and optimisation of your health may help reduce some of these risks. I would therefore recommend that you consult an obstetrician and gynaecologist or get a preconception health assessment at specialist centres like KKH, to access optimal preconception care to improve your chances of a healthy pregnancy.
