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be a big part of your life at this moment, it’s not the only thing you have going on in your life. Make time for your family, your partner, your friends, your hobbies — and anything else that helps you remember that you had a life before you started thinking about pregnancy, and you still do!

Getting Checked Out from Top to Bottom

      Having a checkup even before you try to get pregnant is always a good idea, and it’s essential if you’ve been trying for a few months and still getting “not pregnant” results on the home pregnancy tests. Sometimes simple imbalances in your thyroid levels, or other levels easily checked by a simple blood test, can be keeping you from getting pregnant.

      Having a full physical

      You can see either your primary care physician (PCP) or your gynecologist for a checkup — or both! Your PCP looks at the “big picture” while your GYN looks mainly at your reproductive issues. Either one can order blood work and do a physical exam. (See Chapter 8 for more on choosing a doctor to help you get pregnant.)

      Do you need to book a full body MRI or CT scan to find out if you’re in shape to get pregnant? No, a half hour with your doctor should do the trick. If you’re putting off a visit because you’re afraid of being “yelled at” because you’re overweight, have bad habits you know you’ll be lectured about, or are terrified of having blood drawn, now is the time to put those fears aside.

      A routine checkup by your gynecologist or family doctor may be all you need to help you get pregnant; for example, your doctor can look at the following possible pregnancy stumbling blocks:

       Your weight: Are you underweight or overweight? Being either over- or underweight may interfere with pregnancy.

       Your sexual practices: Are you missing the big day each month because you’ve been misinformed about when you ovulate?

       Your sexual history: Do you have a sexually transmitted infection (STI) that could be preventing pregnancy? (See the section, “Understanding Common Infections That Can Cause Uncommon Results” for more on STIs.)

       Your habits: Do you douche right after sex? You may be washing some of the best swimmers away!

       Your blood pressure: Women with high blood pressure may be prone to developing serious hypertensive disease during pregnancy.

The physical exam includes examination of the thyroid gland in the neck, breasts, heart, lungs, abdomen, and reflexes (for neurologic response). A pelvic exam includes a vaginal speculum exam to evaluate the cervix (this generally means a PAP smear!), a bimanual exam to assess ovaries and uterus, and a rectal/vaginal exam. A transvaginal ultrasound frequently completes the initial pelvic exam so that your ovaries and uterus can be visualized.

      Checking your blood levels

      The good thing about having blood drawn is that a single specimen can be used to test for many different health conditions, including some that can interfere with getting pregnant; we look at a few in the next sections.

      Looking at your thyroid function

      Women who have an underactive or overactive thyroid may have trouble getting pregnant. Thyroid abnormalities can cause anovulation (no egg is released), irregular menstrual cycles, or short menstrual cycles. (See Chapter 2 for more about menstrual dysfunction.)

      Hypothyroid, or low thyroid levels, can raise your prolactin level (prolactin is a hormone that helps control milk production in breastfeeding women). High prolactin levels can prevent ovulation; prolactin levels can be diagnosed with a blood test.

      Running a chemistry panel

      A chemistry panel tests your blood sugar to show if you have diabetes; it also tests your liver and kidney functions. Many health problems that can have impact on pregnancy can be found through a chemistry panel.

      Checking your blood count

      A complete blood count, or CBC, tests your hemoglobin, which shows if you’re anemic. It also tests your white blood count, which can show chronic infection.

      

When you go for your routine checkup, your doctor will be doing the basic things to see if you are healthy overall. This is the starting point. Additional testing to assess why you are not getting pregnant is discussed in Chapter 11.

      Checking your medications

Have you overlooked something that could be interfering with your getting pregnant? Think back a few months, especially when thinking about sperm production; the sperm being ejaculated today have been over two months in the making, so anything your partner was taking a few months ago could be affecting his sperm count today. Ask yourself the questions in the following sections about a few possible deterrents you may not have thought about.

      Taking a closer look at prescription medications

      What you put in your body may matter when you are trying to get pregnant. Taking a quick inventory of any ongoing or recent prescription drugs can identify if any of these are getting in your way:

       Has your partner taken antibiotics, such as erythromycin or gentamycin, or antifungal medications, such as ketoconazole, or been treated for psoriasis with methotrexate? Has he been on anabolic steroids? These medicines can all affect sperm production.

       Do you or your partner take medication for high blood pressure? Sometimes, when you’ve been taking a medication for a long time, you almost forget that it can have serious side effects. Men who take certain types of antihypertensives called calcium channel blockers may produce sperm that can’t penetrate eggs well; other high blood pressure medications may cause retrograde ejaculation, a condition in which the semen is pushed backwards into the bladder instead of being ejaculated out; or they may cause an inability to get and sustain an erection. Some antihypertensives are dangerous in early pregnancy as they can cause birth defects. Other antihypertensive drugs are available that don’t have these effects, so talk to your doctor about switching medications if possible.

      

By definition, medications are substances that are prescribed and regulated by the FDA. Many medications can have a negative effect upon fertility or on a pregnancy, but there is an easy way to check the potential for problems on FDA-regulated drugs. Medications are categorized as to their effect on a pregnancy with the majority being either category B (okay to use) or category C (use only if benefit outweighs risk). By using this categorization system, you can determine if the medications you are taking are worth it:

       Category A is for drugs that have a proven safety record backed by research on women.

       Category B drugs have shown safe use in animals, but there are no well-controlled studies in humans.

       Category C includes drugs where animal studies have shown an adverse effect but there are no well-controlled human studies to tell us what happens in humans. This is where a risk-benefit evaluation helps to decide if the medication should be used.

       Category D is where studies have shown an adverse effect for humans but where special circumstances may warrant the use of the medication.

       Category

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