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You are right — the answer is “no.” These medications have proven adverse effects on pregnancy and no amount of benefit outweighs the risk — just don’t use them.

      

Do not stop taking any prescription medication before discussing it with your doctor. You are on that medication for a reason!

      

Some of the commonly used medications for fertility treatment have very scary warnings on their labels. Do not freak out! These warnings don’t apply to your situation (or else your physician would not be prescribing them) as long as the physician knows you are trying to get pregnant.

      The good and bad of antidepressants

      Considering how many people are using antidepressants, it is surprising how little research has been done on the influence of antidepressants on fertility. There are a number of categories of medications that are antidepressants. However, the largest group are the selective serotonin reuptake inhibitors (SSRIs). These work by increasing the levels of serotonin in the brain. Serotonin is a chemical in the brain that acts as a messenger between brain cells. Examples of SSRIs are Prozac, Lexapro, Zoloft, Paxil, and Celexa to mention a few.

      A recent review identified 16 articles that studied the effect of SSRIs on fertility. Six of the studies demonstrated no effect on fertility, three suggested a negative effect, and one demonstrated an increase in pregnancy rate. Although the research methodology was considered poor, six of the studies demonstrated a negative effect on the semen parameters. So, what to do? First, ask yourself if you really need those little happy pills. If not, stop — under the direction of the prescribing physician since some cannot be stopped suddenly. If you truly need those pills, so be it. Just remember to notify your fertility doctor of the pills you are taking.

      Reviewing nonprescription medications

It is amazing how often we grab an over-the-counter (OTC) medication to take care of a back sprain after playing pick-up basketball or a rash on the leg after hiking in the woods. Who checks with a doctor first? Well, things are different when you are trying to get pregnant and — as we warn you about vitamins and supplements in Chapter 9 — you need to pay a little bit more attention to what you are putting in or on your body. Your fertility clinic will no doubt give you a list of medications that are acceptable, but here a few general tips that you should think about before popping a pill or rubbing on salve:

       Acetaminophen is generally considered safe to use as a painkiller for various aches and pains.

       NSAIDS (non-steroidal anti-inflammatory drugs), including ibuprofen, may interfere with ovulation and can increase bleeding if taken prior to any procedures (like an egg retrieval). One study suggests that high doses impact sperm production. These should be used with clinic instruction only.

       Aspirin can increase bleeding so use with direction only.

       Milk of magnesia and antacids are usually fine to settle down that “icky” tummy.

       Topical preparations for itches (like Cortaid) or minor skin infections (like Neosporin) can be used as long as you don’t overdo it and ignore what is causing the problem.

      

The best thing you can do is answer honestly when your doctor asks you “What medications do you take?”

      Deciding if you need a mammogram

      It’s not essential to have a mammogram before getting pregnant, especially if you’re over the age of 40 or if you have a family history of breast cancer. In fact, the American College of Obstetricians and Gynecologists (ACOG) recommends that discussions between physicians and patients of screening mammography to determine when to start them should take place around age 40, but definitely by age 50. Some fertility clinics are making mammograms “required” for all patients who will undergo IVF or are over a certain age, so don’t be surprised if this test gets added to your list of things to do. You might think that having a mammogram “can’t hurt.” That actually is very incorrect. Every medical test has a certain “false positive” rate, meaning that the test says you have a problem when in fact you don’t. So, every test has a trade-off between correctly identifying a disease when it is present and correctly telling you that you don’t have a disease if you don’t. Women who have a mammogram that gives them a false positive (the test says you have breast cancer, but in fact you don’t), will undergo unnecessary further testing, interventions, and psychological trauma. The current recommendations for mammograms take into account the balance of false negatives and false positives.

During the time of your pregnancy (ten months), along with the time you plan to breastfeed, mammograms will not be a good option. This could be one to two years, depending on how long you choose to nurse. Talk to your OB/GYN about this before you get pregnant, as she may elect to do a baseline mammogram prior to conceiving.

      Seeking other prepregnancy medical counseling: Do you need it?

      If you have a chronic disease (diabetes or lupus, for example) or condition (such as heart problems), have had pregnancy or delivery problems in the past, or you are over a certain age, your doctor may want you to have further evaluation by another specialist before you begin treatment. Sometimes this is as simple as going to the doctor that handles your disease/condition to get what we call “medical clearance,” or the go-ahead, to start fertility treatment. Medical clearance lets the clinic know that your condition is under control and that another specialist has looked at you and the proposed treatment so that all risks are identified and managed. Here are two other specialists that you may be asked to see.

      Looking for input from maternal-fetal medicine (MFM)

      MFM (maternal-fetal medicine) is a subspecialty of obstetrics. An MFM has done a four-year residency after medical school and then a fellowship of three to four years. All MFMs are board certified obstetricians. MFMs manage complicated maternal and fetal medical problems. Women with severe diabetes, heart disease, neurological disease, and so forth are managed for their medical condition. Frequently, MFMs work with the OBs to co-manage a person, with the OB actually doing the delivery. The most common path to an MFM is a referral from an OB or reproductive endocrinologist (RE) who has identified a problem that needs expert management. If a person knows that she is high risk for pregnancy, she may seek out an MFM without seeing a general OB first. IVF pregnancies may be considered high risk (especially multiples), but they can generally be comfortably managed by a general OB.

      Pursuing genetic counseling

      Genetics seems to be everywhere today, from prenatal carrier screening, a family history of a genetic disease, or a defined genetic disease with either parent, to a genetic disease of the developing fetus. Any one of these issues may be better served by genetic counseling. The field of genetics is moving so fast that the generalist or even the REI can’t keep up with all the recent developments. Genetic counselors are extremely helpful in informing patients about the significance of genetic problems. Chapter 3 tells you more about genetics and your genes.

Chapter 5

      It Worked the First Time! Tackling Secondary Infertility

      IN THIS CHAPTER

      

Defining secondary infertility

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