Ask the doctor about getting pregnant

Hi there, I am 38 years old and have been living In Thailand since January in a children’s home in Phetchabun, central Thailand. We have tried for a baby for 8 years and did do 4 rounds of AI and got pregnant but when we went for a scan the baby had no heartbeat. I had to have a curet. I missed a period ( last period February 26th) I did a home test it says positive and I have had morning sickness. We are going to go home end of June. Should I go to a doctor here or wait until I get home. Also I woke in the middle of the night with tonsillitis and could not swallow- I had aspirin with out thinking to check packet. I then had another lot when I woke up and then panadol the next day. I just had a not thinking moment and then realise and read the packet and now extremely worried.

Referring to your information, we would recommended you to go to a pregnancy health care provider near you for antenatal care as soon as you suspect you’re pregnant. Once you go back to your home country, you can follow-up your prenatal care schedule with your pregnancy health care provider there. This will ensure that you and your baby get off to a good start.

As for the aspirin, it is ok during the first trimester as low-dose aspirin therapy is sometimes prescribed during pregnancy to help treat some medical conditions. However aspirin is not recommended to use later during pregnancy, especially after 24 weeks. If you need to take a pain reliever during pregnancy, ask your health care provider about the options. He or she might approve use of Paracetamol or Panadol.

For further information please see the following:

Patient information: Taking over-the-counter medicines during pregnancy (The Basics): http://www.uptodate.com/contents/taking-over-the-counter-medicines-during-pregnancy-the-basics?source=search_result&search=usage+aspirin+in+pregnancy&selectedTitle=1~150

Aspirin: Patient drug information: http://www.uptodate.com/contents/aspirin-patient-drug-information?anchor=F10017633#F10017633

Boonsaeng Wutthiphan M.D.
OB/GYN, Women – Gynecology
Samitivej Hospital

I had my period on Feb 19th. Then I had sex the weekend after it was done. I took the morning after pill. Then got my period again around march 6th. So I got my last period on March 27th. I had sex on the last day of it which was the 31st. I didnt take the pill or use a condom. On April 12th I think i experienced implantion bleeding. I saw alittle pink when i wiped and again the next day.It was only those two times that i had seen blood, and only when i wiped. So my questions are: Can I be pregnant, and how long until I’m able to take a home pregnancy test? Thanks!

Refer to your period cycle, you can take a pregnancy test on April 26. It can be done in the morning or after waking up in order to get the most accurate result. You also mentioned that you had some bleeding, your pregnancy result can tell you the possible cause.

  1. When your result is positive, it might be implantation bleeding which can occur after conception. This is normal and common. It will stop on its own and doesn’t require any treatment. However if the bleeding persists during pregnancy, you should contact your health care provider.
  2. When your result is not positive, it might be other physical causes such as pelvic abnormality, etc. It is one of the symptoms that women should not ignore. If the bleeding persists between periods, you should seek medical help to find out the real cause of bleeding.

Boonsaeng Wutthiphan M.D.
OB/GYN, Women – Gynecology
Samitivej Hospital

I got married 2 years ago, but until now I am not yet pregnant. Could you suggest when I should have intercourse? Is it during ovulation? In March I menstruated beginning on the 16th and finished on the 20th. I am 34 years old. Looking to hearing your suggestions.

When you try to conceive, you need to know when you’re ovulating and exactly when to have intercourse. The ovulation test should be taken after your period 12-18 days. Refer to your case, the test should be taken during April 1-7. If the result is positive, then it is the right time to have intercourse on that day, the next day and the day after tomorrow. The ovulation test can be bought at any drug store or hospital. If you buy at hospital, you can ask for further explanation and buy the ovulation test without the doctor’s order.

However we do recommend to adjust or change your lifestyle if unhealthy and check your immune system before ovulation test.

Here is the check-list to run through for healthy preparation. This can be achieved for both partners. (husband and wife)

Pre-existing medical problems (hypertension, diabetes, epilepsy, thyroid disorder, cardiac problems and drug history)

  • Stabilize medical conditions and ensure that medical control is optimal
  • Check that drugs needed are safe for use in pregnancy and do not affect sperm function
  • Where appropriate, refer woman to an obstetric physician for advice on implications of the condition in pregnancy

Weight

  • Check BMI
  • Modify diet and doing more exercise to lose weight and they should aim for BMI < 30. Women with BMI < 20 should be advised to gain weight and reduce exercise if they are exercising excessively. Being considerably underweight is associated with an increased risk of miscarriage and intrauterine growth retardation. Proper diet and exercise are important for optimal reproductive function.

Smoking & caffeine intake

  • Advise both partners to stop smoking
  • Caffeine intake less than 2 cups of coffee daily

Recreational drugs

  • Advise both partners to stop using recreational drugs

Check-up the immune system of both partners

  • For the safety of the child. Some diseases may be genetically transmitted to the child and these include anemia, thalassemia, and hemophilia. In some families, the diseases have been transmitted through several generations. A health check-up before pregnancy will help to identify the potential risks that may affect the unborn child. It will also help in planning your pregnancy and to ensure that your pregnancy is safe. Blood test will be done for ABO Group for Hematology, Rh Group, Complete blood count, Hemoglobin Typing, VDRL, Anti-HIV, HBs Ag, Anti-HBs, Rubella Igs (women only), etc. Please read details at http://www.samitivejhospitals.com/price_package_detail/premarital_check-up_and_preparing_for_pregnancy_554/en
  • If you don’t have particular immune system such as Hepatitis B or Rubella, then you need vaccine to boost your immune system at least 3 months before pregnancy.

Boonsaeng Wutthiphan M.D.
OB/GYN, Women – Gynecology
Samitivej Hospital

Can metformin help a women to get pregnant?

Metformin is an ovalation induction medicine normally used for treating PCOS (Polycystic Ovarian Syndrome). PCOS is the most common cause of female infertility. It is difficult to answer “yes” or “no” to your question if we don’t know the exact cause of the infertility. We can say that Metformin is not a fertility drug.

Why can PCOS cause infertility? PCOS is a health problem that can affect a women’s menstrual cycle, ability to have children, hormone level, heart and physical appearance. Here are some symptoms that you can look for:

  • Menstrual abnormality: your period can be either last for days longer, or you may have fewer cycles than usual.
  • Higher male sex hormones: The ovaries usually make a tiny amount of male sex hormones (androgens). But when you have PCOS, androgens are slightly higher. This causes the patient to stop ovulation. The patient may get acne and have additional facial and body hair.
  • Cysts on the ovaries: Enlarged ovaries contain numerous small cysts which can be detected by ultrasound.

Back to your question, some women may conceive after taking metformin to get their PCOS under control, but it is not believed to be primarily due to the side effects of metformin. However, recent studies have indicated that metformin alone is not a good solution for infertility in cases of PCOS. Therefore, if patients have problems with conceiving due to PCOS, they might have to consult with their OB/GYN for the right treatment.

There are many causes of infertility. If you are trying to conceive, diagnosis is necessary to recommend the right treatment.

Wirote Siripatananont, M.D.
OB/GYN and Infertility specialist
Samitivej Hospital

When is the right time to have sex that will lead to pregnancy? What are the drugs to take to increase my chances of getting pregnant? i was on contraceptive injections for two years and i just started seeing my regular menstrual flow since I stopped taking the injections 4 months ago.

The best time to have sexual intercourse is during ovulation.

If you have been taking birth control pills for so long, you need to stop using them before you are ready to get pregnant. After a 3 months period you can start using an ovulation testing kit. The test should be done every 12 days after your period. You should begin having intercourse on the first day of a positive result and for 2 additional consecutive days.

Boonsaeng Wutthiphan M.D.
OB/GYN, Women – Gynecology
Samitivej Hospital

At what age does it become more difficult or complicated for women to get pregnant and have children? What kinds of complications arise?

Women over 40 years of age have less chances of pregnancy due to declining ovarian function. Moreover if they get pregnant, there are more likely to have chromosomal defects like Down syndrome. And amniocentesis is needed for diagnosis. It raises the risk for miscarriage due to defection in fertilized ovum (natural selection). By being older, you may have more chance to develop maternal complications during pregnancy such as high blood pressure, preeclampsia and placenta abruption.

Nisarat Kasatri, MRTCOG, FICS M.D.
Specialist in OB/GYN
Samitivej Hospital

Recent question from our readers
I used to be pregnant but only one month after I knew that I was going to have a baby it was lost. It happened two time like this. I want to ask why it is always like that? Me and My husband really want to have a baby.

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