Tuesday 5 May 2015

Are you postponing pregnancy?



Because of increasing importance to studies and profession, nowadays women are postponing the pregnancy. 
So planning pregnancy in 30's is becoming common today. Compared with 20's, planning pregnancy in 30's can lead to few problems. 
With increasing age the function of ovaries will get affected, number of ovarian follicles will decrease and remaining follicles may not respond properly to hormones. 
Possibility of problems like hormonal imbalance, pelvic inflammatory disease, endometriosis etc increase with age. 
Adverse effects of using contraceptive measures for prolonged period, possible medical complications diabetes, hypertension etc will increase with age. 
Tensions at work place can also affect fertility by leading to hormonal imbalance. 
Before planning for pregnancy in 30's, the factors to be considered are: 
-Folic acid supplementation should be started around three months before pregnancy. 
It helps in neurological development of baby and helps in conditions like anencephaly. 
-If the woman is having irregular periods, menstrual irregularity should be corrected before planning for pregnancy because menstrual irregularities can lead to difficulty in planning pregnancy and also infertility. Usually menstrual cycle with length of 21 days to 35 days and menstrual flow for 2 to 7 days should be considered as normal only. Deviation from these normalcy needs evaluation.
 Physical examination to access weight, height, BMI, anemia, thyroid abnormalities and gynecological examination to access the size, shape of uterus and adenexal pathology helps in finding out the possible cause of irregular periods. 
Then depending on the findings required investigations like estimating hemoglobin, blood sugar levels, gonadal hormonal profile, thyroid hormonal profile, prolactin levels estimation, ultrasound etc can help finding out the possible cause of irregular periods and treatment can be taken accordingly. 
If decreased ovarian reserve is suspected in ultrasound due to age factor, AMH( (Anti-Mullarian hormone) levels estimation is adviced. AMH is produced by the ovarian anthral follicles. 
Normal AMH levels indicate good ovarian reserve. Women with low AMH levels should plan for pregnancy early without postponing. 
-In case of regular periods or after correction of irregularity, planning intercourse during the time of ovulation increases the possibility of pregnancy. 
Usually ovulation occurs in the middle of the cycle. In case of regular 28 to 30 days cycles, ovulation is possible between 14th to 16th day of the cycle. 
-In case of infertility not getting corrected with medicines, artificial reproductive methods may be needed depending on the problem. 
Like in case of seminal abnormalities depending on spermatozoa count artificial methods ranging from IUI (Intra uterine insemination) to ICSI (intra cytoplasmic sperms injection) may need. After becoming pregnant also elderly women are more to some problems like hyperemesis gravidarum, means excessive vomitings in the first trimester of pregnancy and also pregnancy induced stress is more in elderly pregnant ladies. 
Medical complications like pregnancy induced hypertension, gestational diabetes etc can increase with age. Already existing chronic hypertension, diabetes mellitus, thyroid abnormalities etc can aggrevate during pregnancy. Placental problems like decreased blood supply to placenta due to age related vascular changes and also placenta previa etc are more common in these elderly pregnant women. 
Incidence of operative deliveries also increase in elderly women because of uterine inertia. 
Babies of elderly pregnant women are more prone for chromosomal abnormalities like Down's syndrome, preterm or intrauterine growth retardation etc complications. 
So, better to think once again when you want to postpone the pregnancy. 

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