TRYING TO GET PREGNANT: 14 FERTILITY MYTHS DEBUNKED

We live in the era of informatics. Knowledge is easily accessible to us: we can learn virtually anything by just googling it. But paradoxically too much information many times leads to misinformation.

When it comes to fertility issues, there is a lot of disinformation going around. Therefore, it is no surprising what a recent survey showed: knowledge regarding ovulation, fertility, and conception issues is limited among women, and many tend to believe certain myths and misconceptions.

These are 14 fertility myths most people believe, but that science has debunked:

MYTH #1.  Maternity wise, 40s is the new 30s

Our life expectancy is longer, and we tend to postpone maternity due to career or study purposes. From that aspect, the 40s can be easily regarded as the new 30s. Unfortunately, this is not true for our ovaries: by the age of 30, a healthy woman has about a 20% chance of conceiving each month, by the time she reaches 40 her odds drop to about 5%.

This is one of the most commonly believed misconceptions: unaware of the age-related fertility decline, many women start seeking  help to conceive in their 40s, when they may have already missed the opportunity to become parents. 

You should be aware that there is a biological clock, and it’s ticking! If for personal reasons you cannot have a child right now, you may freeze your eggs to use them in the future.

MYTH #2. Certain sex positions increase the chances of getting pregnant

You will find plenty of (mis)information on this topic! In general, it is said that the best positions for getting pregnant are the missionary position (the woman lying on her back, her partner on top) and the “doggy position” (rear vaginal penetration, with the woman on her hands and knees) because they provide the deepest penetration, allowing the man to ejaculate closer to the opening of the cervix. 

In fact, there’s no scientific evidence to prove that. This belief is largely based on a single study that looked at the position of the penis in relation to these two sex positions, but it didn’t address pregnancy chances at all.

Therefore, no position seems to be better when it comes to maximizing your chances of making a baby. Sperm can be found in the cervical canal just a few seconds after ejaculation, and within 5 minutes in the tube, regardless of the coital position.

MYTH #3. Lifting your legs in the air for 20 minutes after having sex will help you get pregnant

You have probably heard this one: “lie in bed with your feet in the air after having sex to increase your chances of getting pregnant”. In fact, this is not (totally) true. You may lay in bed for 10-15 minutes after intercourse, as by this time the sperm have largely reached the cervix, and many may even be inside the tube.

In fact, a new study challenged both beliefs: women having artificial insemination were split into two groups – one that rested on their back with their knees raised for 15 minutes after the procedure and one that got up immediately. It turned out that, after several courses of treatment, 32% of the immobile group fell pregnant, compared with 40% per cent in the active group.

Therefore, there is no need to put pillows under your bottom during intercourse to get an advantageous tilt, or to perform cycling motions with your feet in the air.

MYTH #4. If we have sex every day the sperm becomes too weak, reducing our chances of getting pregnant 

How often should we make love to boost our chances of pregnancy? You will find all sorts of advice on the web: every other day, 3 times a week, every single day! Which one is correct?

One thing is clear: abstinence intervals greater than 5 days impair the sperm number and quality. Nevertheless, there is not much difference whether men ejaculate every day or every other day. Most fertility specialists used to recommend intercourse every other day, as this would increase sperm quality, particularly in men with lower sperm counts (oligozoospermia). However, recent studies show exactly the opposite: oligozoospermic men had better semen quality with daily ejaculation!

Recent scientific evidence suggests that making love every day confers a slight advantage: the highest chances of pregnancy (37% per cycle) were associated with daily intercourse, although sex on alternate days had comparable pregnancy rates (33%). On the other hand, we should keep in mind that the “obligation” to have sex every day may induce unnecessary stress to the couple, resulting in lack of sexual desire, low self esteem, and ultimately reduced frequency of intercourse.

Therefore, reproductive efficiency is highest when you have sex every day or every other day. The optimal frequency, though, is best defined by each couple’s own preference.

MYTH # 5. We only have sex when I ovulate, on day 14 of my cycle

Ovulation (when the egg drops from the ovary into the tubes) occurs once a month, usually between day 11 and day 21 of the cycle (measured from the first day of your period).

Each woman ovulates on her own schedule. While it is usually said that a woman with a 28-day cycle ovulates on cycle day 14, that’s not necessarily true: a study found that fewer than 10 percent of women with regular, 28-day cycles were ovulating on day 14.

We know that sperm cells are able to survive in the reproductive tract of a woman for about 5 days, and that once the egg is released, it will die in about 12-24 hours. Therefore, the fertile period -or “fertile window”- is a 6-day interval ending on the day of ovulation.

To boost your odds to become pregnant, have sex before and during ovulation, every day or every other day. If your cycles are irregular and you cannot figure out your fertile days, you may use an ovulation predictor kit, or otherwise visit a specialist, who can help you find your fertile window.

MYTH # 6. Smoking doesn’t affect our chances of getting pregnant. I will quit smoking as soon as I get pregnant

You are most likely aware that smoking during pregnancy is dangerous, as it can lead to miscarriage, premature birth, low-birthweight babies and -according to recent studies– congenital malformations.

But you should also know that smoking is harmful for your fertility: smoking as few as five cigarettes per day is associated with reduced fertility, both in women and men, and this seems to be true even for secondhand smoking. It has been estimated that smokers may have a 10-40% lower monthly fecundity (fertility) rate, and that up to 13% of infertility is due to smoking.

Smoking can affect ovulation, as well as the ability of the fertilized egg to implant in the uterus. The effect of tobacco is so harmful for the ovaries that menopause occurs, on average, one to four years earlier in smoking women than in nonsmoking ones.

Men are also affected by tobacco: decreases in sperm density, motility, and abnormalities in sperm morphology have been observed in men who smoke, which impact a man’s ability to fertilize an egg. 

Therefore, before trying for a baby, do yourself a favor … and put out the cigarette for good!

MYTH # 7. You don’t need to worry about your age. There’s always IVF

Another common misconception! Many women believe that, if age-related infertility strikes, they can overcome their problem by getting treated with in vitro fertilization (IVF). In fact, just as natural fertility declines with age, success rates with IVF also decline as a woman gets older.

According to the USA Center for Disease Control and Prevention (CDC), women younger than 35 years old have 33% chances of having a baby after IVF; for women ages 38 to 40 the success rate drops to 17%, while those 43 to 44 years old have only 3% chances of giving birth after IVF (using their own eggs).

IVF is not a guarantee to have a baby, and does not extend a woman’s reproductive life. Despite the number of celebrities having babies in their mid-40s and beyond, they may have not necessarily used their own eggs. While every woman has the right to keep her privacy, there is a wrong perception left that fertility treatments can extend a woman’s fertility span. There is a very low probability of improving success of conceiving after age 43 by using assisted reproduction using your own eggs. Nevertheless, you may opt to use oocyte donation (eggs of a younger woman) if age-related infertility stands in the way of parenthood.

MYTH # 8. A woman can’t get pregnant if she doesn’t have an orgasm

For men, things are clear: no orgasm, no pregnancy, as ejaculation occurs during orgasm. Well, that’s not entirely true: semen can be released during intercourse prior to orgasm in the so-called pre-ejaculation fluid, or pre-come (read more here).

For women though, getting pregnant has nothing to do with an orgasm. But could female orgasm improve the chances for conception? The answer is not clear.

Researchers have wondered for years about the purpose of female orgasm, and many theories have been proposed: 

  • Just the pleasure it provokes, so that women want to reproduce and preserve the species!
  • The “poleaxe” hypothesis: orgasms make women feel relaxed and sleepy so that they will lie down after sex and the sperm reach their destination more easily.
  • The “upsuck” theory: the contractions of the uterus “suck up” the sperm released in the vagina and help them travel through the uterus to the tubes.
  • Pair bonding: the hormones produced during orgasm (such as oxytocin and prolactin) contribute to warm feelings towards her partner.

Orgasms are not necessary to get pregnant, but there are plenty of good reasons to have one! Nevertheless, it is not uncommon that women trying to conceive link the desire for an orgasm with their desire to have a baby; this leads to psychological pressure and difficulty achieving orgasm, adding frustration to a process that is supposed to be pleasurable…

Try not to consider the orgasm just as goal to get pregnant. Enjoy the intimate time with your partner, without any pressure. If you have an orgasm, great. If not, that’s fine, too!

MYTH #9. We’ve already had one child, so conceiving again will be easy

Perhaps, but it’s no guarantee. Many individuals experience secondary infertility, or difficulty conceiving a second or subsequent child. 

Secondary infertility may be caused by age-related factors, both for you and your partner. Sometimes, a new underlying medical condition develops. Eventually, a fertility issue that always existed gets worse; while it didn’t prevent pregnancy before, now it has become a problem. A previous pregnancy may actually be the reason you don’t get pregnant again: surgical complications or infection after childbirth may have provoked scarring, which may in turn led to infertility.

Things change with time. Even if you got easily pregnant on your own before, if you’re struggling to have another child talk to your doctor, who can advice you on the next steps to follow.

MYTH #10. Infertility is a woman’s issue

Typically, the causes of infertility break down like this: 

  • Approximately one third of the couples struggle with male infertility;
  • In another third, the problem is female infertility;
  • The remaining third will either face both male and female fertility issues, or a cause will never be found (unexplained infertility).

Common causes of female infertily are: age, PCOS (polycystic ovary syndrome), tubal or pelvic issues, endometriosis, and family history. 

Common causes of male infertility tend to be from prior surgery, infection, or a problem present at birth.

As part of the preliminary work-up to determine the cause and treatment of infertility, both women and men will need to undergo clinical and specialized complementary exams.

MYTH #11. Men’s age doesn’t matter

While some men can father children into their 50’s or 60’s, men’s fertility isn’t age-proof: it starts declining in their 40s, although less drastically as compared to women’s fertility.

As a man ages, the concentration of mobile, healthy sperm and semen volume overall will decrease. It is clear now that men over the age of 40 have higher chances of having children with chromosomal abnormalities, causing miscarriages in their female partners. Moreover, researchers have found a direct link between paternal age and an increased risk of autism and schizophrenia. 

A man’s age does matter. While men may not have a complete drop off in fertility like women do, “advanced paternal age” is something couples should be aware of. Men’s biological clock is also ticking!

MYTH #12. If I take good care of my general health, my fertility will be in check too

Whereas a healthy body and mind may boost fertility in certain cases, most infertility situations cannot be resolved by a lifestyle or diet change, particularly those related to age.

It is a common belief that certain diet types can help you get pregnant. There is no evidence that vegetarian diets, low-fat diets, antioxidant- or vitamin-enriched diets will increase your chances of having a child.

A woman’s weight plays a role in fertility: those who are either very thin or obese may find it hard to conceive. If you are trying to get pregnant, learn more about some lifestyle tips to boost your chances of getting pregnant here.

MYTH #13. If a man can ejaculate, his fertility is fine

Many myths surround male fertility and their sexual performance. It is a common (and unfortunate) myth that if a man’s fertility is compromised, this means his sexual performance is the problem. This is not true. Problems with sperm count, shape, and movement are the primary causes of male infertility. 

Another common myth is that you can tell there is a problem with the sperm just by looking at the semen. In fact, even men that have no sperm cells at all (azoospermia) usually have normal-looking semen. 

For the vast majority of men with infertility, there are no visible or obvious signs that anything is wrong. Healthy erectile function and normal ejaculation are not guarantee that the sperm is in good shape.

That said, erectile dysfunction can be a possible symptom of infertility; it may due to low testosterone levels or a physical injury. Difficulty with ejaculation can also be a signal certain medical problems. But these are uncommon signs of male infertility.

If you are struggling to get pregnant, have your partner check in with his doctor. A semen analysis will help clarify whether his sperm are fit for conception.

MYTH #14. The birth control pill will affect your future fertility

All scientific evidence agrees that hormonal contraceptives do not make women sterile. Moreover, they may confer increased likelihood of pregnancy with long-term use, and in certain cases they can also preserve fertility. Read more on the contraceptive pill here.

 

To summarize:

Myths and misconceptions regarding fertility and conception are, unfortunately, widely disseminated. This is a serious problem, as misinformation may lead not only to unnecessary stress, but also to take wrong decisions…

Get yourself well informed! Consult your gynecologist, who can help you with any concerns you have. Your doctor can also give you some tips on lifestyle changes to optimize your fertility, prescribe some exams, and tell you when to come back if you don’t achieve pregnancy on your own.

Last, a good piece of advice: if you want to get pregnant, have lots of sex – as much as you want, whenever you want – and enjoy it! After you have had sex, do whatever you want – just don’t smoke 😉

 

Photo credits

Intro: pixabay.com; 1: rma-fl.com; 2: motherandbaby.co.uk; 3: romper.com; 4: pixabay.com; 5: wsaw.com; 6: babycenter.com; 7: nexter.org; 8: irishtimes.com; 9: health.clevelandclinic.org; 10: thefertilechickonline.com; 11: businessinsider.com; 12: hayatouki.com; 13: livescience.com; 14: pinterest.com

EGG DONATION IN GREECE: ALL YOU NEED TO KNOW


Assisted reproduction techniques help thousands of couples with infertility to circumvent their problem and become parents. Nevertheless, when it is not possible for a woman to conceive due to poor egg quality or from having no eggs at all, she may still become pregnant by using eggs from a donor.

The first pregnancy with egg donation was reported in 1983, and ever since, more and more women are choosing this procedure to achieve their dream of having children. The main reason for this trend is that women are increasingly postponing childbearing until later on in life, when their fertility is often reduced; another reason is that over the years, the process has become highly successful due to recent technologies advances and improved freezing techniques.

What is egg donation?

Egg donation is a form of assisted reproduction by which a woman donates her ova to enable another woman to conceive. These oocytes are fertilized by the recipient’s husband sperm, or alternatively by a donor sperm.

The resulting embryos are transferred into the recipient uterus, which has been adequately prepared to receive them. The difference with routine in vitro fertilization (IVF) is that the egg donor is not the recipient; that is, they are two different women.

If pregnancy occurs, the recipient will have a biological but not a genetic relationship to the child, and her partner (if he provided the sperm) will be both biologically and genetically related.

What are the indications for egg donation?

Egg donation may be considered in the following situations:

  • Premature ovarian insufficiency: a condition in which menopause begins earlier than usual, usually before the age of 40 years old. In most cases the cause is unknown, but it may be the result of certain diseases, chemotherapy, radiotherapy or surgical removal of the ovaries. Egg donation is also suitable for women who were born without ovaries.
  • Low ovarian reserve: when there is a decrease in the number of eggs, resulting in reduced chances of pregnancy. Generally, this is due to advanced reproductive age, as the number of oocytes -and therefore fertility- decreases rapidly after the age of 35-40 years old.
  • Genetically transmitted diseases: women affected by, or carriers of a significant genetic disease who would prefer not to pass this disease on to their child.
  • Previous history of failure with IVF: especially when egg quality seems to be the problem.

Who are the egg donors?

1) Anonymous, voluntary donors: According to the Greek law, candidate egg donors are covered by anonymity and are required to sign a specific consent for the donation of their genetic material. In order to accept a woman into an egg donation program she should meet the following requirements:

  • Age between 18 and 35 years old.
  • She should be healthy, non-smoker, with no personal or family history of genetic diseases.

By law, the donor receives financial compensation only for the loss of working days, travel and other expenses incurred during the treatment cycle in which she participates. In any case, egg donation is an altruistic, anonymous and voluntary act.

2) Egg sharing: Women undergoing IVF may agree to donate their surplus oocytes to other women with infertility.

3) Known donor: a person who is known to the recipient, usually a close relative of friend. According to the Greek law, oocyte donation is an anonymous procedure, that is, the donor has no access to the child born, nor the recipient to the donor. Therefore, in Greece the donation of ova to known persons is forbidden by law.

Evaluation of the egg donor


Each candidate donor, after being fully informed about the egg donation program, completes a thorough questionnaire on her family, medical and psychological history. In addition, she is the subject of a series of exams to determine whether her health is in good condition and she can respond properly to the hormonal therapy.

The evaluation involves a comprehensive physical and gynecological examination, as well as the assessment of her psychological and mental status, her genetic material and reproductive system.

In addition, donors undergo the following laboratory testing:

  • Blood type and Rhesus
  • Hepatitis B & C
  • HIV 1 & 2
  • Syphilis
  • Hemoglobin electrophoresis
  • Sickle cell trait testing
  • Cystic fibrosis (CF) mutation
  • Fragile X testing
  • Conventional karyotype. It is also possible to a perform a molecular karyotype, upon request of the recipient couple.

A donor is ineligible if either the questionnaire or the screening tests indicate the presence of risk factors, or clinical evidence of an infectious or genetic disease.

Evaluation of the recipient couple 


Adequate screening and preparation of the recipient couple are essential for the success of an egg donation program.

According to the Greek law, a woman is considered suitable to receive oocytes when her uterus has normal morphology and functionality and has not exceeded the age of 50 years.

The evaluation of the recipient couple is similar to that of couples undergoing routine IVF. First, the physician obtains a thorough medical history from both partners.

The assessment of the woman includes an in-depth physical and gynecological examination, a detailed pelvic ultrasound and laboratory testing. Briefly, the ovarian function, her blood group, and exposure to certain infections are examined. In addition, a Pap smear test and cultures for certain microbes (Neisseria gonorrhoeae, Chlamydia trachomatis, etc) are obtained.

In some cases, the uterine cavity is evaluated with hysterosalpingography (HSG), sonohysterography or hysteroscopy. If the woman is over 45 years old, a more thorough assessment of her cardiac function, pregnancy-induced hypertension and gestational diabetes risk are recommended. The effect of advanced maternal age on pregnancy will be discussed extensively, as well as any medical conditions that may affect pregnancy.

An embryo transfer trial before the actual procedure (“mock” embryo transfer) is strongly recommended. It allows to determine the best way to place the embryos into the uterus, and ensures that there are no unexpected obstacles along the way. Sometimes the cervix is very narrow and hinders the transfer of the embryos into the uterus; this may result in significantly reduced chances of pregnancy. In case of a narrow or distorted cervical canal, a cervical dilation may be recommended.

A treatment trial in a previous cycle with the same medications used for the endometrial preparations is proposed when possible, in order to assess the uterine response to hormone therapy.

The male assessment includes a semen analysis, blood group and genetic testing, among other exams.

According to the Greek law, the recipient couple should be tested for syphilis, hepatitis B and C, HIV-1 and HIV-2 within the six months preceding the treatment cycle.

The procedure

Preparation of the donor for egg retrieval 

The donor follows the procedure of a standard IVF. Initially, she undergoes ovarian stimulation, that is, she receives a combination of hormonal medications in order to achieve the development of a sufficient number of oocytes within the ovaries; egg development is monitored by ultrasound and blood exams at regular intervals. When the oocytes are at the appropriate size, ovulation is triggered by an injection of human chorionic gonadotropin (hCG). Oocyte retrieval, scheduled approximately 34-36 hours after hCG administration, entails the use of a needle which is inserted through the vagina into the ovaries, whereby the eggs are aspirated under ultrasound guidance. The procedure is carried out under a mild sedation.

The ova obtained are evaluated for their maturity and then fertilized with the partner’s sperm, which has been processed in the laboratory. Donor sperm may be also utilized when indicated.

The male partner should provide the semen sample the day of the donor’s egg retrieval. Alternatively, if the presence of the partner is not possible on that day, the semen can be cryopreserved (frozen) at an earlier time.

Preparation of the recipient for embryo transfer

In order for the embryos to implant into the recipient’s uterus, the endometrium (uterine lining) must be prepared and synchronized with the donor cycle.

There are numerous protocols for endometrial preparation. Briefly, women who still have menstrual period may receive an injectable medication for temporary suppression of the ovarian function. When the donor starts ovarian stimulation, the recipient receives a hormone called estradiol to achieve endometrial growth. Estradiol can be administered orally or through a transdermal patch. Ultrasound assessment of endometrial thickness -and occasionally blood tests- are performed during this period. On the day after the donor receives hCG, the recipient begins treatment with progesterone. Progesterone causes endometrial maturational changes that allow the embryo to implant. Progesterone can be administered by intramuscular injection, vaginally or orally. Besides estradiol and progesterone, other medications may be prescribed if required.

The embryos are transferred into the recipient’s uterus, usually within three to five days after fertilization of the eggs in the laboratory. Embryo transfer is done using a thin catheter inserted through the cervix into the uterus. If the recipient couple has extra embryos, they will be cryopreserved (frozen). Thus, it is possible to transfer these embryos at a later time without the need for another egg donation.

Hormonal therapy with estradiol and progesterone continues until the recipient takes a blood pregnancy test (β hCG). If the test is positive, the hormones are continued during the first trimester of pregnancy.

Success rates with egg donation

Since egg donors are young and healthy women, success rates are higher than those obtained with conventional IVF. The age of the recipient does not seem to affect the success of the procedure. According to data from the National Agency of Medically Assisted Reproduction, the pregnancy rate with egg donation in Greece is 54%.

Nevertheless, the greater the number of attempts with donor-egg IVF, the higher the odds of success. Thus, it is estimated that the success rates after the third attempt reach almost 90% in most cases.

Many factors play an important role in the success of the procedure: adequate evaluation and preparation of both donors and recipients, optimal synchronization between them, high laboratory standards and well-trained scientific staff, will all have a positive impact on pregnancy rates in an egg donation program.

Risks of egg donation 

1) For the donor:

Egg donation is a very safe procedure. Nevertheless, it is not entirely risk-free. Medicines taken to stimulate the ovaries, oocyte retrieval and the anesthesia required are all possible sources of complications. Briefly, the side effects of medications are usually mild, as one of the most feared complications in assisted reproduction, ovarian hyperstimulation syndrome is very rare in these cases. The remaining risks are estimated as follows: anesthesia risks: 1 / 10,000; risk of severe bleeding from oocyte retrieval: 1 / 2,500; risk of infection: less than 1/500.

It should be noted that the fertility of women who become egg donors is in no way affected. In fact, the eggs donated would have been otherwise discarded by their bodies.

2) For the recipient:

The possibility a donor transmits an infectious disease to the recipient is virtually non-existent, provided that proper evaluation of the egg donor has been performed, as dictated by the Greek law.

The most common risk for the recipient is the occurrence of a multiple pregnancy (twins) if more than one embryo is transferred. In any case, in egg donation cycles, the transfer of more than two embryos is strictly forbidden by the Greek law. If the couple is opposed to the possibility of a twin pregnancy, then only one embryo may be transferred (single embryo transfer, SET).

Pregnancy complication risk in recipiens with advanced age should be assessed individually for each case.

3) For the child:

To date, thousands of children have been born with this procedure, and the available data is reassuring, and equivalent to that of conventional IVF: the rate of birth defects is the same as the general population.

THE LEGISLATION IN GREECE 

On Egg Donation

  • Egg donation is an altruistic act, voluntary and with no financial benefit. Donors are compensated only for the working days they lose as part of the donation process and their travel expenses.
  • Donation of ova and sperm is allowed in Greece provided donor anonymity is ensured.
  • Egg donation is not allowed to women over 50 years old.
  • Donors must sign an oocyte concession consent.
  • Recipients sign a document stating that they are married and accept to undergo in vitro fertilization with egg donation. If they are not married, they should sign a notary act stating that they wish to undego IVF using the egg donation method.

On Assisted Reproduction

On January 27 2005, the law 3305/2005 on the application of assisted reproduction techniques was reported.

The Greek law on medically assisted reproduction is one of Europe’s most flexible. It safeguards the couple who wants to have a child based on medical, biological and bioethical principles. Its main purpose is, ultimately, the protection of the child to be born.

Basic principles of the current legislation

Some of the key points of the in-force law are the following:

1) Assisted reproduction methods are legal and allowed for women up to the age of 50 years, as this is considered the limit for natural conception.

2) The donation of ova and sperm is permitted, but the consent of the spouse or partner is also required.

3) Pre-implantation genetic diagnosis is allowed with the purpose of diagnosing whether the resulting embryos are carriers of genetic diseases. Consent of the concerned individuals is required.

4) Sex selection is prohibited unless a serious sex-related hereditary disease is avoided.

5) Cloning for reproductive purposes is prohibited.

6) Cryopreservation of genetic material or fertilized eggs is permitted.

7) The use of a gestational carrier (surrogacy) is allowed. A surrogate is a woman who carries a pregnancy for another couple or woman, who wishes to have a child but is unable to get pregnant for medical reasons. The surrogate woman must undergo medical and psychological examination. There should be no financial transaction other than the costs resulting from pregnancy exams, loss of work, etc. The procedure requires a special permit from a judge.

8) Assisted Reproduction Units are established and operate with the permission of the competent Authority, which shall give its agreement and verify that the legal requirements are met. For any violation, it sets administrative and criminal penalties.

9) The law sets age limits for sperm donors (younger than 40 years old) and egg donors (younger than 35 years).

10) Single women are allowed to conceive with assisted reproduction.

11) Donors must undergo clinical and laboratory testing and are not admitted to donation programs if they suffer from hereditary, genetic or infectious diseases. The use of fresh semen from donor is not permitted; only frozen semen may be used.

 

More info at gofertile.eu

PREGNANCY SYMPTOMS: WHAT TO EXPECT THE THIRD TRIMESTER

Almost there! The third trimester is full of expectation, as the moment you will hold the baby in your arms approaches. But the excitement comes with a lot of uncomfortable symptoms…

The third trimester lasts from the 7th through the 9th month of pregnancy, that is, from week 28 till the moment you give birth, usually around week 40. This period can be challenging and tiring, as your womb grows and creates a lot of discomfort. Most of the symptoms you will experience are those that appeared during the second trimester, although they will be more intense now: back pain, leg swelling, sleep problems, itchy skin…

But keep a positive attitude! Read this list with the most common symptoms of the last three months of pregnancy and learn what you can do to relieve them. We will focus on the symptoms that appear during the third trimester, or that are somewhat different now. This is what you can expect:

1) Abdominal muscle separation

As your uterus grows, it pushes against the abdominal wall and stretches its muscles (the ‘six pack’ muscles), which will start separating in the middle and cause a bulge, or gap  in the middle of the abdomen. This condition, called diastasis recti abdominis, is more evident when the abdominal muscles are tense, such as during coughing or getting up from a lying down position. Diastasis recti can cause lower back pain, making it difficult to carry out certain activities, such as lifting objects.

Not all women develop abdominal muscle separation; you are more likely to get it if you are older than 35 years-old, have a multiple pregnancy or carry a large baby, or have repeated pregnancies.

What can you do about it:

  • Muscle separation lessens in the months that follow delivery, although some degree of separation may remain. Certain exercises will help you regain abdominal strength after childbirth.
  • During pregnancy, avoid aggressive abdominal exercises (such as sit-ups), which may provoke or worsen diastasis recti.
  • If abdominal muscle weakness associated with diastasis recti is interfering with your daily activities, seek the advice of your care provider or a specialized physiotherapist, who can indicate certain strength and postural correction exercises.

2) Breast leakage

By the end of pregnancy, you may notice a yellowish fluid leaking from your nipples, and this is normal. This substance, called colostrum, will nourish your baby in the first few days after birth.

While some women leak quite a lot of colostrum, others don’t leak at all. Leaking won’t make any difference to how much milk you will produce once your baby is born.

What can you do about it:

  • If you just leak a few drops, then you don’t need to do anything. But if it bothers you, you may wear nursing pads inside your bra to absorb the milk.
  • You should call your doctor or midwife if the nipple discharge becomes bloodstained.

3) Carpal tunnel syndrome

Tingling, numbness, weakness and pain in the hands during the last trimester are usually caused by a condition called carpal tunnel syndrome (CTS).

CTS is common in pregnancy, and happens due to the fluid retention in the tissues of the wrist, which in turn squeezes a nerve (the median nerve), that runs down to your hand and fingers. Women that keep doing forceful or repetitive hand and finger movements (such as long hours at a computer, or the use of vibrating equipment) may have worse symptoms.

What can you do about it:

CTS usually disappears without treatment after childbirth, when pregnancy-related fluid buildup is relieved. In the meantime, you may try the following:

  • Avoid activities that may be causing symptoms.
  • Wear a wrist splint to keep your wrist straight, especially at night, when the symptoms can be more bothersome.
  • Do exercises to stretch and strengthen the muscles in the hand and arm.
  • Alternative therapies, such as acupuncture might help relieve hand pain.
  • If nothing works, talk to your doctor, who may prescribe certain medications.
  • Surgery is the last resort treatment, but unless CTS become intolerable, it will be delayed until after birth.

4) Dreams and nightmares

You knew about the sleep problems during pregnancy. But you may get surprised, even disturbed when you start getting frequent and vivid dreams, occasionally nightmares; you may also realize that you remember your dreams more clearly.

The exact reason of these changes in the dream pattern is not clear, but they seem to be related to hormonal and emotional factors, as well as the frequent sleep disruptions that come with pregnancy (read more here).

What can you do about it:

  • If your dreams are just more frequent or more vivid, you will just have to cope with them.
  • However, if you have frequent nightmares, that are too disturbing, don’t let you sleep or cause you intense anxiety, you may consider sharing them with a friend, your doctor, or a therapist.

5) Clumsiness, waddling

You may have noticed that, as pregnancy progresses, you get clumsier: things fall from you hands, you bump into doors, you may accidentally fall down! It is not just you, clumsiness is normal in pregnancy and is related to many factors: you are heavier and your growing womb changes the center of gravity, making it more difficult to move; your “pregnancy brain” makes it harder for you to concentrate on your activities; in addition, a hormone called relaxin relaxes all the joints in your body. Therefore, you won’t have the balance or dexterity you used to have.

The same reasons explain why, at the end of pregnancy, you will start waddling, which in turn will make you even clumsier!

What can you do about it:

Clumsiness is normal and there is not much you can do to prevent it. However, it is important that you take measures to protect yourself -and others- from accidents:

  • Avoid situations where you have a high risk of falling, such as standing on a ladder, using stairs, riding a bicycle, etc.
  • Wear comfortable shoes, that should not be neither too flat or too high (read more here).
  • Pay attention whenever you walk on wet, icy, or uneven surfaces.
  • Avoid gaining too much weight, which will make clumsiness much worse.
  • Call your doctor if, besides clumsy, you feel dizzy or lightheaded, your have blurred vision, headache, or any pain.

6) Emotional changes

As you get closer to childbirth, your anticipation grows, so do your anxiety, fears and concerns! Besides all the hormonal-related emotional changes, you may start getting worried about the delivery itself, as well as all the changes the baby will bring, your role as a parent, etc (see here).

What can you do about it:

  • Stay calm, mild physical activity can help (read here), eat well (here), indulge yourself with a beauty treatment! (here).
  • Taking childbirth classes can help you feel more prepared to face labor and delivery.
  • Discuss your emotions and fears with your doctor or midwife.
  • Sharing your feelings with friends, your partner or other moms-to-be can be very helpful.
  • Nevertheless, if you feel constantly down or overwhelmed, if you have negative or suicidal thoughts, if you can’t go ahead with your daily life you must discuss it with your doctor.

7) Fatigue

Forget the energy you had during the second trimester: fatigue is back! Carrying extra weight, waking up several times during the night to go to the bathroom, and dealing with the anxiety of preparing for a baby can all decrease your energy level.

What can you do about it:

  • Eat healthy, frequent and small meals: it’s a good idea to keep with you healthy snacks that you can grab whenever you feel out of energy.
  • If you work, take regular, small breaks; you may even consider taking a quick nap!
  • Light exercise can make you feel more energetic: walking, swimming or prenatal yoga are good options, but listen to your body! Don’t force yourself.
  • Check with your doctor if you feel extremely tired, so that she/he may do some blood test to rule out anemia or other problems.

8) Forgetfulness (“Pregnancy brain”)

It’s not a myth: intense forgetfulness, known as “pregnancy brain” is a normal symptom of pregnancy, which nevertheless can be very annoying!

It is mostly related to pregnancy hormones, but sleep disturbances and fatigue can make it worse.

What can you do about it:

Don’t worry! Your brain will work normally again after delivery. Well, sort of, as you will have to deal with the sleepless nights while taking care of your baby 😉

In the meantime, these tips may help:

  • Stay organized! Write down what you need to do, technology may help: reminders on your phone or to-do lists in your computer will make it easier.
  • Ask for help: cut down on what you’re responsible for by delegating some jobs to others.
  • Eat well: certain foods may boost your memory: eating plenty of choline-rich foods and DHA-rich foods during pregnancy may help boost your -and your baby’s- brain function.

9) Frequent urination, urinary incontinence

As your baby grows, the pressure on your bladder increases, causing a constant feeling you need to go to pee. This may be worse during the night, because when you lie down, the fluids you retained in your legs and feet during the day make its way back into your bloodstream and eventually into your bladder.

Many women also experience stress urinary incontinence, that is, they lose some urine when they cough, laugh, sneeze, lift heavy objects, or exercise.

What can you do about it:

To reduce frequent urination:

  • Avoid beverages that contain caffein, which has diuretic effect.
  • It’s not a good idea to cut down on fluids, as your body needs plenty of them during pregnancy. Instead, you may reduce fluid intake in the hours before you go to bed.
  • Lean forward when you urinate: this helps empty out your bladder better.

To avoid incontinence:

  • Empty your bladder before exercising.
  • Wear a panty liner to catch any unexpected leakage.
  • Kegel exercises, which strengthen the muscles of the pelvic floor, can also help minimize stress incontinence.

You should inform your doctor or midwife if you feel pain or burning with urination, if your see blood when you wipe or if you feel the urge to pee even when you produce just a few drops at a time. These could be signs of a urinary tract infection (UTI).

10) Heartburn

Another symptom you may have experienced during the first three months of pregnancy, got better during the second trimester but now came back! While the heartburn you experienced during the first trimester was hormone-related, now your enlarged uterus is to blame, as it crowds the abdomen, pushing the stomach acids upward.

What can you do about it:

  • Eat small, frequent meals, don’t eat too much before going to bed.
  • Avoid too spicy, greasy, acidic or sweet foods.
  • Don’t lie flat, sleep with two or more pillows to have your head at a higher level than your body.
  • Call your doctor if you can’t cope with heartburn, who can prescribe you an antiacid medication that is safe for pregnancy.

11) Pelvic pain

Once you’re in your third trimester, you may experience pain and pressure in your pelvic region, as the weight of your growing fetus presses down on certain nerves that run into the legs; for the same reason you may also feel tingling, numbness and pain along the outer thigh; which can be very annoying for some women.

Relaxed pelvic joints are a common cause of pelvic pain: toward the end of your pregnancy the hormone relaxin helps the ligaments become loose in preparation for childbirth. This hormone can also loosen your pelvic joint, and even cause it to separate a bit. It’s common to feel pain near your pubic bone, and you may also feel like your legs are unstable. This is called Symphysis pubic dysfunction (SPD).

Your fetus’s head can also to rub your tailbone, causing tailbone pain and pressure. The condition is called coccydynia and occasionally the pain can be very intense.

Braxton Hicks contractions can also cause pressure and tightening in the pelvis (see below). Constipation also can cause pelvic pain or discomfort (see here).

What can you do about it:

Be patient! Once your baby is born, all the pressure-related symptoms will be gone; in addition, relaxin production will cease and the joints will be firm again, easing your pain. In the meantime:

  • Get plenty of rest;  a change of position that shifts the pelvic pressure away from the nerves responsible for the pain should provide some relief.
  • Avoid lifting heavy things.
  • Warm compresses on the painful the area may ease soreness.
  • Pelvic support belts can help stabilize the area.
  • If the pain is severe enough, ask your doctor about painkillers.

12) Swelling

During the second trimester some women experience some swelling of the ankles and feet. Now, swelling – or edema will be also evident in the hands, face and upper legs.

Swelling is normal and is caused by the excess blood and fluids your body produces to meet the baby’s needs. This extra fluid will also soften the body and help it expand as the baby grows, and prepare the joints and tissues to open more easily during delivery.

Swelling is usually worse with warm weather, if you stand up for long periods of time, if you consume too much caffeine or salty foods, or if your diet is low in potassium.

What can you do about it:

  • Reduce salt intake, avoid adding extra salt to meals.
  • Avoid caffeine consumption.
  • Eat foods high in potassium (such as bananas).
  • Minimize outdoor time when it’s hot.
  • Avoid long periods of standing or sitting.
  • Move regularly your feet, or keep your legs elevated while sitting.
  • Wear comfortable shoes (read more here).
  • Avoid clothes that are tight around your wrists or ankles.
  • Wear supportive tights or stockings.
  • Get plenty of rest, swimming may also help.
  • Use cold compresses on swollen areas.

13) Shortness of breath

As your pregnancy progresses you may start feeling breathless after minimal amounts of physical exertion, or even when talking!

Mild breathlessness is totally normal; during early pregnancy is due to pregnancy hormones, which make you take more and deeper breaths, so that you get additional oxygen for the baby. But in the third trimester, shortness of breath  is mostly related to your expanding uterus putting pressure on the lungs and diaphragm, making it harder to take a deep breath.

What can you do about it:

  • Don’t overdo it with your daily activities or while exercising; when you feel breathless, slow down.
  • Make room for your lungs to take air: stand up straight, don’t sit down for long periods of time, sleep propped up on pillows.
  • If the shortness of breath is severe, you have chest pain or a quick pulse, call your doctor immediately.

14) Vaginal discharge

Increased vaginal secretions are completely normal and start during the first trimester. These discharge helps prevent infections travelling up from the vagina to the womb.Towards the end of pregnancy, the amount of discharge increases and can be confused with urine; close to delivery it may even contain streaks of thick mucus and some blood (this is called “bloody show”; we will discuss more about it in another post). Vaginal secretions should be white or clear, and should not smell unpleasant.

What can you do about it:

  • You may wear panty liners, but do not use tampons.
  • Prefer cotton underwear, avoid string or thongs that may cause intense rubbing, which together with the increased discharge can favor yeast or other infections.
  • Avoid vaginal douching (which is never a good idea, but especially during pregnancy).
  • Pay attention to washes and wipes that could be irritating, increasing your chances of a vaginal infection.
  • Call your doctor or midwife if you have discharge that is yellow, green or foul-smelling, if you have intense itching or burning, symptoms that may show that you have a vaginal infection. Likewise, call your healthcare provider if you have a lot of watery, vaginal discharge, which may signal that you broke your water bag.

15) Vulvar varicose veins

If you feel something “like worms” on your genital area, together with some pressure, swelling of discomfort in the vulva, don’t panic! These are dilated vulvar veins and occur due to the increased blood flow to the area, and the pressure the growing uterus puts on the veins of your lower body. Vulvar varicosities are seen quite often during pregnancy, either alone or with varicose veins of the legs, or hemorrhoids. Long periods of standing, exercise and sex can aggravate them. Occasionally though, they are completely asymptomatic, and the only way you’ll know you have them is because your doctor tells you.

What can you do about it:

Most of the times, vulvar varicosities don’t affect your mode of delivery, and they go away on their own after birth. If they are bothersome, you may try the following:

  • Wear support garment specifically designed for vulvar varicosities.
  • Avoid standing for long periods of time.
  • Swimming helps lift the baby from the pelvis and improves blood flow, relieving your pain.
  • Elevate your hips slightly when lying down to promote circulation; you may place a folded towel beneath your hips.
  • Cold compresses applied to your vulva may ease discomfort.

What else to expect

Baby movements

  • During the second trimester and beginning of the third, your baby has plenty of room in the womb, so most likely you will feel pushing, swirling, twisting, and kicking. But as he/she grows bigger, there is less space for movement; thus probably you won’t get the punches and kicks you were used to. Instead, you’ll feel more wiggles, stretches and turns. Although by the end of pregnancy mobility may be reduced when he gets engaged in the pelvis, the baby should keep moving until the moment he is born.
  • Keep in mind though that the baby is not constantly on the move: there are times when she sleeps. Towards the end of your pregnancy, the baby rests for about 20 minutes at a time, but occasionally the rest periods may be as long as 50 or 75 minutes.
  • Although you may have read or heard you need to count the baby’s kicks, there is a huge variation among babies, and no normal values for baby’s kicks have been determined; therefore, a written record of your baby’s movements is not necessary. Since every baby has a different pattern of waking and sleeping, what is important is to follow up on your baby’s own pattern of movements. If you notice a change in your baby’s pattern of movements, or are worried at any stage, contact your midwife or doctor, so that they can check the baby’s wellbeing with certain specific tests.
  • At some point you may not be sure whether you felt your baby kicking. Keep in mind that you’re more likely to be aware of your baby’s movements when you’re lying down rather than sitting or standing. Therefore, in the doubt, have a snack, particularly something sweet, lie down on your side and wait. You may also try making some noise, or playing loud music. If your baby starts moving around, most likely everything is fine.

But you should contact your midwife or doctor right away if you notice any of the following:

  • You don’t feel several movements while lying on your side for two hours.
  • Your baby doesn’t start to move in response to noise or some other stimulus.
  • There’s a big decrease in your baby’s movements, or a gradual decrease over several days.

Weight gain

  • You should aim for a weight gain of about 1-2 kg per month during your third trimester, but it is not unusual to lose 1 or 2 kilos by the end of pregnancy, as your stomach gets compressed by the baby and you get a feeling of fullness even with small meals. In total, you should have put on about 12 kg (8-16 kg). However, your doctor may recommend that you gain more or less weight if you started out your pregnancy underweight or overweight.
  • It is very important that your weight gain doesn’t exceed these limits, as it may lead to several complications in pregnancy and delivery, such as high blood pressure, gestational diabetes, backache or delivery complications due to increased fetus weight. Not to mention that it will be more difficult to get back to your pre-pregnancy weight…

Braxton Hicks contractions

  • Pressure or tightening in the pelvis that comes and goes could be contractions, but if they’re sporadic and not painful, they’re most likely Braxton Hicks contractions. They usually begin as early as the second trimester; however, they are most commonly experienced in the third trimester.
  • Braxton Hicks are also called “practice contractions” because they are a preparation for labor. They are irregular in intensity and frequency, usually painless or just uncomfortable (although sometimes they may be painful).
  • As Braxton Hicks intensify close to the time of delivery, they are often referred to as “false labor” and they may help prepare the uterus for delivery. These practice contractions may be more intense or frequent when you are too tired, your baby is very active, after sex or due to dehydration.

If you are not sure whether the contractions you feel are true or false labor, try the following:

  • Lie down, get some rest and wait.
  • Take a warm shower or bath.
  • Drink some fluids.

If none of these steps works at any stage of pregnancy; or if you are less that 37 weeks pregnant and you have contractions every 15 minutes or closer that persist over two hours, contact your health care provider.

Signs of Labor

When getting closer to the due date, most certainly you will start wondering: What are the signs labor is coming? How will it feel? and mainly: Will I understand when it’s time? A post answering these questions will follow soon… Stay tuned!

When to worry

Any of these symptoms could be a sign that something is wrong with your pregnancy. Call your doctor right away if you experience any of these symptoms:

  • Severe abdominal pain or cramping
  • Severe nausea or vomiting
  • Bleeding
  • Severe dizziness or fainting
  • Rapid weight gain or intense swelling
  • Fever (unrelated to a cold)
  • Pain or burning during urination
  • Watery vaginal discharge
  • Abundant green, yellow, foul-smelling discharge.

This list of not exhaustive; do not hesitate to contact your healthcare provider for any other symptom you are unsure whether it’s normal or not.

References

  • NICE: Antenatal Care- Routine Care for the Healthy Pregnant Woman. March 2008, UK
  • HAS: Comment mieux informer les femmes enceintes? Avril 2005, France

Photo credits

Intro: Flickr.com; 1) lifeopedia.com; 2) sheknows.com; 3) momjunction.com; 4) answerforsleep.com; 5) health.com; 6) Flickr.com; 7) healthymamabrand.com; 8) healthywomen.org; 9) intimina.com; 10) baby-pedia.com; 11) onlymyhealth.com; 12) medicmagic.net; 13) dnaindia.com; 14) pinterest.com; 15) amazon.com; Baby movements: babycenter.ca; Weight gain: parenthub.com.au; Braxton Hicks: birthcentered.com; When to worry: herb.co

PREGNANCY SYMPTOMS: WHAT TO EXPECT THE SECOND TRIMESTER

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You just made it through the first trimester of your pregnancy! Congratulations!

The second trimester – which lasts from the beginning of week 14 through the end of week 27- is for most women, the easiest of all three: the annoying symptoms of the first trimester usually disappear and you feel full of energy again! In addition, you will be less heavy, tired and anxious than during the third trimester…

The fact that you feel better doesn’t mean that nothing is going on! Your baby grows very fast during this period, and your body is working incessantly; thus you will notice many changes…

From all the symptoms you had during the first trimester (see here), many will disappear, other persist and some new will show up.

These symptoms usually disappear or ease during the second trimester:

  • 2nd trimester B&Wnausea and vomits,
  • food aversions,
  • heartburn,
  • frequent urination,
  • acne.

These are symptoms that may persist:

  • dizziness,
  • bleeding of gums and nose,
  • stuffy nose,
  • vaginal discharge,
  • headache,
  • constipation,
  • food cravings.

In this article we will focus on the symptoms that make their appearance during the second trimester, or that are somewhat different now. Here is what you can expect:

1) Backache

While back pain during the first trimester is mostly related to mild uterine cramping, as pregnancy progresses it’s caused by weight gain and  the shift of your center of gravity as a result of the growing uterus. Thus, you gradually adjust your posture, which results in back pain or strain.

What can you do about it:

  • avoid standing up for long periods of time,
  • sit up straight; use a chair with good back support,
  • sleep on your side; a pillow tucked between your legs may help,
  • avoid carrying anything heavy,
  • wear comfortable, low-heeled shoes with good arch support (read more here),
  • a heating pad may provide some relief,
  • if you feel really uncomfortable you may have a pregnancy massage.

If these measures don’t work or if the pain is strong, call your doctor, who can prescribe you a pain medication suitable for pregnancy.

2) Breast enlargement

2nd trimester breastsWhile the tenderness and swelling you experienced during the first trimester usually wear off by now, your breast will keep growing in preparation for breastfeeding. You may occasionally have some leakage of milk.

What can you do about it:

  • wear a support bra; most likely you will need a bigger size,
  • avoid lacy or wired bras.

3) Emotional changes

2nd trimester emotional prenatal yogaAs pregnancy progresses your body changes, so do your emotions! Your hormones certainly play a role, but it’s not only that: there is so much going on! So it’s natural to be worried or anxious at times, or to have mood swings (see here).

You will most likely feel less tired and with more energy than before, so enjoy your pregnancy! Start preparing yourself for the coming of your baby, you can learn more about labor and delivery. Focus on healthy lifestyle regarding nutrition (read here) and physical activity (here). This may be also a good time to indulge yourself with a trip, or some vacations! (see here).

Some women experience increased sexual desire during this period of pregnancy (more info here); others may feel unattractive as the womb grows. Spoil yourself with some beauty treatments! (read more here).

Although mood swings are an inextricable part of pregnancy, keep in mind that if you feel constantly down or overwhelmed, if you have negative or suicidal thoughts, if you can’t go ahead with your daily life you must discuss it with your doctor.

4) Hair changes

2nd trimester hairHormonal changes during pregnancy favour hair growth. This may be great for the hair on your head, which usually becomes thicker, but not so great for hair growing on your face, arms or back!

What can you do about it: 

  • Shaving, tweezing and waxing are safe options, although not always easy to implement as your belly grows!
  • Regarding laser, electrolysis and depilatory creams the experts’ opinions are divided (read more here).

You may discuss with your doctor which is the best technique for you.

5) Hemorrhoids

2nd trimester hemorrhoidsMost women will feel, at some point in their pregnancy, some soft lumps around the anus. In fact, hemorrhoids are swollen veins, which enlarge in pregnancy due to the increased pressure exerted by the growing uterus.

Although sometimes hemorrhoids are asymptomatic, the can be itchy, or painful; they may eventually bleed.

What can you do about it:

  • avoid constipation – they will get worse,
  • you may try a sitz bath (that is, you sit in warm water),
  • if they are too uncomfortable, you may ask your doctor about a hemorrhoid ointment.

6) Leg cramps

2nd trimester leg crampsPainful leg muscle contractions typically affect the calf, foot or both; they are common during pregnancy, and usually occur at night.

The exact cause of leg cramps isn’t clear; possible reasons include pregnancy hormones, compression of the legs’ blood vessels, and calcium or magnesium deficiency.

What can you do about it:

  • regular physical activity might help prevent leg cramps; stretch your calf muscles before bedtime,
  • stay hydrated,
  • choose comfortable footwear with good support,
  • a hot shower, warm bath, ice or muscle massage can all help,
  • eat magnesium-rich foods, such as whole grains, beans, dried fruits, nuts and seeds.

Discuss with your doctor whether it’s OK for you to take a magnesium or calcium supplement.

7) Restless leg syndrome (RLS)

2nd trimester restless legIf you are among the 20% of pregnant women who suffer from this condition, you may have felt an itchy, pulling, burning or creepy-crawly sensation which causes an overwhelming urge to move your legs.

RLS usually strikes at night, when you are lying down or sitting for prolonged time periods; it may also affect the arms. Once you move your legs or arms, the feeling subsides; the problem is that, by then, the movement has already woken you up, making you feel tired and cranky during the day…

The cause of RLS is unknown, but in some women it may be triggered by a deficiency of iron or folic acid.

What can you do about it:

Be patient! RLS goes away right after birth… If your RLS is not that severe, simple lifestyle changes may help:

  • avoid drinking beverages with caffeine (coffee, soda, etc), particularly during the afternoon or evening,
  • don’t exercise close to bedtime (exercising can wind you up),
  • establish a sleep routine: go to bed and wake up at the same time every day,
  • relax before bedtime: take a warm bath, read a book…

When you wake up with RLS:

  • massage your  legs,
  • apply warm or cold compresses to your leg muscles,
  • get up and walk or stretch your legs,
  • a vibrating pad placed under the legs (Relaxis) seems to help some women.

The treatment of severe RLS is challenging during pregnancy, as medications used for its treatment are possibly dangerous for the baby.

  • You may ask your doctor to check your iron levels, if they are low you can take an iron supplement.
  • If RLS makes you feel miserable, discuss with your doctor the possibility of a medical treatment (opioids); this would be the last resort as opioids can cause withdrawal symptoms in the baby.

8) Round ligament pain 

2nd trimester round ligament painAs the womb grows, the ligaments that support it start stretching, making them more likely to become strained.

Round ligament pain is one of the most common complaints during pregnancy. Sudden movements can cause the ligaments to tighten quickly, which provokes a quick jabbing feeling, often felt in the lower belly or groin area on one or both sides, most commonly on the right side. Generally the pain is triggered by exercise, sneezing, coughing, laughing, rolling over in bed or standing up too quickly, and lasts only a few seconds or minutes.

What can you do about it:

  • avoid sudden movements,
  • flex your hips before you cough, sneeze, or laugh,
  • mild exercise will help you strengthen your abdominal muscles,
  • stretching exercises and yoga can be helpful,
  • a heating pad or a warm bath may ease pain,
  • you may take a painkiller such as acetaminophen.

Round ligament pain usually doesn’t last long. If you have severe pain that lasts more that a few minutes, or if it is accompanied by fever, burning with urination, or difficulty walking you should call your doctor right away.

9) Skin changes

2nd trimester skin changes woman with hatPregnancy hormones and your growing uterus are responsible for numerous skin changes that you will start noticing from now on. Here are the most common:

Pregnancy glow: pregnant women often look as though they are “glowing” because hormones increase the skin oil production and vascularisation, thus your face may appear flushed and shiny.

Mask of pregnancy: also called chloasma;  an increase in the pigment melanin leads to brown marks on the face.

Linea nigra: related as well to increased melanin, it’s a dark line down the middle of the abdomen.

These skin changes should fade after the baby is born. In the meantime, you can use makeup to conceal them.

Keep in mind that your skin is more sensitive to the sun right now, so make sure to wear a high-protection sunscreen;  limit also your time in the sun, especially between 10 am and 4 pm; a hat and sunglasses will provide extra protection.

Itchy skin: as your skin stretches due to your growing belly -and weight gain- it may feel itchy and dry, especially around your womb and breasts2nd trimester skin changes.

To relieve it, moisturize often with mild skin care products; do not take hot showers and baths, which will dry out even more your skin. Also, avoid synthetic clothing which may irritate your skin.

Inform your doctor if your itching is unbearable, she/he can recommend you a medication adequate for pregnancy, and eventually rule out certain rare conditions which may be dangerous for you or your baby (though they usually appear during the third trimester).

Stretch marks: as with itching, stretch marks are the result of your skin expanding. Starting now, you may notice red or purple lines on your abdomen, breasts or thighs.

Watch your weight gain! The more weight you gain, the more likely to get stretch marks. Many creams and lotions are available to prevent them, although their efficacy is not backed up by much scientific evidence… In any case, most stretch marks will fade on their own after delivery.

10) Sleep problems

2nd trimester sleep problemsWhile everybody tells you to rest now to get prepared for the sleepless nights ahead once the baby is born, sleeping in pregnancy is not easy! A recent study showed that 3 out of 4 women! experience poor sleep quality: from all women included in the study, all of them reported frequent awakening, mostly due to frequent urination and difficulty finding a comfortable sleep position; insomnia, breathing problems (snoring and sleep apnea) and restless leg syndrome (see above) were also common complaints.

And let’s not forget heartburn, leg cramps, stuffy nose, eventually vivid dreams or nightmares…

What can you do about it:

  • avoid caffeine in the afternoon or evening,
  • stay away from sugar at night,
  • don’t drink too much right before bedtime to avoid frequent visits to the toilet,
  • work out, but only until early evening, as exercise can be energizing,
  • have a light snack before bedtime to prevent “hunger attacks” at night,
  • a glass of warm milk before sleeping may help,
  • take a warm bath just before bed,
  • keep your room cool; research has shown that is useful for better sleep,
  • a massage before sleeping can soothe you, as well as relaxation exercises, deep breathing, meditation, yoga, etc,
  • making love can also help!

You should mention any sleep problems to your doctor, who might be able to suggest more tips or eventually prescribe you medications that are safe during pregnancy.

11) Spider and varicose veins 

2nd trimester spider and varicose veinsYour blood circulation increases to send more blood to your baby; this can cause tiny red veins known as spider veins. Pressure on your legs from the growing uterus can result in swelling of your legs’ veins, which become blue or purple; these are called varicose veins.

What can you do about it:

Spider veins usually fade once your baby is born.

Varicose veins should improve within three months after you deliver. In the meantime, you may prevent them from getting worse:

  • avoid standing up for long periods of time,
  • get up often, move throughout the day,
  • keep your legs elevated (prop them on a stool) whenever you have to sit for a long time,
  • wear support hose.

12) Swelling of the ankles and feet

2nd trimester swollen legsA very common symptom, is experienced by about three in four pregnant women, starting at about week 22 of pregnancy and lasting until delivery.

What can you do about it:

  • try to keep active,
  • avoid long periods of standing or sitting,
  • if you can’t avoid sitting or standing for a long time, move regularly your feet, or
  • keep your legs elevated while sitting,
  • support hose can help.

What else to expect

Quickening”, baby movements

At about 20 weeks you will probably start feeling the first flutters of movement in your belly, which is often called quickening. Quickening may be first felt as early as week 15, but usually around weeks 18 to 22. A multipara (that is, a woman who has been pregnant before) usually feels the baby earlier. Some women won’t experience quickening until week 26, so don’t worry!

Keep in mind that babies, like the rest of us, are all different: while some are very active, others are more calm; activity also varies among different days and within the same day.

Weight gain

2nd trimester what elseYour appetite should be back during the second trimester, once nausea and vomits have diminished or gone away. Since now you will feel hungrier, be aware of how much you’re eating! You only need about an extra 300 to 500 calories a day during the second trimester, and you should be gaining about 1,4 -1,8 kilograms a month until delivery. However, if you were overweight before pregnancy, your doctor may recommend gaining less weight.

Discuss with your health care provider what’s best in your case in order to manage your weight throughout pregnancy.

Braxton Hicks contractions

During the second trimester, your uterus may start contracting. These contractions, called Braxton Hicks, should be weak and come and go unpredictably.

If contractions become painful or regular, they could be a sign of preterm labor, so you should inform your doctor.

When to worry

2nd trimester warningAny of these symptoms could be a sign that something is wrong with your pregnancy. Call your doctor right away if you experience:

  • Severe abdominal pain or cramping
  • Bleeding
  • Severe dizziness or fainting
  • Rapid weight gain or intense swelling
  • Fever (unrelated to a cold)
  • Watery vaginal discharge
  • Abundant green, yellow, foul-smelling discharge.

 

References

  • NICE: Antenatal Care- Routine Care for the Healthy Pregnant Woman. March 2008, UK
  • HAS: Comment mieux informer les femmes enceintes? Avril 2005, France

Photo credits

Intro: Getty images, businessinsider.com; 1) simplebackpain.com; 2) pinterest.com; 3) kentuckianamommies.com; 4) drdina.ca; 5) hemorrhoidexpert.org; 6) newkidscenter.com; 7) babygaga.com; 8) viphealthandfitness.com; 9) woolworthsbabyandtoddlerclub.com.au, beautysouthafrica.com; 10) thebabychecklist.com; 11) pinterest.com; 12) pinterest.com; What else: popsugar.com; When to worry: earlypregnancy.net.