It is natural and normal to still feel nervous and worried at this point. The purpose of this information sheet is to let you know what to expect and how to handle any problems that might arise. Your specific monitoring scheme is designed to meet your needs and may vary somewhat from what is described below.
In most cases, after the initial pregnancy test, the HCG level is repeated 2 days later. For most normal pregnancies, the initial level will roughly double during that time period. Your progesterone level may also be checked twice to make sure that it is adequate and supplementation will be ordered if it is not.
Pregnancy dating can be confusing. This is because pregnancies are dated from the date of the theoretical last menstrual period which would have been roughly 3-weeks prior to the embryo transfer if this were a spontaneous conception. The first ultrasound appointment is typically around 6-weeks of gestation. A pregnancy at this stage will appear as a gestational sac on the ultrasound scan. The purpose of this visit is to identify the number of sacs and verify that it/they are in the uterus.
Usually, sometime between 6 to 7 weeks of gestation, the heartbeat of the embryo can be detected. The “crown-rump length” of the embryo will be measured and compared to the expected size.
At 7 to 8 weeks of gestation, the embryo will be measured again in order to verify normal growth and the heart rate will be checked again. Less than 10% of pregnancies that have progressed to this point will end in miscarriage.
If all is well at this point, usually you will be transferred to your OB-GYN for ongoing prenatal care.
Many of our pregnant patients (including all of our IVF patients, egg-donor recipients and cryopreserved embryo recipients) may be on progesterone and estrogen during the early portion of the pregnancy. If you are not on progesterone (or estrogen) it is because it has been determined by blood tests that you do not need it. The progesterone and estrogen that are taken are natural progesterone and estrogen. Progesterone can be given by intramuscular injection, vaginal suppository, vaginal gel, or vaginal capsule. Estrogen can be given orally, vaginally, by intramuscular injection or by transdermal patch.
The FDA has placed warnings on all reproductive hormones that they should not be used in pregnancy. This is because some synthetic hormones have definitely been associated with birth defects. However, no harmful effects to the mother or the fetus are presently known to medical science from the use of natural progesterone or estrogen. Failure to take the progesterone (or estrogen) as directed could result in miscarriage. As your pregnancy progresses, your dose may be modified in response to how well the placenta is making the hormones. Do not stop the hormones unless told to do so by your doctor or nurse.
During the first few weeks of pregnancy, about 80% of normal pregnancies will show doubling of the HCG levels each 48 hours. If your numbers do not increase normally, there are 3 possibilities: you could have a normal pregnancy that is in the “slowest” 20%; the pregnancy could be abnormal and in the uterus; the pregnancy could be in the fallopian tube (ectopic). In this case, we will follow your levels quite closely until we can determine which of these is true.
Ectopic pregnancies are pregnancies that implant outside the uterus. About 95-97% of them occur in the fallopian tubes. Ectopic pregnancies represent 2-5% of the pregnancies. Ectopic pregnancies can be treated medically or surgically, depending upon the situation. If untreated, they can rupture and become a life-threatening condition. Our monitoring is designed to make the diagnosis before this could happen.
You should eat a well-balanced diet supplemented with the prenatal vitamins prescribed by your physician. Sensible eating habits, combined with your prenatal vitamins, are sufficient to maintain your pregnancy. The United States Department of Agriculture recommends that a healthy diet consists of two to three servings of milk and meat products, three to five servings of vegetables, two to four servings of fruit and six to eleven servings of grain daily. They also recommend that fats, sweets and oils be used sparingly. The average weight gain during the first trimester is 3-5 lbs. However some women gain more and some women lose weight. The body stores fat for even most slim women who are adequate to sustain a pregnancy in the absence of weight gain.
Avoid all beverages containing either caffeine or alcohol as well as all herbal remedies &/or supplements except those approved by your physician. You should also avoid foods made with unpasteurized milk products or raw shellfish.
Sugar substitutes: Unfortunately, not much human research has been done on saccharine use in pregnancy. Animal studies, however, show an increase in cancer in the offspring when pregnant mothers ingest the chemical. Added to the evidence that the sweetener crosses the placenta in humans and is eliminated very slowly from fetal tissues, these studies suggest that it is sensible not to use saccharine during pregnancy.
On the other hand, studies have not found any harmful effects from the use of typical amounts of the sweetener aspartame (Equal, NutraSweet) by most women during pregnancy.
Because of the risk of mercury contamination which can affect the developing fetal nervous system the FDA suggest pregnant women avoid swordfish, tilefish, shark, mackerel. You should also limit your consumption of other fish including tuna to less than 12 oz per week. Because of the risk of hepatitis or parasitic infection, any uncooked seafood should be avoided including oysters, clams and raw sushi or sashimi.
We also advise refraining from any strenuous physical exercise such as high-impact aerobics, running, etc. The following guidelines for exercise in pregnancy are provided by the American College of Obstetricians and Gynecologists:
Women who have a history of miscarriage, premature labor, multiple pregnancies, vaginal bleeding or heart disease should consult with their physician about exercise during pregnancy. A woman with a sedentary lifestyle should not begin a fitness program during pregnancy. If a woman is physically fit, she may be able to tolerate the same level of exercise during pregnancy with only minor modifications. Many women who have conceived during an IVF cycle may be on activity restrictions for the first few weeks of the pregnancy.
Most of the development of the major organ systems occurs during the first trimester. For this reason, we suggest that you avoid hair coloring, x-rays, or exposure to pesticides and chemicals if possible.
Whether or not exposure to microwaves is harmful is still controversial. It is believed that two types of human tissue—the developing fetus and the eye—are particularly vulnerable to the effects of microwaves because they have a poor capacity to dissipate the heat the waves generate. The following precautions should take place:
Household Cleaning Products. No correlation has ever been noted that using household cleaning products causes birth defects. No studies have proven that the occasional incidental inhalation of ordinary household cleansers has any detrimental effect on the developing fetus; on the other hand, no studies have proven frequent inhalation completely safe. The following are guidelines in screening out potentially hazardous chemicals:
Insecticides. Some chemical insecticides have been linked to birth defects. Whenever possible, take the natural approach to pest control. If your neighborhood is being sprayed, avoid being outdoors as much as possible until the odor has dissipated—about 2 to 3 days. When indoors keep the windows closed. The chemicals are only dangerous as long as the fumes linger. Inside the house, use “motel” or Combat-type traps to get rid of roaches and ants; use cedar blocks instead of mothballs in clothes closets.
Paint Fumes. It has been reported that latex paints contain unsafe amounts of mercury. Federal regulations now require that paints be reformulated so they don’t contain mercury. But because you don’t know what hazard may turn up in paint next, painting should be avoided during pregnancy. While painting is being done, try to arrange to be out of the house. Make sure there is adequate ventilation. Completely avoid exposure to paint removers.
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