Pregnancy following infertility treatment: is it high risk?

After months and sometimes years of worry, anxiety, and disappointment, you are finally pregnant and released from care by your reproductive endocrinologist (REI). It is time to transition to your obstetrical (OB) provider (antenatal clinic) for prenatal care. Am I considered “high risk”?

Yes…

Some conditions that contributed to your infertility (such as age, hormonal imbalance, and certain genetic conditions) may increase your risk for preterm labor or birth, pre-eclampsia, or bleeding during pregnancy. Also, if you are pregnant with twins or triplets, you will be considered high risk and a maternal fetal medicine doctor may follow you during your prenatal care and delivery.

But, not necessarily

If you did not have preexisting health conditions or have a multiple gestation pregnancy, you may not be more at risk for adverse pregnancy outcomes than the pregnant patient who conceived without assistance. This does not mean that you will not experience any complications, but the purpose of prenatal care is to monitor patients for problems that may occur. Should any complications arise during your pregnancy, your OB healthcare provider (antenatal clinic) will be prepared offer advice and a management plan.

What are my options for pregnancy/prenatal (OB) care?

Unless you experience complications related to a previous medical condition or an outcome of your fertility treatment, you have the same options for prenatal care as all other pregnant women. You may decide to see an OBGYN (obstetrician), a Certified Nurse- Midwife, or in some countries such as the US, a Nurse Practitioner. To make the best decision, consider what you and your partner desire for your prenatal care and delivery. For example, would you prefer a more holistic interaction to approach your care with limited use of technology, or would you prefer to have every medical test available (or are you somewhere in between)? Although providers follow standard care procedures, each provider has their own practice style. Think about the flow of the office visits/clinic appointments that you would prefer and the amount of time you need/want during each visit.

There are decisions you will make about your birth wishes; some questions you may want to ask your obstetrical/antenatal provide could include:

  • What is your opinion on induction of labor?
  • What is your approach to managing comfort/pain during labor?
  • Will you be the obstetrical/antenatal provider who attends my birth?

How often will I visit my provider/attend the antenatal clinic?

While being treated for infertility, you may have had frequent contact with your doctor or other members of the Fertility Team. If you are not experiencing any complications during your pregnancy, you will not see your obstetrical/antenatal provider as often. During the first several months of your pregnancy (perhaps when you are the most anxious), the American College of Obstetrics and Gynecology recommends that women see their provider every four weeks. If you are anxious about the spacing of office visits, talk with your provider about your feelings. They may be willing to see you more often or they may suggest strategies to help you alleviate some of your anxiety. You will likely start to feel less anxious as the pregnancy progresses especially when you are able to feel the baby move. At 28 weeks of pregnancy it is recommended that prenatal visits are increased to every two weeks. At 36 weeks, you will begin to see your obstetrical/antenatal provider weekly. Of course, if complications arise or if you are considered a high-risk pregnancy, this schedule will be adjusted.

What if I do not feel happy all the time?

You may be physically similar to couples who have conceived without assistance, but that does not mean you feel emotionally like everyone else. It is normal to continue to feel a little anxious about the pregnancy and to worry that you may experience a miscarriage especially during the first few months. You may be simultaneously excited about early discomforts of pregnancy such as breast tenderness, nausea, or vomiting because the symptoms may verify the pregnancy and yet annoyed about the loss of control of your body. It is ok (and normal) to feel grateful that you are pregnant AND complain about the discomforts that you are experiencing. Seek out support and talk about your feelings. You may consider joining a support group of couples who are having a similar journey through infertility and pregnancy. If you are not experiencing complications, incorporating exercise for 30 minutes most days of the week is recommended and can go a long way in helping you to feel better.

Where can I give birth?

If you are not considered high-risk, you may choose to deliver in a hospital, freestanding birth center, or even in your home. Your provider may only deliver in certain settings, so it is a good idea to discuss your plans during your consultation visit. Your provider can help you determine the safest place for you to give birth.

What is a doula?

Another source of support during the pregnancy and delivery is a doula. Even in cases where the pregnancy is high risk, a doula may provide a needed source of support. A doula is birth attendant who will assist you during labor and early postpartum. Doulas are not trained to perform medical assessments or give medical advice; however, studies have shown a decrease in the rate of cesarean section when they are a part of the OB team. Some doulas will make home visits prior to your labor to get to know you and your partner or labor support person. Some doulas provide postpartum support for a few weeks after delivery. Often providers will make recommendations about doulas with whom they have worked with in the past. Doulas typically charge a fee for their services. Hospitals may offer free doula services, and in some states in the U.S., doula services are covered by private healthcare insurance.

Should I consider childbirth classes?

There are many types of childbirth classes from which to choose. Whether this is your first childbirth class, or you attended a class in past, it is always good idea to educated about current best practices regarding pregnancy and the delivery. There are special classes for couples expecting twins and triplets to help plan for birth and the postpartum period. Most couples in a childbirth class are at the same stage of pregnancy, so the other class participants may be an additional source of support. Talk with your obstetric team about the kind of classes they recommend. If you are planning to breastfeed there are also courses that offer instruction and support to help you and your partner.

Take care of yourself as you transition from her fertility team to obstetrical/antenatal care. Reach out for the support and the information you need. You and your partner are not alone.