Undergoing infertility treatment can be overwhelming for some patients. The time and energy that is needed, both physically and emotionally can drain even the staunchest crusader. To cope most effectively with the stresses of infertility treatment you will need support. While friends and family will prove to be invaluable allies, there is nothing like connecting with like-minded individuals who might also be going through your very experience.

Not surprisingly, the Internet offers an abundance of resources for infertility support. A Google search for “infertility support” garners 7880 hits! The topic of infertility “emotional support” nets 46,500 sites. Even narrowing the search with a specific diagnosis, such as “endometriosis support,” 13,300 responses does not seem like much of an improvement. When you are feeling lonely and isolated because of your infertility the last thing you need to do is wade through thousands of sites.

So, we at Pacific Fertility Center have waded through them for you. Here are some of the most helpful sites with a bit about what you might find. Many of these can be directly accessed from our website at InfertilityDoctor.com. These sites may also link you to other sites.

We would like to offer a warning about chat rooms. While it is amazing how many women share their experience and offer you words of encouragement via Internet chat groups, please be wary of fellow infertility patients offering medical advice based on personal experiences, anecdotal evidence and/or fuzzy research. It is important to realize that while your medical situation may be “similar” to someone else’s, the details of your case are what make the difference. Your physician is the best resource of sound medical advice.

ACOG.org American College of Obstetricians and Gynecologists – Excellent patient education pamphlets, books and updates on legislation affecting women’s healthcare.

www.cdc.gov/ncbddd/bd/abc.htm ABCs of having a healthy pregnancy – Centers for Disease control and Prevention: National Center on Birth Defects and Developmental Disabilities’ informative website.

theAfa.org American Fertility Association – Education, referrals, research, support, chat room.

ASRM.org American Society for Reproductive Medicine – Patient section offers fact sheets on infertility and adoption. ASRM is the nation’s largest professional organization of fertility experts.

b4pregnancy.org Information and resources concerning healthy lifestyle changes in separation for pregnancy.

Childofmydreams.com Resource for infertility and adoption.

DCNetwork.org The Donor Conception Network – A British network of parents with children conceived with donated sperm, eggs or embryos, adult offspring and those contemplating or undergoing treatment.

Ferre.org Ferre Institute – Resource and information on medical genetics, infertility, adoption, including special sections for those of color, LGBT and other cultural issues.

Fertilehope.org Fertile Hope – Information, support and hope to cancer patients facing infertility.

Hopeforfertility.com HOPE for Fertility – Volunteer emotional support for fertility and adoption challenges.

Hygeia.org Hygeia® – Support for Perinatal Loss and Bereavement

MissingGRACE.org Missing GRACE – International support and resources for infertility, loss, and adoption. Grieve, Restore, Arise, Commemorate & Educate.

Protectyourfertility.org Protect Your Fertility – Information for women and men about infertility produced by the American Society for Reproductive Medicine.

Resolve.org RESOLVE – National education, support and advocacy groups for infertility and adoption. Local chapters

Seronofertility.com and Fertilityneighborhood.com Pharmaceutical company sponsored sites with informational options including news sites.

Singlemothers.org Single Mothers by Choice or Chance – Support network for single mothers with local chapters.

Law Tries to Keep Up with ART: A spate of judicial decisions here in California has family law attorneys paying close attention to a handful of unique conflicts, or “gray zones” made in some way possible by Assisted Reproductive Technologies (ART). As the definition of “family” expands more broadly, thanks to ART, new laws are actually being forged. Couples that don’t fit the rubric of a traditional family (heterosexual man + woman = marriage) are being asked to make sure they have all of their legal ducks in a row.

A few California cases are summarized here, including at least one that may reach the state Supreme Court.

Lesbian Parents and Child Support: This complex case involves two lesbian partners, not registered as domestic partners, who jointly agreed to have children using the same sperm donor. Both women conceived, one year apart, and one of the infants was born with Down syndrome, prompting one of the women to remain at home as the care-giver. Two years later, the two women separated and the primary caregiver began receiving monthly child support payments from the woman who worked. When the child support provider halted payments after 18 months, county social workers attempted to tap her wages, a standard to which a biological father would have been held.

Although a Superior court judge agreed with the county that child support payments should continue because the woman showed initial “intent” to raise the children, this past May the Court of Appeal in Sacramento reversed that decision to the dismay of gay rights legal activists. This decision is particularly disturbing, asserts Deborah Wald, a San Francisco attorney who specializes in non-traditional family law. “Children of same-sex couples do not have the same rights compared to children that have two parents of opposite sex; this is a shocking ruling and one that we are confident that the state Supreme Court will overturn,” she said. Posthumous Conception: Many are anxiously watching a case that is pending final decision by the Los Angeles federal court. A wife had medical personnel extract her husband’s sperm for freezing after his unexpected death. This was not contested. Four years later, after she conceived a daughter with his sperm, the mother sought Social Security survivor benefits. Although she didn’t seek inheritance or life insurance claims, the outcome of this case is expected to have implications in these other areas.

The Social Security Administration denied the benefits, insisting that the deceased dad is not recognized as the father under California law. The SSA follows specific state guidelines in resolving such issues, and has granted posthumous benefits in other states. But California has no laws governing children conceived after the death of a parent. This case has simultaneously prompted the state Legislature to craft AB 1910, which is enjoying broad support. This bill establishes that a posthumously conceived child is entitled to inheritance rights and other benefits under the Uniform Parentage Act if the decedent intended his or her genetic material to be used for posthumous conception of the child and expressed it in writing. It is expected to be signed by the Governor in September. Copies can be found at www.assembly.ca.gov .

Lesbian Parents and Custody: A woman who provided the donor eggs for her female partner, enabling the partner to conceive twins, signed away her parental rights per a standard egg donor contract used by a Bay Area infertility clinic seven years ago. Nevertheless, the two women spent the next six years living together and raising the children. As the egg donor started pressuring the gestational mother about being identified as a legal co-parent, their relationship fell apart, and the gestational mother moved across country with the twins, eventually cutting off all contact between the children and the egg donor.

A California Court of Appeals ruling affirmed the gestational mother’s hold on primary custody, saying its decision is based on the “intent” contract signed by the egg donor, which absolved her of all parental rights and future claims. The biological mother has appealed, the case has received a flurry of press, and the case may end up at the First District Court of Appeal in 2005.

Preimplantation genetic diagnosis (PGD) is a technique used to identify many inherited diseases. PGD uses DNA amplification to identify embryos with specific mutations of single genes, which may have been acquired from the mother, or father or both.

What PGD can do:
1. PGD can diagnose embryos at risk for some specific genetic diseases if the parent(s) are known to be carriers, and the molecular genetic basis of that disease is known.
2. PGD identification enables elimination of those embryos carrying the genetic mutation that causes the disease in question. It cannot repair those mutations.

What PGD cannot do:
1. PGD cannot guarantee that the baby will be free of all diseases or birth defects because the genetic basis for many defects is unknown. At this time, it is impractical or impossible to screen for most diseases, such as diabetes and cancer, or birth defects such as cleft lip and palate.
2. PGD cannot diagnose all diseases, even if the genetic basis is known, because some of the rarer diseases do not yet have available DNA probes.
3. PGD cannot determine traits, such as eye color, height, intellectual or athletic abilities.
4. PGD is not perfect, despite how sophisticated it is. Errors in diagnosis can occur, albeit at a very low rate. Confirmation of the correct diagnosis should be done by chorionic villus sampling (CVS) or amniocentesis, once the pregnancy is established.

The second type of genetic analysis is what we like to call Preimplantation Genetic Screening (PGS) to look for abnormalities in entire chromosomes missing or extra chromosomes or multiple complex abnormalities in chromosome numbers.

What PGS can do:
1. PGS can screen for abnormalities in 9 out of the 23 chromosome pairs. Currently it is not technically possible to screen for abnormalities in the other 14 chromosome pairs.
2. PGS can help to reduce the risks of miscarriage, commonly due to Monosomy X (one X chromosome) or Trisomy 16 (three of chromosome 16).
3. PGS can help to significantly decrease the risk of Down Syndrome (Trisomy 21) and Trisomy 18, as well as abnormalities in numbers of sex chromosomes (X and Y) (These are among the few abnormalities in fetuses that can survive to the time of amniocentesis and birth).
4. PGS can reduce the number of embryos one must transfer to find the embryos most likely to succeed.
5. PGS may help couples experiencing multiple IVF failures to determine if the failed implantations may be due to aneuploidy (chromosomal abnormalities).
6. PGS can determine the gender of the embryo.

What PGS cannot do:
1. PGS cannot screen for specific genetic diseases couples at risk need PGD.
2. PGS cannot guarantee that the baby will be free of all diseases or birth defects.
3. PGS is not perfect. The detection rate is between 90-93% for the chromosomes analyzed, which is why we still recommend CVS or amnio as a confirmation of PGS findings.

Couples who are at risk of passing on an inherited disease are probably familiar with genetic counselors. However, those who have decided to undergo IVF with Preimplantation Genetic Diagnosis (PGD) will need to see a genetic counselor who is specialized in the procedure of PGD itself. It is important to make sure that the mutation in question can be diagnosed by PGD since not all heritable diseases have DNA probes. And sometimes there are other means of using PGD to determine mutation likelihood.

In cases where there is concern about chromosomal abnormalities rather than single gene defects, Preimplantation Genetic Screening (PGS) is another option that requires a genetic counseling session. The genetic counselor can help patients understand the basics of chromosomes, how they affect the health of embryos and what this testing conveys about the embryos.

Some of the common reasons why patients undergo PGS include:
1. Age (eggs of women >35 years old have a higher risk for chromosome abnormalities),
2. Unexplained recurrent pregnancy loss,
3. Gender selection for genetic disease,
4. History of unexplained unsuccessful IVF cycles.

Who Are Genetic Counselors?
Genetic counselors are health care professionals with graduate degree training in genetics and counseling, and certified by the American Board of Genetic Counseling. Genetic counselors practice in several subspecialty areas of genetics including assisted reproduction technologies, infertility genetics, and prenatal diagnosis. Because your genetic counselor can see you to discuss PGD or PGS, as well as prenatal testing options once you are pregnant, you will receive continuity of care. He/she will help you understand the complex information involved in your PGS cycle, and encourage your own decision making according to your needs. He/she will also serve as a liaison between you, your fertility doctors, and the PGD/PGS laboratory.

What Happens During A Genetic Counseling Visit?
There are two main objectives:
1. Family History Review: Your genetic counselor will take a three generation family tree (pedigree) to identify any additional genetic risks. This process ensures that the type of screening being offered is correct, and to identify any additional testing needed. Medical records may be requested for review.
2. Informed Consent: Informed consent includes an in depth discussion of the PGD/PGS process, from beginning to end, and a review of the information in the consent form, which is designed to inform and protect patients. Important information contained in the consent form includes risks and limitations of PGD/PGS, as well as the purpose of the procedure and the diagnostic technique. Your genetic counselor is available to answer questions regarding its content and to help you thoroughly understand it before signing. For those who have already gone through IVF, the beginning of the IVF with PGD/PGS cycle will be familiar. However, as complex as IVF is, embryo testing adds yet another layer of complexity. Additional steps include biopsy procedures, screening of a single cell for specific chromosome abnormalities or DNA mutations, and reviewing the results prior to embryo transfer. Only a genetic counselor is especially trained to mentally guide you through this process before you are actually in cycle so that, hopefully, there are no unanticipated outcomes.

How Can I Find Out More?
Please contact the Certified Genetic Counselor working with Pacific Fertility Center: Lauri Black at (415) 600-6371.

– Carolyn Givens, MD and Lauri Black, MS, CGC contributed to this article

A woman trying to get pregnant doesn’t need the added stress of wondering if her breast milk carries any toxic synthetic chemical residues from everyday items or environmental pollution.

Besides methylmercury in fish, there are chemical residues found in fire retardants in the foam of that gorgeous new couch, organochlorines in common garden pesticides and anti-wrinkle agents in new clothes. Some residues are benign, and wash through the body; others linger, and through persistent exposure, can show up in blood, fatty tissue and breast milk.

Although the cumulative effects of these so-called bioaccumulators are actively being studied, there are good reasons not to panic. First, not all chemicals that enter a woman’s body persist. Many residues are attracted to water rather than fat, and will exit the body through urination.

Second, there is a global movement of activists and scientists working to recognize that women and their children have a fundamental right to clean breast milk. The most problematic pollutants have already been identified, and health activists are determined to stop exposure. In August 2003, they were victorious when California legislators passed a law to ban a class of chemicals used in common fire retardants known as PBDEs that were showing up in large amounts in breast milk.

Finally, some experts concur that the health benefits of breast feeding outweigh the potential negative impacts of low-level lingering chemicals in the breast milk. Some studies have even shown that breast milk can reverse some of the negative effects of low-level fetal exposure to toxic chemicals.

If you are inclined to get more involved in this topic, keep abreast of California State Senator Deborah Ortiz’s legislative initiative SB1168 Biomonitoring Program. This pilot program would enable target women to be tested for the presence of harmful chemicals, and it would represent the first statewide initiative of its kind.

Many women of child bearing age are wondering which fish to buy to get those beneficial omega-3 fatty acids without poisoning themselves or eating the last of some endangered species.

Higher intakes of the omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), appear to decrease the risk for hypertension, atherosclerosis, type 2 diabetes, and some inflammatory diseases. DHA decreases the likelihood of premature birth, and is key to normal brain, retinal and possibly testicular development in fetuses.

Mackerel, herring, salmon, halibut and tuna have the greatest amounts of EPA and DHA, but caution is advised.

Some seafood contains significant amounts of methylmercury (meHg), which is toxic to the nervous system and may negate the cardiac benefits of fish. Large scale mercury poisonings 30-40 years ago in Japan and Iraq resulted in infants with cerebral palsy, mental retardation, developmental delay, seizures, blindness, and hearing impairment. While some mothers of affected infants were asymptomatic others showed toxic effects including fatigue, muscle and joint pain, headaches, hair loss, impaired memory and concentration, numbness, loss of peripheral vision, blindness, decreased coordination, difficulty walking, kidney failure, and death.

Research in monkeys has revealed that the reproductive effects of meHg include sperm toxicity, decreased pregnancy rates and increased miscarriages and stillbirths. Human studies describe higher mercury levels in couples experiencing infertility than in fertile couples. In ongoing studies, measurable decreases in intelligence and evidence of learning disabilities have been tied to methylmercury in children of some, but not all fish eating populations.

Toxic amounts of mercury rain down from skies polluted by the burning of coal and leach into waterways from old gold and mercury mines, including one in Marin near Tomales Bay. Bacteria convert the inorganic mercury to meHg, which then increases in concentration in organisms as it moves up the food chain. The human intestine absorbs 95% of ingested meHg, and then the body slowly excretes it over a period of months. Unfortunately, ingested methylmercury can show up in breast milk.

In 2000 the National Academy of Sciences (NAS) set the maximum acceptable daily meHg intake at 0.1 mcg/kg of body weight although some scientists have proposed an even lower threshold. Others have used a weekly or monthly intake guideline, which permits higher intake on any individual day, but limits the amount of fish eaten per week.

The San Francisco Chronicle recently sponsored an analysis of locally purchased fish, which revealed that a 120 lb. person could easily ingest 4 to 40 times her daily allowable intake of meHg by choosing popular fish including swordfish, halibut, Chilean sea bass, and ahi tuna. In separate tests white albacore tuna exceeded the NAS standard by 11 fold and chunk light by 3 to 4 fold.

Consistent with these findings is the report published last year by San Francisco physician Jane Hightower. She found that 66 of her female patients had an average blood meHg level three times the maximum recommended by the National Academy of Sciences (NAS). Many were symptomatic as were some of the children she studied. Agreement on what constitutes “safe” levels of exposure for pregnant women is still pending the outcome of ongoing studies. New data indicate that blood mercury concentrations are higher in the umbilical cord than in the mother and consequently, that 16% of infants are exposed to excessive mercury levels before birth. At an EPA conference in January a new maximum daily meHg intake for pregnant women of 0.07 mcg/kg was proposed.

The FDA has issued a warning that women who might become pregnant should avoid shark, swordfish, king mackerel and tilefish and PFC would add white albacore tuna. By not eating swordfish, shark and tuna, you’re not only protecting yourself but also these threatened species (www.montereybayaquarium.org). Also, many fish from Northern California waterways should not be eaten by women of childbearing age because of mercury or PCB contamination (www.oehha.ca.gov/fish.html).

Beth Schriock, MD, a pediatric endocrinologist, is PFC’s Clinical Research Coordinator. She has a keen interest in the environment’s impact on human health.

Following Halloween, the holiday season suddenly looms. Excited children, crowded stores, decorations, and holiday parties are all set to descend on us. Yet because the winter holidays tend to celebrate families and children, these usually joyous occasions can bring up painful feelings when you are struggling to create and celebrate with a family of your own. In order to feel as good as possible during the holidays, you will need to develop some good holiday coping skills. Coping is “developing the ability to manage in a difficult situation.” Here are a few suggestions. Use whichever of these suggestions seems helpful to you. Do what feels right for you.

DO: Give up any and all feelings of guilt for how you are feeling. There is no right or wrong way to experience infertility. Your feelings may run the gamut from indifference to intense anger and despair and everywhere in between.
DO: Reach out to childfree friends. Their parties will be adult-focused.
DO: Choose the gatherings you attend carefully. If you are upset by being around children or babies gracefully decline invitations to events where they are likely to be present. Know your limits and stick with them.
DO: Think of non-child centered holiday rituals. Take a vacation. Eat at a fancy restaurant.
DO: Continue to get moderate amounts of exercise. Eat healthy and get plenty of rest. You will feel better if you treat your body with care.
DO: Shop for the holidays online or from catalogs. You will avoid mall madness.
DO: Attend religious services at the time when there will be the least number of children. Or attend on a university campus, as those services tend to be more adult focused.
DO: Volunteer at a nursing home or homeless shelter. It may help to help others having a difficult time at the holidays.
DO: Plan for how you will answer uninvited questions about when you’re going to have children. Remember, you are not required to tell them your entire “story!”
DO: Meet and talk with others who are experiencing similar feelings. Finding that you are not alone helps. DO: Communicate with your partner to let him/her know of your feelings. If you are single, call a friend with whom you feel safe to share your feelings.

Alcohol and pregnancy don’t mix.

This article includes contributions from Isabelle Ryan, MD and Beth Schriock, MD

Studies have tied alcohol consumption during pregnancy to increased risk for stillbirth and first trimester miscarriage. Indeed – alcohol abuse by women who are expecting is the number one cause of birth defects, premature births, low birth weight and mental retardation. A shocking 12,000 babies each year are born with Fetal Alcohol Syndrome (FAS) and at least twice that many with the milder Fetal Alcohol Effects (FAE) associated with learning disabilities and lower alcohol intakes.

While the tragedy of FAS is well established, less certain is whether casual consumption of alcohol while trying to conceive either hinders or helps a woman’s chances. Past published studies have been mixed as to whether there is an association between moderate alcohol consumption and waiting time to pregnancy. One study did show decreased probability of conception in women imbibing 1-5 drinks per week. Another study saw no effect of 7 or more drinks per week in younger woman but women over 30 were more likely to be infertile. None of these studies have stratified the data to see if any type of alcohol might benefit or hinder. Yet a recent study drew a mildly positive correlation between moderate wine drinking and pregnancy.

The study, published in the September Journal of Human Reproduction was conducted at the Danish Epidemiology Science Center in Copenhagen by Mette Juhl, who had already researched the impact of moderate alcohol consumption on conception. Her past survey work concluded that moderate consumption of alcohol (up to 7 glasses per week) does not reduce a woman’s chances of purposefully getting pregnant.

For this study, the researcher set out to take a closer look at specific types of alcohol consumed by the 29,844 pregnant women who had participated in the first survey. Researchers discovered that wine drinkers had a nearly 30 percent greater chance than nondrinkers of getting pregnant within one year of trying. Woman who exclusively drank wine became pregnant sooner than those that drank only beer or hard liquor (spirits). Interestingly, drinking all three types of alcohol was associated with the shortest time to pregnancy.

Again, the study confirmed that heavy drinking of spirits actually decreases conception chances. Women who drank more than seven shots per week were 240 percent less likely to conceive. However, it is important to note that many of these women also had other risk factors for subfertility (smoking, greater incidence of pelvic infections or abdominal surgeries).

Ms. Juhl is cautious to point out that it may not be wine consumption per se, causing the increase or decrease in pregnancy success, but rather other lifestyle influences that may go along with wine drinking. For instance, some oenophiles enjoy healthier food than nondrinkers and beer or liquor drinkers. They also are more likely to be of average weight, and practice healthier lifestyle habits. The wine drinkers were less likely to smoke; smoking has been shown to prolong time to conception. Other confounding factors such as caffeine consumption, partner’s age and frequency of intercourse were not evaluated. She cautioned against drinking alcohol specifically to try to conceive, since this benefit was quite mild.

As little as one drink per day in pregnant women has been linked to decreased cognitive performance in their infants. Alcohol can have detrimental effects on the fetus as early as three weeks gestation – before a woman even knows she is pregnant. The “safe” amount of alcohol intake for pregnant women has not been established. Given that wine drinking could just be a proxy for a healthier lifestyle and the known negative effects of alcohol on the fetus, it is premature to encourage the consumption of wine to enhance conception.

For now we at PFC endorse the positions of the Centers of Disease Control (www.cdc.gov/ncbddd) and the American Academy of Pediatrics (www.AAP.org) advising that women attempting pregnancy should abstain from alcohol.

References:

American Academy of Pediatrics: Preventing Fetal Alcohol Syndrome. www.aap.org/advocacy/chm98pre.htm

CDC: Alcohol Use and Pregnancy. www.cdc.gov/ncbddd

National Institute on Alcohol Abuse and Alcoholism: Fetal Alcohol Exposure and the Brain. www.niaaa.nih.gov/publications/aa50.htm

Barefoot JC, Gronbaek M, Feaganes JR, McPherson RS, Williams RB, Siegler IC. Alcoholic beverage preference, diet, and health habits in the UNC Alumni Heart Study. American J of Clinical Nutrition 2002;76 (2): 466-472.

Bolumar F, Olsen J, Boldsen J. Smoking reduces fecundity: a European multicenter study on infertility and subfecundity. The European Study Group on Infertility and Subfecundity. Am J Epidemiol. 1996; 143 (6): 578-87.

Bolumar F, Olsen J, Rebagliato M, Bisanti L. Caffeine intake and delayed conception: a European multicenter study on infertility and subfecundity. The European Study Group on Infertility and Subfecundity. Am J Epidemiol. 1997; 145 (4): 324-34.

Jacobson JL, Jacobson SW, Sokol RJ, Martier SS, Ager JW, Kaplan-Estrin MG. Teratogenic effects of alcohol on infant development. Alcohol Clin Exp Res. 1993; 17 (1): 174-83.

Jensen TK, Hjollund NH, Henriksen TB, Scheike T, Kolstad H, Giwercman A, Ernst E, Bonde JP, Skakkebaek NE, Olsen J. Does moderate alcohol consumption affect fertility? Follow up study among couples planning first pregnancy. BMJ. 1998; 317: 505-510.

Juhl M, Andersen AM, Gronbaek M, Olsen J. Moderate alcohol consumption and waiting time to pregnancy. Human Reproduction. 2001; 16 ( 12) 2705-2709.

Juhl M, Olsen J, Andersen AM, Gronbaek M. Intake of wine, beer, and spirits and waiting time to pregnancy. Human Reproduction. 2003; 19 (9): 1967-1971.

Kesmodel U, Wisborg K, Olsen SF, Henriksen TB, Secher NJ. Moderate alcohol intake during pregnancy and the risk of stillbirth and death in the first year of life. Am J Epidemiol. 2002; 155 (4): 305-12.

Kesmodel U, Wisborg K, Olsen SF, Henriksen TB, Secher NJ. Moderate alcohol intake in pregnancy and the risk of spontaneous abortion. Alcohol Alcohol. 2002; 37 (1): 87-92.

Rosenberg A. Brain Damage Caused by Prenatal Alcohol Exposure. Scientific American. July/August 1996; 42-51

An almost universal piece of advice from woman-to-woman trying to conceive is to take a daily dose of folic acid, also called folate. Folic acid is a B-vitamin that decreases neural tube birth defects by a dramatic 70%. Women who take 400 micrograms per day of folic acid on top of a healthy diet while attempting to get pregnant often assume that this is adequate.

At Pacific Fertility Center, we go one step further, and recommend a prenatal vitamin supplement for our patients undergoing fertility enhancement procedures. Besides the essential dose of folate, prenatals also contain other critical ingredients, such as iron and calcium.Additional iron is important as uterine blood volume builds up. Calcium is needed for a developing fetus, as well as to offset the iron, which impacts calcium absorption.

Some women complain of nausea from swallowing prenatal vitamins, which is usually caused by the iron concentration irritating the stomach lining. One way to overcome this queasiness is to take the pill with a full meal, or in half doses, twice a day. (Best to avoid dairy products, however.) Chewing ginger or sipping ginger tea also helps prevent digestive unease. And as a last resort, you may be a candidate for slow fe, which is an iron supplement designed for extremely slow absorption.

With so many over the counter vitamins available, some may wonder how these differ from prescription-based prenatals. In most cases, prescriptions are written so that insurance companies will cover the cost – there is generally no substantial difference in quality.

Also, it may be overwhelming to determine how prenatal vitamins differ in quality, given the sheer volume of products in the marketplace. Some women prefer vitamins with the least amount of flavoring and coloring additives; with fewer ingredients, absorption may be enhanced. If you would like to double check whether your prenatal supplement has what you need, you can compare the label with this list of important ingredients:

Folic acid 400 micrograms (mcg)
Calcium 250 mg
Iron 30 mg
Magnesium 320 mg
Vitamin A 800 mcg (8,000 I.U.)
B6 2.2 mcg
Vitamin C 65 mg
Vitamin D 10 mcg
Vitamin E 10 mcg
Zinc 15 mg

Supplementing your diet with a prenatal vitamin containing these basic ingredients helps create the building blocks for a successful pregnancy. Please don’t hesitate to ask your PFC physician if you have any questions.