Once You Become Pregnant

Photo Courtesy of Steve Williams

Our patients work very hard to become pregnant and one of the most common questions patients ask once they test positive on a home pregnancy test or from a blood pregnancy test at Southern Ontario Fertility Technologies (S.O.F.T.) is, “What do I do now?”

Download a PDF version of the Once Your Become Pregnant information sheet which includes the My Pregnancy Tool Checklist that tracks your pregnancies most important information.

A Beta Human Chorionic Gonadotropin (BhCG) is the blood pregnancy test that is completed at S.O.F.T. a minimum of 14 days after a presumed ovulation, intrauterine insemination (IUI), fresh embryo transfer (ET) or frozen embryo transfer (FET).  This test measures the amount of hormone a developing embryo is creating as it implants and develops during early pregnancy.  After a positive test you will be asked to come back to the clinic in 48 hours to repeat the test again.  In 85% of viable intrauterine pregnancies at S.O.F.T. the BhCG concentration in blood rises by at least 66% every 48 hours during the first 41 days of pregnancy.  At S.O.F.T. we do this double check because of the efforts involved in achieving a pregnancy; we want to give you a confirmation that you are pregnant and that the pregnancy is progressing without concern.  After your second blood test comes back at or above this 60% mark one of our ultrasound technologists will book you for your Early Pregnancy Ultrasound.  At S.O.F.T. we understand the stress involved in knowing how your pregnancy is progressing so patients can come in for subsequent BhCG blood tests if they would like.

Women are encouraged to start/continue taking a daily multivitamin with a minimum of 0.4 mg of folic acid once they become pregnant.  Many prenatal vitamins (PregVit®, Materna® & generic brands) have 1000mg in them and these are safe to take once daily.

7 – 9 Weeks Gestation:

An initial ultrasound will be booked 40 days after your IUI or embryo transfer or between 7-9 weeks gestation based on the first day of your last menstrual period (LMP).  This ultrasound is known at S.O.F.T. as your Early Pregnancy Ultrasound and there is an information sheet available on our website.  The Early Pregnancy Ultrasound at S.O.F.T. is a vaginal ultrasound booked for 30 minutes completed by one of our ultrasound technologists.  No preparation is required and you can have an empty bladder.  This ultrasound is to check for appropriate dates, takes a crown rump length (CRL) measurement and a heart rate.  After your ultrasound you will meet with one of the S.O.F.T. physicians to review your ultrasound and discuss your pregnancy.  Based on the measurements of the baby during the ultrasound we will provide you with an expected due date.

Once your Early Pregnancy Ultrasound is completed we encourage you to inform your Family Doctor or primary healthcare provider of your pregnancy.  A copy of your ultrasound report will be sent to them along with this information sheet and any bloodwork if requested.  Please feel free to provide them with access to the My Pregnancy Tool found on our website and on The SOFT Fertility Blog.

Your spouse, partner, family & friends are always welcome during any ultrasound at S.O.F.T..  Actually we encourage you to bring someone with you as research has often demonstrated this helps to build a stronger bond with your baby.  We do ask patients to invite no more than to 2-3 individuals due to limited seating in the ultrasound suites.
In situations where spotting, cramping, bleeding, abdominal pain or other concerns occur during a pregnancy the staff at S.O.F.T. will attempt to book an ultrasound as early as possible to check on the development of your baby.  During this ultrasound we will assess for a heartbeat as well as the position of the gestational sac to make sure it is placed in the uterus.   Spotting and/or bleeding is never normal but it does happen during many pregnancies.  When this happens you will be concerned which is a natural reaction.  We encourage patients to contact S.O.F.T. and speak with a nurse about their concerns.  A blood test can be easily arranged to check against previous results to determine if the numbers are continuing to rise.  Often patients will be placed on vaginal progesterone to help stabilize their uteral lining and to provide reassurance to our patients that they are doing everything they can to ensure the pregnancy succeeds.  As mentioned above you can ALWAYS call S.O.F.T. with your concerns.  If excessive bleeding or a serious concern occurs outside clinic hours we advise our patients to go seek a physician at a local clinic, Urgent Care Centre or Emergency Department.

If interested, patients will have an opportunity to meet with a Registered Dietitian (R.D.) after their Early Pregnancy Ultrasound to discuss pregnancy resources, healthy weight gain, adequate nutrition, exercise and to assist in supporting a healthy pregnancy.  This new service will begin in August 2011.  Patients who wish to schedule an appointment at our clinic can contact one of our receptionists.

After the initial ultrasound your Family Doctor, Midwife or OB/GYN is responsible for completing a two-part document known as your Antenatal Record (Part 1 & 2).  Part 1 involves a discussion of your obstetrical history, medical history, physical exam, date of last PAP, urine culture, swabs for Gonorrhea & Chlamydia, initial bloodwork and discussion of risks associated with pregnancy.  If you have completed a cycle of intrauterine insemination (IUI), in vitro fertilization (IVF) or frozen embryo transfer (FET) at S.O.F.T. we will forward copies of your program bloodwork (HIV, Hepatitis, Syphilis, Rubella Immunity & Blood Type) to whoever is following your pregnancy.  Part 2 involves a plan of management for any risk factors, recommended immunizations, documentation of physical changes for both you and the baby during pregnancy and topics discussed during your plan of care.  Part 2 also includes documentation for your first postnatal visit.

It is the recommendation of our physicians at S.O.F.T. that you are followed by your Family Doctor, Midwife or OB/GYN a minimum of every 4 weeks during your pregnancy until 28 weeks, every 2 weeks until 36 weeks and then every week until delivery.  More frequent visits and ultrasounds will be required for multiple pregnancies.

11 – 13 Weeks Gestation:

Your Nuchal Translucency Ultrasound (NTL) is the next ultrasound completed between 11 weeks and 13 weeks 6 days at S.O.F.T..  This ultrasound is part of the Integrated Prenatal Screening completed to detect the risk of chromosomal defects such as Trisomy 21 and Down’s Syndrome.  It is a non-invasive series of tests that include an ultrasound, questionnaire and two blood tests. 

There is a risk, in every pregnancy, of chromosomal defects with the overall risk increasing with age, family history of genetic disorders or previous trisomic offspring.  The ultrasound involves measurements to determine adequate growth of the developing baby/babies.  One specific measurement is taken of the nuchal translucency, which is the subcutaneous accumulation of fluid located at the back of the baby’s neck.  An increased nuchal translucency is associated with chromosomal defects as well as many fetal malformations and genetic syndromes.  An abnormal measurement will increase the overall risk of genetic abnormality but does not guarantee that the fetus will have a chromosomal defect.  Please keep in mind that the testing component of the screening is optional.  Patients who choose to have only an ultrasound can choose to not do the blood tests or have their NTL reported for screening purposes.

This ultrasound is performed by an ultrasound technologist at S.O.F.T. who is specifically registered to do nuchal translucency scans by holding registration with Fetal Medicine International.  The ultrasound is done on top of the abdomen and is booked for 45 minutes to allow the approximate 15-35 minutes needed to take measurements depending on the position of the baby.  There are instances where no nuchal translucency can be documented despite the ultrasound technologist’s attempts to change the position of the fetus with gentle movement.  No preparation for the scan is necessary although it is recommended that patients not have a completely empty bladder.

After the ultrasound is completed your weight and a short series of questions is completed.  Blood work is also completed after the ultrasound unless there is a multiple pregnancy.  This first blood test along with the ultrasound and a second blood test (between 16-18 weeks gestation) comprise the triple screening or integrated component of the prenatal screen. 

16-18 Weeks Gestation:

For the second blood test in the IPS Screening you will be given a requisition (Part 2) that can be completed at S.O.F.T. during the indicated dates on the requisition.  We ask patients to come to S.O.F.T. for this second test on Monday-Thursday before 11:00am so that courier can pick up the blood work that same day.  The test can also be completed at your doctors’ office or at a local blood lab.  This information, with the measurements from the initial ultrasound, is entered into a computer program that determines the overall risk of genetic complications.  A final report is sent to S.O.F.T. from the Maternal Serum Screening Lab at London Health Sciences Centre (LHSC) usually 2-3 weeks after the second blood test is completed and this final report will be faxed to your Family Doctor, Midwife or OB/GYN once received.  If no abnormalities are visualized on the ultrasound there is a very low risk of abnormalities being detected in the subsequent blood tests.

If a fetus has an increased nuchal translucency at the time of ultrasound an appointment will be made with either Dr. Martin or Dr. Frank to discuss any concerns.  If we receive a positive report one of the nurses at S.O.F.T. will arrange for an appointment with a genetics counselor at LHSC or another centre on the patients behalf.  This appointment is never mandatory but it is encouraged so patients can gain additional information about any potential risks.

As with your earlier ultrasound a copy will be sent to your Family Doctor, Midwife or OB/GYN once reviewed by our physician. Vaginal progesterone is often stopped after 10 weeks gestation but some patients will stop taking their progesterone after their NTL ultrasound if they are still concerned as this is the usual time family and friends are informed of your pregnancy.

18 – 22 Weeks Gestation:

The final scheduled ultrasound is completed at S.O.F.T. between 18 and 22 weeks.  In this ultrasound measurements are taken to determine appropriate growth of the baby/babies.  This detailed scan is performed to assess major anatomy such as the spine, heart, brain, stomach, bladder, kidneys and limbs.  The uterus, placenta and umbilical cord are also examined.  It is during this ultrasound that the sex of your baby can be determined depending on the baby’s position and cooperation.  For this external ultrasound we ask patients to have a comfortably full bladder.

After your 18-22 week ultrasound it is important to inform your family doctor that you require a referral to a Midwife or OB/GYN if this has not already been completed.  If your family doctor prefers that S.O.F.T. makes the referral on your behalf Dr. Martin or Dr. Frank will send a request to an OB/GYN or Midwife for you and you will be called with an appointment.  If you have no family doctor Dr. Frank will follow your pregnancy every four weeks until an appointment with an OB/GYN is made by our clinic on your behalf.  It is important to remind reception once you become pregnant if you do not have a family doctor.

In the event of any complications that put your pregnancy at a higher risk (twins, current or previous complications during pregnancy) a referral will be made earlier by S.O.F.T. to a specific OB/GYN and you will be notified of your appointment.  You should inform your Family Doctor of any appointments made with the OB/GYN.

At any time during your pregnancy a requesting physician can ask for additional ultrasounds to be completed at S.O.F.T..  Many patients feel comfortable at our clinic and all that is required for an ultrasound after your 18-22 week ultrasound is a requisition specifying what information your doctor would like.  Routinely these are done as an ultrasound to specifically measure the growth of the baby/babies. 

S.O.F.T. unfortunately does not perform 3D/4D ultrasounds for entertainment purposes.  There is an information sheet available on our website and as part of the My Pregnancy Tool explaining this technology including the benefits, risks and controversy.  If a medically indicated ultrasound is completed at S.O.F.T. after 22 weeks on behalf of your physician we will provide patients with a few 3D photos to take home as part of their ultrasound experience. 

Additional Recommendations:

At approximately 24-28 weeks your Family Doctor, Midwife or OB/GYN may book you for a 1 hour Oral Glucose Tolerance Test that is suggested to screen for Gestational Diabetes Mellitus (GDM).  Women with multiple risk factors for GDM should be screened during their 1^st trimester.  Some of these risk factors include previous diagnosis of GDM, Polycystic Ovarian Syndrome (PCOS), a member of a high risk population, Body Mass Index (BMI) ? 30 kg/m² and ? 35 years of age.

Group B Streptococcus (GBS) Testing should be completed at 36 weeks.  GBS is a common bacteria that can be found in the vagina, rectum and urinary bladder of women.  While this bacteria can be easily treated with antibiotics the concern is with the possibility of bacteria being present during delivery.  You may be placed on antibiotics during delivery you are tested as GBS positive.

Concerns regarding Rh factor should be directed to your Family Doctor, Midwife or OB/GYN and a decision on if any injection is required is usually done around 28 weeks.

If you are taking a low dose aspirin (LD ASA) and/or Fragmin injections your Family Doctor, Midwife or OB/GYN will inform you of when to stop taking these medications.  This is often done after 30 weeks and you will be advised by them on their preference for you to stop.

Patients taking dihydroepiandrosterone (DHEA) supplements for diminished ovarian reserve and recurrent pregnancy loss should stop taking DHEA once they become pregnant.  The main reason for this recommendation is that there is currently no research published on DHEA supplementation during pregnancy.  Although at S.O.F.T. we do not feel there would be any adverse risks during pregnancy, because DHEA is a mildly androgenic (male) pre-cursor hormone for both testosterone and estrogen it would be best practice to advise patients to stop once they know they are pregnant.  There is no known risk of taking DHEA before you know you are pregnant so we advise you take DHEA until your first positive pregnancy test.

Questions about medications during pregnancy and during lactation are always best answered by your pharmacist or by accessing Motherisk.  Motherisk is an online and telephone resource run by the Hospital for Sick Children in Toronto, Ontario.  They have numerous online resources for questions about almost every topic during pregnancy.  Their telephone Helplines offers resources to women on topics including alcohol & substance abuse, morning sickness, HIV & HIV treatment and general information/requests.  This is often referred to at S.O.F.T. by our nurses as the best resource to access during pregnancy and a tool we access on a frequent basis.

Questions about your pregnancy can be directed to any of the S.O.F.T. nurses at any time during your pregnancy and we encourage patients to follow The SOFT Fertility Blog for both new and current articles relevant to pregnancy and post-partum care.

Download a PDF version of the Once You Become Pregnant information sheet which includes the My Pregnancy Tool Checklist that tracks your pregnancies most important information.

Visit the My Pregnancy Tool page for more resources on your pregnancy.