Answers from our Experts

There is good evidence that having a good level of folic acid in the bloodstream at the time of conception substantially reduces the risk of the baby having neural tube defects such as spina bifida. Public health authorities in UK, USA and elsewhere recommend that healthy women take 0.4 or 0.5 mg folic acid per day (this is available in many pre-pregnancy vitamin supplements) and those with risk factors for poor folic acid metabolism, such as women taking anti epileptic drugs or with MTHFR gene mutations should take 5.0 mg per day. What is important is to have it in the egg before it is fertilised.

Most foods are completely harmless during pregnancy and it's important to maintain a balanced healthy pregnancy diet with sensible amounts of the various nutritional categories. However there are worries at present about listeria infection that can be caught from unpasteurised and raw foods. These include unpasteurised milk, soft cheeses, pre-prepared salads (for example, from salad bars), unwashed raw vegetables, pate, cold diced chicken and pre-cut fruit and fruit salad. To prevent listeriosis avoid these high risk foods and thoroughly cook raw food from animal sources, such as beef, lamb, pork, or poultry, keep and prepare raw meat separate from vegetables, cooked foods, and ready- to-eat food and wash raw vegetables and fruit thoroughly before eating.

In the past, gynaecologists advised women to wait at least three months before trying to become pregnant after a miscarriage. However research has shown that the chance of a healthy pregnancy is no different if you try again after the first normal period after the miscarriage. There is no benefit from waiting and many women want to try again as soon as is safe. However make sure that you feel ready psychologically. It is healthy and normal to grieve for the lost pregnancy and not everyone wants to be pregnant again immediately.

Women with polycystic ovary syndrome often don’t ovulate, or at least not regularly. This group of women will have irregular or infrequent periods. If you are not ovulating then the egg is not released from the ovary to pass into the Fallopian tube in order to be fertilised and implanted in the uterus.

There are several treatments for anovulation (a cycle when no egg is released) with polycystic ovary syndrome. These include Letrozole or Clomifene (Clomid) tablets and injections of fertility drugs. The European Society for Human Reproduction and Embryology (ESHRE) has produced helpful guidelines on this topic. Your doctor will be able to advise on this and refer you to a specialist clinic for help.

Sperm that are stored within the testicles for too long accumulate damage to the DNA and are less fertile. With couples who have frequent (daily) intercourse, the man will have a lower sperm count per ejaculation but the sperm will be more fertile. If you are trying to conceive then try to have intercourse at least every other day around the time of ovulation.

The Clearblue ovulation tests can help with this. If you like to have intercourse more often, then this will do no harm. However it’s important also to avoid stress so if you prefer less frequent intercourse then just try a little harder at this time of the month.

It's obviously important for your young baby to have time with their parents, both for the physical support from breast feeding but also the nurturing and bonding that are vital to your baby's development in the early months. Many women who breast feed will notice a delay in their periods restarting after childbirth, although this cannot be relied on as a form of contraception. A short interpregnancy interval may be associated with increased risk of adverse outcomes such as miscarriage: best to wait at least six months before trying again.

It's also important to decide what size of family you want, and work this out against your age. The age of the couple, especially the woman, has a big impact on chances of getting pregnant again. If she's over 35 or comes from a family with early menopause then it's worth trying again sooner rather than later. This is also the case if the man is over 45.

Yes, it's possible to ovulate twice but this usually happens at about the same time of the cycle. This is how non-identical twins occur, from ovulation of two separate eggs. It happens more often in women over 35 which is one reason why the older group have more twins (the other is that many IVF clinics will replace two embryos for older patients whereas those under 40 generally have one embryo replaced)

This seems to be an old wives tale. Many women notice that semen seems to 'leak back' from the vagina after intercourse and so lie on pillows or with their legs in the air after sex. However this loss is just the seminal fluid - the motile sperm move very rapidly into the cervical mucus so don’t worry about this leakage.

Probably not. See above - if it's going to happen then it will, and lying in unusual positions won't help.

Many women with mild endometriosis will conceive easily although chances of subfertility even for the mild group are higher than the background rate for age. Severe endometriosis can damage the Fallopian tubes and ovaries, and the adhesions that can come with endometriosis can also block the tubes. Your gynaecologist will be able to advise you on what to do about this. Don't try for more than a few months without getting advice.

Folic acid is the most important. However it’s worth having your vitamin D level checked and taking a replacement if you are deficient (which many of us are). If you have a diet that is light in red meat then you may need an iron supplement and if you have a vegan diet then other supplements may be worth considering. However there is a large industry designed to sell vitamins and supplements to women wanting to be pregnant, and there's not much evidence that healthy young people with a balanced diet need to take all of these potions.

Not unless he has specific health problems or has dietary restrictions. If you've been trying for a while its worth asking your doctor to arrange a sperm count for him - if this is normal then don’t worry about diet. Stop smoking, drink moderately on at most two or three occasions per week, keep your weight in the normal range for your height (but don’t lose too much) and enjoy a happy love life.

Many women quite naturally have a menstrual cycle that varies by a few days month to month. If you are trying for a baby, accurately identifying your wider fertility window can be an advantage. See the available solutions in the video below.

It might be normal as long as it is just spotting, not like a normal period, and you are not experiencing any significant pain that requires more than a mild painkiller like paracetamol. If the spotting during pregnancy continues and /or you have any concerns speak with your doctor. If you continue to experience spotting during pregnancy your doctor will most likely arrange an early ultrasound scan.

If you followed the test instructions correctly the results of home pregnancy tests are very accurate. It may be possible that you experienced an early loss. Sadly this is not uncommon as about quarter of pregnancies will end in an early pregnancy loss. To be certain repeat another pregnancy test in a week's time.

No, even if you had just ovulated and your egg has been fertilised, it is too early to test. It takes about a week for a fertilised egg to travel through the fallopian tube and implant into the lining of the uterus (womb). The hCG produced by the egg can only be detected in your urine once the egg has implanted. If you test before the egg has implanted (typically about 7 days before your missed period), there will be no hCG present, so a pregnancy test will always give a negative (Not Pregnant) result. The earliest you can test with the most sensitive tests currently available is 6 days before your missed period (typically 10 days after ovulation).

It is unlikely to have harmed the baby and a continuing pregnancy is a sign that everything is normal. Going forward, the safest advice is to drink no alcohol at all whilst pregnant.

Even though false positives in pregnancy tests are rare because these tests detect a hormone called human Chorionic Gonadotrophin (hCG) which typically only present when you are pregnant. However, if you are taking fertility medication that that contains hCG, if you have recently been pregnant whether you just had your baby, a miscarriage or a termination, or if you have certain ovarian cysts, kidney disease, some types of cancers or are going through perimenopause you could get a false positive result in your test.

Most pregnancy tests are over 99% accurate from the day you expect your period. However, I know it can be hard to wait and the most sensitive tests can be used up to 6 days before you miss your period, which is 5 days before the expected period. Be aware that if you choose to test early and get a not pregnant (negative) result you may simply be testing too early and you should test again on or after the day your period is due.

Taking the pill at any stage in pregnancy is unlikely to cause problems. Stop taking the pill when you find out that you are pregnant. Make sure that you tell your doctor that you fell pregnant on the pill, who will arrange for you to have the normal check-ups and scans for your pregnancy.

No, you should not be having periods during pregnancy. Any bleeding in early pregnancy may be a sign of a threatened early pregnancy loss. However many women with light bleeding, will go on to have a normal pregnancy. If you do have any bleeding, it is important to discuss with your doctor or midwife who may refer you on for an early ultrasound scan.

If you have tested before your period is due and got a 'Pregnant' result this is very accurate and you can rely on the result. This means the level of pregnancy hormone was high enough to be detected.

Not all women will suffer from pregnancy symptoms, such as feeling or being sick. Look out for breast tenderness (which may be intermittent) as this is the symptom that is most commonly reported. However all pregnancies are different so do not worry.

Nausea and vomiting is very common affecting 8 out of 10 pregnant women. Whilst it is very unpleasant and can affect your day-to-day life, there is no evidence that nausea and vomiting has a harmful effect on your baby. In fact, you have a slightly lower risk of miscarriage.

Your baby will take what it needs from your body. When suffering from morning sickness make sure that you drink plenty of water and try to eat little and often. It is also recommended that you avoid any food or smells that trigger symptoms. Some women find that acupressure bands may help. If you are really struggling, you can see your doctor who may be able to prescribe you some anti-sickness medication.

Hyperemesis gravidarum is extreme nausea and vomiting and can be potentially life-threatening. Symptoms include prolonged episodes of vomiting, dehydration, and weight loss.

Hospital treatment may be needed. Many units now offer treatment on a day case basis, but in severe cases admission may be needed. Treatments include intravenous fluids and anti- sickness medication.

An ectopic pregnancy is when the pregnancy develops outside the uterus (womb). Almost 99% of pregnancies are normally located in the uterus; however ectopic pregnancies can affect any woman. Be aware that ectopic pregnancy can present with a variety of symptoms. Not all women experience symptoms. Initial ectopic pregnancy symptoms could be pain (requiring more than a mild painkiller like paracetamol to relieve) and bleeding. If the ectopic pregnancy is rupturing you may experience a generalised tummy pain which is often associated with shoulder tip pain. Other reported symptoms include pain on passing urine, pain when opening your bowels or pain when walking. If you experience these symptoms you should seek immediate medical attention. If you have had a previous ectopic pregnancy the National Institute of Clinical Excellence has advised that you may self-refer to an Early Pregnancy Clinic where you can obtain expert advice and scanning. You need an ultrasound scan to confirm the location of the pregnancy.

Stress and stressful situations may have a temporary effect on reproductive hormones, resulting in a lack of ovulation. This can be seen most commonly in acutely stressful situations, elite female athletes, women with severely low weight, and eating disorders. The alterations in ovulation can inhibit predictable attempts at pregnancy. However, as these stressors resolve, ovulation should return and fertility is no longer impacted.

The normal menstrual cycle range is usually from 21 - 35 days. Cycles shorter or longer than that can be associated with fertility
issues due to delayed or lack of ovulation, especially if the periods are not predictable. Over the course of a woman's reproductive life span, her typical cycle lengths should fall within this range. If your cycles are usually less than 21 days or longer than 35 days, you should see your physician for further evaluation.

The inability to get pregnant after a successful birth is called secondary infertility.  A number of acquired factors can impede your ability to get pregnant. The most common causes are a women's increasing age and changes in sperm production. If you had a child in the past and you are now over the age of 35 years, your ability to get pregnant may have decreased. This could be due to changes in ovulation, changes in the uterine or fallopian tube structures, and the genetic quality of the eggs being released. Also, as your male partner ages or acquires new medical diagnoses, he may have a sperm abnormality that has caused a decrease in his sperm count, motility or shape. If you are experiencing secondary infertility, you should speak with your healthcare provider to initiate a fertility evaluation.

Typically, a pregnancy termination will not affect your ability to get pregnant in the future. On rare occasions, you may develop adhesions or scar tissue in the uterus that can cause issues with future fertility. If you are having normal monthly cycles, the chances of these adhesions affecting your fertility are low. Seeing your fertility specialist or gynaecologist will be helpful in making sure your uterus has not been affected, especially in the setting of infertility for greater than 6 months (if > 35 years old) or 1 year (if < 35 years old). If your menstrual flow has lighten significantly after a surgical procedure of the uterus, seeking help from your health care provider is recommended

Women are born with all the oocytes (eggs) that they will have for their lifetime – this is your “ovarian reserve.” As women age, this ovarian reserve slowly decreases as oocytes are recruited and used during the menstrual cycle.

Once the ovarian reserve has been depleted, menopause will occur. There are two common ways of measuring the ovarian reserve: first with an ultrasound and second with blood testing, measuring you Anti-Mullerian Hormone (AMH) and/or your Follicle Stimulating Hormone (FSH).

The ultrasound should be performed between cycle day 2-5 and will count the number of resting follicles (cysts containing oocytes) within the ovary.

The Anti-Mullerian hormone (AMH) is a hormone created by the resting oocytes within the ovary. AMH levels can be drawn at any time during a menstrual cycle. The levels can be affected by current or recent long term birth control use. Fertility specialists use the AMH by comparing it to known “average levels” based on a woman’s age. The higher the AMH, the greater the number of oocytes present. The AMH level is helpful when determining medication doses during fertility treatments but is NOT correlated with a person’s ability to become pregnant.

Finally, FSH can be drawn in conjunction with Estradiol on cycle day 2-4 to measure ovarian reserve. Elevations in FSH when the ovary is at rest (low Estradiol levels) indicate that the brain is working harder than normal to force the ovary to start producing an egg.

Together, these two tests can be used to determine waning ovarian function, indirectly indicating a lower ovarian reserve.

More detailed information on ovarian reserve testing can be found at www.reproductivefacts.org

In 2012, the American Society for Reproductive Medicine stated that egg (oocyte) freezing is no longer considered experimental. Because of this, fertility centres can now freeze eggs for women who may want to use them in the future. Patients who are considering this option can either freeze eggs alone or freeze a combination of eggs and embryos (fertilized eggs) using donor sperm. As of now, the thawing of eggs and subsequent fertilization varies between fertility centres. However, newer data has shown that this can be a great alternative for women wanting to preserve their fertility for the future. The ideal age has not been established, however, freezing eggs between 30-35 years old provide the best chances of future success.

Women sometimes don't ovulate every month for a number of reasons. If you have menstrual cycles that occur predictably every 21 to 35 days and you have symptoms of breast tenderness, bloating, pelvic or uterine cramping, or mood changes prior to your menstrual cycle, you probably are ovulating. However, if your cycles are usually over 35 days or unpredictable, you may not be ovulating consistently or not at all. The most common reason for women not ovulating (outside of pregnancy) is Polycystic Ovary Syndrome (PCOS). PCOS is a condition that you are born with that causes hormone imbalances that prevent ovulation on a regular and consistent basis. Other conditions causing a lack of ovulation include low thyroid function (hypothyroidism), high prolactin production
(hyperprolactinemia), and perimenopause. If you feel that you are not ovulating consistently, you should see your health care provider.