Are you in late 30’s and planning a pregnancy? Doctor gives complete guide

Having a child is not just an emotional journey, but it is an entry into a vast world of responsibilities and unlimited love. Most modern-day couples decide to have a child only after achieving financial security and better career prospects. So, many of them do not have a clear idea of the ‘right time’ to have a child, when their career and dreams are on one side and age and health on the other. This journey demands not just physical health but also mental readiness and financial security. Aster Medcity's Dr Shameema Anwar Sadath, a senior consultant in obstetrics and gynaecology and an IVF specialist, explains the right time for pregnancy, when to see a doctor and more.

When is the right time?
Women’s reproductive ability changes with age. Unlike men, a woman is born with enough eggs for a lifetime. However, the number and quality of these eggs change as she ages. 
20’s: nature’s preference
Biologically, the perfect reproductive age for a woman is in her 20’s. The number and health of the eggs would be incredible during this time. Besides, the fertility rate is up to 25 per cent each month. Moreover, the risk for gestational diabetes and high blood pressure is significantly lower in the 20s. 
30s: the beginning of changes
The body begins to show notable changes after you hit 30. The reproductive rate may also drop after 32. 

Advanced maternal age
Medical science terms pregnancies after 35 years as advanced maternal age. The scope for natural conception reduces by ten per cent, and there will be a slight increase in the risk for genetic disorders like Down syndrome in the babies. Moreover, advanced maternal age increases the risk of gestational diabetes and pre-eclampsia. The number of eggs drops drastically after the woman turns 37. So, it might be difficult to get pregnant at this age. 

The body gets ready
A mother’s body must be a ‘safe home’ to nurture a baby. Modern medical science calls this pre-conception care, which includes the health care and lifestyle support given before a person becomes pregnant to improve the chances of a healthy pregnancy and baby. 
Note for women who opt for late motherhood
Many women opt for late motherhood, prioritising studies and a career. Modern medical science offers a few tests and methods that would help them achieve their dream. 

Ovarian Reserve Test
Ovarian Reserve Tests, like the Anti-Mullerian Hormone test, are used to estimate how many eggs a woman still has in her ovaries. 
Thyroid and diabetes tests
Make sure that your thyroid and diabetic levels are normal before getting pregnant. 

Egg freezing 
Egg freezing is a fertility preservation method where a woman’s eggs are collected from the ovaries, frozen and stored for future use. Although age is a crucial factor in reproductive health, it is possible to give birth to a healthy baby even after 35 years if you follow a healthy lifestyle and undergo proper medical checkups. However, giving birth after 35 demands meticulous planning and extra care. 

Folic acid
Folic acid (400 mcg) tablets should be taken at least three months prior to conception. This helps with brain and spine development in babies. 
Power of nutrients
Making certain changes to your regular diet will improve egg quality and help you enjoy a healthy pregnancy. Food items such as spinach, drumstick leaves, and dates can help prevent anaemia. Besides, eggs, legumes, and fish are rich in protein. 

Avoid these
It is better to avoid too much sugar and salt in your food while trying to conceive. Besides, processed foods and drinks containing artificial colourants should also be avoided, as they may lead to hormonal imbalances.  Obesity could harm your chances of conception. However, overexercising is not the solution for this. Brisk walking for 30 minutes daily will improve blood circulation. Meanwhile, yoga will strengthen muscles, and breathing techniques will help maintain hormonal balance, reducing stress during childbirth. 

Healthy mind
The health of the mind is as important as a healthy body. Chronic stress could adversely affect ovulation. Instead of constantly worrying why you are not getting pregnant, you could believe that you are getting ready to welcome a baby. Make sure to grab at least 7 – 8 hours of good quality sleep as lack of sleep increases the levels of cortisol, which is a stress hormone.

Frequently Asked Questions
1. How important is a father's health for a woman's pregnancy? 
Pregnancy is not the responsibility of only the woman. A man's health and lifestyle play a key and unavoidable role in the birth of a healthy baby. In most cases, infertility tests are limited to women, while the infertility may be caused by the man’s health. The following habits could improve the quality and movement of the sperm. 

2. What are the lifestyle changes required for a healthy pregnancy?
•Say no to intoxications – Smoking could shatter the sperm’s DNA, while alcohol consumption could reduce the testosterone levels and affect sperm production. 
•Avoid heat – Testicles maintain a temperature lower than average body temperature. So, men shouldn’t wear tight underwear. Besides, keeping the laptop on the lap for longer durations and hot showers, too, should be avoided.

3. What are the nutrients required for healthy sperm?
Zinc – Eggs, legumes and nuts are loaded with zinc, which increases the number of sperm. 
Antioxidants – Vitamin C (oranges, lemons) and vitamin E (almonds) protect sperms from damage. 
Omega-3 – Fish and walnuts will improve the movement of sperm. 

4. How to exercise and sleep right for healthy sperm?
Obesity leads to hormone imbalance. So, exercising daily improves testosterone levels. Besides, getting 7 – 8 hours of good sleep at night is essential for maintaining sperm health. 

5. What are the medical tests to do before planning a pregnancy?
Both men and women could consult a doctor and do the following tests before planning a pregnancy. 
Thyroid function test – Fluctuations in thyroid levels could impact conception. 
Diabetes and blood pressure – These should be under control. 
Vaccinations – Make sure you have been vaccinated against diseases such as rubella. 
Pregnancy is not just a physical change; it is a pivotal stage in life where you begin to love and appreciate yourself. 

6. How important is emotional bonding during pregnancy?
More than physical health, the mental and emotional support that you give your partner is important. A woman suffers chronic stress when conception is delayed. The partner should ensure that she knows it is not just her fault. Moreover, make sure to accompany her to the doctor for tests and treatment, as it would boost her confidence. Avoiding disputes to create a happy atmosphere at home helps in producing hormones that are favourable for conception. Pregnancy is not the journey of a single person. Both partners are equally involved in this amazing journey. 

7. What is ovulation?
Couples trying to conceive should understand ovulation. Ovulation is the process during the menstrual cycle when one ovary releases a mature egg. This egg survives for about 12–24 hours before fertilisation. However, a sperm can stay alive in a woman’s body for up to three to five days. So, having sexual relations a few days before ovulation improves the chance of conception. 

8. How to determine a woman's fertility window?
It is easier to determine the fertile window if your menstrual cycle is regular. 
Period cycle: The number of days from the first day of one period to the day just before the next period. Usually, the menstrual cycle is 28 – 30 days. 
Here’s how to calculate the fertile window. Ovulation happens 14 days before your next period. For example, if your menstrual cycle is 28 days, ovulation occurs on the 14th day (28-14=14). Then, the fertile window is from the tenth to the sixteenth day of the menstrual cycle.

9. What are the signs of ovulation?
More than referring to the calendar, you could listen to your body to notice the signs of ovulation. 
Vaginal fluids: Clear, stretchy cervical mucus similar to egg white.
Body temperature: Body temperature slightly increases (up to 0.5 degrees) during ovulation. 
Mild cramping: Mild lower abdominal pain. 
Increased libido: Women experience increased sexual desire during ovulation. 

10. What should those who have irregular periods do for a healthy pregnancy?
Those who have irregular periods (PCOS patients) should consult a doctor and undergo a follicular study to ensure that ovulation happens in their bodies. Instead of having sexual relations only on the days of ovulation, the chance of conception increases if it happens on alternate days, a week after menstruation. 

11. When should you see a doctor if you aren't conceiving?
Most couples are able to conceive within a year of trying. However, do not hesitate to consult a doctor in the following cases. 
1)Age and waiting period
Those below 35: If you are under 35 and have been trying for over a year, you should see a doctor for tests. 
Those who are above 35: Do not waste anymore time if you are above 35 years and have been trying for more than six months. The quality of eggs decreases as you age. 
Those over 40: It would be wise to seek preconception advice from a doctor. 

2. Menstrual problems
Irregular periods may be a sign of hormone imbalances or improper ovulation. Meanwhile, excessive pain and bleeding may be caused by endometriosis or fibroids that hamper your chance of conception. 
3. Health history
Miscarriage – Tests are required to find the exact reason if you have had more than three miscarriages. 
Diseases – Those who have thyroid issues, diabetes and high blood pressure should ensure that they are under normal levels. 
Male diseases – Men who have undergone surgery or experienced infections such as mumps should get the necessary tests.