Pre-Conception Counseling

My husband and I met with the high-risk OG/GYN for this first time today! Our fertility doctor asked that we set up this appointment for pre-conception counseling. The goals were 1) to get her sign-off on moving forward, and 2) to establish care with the practice so that if/when I become pregnant I can easily transition into her care.

We actually met with two doctors there: an OB/GYN fellow and the high-risk obstetrician herself. It’s a teaching hospital so there are often students, interns, residents, and fellows around, and fortunately this one was great. She had done her homework on CF pregnancies (even though there’s not a ton of research out there) and was able to answer our questions. She took my history, went over any risk factors she discovered, and told us about common issues CF women face in pregnancy.

We talked the most about the increased likelihood of respiratory infections and exacerbations during pregnancy, which could necessitate my going into the hospital for part of the pregnancy. Hopefully that wouldn’t happen – ugh. The doctors also have fewer antibiotics at their disposal during pregnancy since some have teratogenic effects. We also discussed the increased risk of gestational diabetes as well as the fact that the literature shows CF women are more like to deliver pre-term. She said this could be for a number of reasons, including a CF exacerbation making it necessary to induce delivery early in order to treat the mother with stronger antibiotics. She also told me that the higher a woman’s lung function pre-pregnancy, the better the outcomes tend to be. Another reason we’re getting started sooner rather than later!

My two main questions were regarding my vest and my CF multivitamins. The doctor said it’s safe – and important, in fact – to continue vest use during pregnancy, even though it seems like it would shake the fetus around an awful lot!

Regarding vitamins, the doctor told me her main concern is vitamin A content. Women who are trying to conceive or are already pregnant shouldn’t be taking more than 10,000 IU of Vitamin A per day. When I got home and checked the label on my CF multivitamins, guess what I found? I’m taking nearly 40,000 IU of Vitamin A per day. Yikes! So, I guess I need to work with the OB/GYN and my CF doctor to figure out a vitamin regimen that’s more fetus-friendly before we start with IUI this fall.

I'm taking two of these every daily - definitely too much Vitamin A for TTC! I'm supplementing with additional Vitamin D and folic acid already.
I’m taking two of these every daily – definitely too much Vitamin A for TTC! I’m supplementing with additional Vitamin D and folic acid already.

I only met briefly with the obstetrician, but she seemed knowledgeable and nice. Since she and the fellow had worked together on the consultation prior to the appointment I felt comfortable that I was getting good care. She told me I have the go-ahead to get started whenever we’re ready, and that once I become pregnant I should call her office to set up an appointment with her or another doctor for when I’m 8 weeks along. Since my pregnancy would be considered high-risk due to CF I would need to be seen there frequently – at least monthly, and then weekly toward the end of my pregnancy. That will be in addition to monthly-weekly visits with my CF doctor during pregnancy. It’s going to be a full-time job!

Overall the appointment was exciting and encouraging. Another box checked off the list!

Right now I’m still monitoring my cycles and I’m to report back to the fertility doctor once this current cycle wraps up. After 6(!) days of the flashing smiley face OPKs indicating rising LH levels, yesterday I finally got the solid smiley face indicating peak hormone levels and imminent ovulation. That was a positive on day 16, just like last cycle. Last cycle I got my period on Day 18 which was really weird and definitely a disappointment, so I’m curious to see how things go this cycle. Fingers crossed for a more normal luteal phase this time!

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