For couples trying to conceive, a negative pregnancy test can be most unwelcome and each month that passes by without falling pregnant can lead to increasing frustration and disappointment. I often get asked by couples who are trying for a pregnancy "So when should we seek help?" My guidelines are as follows:

For women who are generally well (regular periods and no underlying medical conditions) and are trying for your first pregnancy:

• If you are 35 years or older, see an obstetrician or fertility expert after 6 unsuccessful cycles
• If you are under 35 years of age, seek help after 12 unsuccessful cycles

Women with very long or irregular cycles, or known gynaecological issues such as polycystic ovarian syndrome (PCOS), can benefit from a consult with a doctor much earlier. If you're not having periods, you're not ovulating so it's essential to address this before conception is possible.

Couples who are having trouble conceiving their second/next child should seek help after 6 unsuccessful cycles so an assessment for secondary infertility can be undertaken.

I provide assessment and initial management of women and/or couples with fertility problems, and work closely with a number of IVF experts should this be required. I am then able to care for women who have conceived via assisted reproductive technologies (including IVF) during their pregnancies.

Many women find it beneficial to be physically, mentally and emotionally prepared for labour and birth. It is important to be well informed about the process of labour and delivery, and most patients are encouraged to attend childbirth education courses with their support person. Many hospitals have a childbirth program available for their patients. Some women choose to attend external courses, such as, calmbirth courses.

After completing classes, many women will establish their own personal birth preferences. This may include the preferred mode of delivery (e.g. vaginal or caesarean section), the environment to birth in (e.g. lighting, music etc.) and the anticipated pain relief options. It is important to be aware that all labours and births are different, and women with a strong birth plan can often find themselves disappointed if their birth is not what they were expecting.

It is important to discuss your birth preferences with your care provider during your pregnancy, and also to discuss the limitations of these. This way you can ensure that you and your baby will be safely cared for.

Pregnancy nausea is common and can occur any time (not only in the morning), usually easing by 10-14 weeks. Many women feel worse late in the day, especially if they are run down or tired. A general feeling of queasiness, sensitivity to many smells and food aversions are common. Vomiting can almost be a relief and sometimes becomes a daily habit. Be reassured that a healthy diet in the first few weeks of pregnancy is not essential, even stopping pregnancy vitamins until the nausea abates can be a good idea. Try eating whatever takes your fancy, the classic is dry biscuits, but salty chips, toasted cheese, fizzy drinks can all help. Small frequent snacks and sips of fluid may be better than a big meal. There are several over the counter medicines that may help such as Vitamin B6, ginger tablets or tea and other medicines that can be prescribed by your doctor. Remember this is a usually a temporary state leading to a good end and won’t harm your developing baby in the short term!

Lower abdominal cramping may be a common symptom in early pregnancy. They are generally mild and easily managed with rest and simple painkiller. The cramps may be related to the enlargement of the uterus or bowel cramps due to constipation.

Cramping that is severe and prolonged, or associated with other symptoms such as bleeding, fever and vomiting may have another underlying cause. It is important to contact your GP or obstetrician if these associated symptoms are present.

From the 28th week of your pregnancy its best if you can sleep lying over on either your left or your right side. This is because the weight of baby and the womb when flat can compress the large blood vessels at the back of the abdomen effecting the return of blood to your heart. This results in less overall blood flow to the womb and reduced oxygen delivery to your baby. Accordingly, research has shown that the risk of stillbirth may increase slightly in later pregnancy in women that regularly go to sleep lying flat. Lying on your side also improves your breathing and keeps up adequate oxygen intake. There is no need to worry if you wake up on your back as the relevant research looked at the way you fall asleep which is usually your most common sleeping position. If this occurs just roll over on to your side as you go back to sleep.

Sleeping on your side can be difficult if you’re not used to it but there are specific aids and pillows available designed to help you stay comfortable.

Hypnobirthing is one of the few natural based therapies reviewed by Cochrane Medical Research Review which has shown promise in providing potential statistical improvements in women’s birth outcomes as it pertains to better pain management, mode of delivery, babies health at delivery and postnatal feeding and settling. There are multiple marketed versions of this technique (Calmbirthing, Nobel Birthing etc.), with the emphasis largely on breathing and relaxation skills, useful along with TENS machines and water (shower/bath) in aiding pain control and labour progression. This can reduce the incidence of medical intervention in childbirth, making it an excellent adjunct to a couple’s preparation for labour.

Twins may originate from one egg (monozygotic) or two eggs (dizygotic).

Monozygotic, or identical, twins occur at the rate of 1 in 250 in spontaneous pregnancies. This frequency is the same in every race, every country, at all weights, at all heights and is not dependent on either age or family history.

Dizygotic, or fraternal, twins occur at an overall rate of 1 in 80 spontaneous pregnancies. In contrast to monozygotic twins, fraternal twins are more common in women who are taller, heavier and older. The peak incidence is at the age of 35 to 39 years. Fraternal twins are less frequent in Asia with the rate in Japan around 1 in 150 pregnancies. They are most common in East Africa with rates of 1 in 20 pregnancies.

Assisted reproduction has a significant influence on the rate of twins.

What screening should I have before falling pregnant?

Pre-pregnancy screening is optional and should ideally be completed before falling pregnant but can still be done after conceiving. One of the most commonly offered investigations is genetic carrier screening, which includes screening for cystic fibrosis, Fragile X and spinal muscular atrophy. More information about this test can be found here: https://www.vcgs.org.au/tests/prepair

Furthermore, it is important to individualize each person’s need for any other screening which may be influenced by one’s family history of hereditary conditions, ethnicity and age. This can be discussed with your family doctor or your obstetrician.

What pre-natal screening should I have after falling pregnant?

Pre-natal screening is also optional and there are two choices available to women from 10 weeks gestation.

The first and more accurate and more costly option is the non-invasive prenatal screen (NIPS), also known as PERCEPT, Harmony etc. (depending on which pathology laboratory you attend). This test may be performed from 10 weeks gestation and looks for fetal DNA in the maternal blood stream to detect pregnancies which have an increased chance of having a chromosomal condition such as Down Syndrome (Trisomy 21).

The alternative to this test which is less accurate and less costly, is combined first trimester screening performed between 9 and 13 weeks. This test involves a blood test at 9-13 weeks and an ultrasound at 12-13 weeks, which gives an estimate that a pregnancy is affected by a chromosomal condition.

There are other screening investigations that may be done after 14 weeks gestation and this all can be discussed further with your family doctor or your obstetrician.

Ultrasound has been an integral part of pregnancy care since the 1970s with universal uptake in the 1990s. But how often should you be scanned and are there any side effects?

Each scan should have a purpose, just like a blood test or examination. Essentially, in pregnancy, there are four common scans.

An early pregnancy or ‘dating’ scan.

For women who conceive via IVF this is usually done to confirm a successful pregnancy. For natural conceptions this can occur either at your first antenatal visit with your private obstetrician in their rooms or at a private ultrasound clinic as arranged by your GP. These scans are designed to confirm the viability of the pregnancy, check if it is a single or multiple pregnancy and accurately date the pregnancy.

The 12 week scan

This is another opportunity to confirm an ongoing heartbeat and double check the dates however this scan, when performed thoroughly, has the ability to screen for conditions such as Trisomy 21 (Down syndrome) and some other common chromosomal conditions. A general review of anatomy should be performed at this scan too, with 40% of structural abnormalities seen this early.

The 20-22 week scan

This is the ‘big scan’. Be prepared to be in the scan clinic for 45 minutes to an hour. A full thorough assessment of all of the anatomy of the baby is checked at this scan. Some parents choose to find out the gender of their baby at this scan.

A third trimester scan

Not all doctors recommend a third trimester scan. Certain medical or obstetric conditions require a scan at around the 32-34 week mark (for example a low lying placenta, diabetes, fetal abnormality) but some obstetricians ask all of their patients to have a scan at 32 weeks to monitor the growth of the baby.

Many private obstetricians also have good quality ultrasound machines in their rooms and will scan you at each antenatal visit. These scans are simple and designed to confirm the presence of the baby’s heartbeat but also enable the obstetrician to quickly view parameters of foetal wellbeing such as the level of water around the baby.

There are a number of medications that are safe during your pregnancy. However, it is always best to consult your doctor prior to commencing any over the counter medications.

If you have an allergy or hayfever, you may use a sedating antihistamines such as chlorpheniramine, pheniramine and promethazine at the recommended dose.

If you have a sore throat, lozengers containing local anaesthetic and antibacterial agents may be used during pregnancy, however it is advised to avoid excessive use as it may cause unwanted side effects, such as diarrhoea.

If you are experiencing a chesty cough, an expectorant such as guaifenesin or a mucoltic such as bromhexine may be used at the recommended dose. If your cough is a dry cough, a cough suppressant such as pholcodine or dextromethorphan is considered safe during pregnancy.

Heartburn is common throughout pregnancy, affecting up to 80% of pregnant women. It is recommended to avoid rich or spicy meals, citrus foods and coffee and to try smaller, more frequent meals. However for relief of the symptoms, you may use an antiacid or ranitidine to ease comfort.

A woman’s recovery from a caesarean birth can vary greatly (just the same as after a vaginal birth).

It can depend on whether it was elective or an emergency caesarean, and how difficult the last few weeks or days were before the birth itself.

Most women will need opiate pain relief in hospital for the first few days, however, by the time they are ready to go home, the requirements for the stronger medication will be much less. Some women are taking a combination of paracetamol/ibuprofen by the time they leave hospital and require the stronger medication only sporadically.

We usually suggest being as mobile as possible without pain but not lifting heavy objects like a pram or a full washing basket for at least the first 3 weeks and then only if there is no pain with doing so.

In the initial week or two at home try to arrange the household activities to occur in a smaller area so that you do not need to climb flights of stairs or walk too far until it becomes easier to move around. “When can I drive a car?” is a common question and women are often keen to regain their independence. There is no universal answer to this and insurance companies will often say “Refer to medical advice”. In general, we suggest it would be safe to drive when no longer taking opioid (strong) pain killers and when a woman is able to twist around to look behind and control foot pedals without any significant pain.

Some women will find they feel ready at 3 weeks and others not until after the 6 week mark. Most of all, don’t be afraid to ask for help with chores, cooking and washing whilst family and friends are around and willing to help you. That way you will have more energy to enjoy your very new baby.

One of the really amazing things about pregnancy is that it allows us to see into the future. In this regard, diabetes in pregnancy gives us a warning that allows us to take action to stop us from developing diabetes in subsequent pregnancies, as well as, in later life. Without any intervention, around 40% of women with gestational diabetes will get it in the next pregnancy, but by modifying our lifestyle and our diet we can actually reduce our lifetime risk of type 1 and 2 diabetes, metabolic syndrome, and cardiovascular disease. What’s more, we will feel great doing so!

I’m so sorry to hear of your recent miscarriage. There is nothing different that you need to do. Next time you are pregnant, I would recommend an early pregnancy scan around 6-8 weeks. Goodluck!

There are two important factors in managing epilepsy in pregnancy- the first is ensuring that you are on ideally a low dose and single agent (but accept that this dose might need to increase in later pregnancy) and the second is to avoid triggers including fatigue. Some obstetricians will recommend an induction of labour at 39-40 weeks with availability of an epidural for pain relief/fatigue management.

Low zinc levels are associated with miscarriage and preterm birth however the typical Australian diet will contain enough zinc. It’s mostly only tested and actively replaced in women who have had a gastric sleeve and have multiple micronutrient replacement requirements.

You can choose an obstetrician at Frances Perry House by viewing their specialist profiles on our website, or by browsing their website or social media channels. This helps you to get a feel for who might be right for you. We also recommend seeking advice from your GP as they are a wealth of knowledge.

Most exercise is safe in pregnancy, especially if you were active prior to conceiving. The body is very effective at regulating the core temperature. Current recommendations are for 30mins of exercise per day.

Blackmore’s pregnancy multivitamin has recommended daily intake quantities for most vitamins. It is likely that you will need to take an additional iron supplement at some point in the pregnancy to support your growing baby and maintain your haemoglobin (red blood cells).

In ideal world preconception bloods are performed- these are the same as the antenatal bloods- and this allows for optimisation of vaccinations (such as rubella) and correction of any underlying/unknown medical conditions such as hypothyroidism/PCOS.

This can be a very stressful and frustrating time. We recommend seeking a referral to a specialist as infertility is defined as no pregnancy after 12 months of regular, unprotected intercourse.

High cholesterol is often associated with other metabolic issues including insulin resistance (PCOS) and increased risks of cardiovascular disease. Whilst the evidence regarding cholesterol levels and sperm function/fertility is mixed, aiming for healthy cholesterol and lipid levels is going to be better for long-term health.

Most obstetricians will want to see you from 7-8 weeks of pregnancy. However, don’t stress if you are past this timepoint- we are always happy to meet new patients at any time in their pregnancy!

The biggest risk factor associated with the use of clomid is of multiple pregnancy (twins or triplets) and these are higher risk pregnancies. If you have used clomid for ovulation induction it is then has been stopped and metabolised by the body prior to conception- and therefore there are no recognised side effects on the baby.

One of the wonderful things about the IUCD (and particularly Mirena) is that it keeps the lining of the uterus thin and fertility returns as soon as its removed in most women. So, no need to wait!

There is evidence that BMI at the extremes (<18.5 and >30) is correlated to higher rates of subfertility, miscarriage and pregnancy complications including fetal growth restriction. Being under or overweight can affect the necessary hormone balances thereby affecting ovulation. There’s some really helpful information here: https://modernfertility.com/blog/weight-bmi-fertility-pregnancy/

Private health insurance takes 12months to commence for pregnancy. Ideally waiting 6-7months is best so that you have active obstetric cover from around 32 weeks!

Your GP is a great first contact once you are pregnant- they can help assist you with arranging a referral as well as organising early blood tests and ultrasounds. If you have chosen an obstetrician prior to pregnancy then your GP can provide the referral for you.

You can have the whooping cough pre-pregnancy however it is recommended to have it in pregnancy (from 20 weeks onwards) as this will help boost antibody production and the transfer of your antibodies across the placenta to the baby. These antibodies will then be available to support the newborn and result in an increased immune response if they are exposed to Pertussis.

Yes its safe to take additional Vitamin D and Elevit. You might need to add an iron tablet in in later pregnancy as well.

There’s no known safe amount of alcohol in pregnancy and it is recommended to limit your intake when you’re trying to conceive. Less is best!

The simple answer is that its never too late! Its probably most important to re-commence them after delivery!

It may take several months for your cycle to return to a regular pattern (it’s hard to predict). I would recommend seeing your GP or O&G specialist in the next few months if your cycle is still irregular.