When To Start Trying For Baby #2

If having a second child is something on your mind or in your heart, then this article is for you.

Dr. Anu Kathiresan

Dr. Anu Kathiresan

There is so much to consider when it comes to planning for another child.

When is the best time to start trying? What if you are still breastfeeding? How long should you wait if you just had a baby? Will your age matter? What if it takes longer than expected?

These are just a few of the questions and factors that play an important role in your decision to expand your family. Luckily for us, fertility specialist Dr. Anu Kathiresan is here to help us navigate this huge topic and put together a game plan.

What are some things women should consider before trying for baby #2?

A few things to keep in mind when trying to conceive include starting a prenatal vitamin with 400mcg of folic acid at least 1 month prior to trying to conceive. This is important to minimizing the chances of a preventable birth defect called a neural tube defect. I generally encourage a healthy lifestyle with a well balanced diet and exercise to maintain a healthy body mass index (BMI) before trying to conceive. It is also important to avoid smoking and drugs, to minimize alcohol and caffeine (<200mg/day), and to avoid commercial lubricants. In addition, it is good to avoid fish high in mercury, unpasteurized dairy products, cold cuts, and raw fish.

When should women start trying for baby #2?

This depends on multiple factors: the female partner’s age, family planning goals for the couple, and how long the mother wants to breastfeed. Women may choose different lengths of time to breastfeed depending on their personal preference or circumstance. Given the many benefits of breastfeeding, it is generally recommended to breastfeed for at least 6 months. As women get older (i.e. over the age of 35), the couple may want to consider resuming trying to conceive after this 6-month breastfeeding time frame because it does become more challenging to conceive as women age. Similarly, if the couple wants to have 3 or 4 kids, the reproductive lifespan has a limited time window, so it is a good idea to start trying to conceive sooner to allow more time to have more kids in the future.

Does method of delivery affect the amount of time you should wait?

If a woman had a vaginal delivery, she can resume having intercourse as early as 6 weeks after the delivery. The most important factor dictating when she could start to try to conceive again will be how long the woman would like to breastfeed and the woman’s age. If the woman is over the age of 35, she may want to consider resuming trying to conceive after she finishes breastfeeding and when normal menstrual cycles recommence.

If a woman had only one prior cesarean section (CS), the woman may be a candidate to have a vaginal delivery with her second pregnancy depending on the initial reason for the CS. For example, a woman who had a CS for a breech presentation is a good candidate for possible vaginal delivery with her second child. In this circumstance, waiting longer to conceive (approximately 19 months) will help to increase to chances of having a successful vaginal delivery after CS. However, with this long time interval, there is also a decline in ovarian reserve that may cause it to be more challenging to conceive. Therefore, in woman over the age of 35, we sometimes need to balance the wait period with the risk of decreasing ovarian reserve. It is good to talk to your OBGYN or fertility specialist about this in advance so you already have a plan in place on how long to breastfeed and how long to try to conceive on your own before seeing a fertility specialist, especially if you are over the age of 35.

Does the amount of time it took to conceive your first child have any bearing on what the experience may be for round 2?

Yes, if it was difficult to conceive your first child, it may be even more difficult to conceive the next child. The reason is a woman will be starting her attempts to conceive at an older age and with a lower ovarian reserve compared to when she conceived her first child.

When should a woman seek help if they are not having success getting pregnant?

When trying to have your second baby, there are a few things to keep in mind about how long to try on your own and determining when you might need to see a fertility specialist. Anyone who has a history of irregular cycles (cycles that come < every 25 days or > every 35 days) or no periods, endometriosis, known or suspected uterine or tubal problems, or their partner has known or suspected male fertility problems should be seen right away when they start trying to conceive. These patients already have a known or suspected cause of infertility and will need an evaluation and likely treatment in order to conceive.

Otherwise, assuming menstrual cycles are regular and there are no known causes of infertility, women under the age of 35yo can try to conceive for 1 year before seeing a fertility specialist. Women over the age of 35yo should be seen after 6 months of trying to conceive. Women over the age of 40yo should be seen by a fertility specialist sooner rather than later.

 
It can become more challenging to conceive with advancing age and decreasing ovarian reserve.
— Dr. Anu Kathiresan
 

What are the next steps a doctor will take, if a woman is having trouble conceiving? (What is the process like and the things they will be checking for?)

The first visit with a fertility specialist includes meeting with the physician, reviewing your history, doing a vaginal ultrasound, and discussing the workup. The workup typically includes blood work (ovarian reserve testing and preconception labs), a semen analysis, and a HSG (which is a dye test to look at uterine and tubal anatomy).  The couple will then meet with the fertility specialist again approximately 3 weeks later to discuss the results of the workup and review treatment options.         

What are the fertility treatment options for most women?

The two most common treatment options are: intrauterine insemination (IUI) and in vitro fertilization (IVF). In an IUI cycle, women are usually given medications such as clomid, letrozole, or gonadotropins to induce ovulation or to increase the number of eggs produced. When follicles (fluid filled sacs which contain an egg within it) reach the right size, ovulation is triggered with an injection, and an IUI is planned approximately 36 hours after. An IUI is a procedure where sperm are washed and concentrated and placed at the top of the uterus with a small catheter. This will position the sperm closer to the eggs and hopefully increase the chances of the egg and sperm meeting and resulting in a pregnancy.

In vitro fertilization has higher pregnancy success rates and involves a series of steps. First, a woman will undergo stimulation of the ovaries with injectable medications with the goal of stimulating several follicles/eggs to grow. Once the follicles reach the appropriate size, ovulation is triggered with an injection, and an egg retrieval is scheduled 36 hours after the trigger injection. An egg retrieval is a minor surgical procedures performed under mild anesthesia with ultrasound guidance. A small needle is introduced into the ovary and the fluid and egg within each follicle are aspirated out one by one. The eggs retrieved from the ovaries will then go to the IVF lab. The male partner also provides the IVF lab with a sperm specimen the same day as the egg retrieval. Each egg will then meet the sperm in a petri dish in the lab. Once fertilization occurs, an embryo is made, which will then grow in the lab for a period of approximately 5-6 days. The embryo will then be either placed back into the uterus or frozen for transfer into the uterus at a later time.

What are some things to consider when deciding which one is best for you?

The main factors to consider when choosing a treatment option are the woman’s age, ovarian reserve (or ovarian function), duration of infertility, if there are multiple infertility factors, and the type of infertility diagnosis. For patients to be considered a candidate for IUI, the fallopian tubes must be open and there must be sufficient number of sperm in the sperm specimen. If the tubes are not open or the sperm numbers are low, then IVF may be the more appropriate treatment option. It is also important to understand the success rates for both IUI and IVF when deciding on which treatment may be right for you.

If someone does decide to pursue IUI or IVF, what is your advice to them to help them have a successful experience?

A good starting point is looking on the internet to see which infertility providers near you have good online reviews. It is also reasonable to meet a few physicians and see which provider you are most comfortable with.

I would also advise patients it is always better to seek assistance from a fertility specialist sooner rather than later. It can become more challenging to conceive with advancing age and decreasing ovarian reserve.

Dr. Kathiresan has extensively published in many peer-reviewed scientific journals and has received several awards for her research achievements. Her work extends beyond the walls of her office so she can continue her mission to educate women about fertility and our ever changing bodies. You can find her on Instagram, YouTube, and there’s a lot of great information in this “Fertility Friday” video series.

Thanks again to Dr. Kathiresan for taking the time to educate readers of The Mom Report on this incredibly important topic!

 
 
Kellie Smith1 Comment