Mom's Day Monday: Is the baby bed ready? Don't Just Crochet A Blanket, See Your Gyno!

The baby bed may not be ready when you go to have a baby. there are many issues: have you had a prior pregnancy, miscarriage, have been told you have an abnormal uterus or just unsure? When you are tying for pregnancy the obvious question is 'do I have a fertile uterus?' This might mean a normal shaped cavity, or the absence of any tumors like fibroid tumors, but the lining itself needs to be healthy for a embryo to implant and grow and form it's placenta. Trying to figure out if the uterus is ready for implantation of the embryo, should it manage all those negotiations of fertilization and leaving the fallopian tube, to finally show up to implant in the endometrium or lining tissue  has been tricky business. Pelvic examinations, pap smears and just the normal cycles of a woman can show that a lot is working well but they do not accurately predict the health of the uterine lining. We shed our lining each month, but stem cells from the base layer of the uterus regenerate it once it is shed, from a thin of about .5 to a thickness of about 5.0 mm. It is also important for that lining to be a the right hormonal phase so it is maximally hospitable to the embryo. Not only that but special K cells (Kornchenzellen)appear in the endometrium that are important to regulate the immune system to protect a developing embryo from being shed. Then there is the effect of the contour of the lining.  But ultrasound, saline infusion sonography, and x-ray aided dye studies also help. An even better look at the uterus can be performed with hysteroscopy to actually look inside the uterus. Polyps and small fibroids are definitely an impediment to an approaching embryo looking for a docking spot. A more rare condition is something called Asherman's Syndrome which is a layer of scar tissue, that may just be a band within the uterus, a whole layer on the uterine lining, or perhaps even involve the muscle layer of the uterus. Ascherman's is what is created when an ablation is done to prevent future periods, and that is why endometrial ablations like the NovaSure and Minerva are to be done only in women who do not want pregnancy in the future. Infections can also cause Ascherman's. These scars can be very difficult to treat as the uterus has lost it's natural stem cells which should be able to re-form the injured tissues. In a study in JAMA in 2004 Taylor and coworkers were able to use bone marrow cells to be the stem cells for new lining tissues, so newer treatments are coming. An infertility treatment cycle depending on exactly how it is planned can be arduous. So the bed better be made if company is coming, and for getting ready to be pregnant your gyno wants you to do more than just crochet a blanket. She wants to check the baby's 'bed' for that first 9 months! And if things aren’t what they should be, and you’ve gone through all the tests above, you can use ovarian clues to whether enough hormone is around to get that lining nice and lush.. We can look at the estrogen levels, both early and later in the cycle. If they rise quickly to over 150 pmol/l on day three there is a good chance of pregnancy. Although doing a progesterone level and taking a pregnancy test are both better actual predictors of that successful pregnancy!