Fertility

Sometimes the biology of woman makes her vulnerable to mean criticism.  This is particularly problematic if she conceives within the first month of her marital life.  If the husband and in-laws understand she will have a peaceful life.  Otherwise she will be subjected to mental trauma. 

Once, a newly married couple had come to me.  Parents-in-law also accompanied.  Young bride was shy and sat silently.  Mother-in-law told me that the girl was supposed to get her periods that week but did not get it.  I asked for pregnancy test and pregnancy was confirmed.  Except the girl there was disbelief in all others’ face.  The boy said he is married just three weeks ago and doesn’t want to have children so soon.  He expressed his doubt that how can a pregnancy occur so early and what could be the duration of pregnancy.  I understood that he is suspecting the girl’s fidelity.  He opted for a scan.  The scan was showing early gestational sac, with a fetal node – suggestive of early pregnancy of 5-6 weeks.  Now all he wanted to know if that marriage had taken place only three weeks ago how can she be more than 5 weeks pregnant.  That is a genuine doubt.

In obstetrics we count pregnancy duration – gestational age, in weeks.  This is counted from the first day of bleeding of menstrual cycle (MC).  The onset of bleeding in a MC is clearing of  the old endometrium (inner most layer of uterus which lodges embryo, nourishes in early stages and develop attachment to placenta to sustain fetus until delivery).  New endometrium starts developing along with ovum in the ovaries.  The changes in ovum that is to be released and fertilized, and endometrium so as to provide nutrition in case of successful fertilization and implantation of embryo that happens in the 3^rd week of MC.  The normal MC is 28 days cycle.  It could vary a few days – 26 to 30 days.  In a 28 day MC ovum is released on 14^th day.  If the cycle duration is more it may be delayed, in a shorter cycle it may be early.  In general, in normal MC the fertile period – chance of conception is from 12^th to 16^th day.  The first two weeks of preparatory period is also added when pregnancy dating is done.  So getting married in the 3^rd week of MC and being diagnosed to have 5weeks pregnancy a week after missing periods is perfectly normal.  There is nothing to suspect any mischief by the girl.  Though obstetrician explains the newly weds and their family the biology of conception and dating, few still doubt.   Illogical doubting spoils future togetherness.  It is good to have scientific understanding of ovulation, fertility and dating of pregnancy which will help in future family planning.

The fertility period in a woman with regular MC of 28 to 30 days is 12^th to 18^th day of MC.  First day of bleeding is considered as first day of MC.  Contraceptive methods are used to prevent either release of ovulation (OC pills) or prevent contact of sperm with ovum (barrier methods, abstinence), or prevent implantation (Intra uterine devices, emergency pill).  This awareness of fertility period in the woman helps to prevent unwanted pregnancy and improve health of woman.