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(October 2004) We're delighted to share this article by Melanie N. that she wrote and developed as she considered having a child! It's an excellent for patients and couples considering starting a family. Always carry hope in your heart and remember that thousands of IC patients have successfully had children, become mothers and grandmothers.

Considering Pregnancy

• Step 1: Making The Decision
• Step 2: Planning for Pregnancy
• Step 3: Learning When and How to Get Pregnant
• Step 4: Baby Making

If you are considering pregnancy and you have Interstitial Cystitis, these are some of the issues that you may face. Write down your questions and concerns and discuss them with your partner and medical care providers. Explore the resources available to you: talking with friends and family, reading books, surfing websites, asking your doctors questions, etc.

Step 1: Making the Decision of a lifetime
Keeping perspective: Pregnancy is for nine months. Parenting is a lifetime commitment.

Here are some of the questions that I explored with my husband. I can't answer these for you.... and it's important that you think about it honestly and openly. They can be tough questions. So, write down yours and and then sit down with your husband and talk about them. Don't rush!

• Do we want to be parents?
• Do we want children?
• Are we willing to change our lifestyle?
• Can we afford children?
• Will we make good parents?
• Do we have family, friends or neighbors who can support us?
• Will both parents work? Who will be the primary care giver? Who will be the primary
• Financial supporter?
• Can we afford childcare?
• What does our health insurance cover?

Here are some of the IC questions that I was worried about and took the time to ask my doctors and other patients.

• Which medications would I have to stop? How far in advance?
• If sex is painful, how will I handle the increased sexual activity?
• Will my IC get better or worse or stay the same during pregnancy?
• Will my pregnancy be considered high risk because of IC?
• What will childbirth be like for me? Is vaginal or cesarean preferable with IC?
• Will my OB/GYN really understand all aspects of my IC?
• How will my Urologist be involved in my pregnancy?
• Do I want to breastfeed?
• Can I be a good mom with IC?
• Can I physically and emotionally handle caring for an infant (then toddler, then child) with IC?
• As my child ages, how will I explain about my illness?
• How will my child feel about having a mom who is sick often?
• Will we need to hire help and can we afford it?
• Will I be able to find the time to continue ongoing treatments (bladder installations, physical therapy, etc)?
• How will I care for my child when my IC is flaring?

If you choose to start a family, keep reading….

Step 2: Planning for Pregnancy

Make appointments with every doctor or medical care provider necessary. This could include your OB/GYN, Urologist, Primary Care Doctor, Pain Specialist, Psychiatrist, etc. This is also a good time to get physicals, annual GYN exams, dental cleanings and x-rays, etc.

Go to these appointments prepared. Take a list of all your medications and treatments, how often you take them and for what reasons. Ask your doctors which meds are safe during pregnancy and which are not. If there are meds that you must stop, find out when you must stop them (prior to conceiving, once you confirm pregnancy, etc). You may also want to ask which meds are safe during breastfeeding. Be advised that you may get different opinions from each doctor.

You and your partner can weigh the pros and cons of each medication. Then you can choose which medications to stop and when.

Ask your doctors what IC treatments are acceptable to use during pregnancy. This information can be especially helpful if your IC flares during pregnancy.

Ask your OB/GYN and Urologist about prenatal vitamins. Folic Acid, Calcium and Iron are the most important nutrients that may need to be supplemented. It is advisable to start taking Folic Acid before getting pregnant.

Many IC patients have difficulty taking vitamins. One major source of problems is Vitamin C which can be very acidic and irritating to the bladder. Look for vitamins that have less acidic forms of Vitamin C (like Ester-C). Another irritant in vitamins can be the dyes and additives. Look for more natural alternatives. Your OB/GYN may give you several samples of prenatal vitamins.

Step 3: Learning when and how to get pregnant:

Do you know when to time sex? Do you really know when your body ovulates? Are your cycles always the standard 28 days long? Do you always ovulate on day 14? Are you (or were you) taking meds that was delaying or preventing ovulation? When do you have to stop the pill before TTC (trying to conceive)?

Step 4: Baby Making

Okay let's face it, if you have IC, sex isn't always easy. In fact, sometimes it's downright painful. So now you want to get pregnant and that means you have to have a lot more sex. Well, atleast you have to have a lot more sex at a certain time of the month. Here are a few tips that you may find helpful.

Physical therapy
PT isn't right for everyone, but if you experience pain with sex it may be worth trying. Ask your Urologist or OB/GYN for a referral. As part of PT, it's important to do Kegels. It's often helpful to have an object to contract against. Your physical therapist can supply you with a vaginal dilator, a small plastic rod that you can insert. Your therapist can also give you a "Mr. Frosty", a condom filled with ultrasound jelly that you can discreetly store in my freezer. Or you can make one by filling a condom with KY jelly. It's used after sex to cool down the vaginal tissues. Read more about pelvic floor therapies in the handbook!

During Sex

• Foreplay. It's necessary to loosen up and lubricate those pelvic muscles and vaginal tissues. Plus it's fun!
• Communication. Keep in mind that baby making can be a bit different than love making. Be sure to communicate with your partner about this transition.
• Lubrication. Some lubricants have been proven to kill sperm, including KY Jelly. Granted, you wouldn't want to rely on them as a contraceptive, but they could hinder your ability to conceive. There is some debate about whether or not Astroglide is sperm friendly. There is a product on the market called Pre-Seed that is recommended for TTC, but there are mixed reviews and it is quite pricey and difficult to find.
  
  Egg white is recommended because it is most like our natural cervical fluid that's present just before ovulation. Yes, plain old egg white, although you might want to look for pasteurized eggs which are available in most grocery stores these days. Simply separate the egg and discard the yolk. It helps to allow it to warm up to room temperature. You can use a small syringe (no needle) to insert it in the vagina. Many women, who struggle with fertility or simply don't produce enough quality cervical fluid, highly recommend using egg white. And let's face it, lube is usually necessary with IC.
  
  
• Positions. Certainly some positions allow deeper penetration and more probability of the sperm reaching the egg. For example, missionary position is considered best and woman-on-top is often considered worst. However you must weigh this against which positions are most comfortable for you. Experiment and have fun!

After Sex

• Void as soon as possible. You may want to consider waiting 10-20 minutes to allow the sperm time to travel up, but there is debate whether or not that's necessary.
  
• If you are prone to UTI's, ask your Doctor about taking a preventative antibiotic after sex.
  
• Both of you should consider showering before and after having sex. At the very least, have your partner wash his hands before sex. A removable showerhead is most helpful for cleaning up afterwards and preventing the spread of bacteria.
• When to test? Some home pregnancy tests claim you can test up to 5 days before your expected period. But remember that they are NOT 100% accurate that early. Try not to stress and remember that you can always try again next month (that's half the fun after all!)

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