The RA Pregnancy Chronicles is a series of posts that share my experiences being pregnant while living with RA.
RA is a disease that disproportionately affects women and girls. According to the Arthritis Foundation, there are nearly three times as many women living with RA than men. Many of these women are diagnosed with RA in their 20s and 30s. There are also 300,000 children growing up with juvenile arthritis, and more than half of them are girls. These young women and girls will need to figure out how to start their lives – and families, if they want them – while also managing their arthritis.
Deciding to start a family can be a complicated decision for any couple, and there’s no question that throwing RA into the mix can make family planning even more complicated. In the past women with RA were often discouraged from getting pregnant, but luckily today most women with RA can have a successful pregnancy with careful planning. A positive attitude and a sense of humor helps a lot too!
If you have RA and are thinking about starting a family, here are some things you should consider and some tips that might help:
Stopping Your Medications
The very first thing you should do if you have RA and would like to get pregnant is to talk to your rheumatologist about the medications you are currently taking. Unfortunately, most medications used to treat RA are not safe to be on while you are pregnant or nursing. Additionally, while some medications may be safe to stay on until you discover that you are pregnant, others may need months to get out of your system before it is safe to conceive.
For example, methotrexate, a disease-modifying antirheumatic drug commonly used to treat RA, falls squarely into Pregnancy Category X. This means that having methotrexate in your system while pregnant can cause fetal death or malformation of the embryo. (In fact, methotrexate is sometimes prescribed to purposely terminate ectopic pregnancies.) Methotrexate also stays in your system for months even after you stop taking it. It is really important to your rheumatologist about how far in advance you will need to stop taking methotrexate before trying to get pregnant.
Each medication used to treat RA will have its own impact on the health of your pregnancy, so it is important to make sure you clearly understand your doctor’s instructions regarding which medications you will need to stop taking and when.
Dealing With Untreated RA
Unfortunately, stopping your RA medications is often a lot easier said than done. Honestly it isn’t an easy process – physically or emotionally. If you are lucky enough to have found medications that are effective then you are used to the benefits they provide your everyday life. When you stop taking these medications you’ll have to face the fact that you will be dealing with partially treated – or completely untreated – RA. This can be scary, frustrating, and discouraging. For me it brought back really unpleasant memories of how I felt prior to my diagnosis.
I made the decision to stop taking most of my RA medications several months before my wedding, so that my husband and I could start trying to conceive as soon as we were married. And I’m not going to lie – it was not easy for me. I had to deal with a lot more pain and fatigue than I was used to at the time, even at my own wedding and on my honeymoon. It was also scary to loose the sense of stability I had fought so hard to regain during the years of searching for an effective treatment.
I got through this difficult transition period by focusing on the fact that this time it was my choice. I was able to consider all the pros and cons before accepting the additional pain and fatigue into my life. And it helped me to know that anything I suffered through was an investment in the future of my family, necessary to the achievement of our goal of having a baby. It also helped that I had unshakable support and encouragement from my husband. So while it was scary and difficult, I am living proof that it is possible to do – even more than once! – particularly with enough love and support.
The Act of Conception
Most of us know that even fully treated RA can sometimes make sexual activities uncomfortable or even impossible. Contemplating intercourse while dealing with untreated or partially treated RA can seem like a completely overwhelming task. But of course it is completely necessary for getting pregnant in the first place! It is really important to talk to your partner to make sure that he understands the difficulties that you are facing and is willing to support you so you can achieve your shared goal together. To deal with pain and fatigue, it may also help to prepare for sex and time it so you won’t be overly tired from other activities. Here is some expert advice for dealing with sex and RA.
Improve Your Odds
To conceive a baby you obviously need to have intercourse around the time that you are ovulating. But did you know that your egg is only ready to be fertilized for about 12 to 24 hours each month? Luckily, sperm are able to live anywhere from three to six days, so that gives a slightly bigger window of opportunity, but it still makes sense to have a good idea of when you ovulate so that you are able to give yourself a better chance of becoming pregnant.
So how do you know when you are ovulating? There are lots of methods for figuring it out. I chose to start by tracking my periods using an app on my phone. All I had to do was input my menstruation data for a few months and then the app helped me predict when I would ovulate (and I would say it was fairly accurate as it helped me get pregnant twice!) You can also chart your basal body temperature first thing every morning using a special thermometer to watch for the serge in your hormone levels. Or you can get to know your cervix as it changes texture and location slightly as ovulation approaches. And if you don’t want to mess around you can always buy an ovulation predictor kit, though these can be a bit expensive to use every month.
Another thing you should consider when trying to conceive is the use of artificial lubrication. While using lube is generally a great option to make sex with RA easier, many sources agree that lube can slow sperm, making them more likely to die before reaching the egg and, thus, making you less likely to end up pregnant. There is one “fertility friendly” lube on the market, called Pre-seed (possibly the worst name ever?) I can say from experience that it is effective as lubrication and doesn’t seem to inhibit pregnancy as we conceived both of our babies while using it.
Be Patient; Stay Optimistic
Getting the timing exactly right to conceive a baby can take time, even for perfectly healthy couples. According to a study published in the journal Human Reproduction, most couples are able to conceive within six cycles by using timed intercourse. But it also is important to remember that when dealing with complications like RA conception may take a little longer. For us it took four months the first time and seven months the second time, and I must admit there were a few months during our second attempt where my RA was so bad we weren’t able to “try” at all.
During this potentially long process of trying and waiting it is really important to remain as patient and optimistic as you can. If you start to get discouraged it can make “trying” seem like a chore – and that’s no fun for anyone involved. However, if you have been trying to conceive for more than a year without success it may be time to see a fertility specialist. It is also really important to seek professional help if you get discouraged to the point of depression.
No matter what happens on your path to starting a family, make sure to remember that you and your partner are partners. And that you love each other! Happy baby making!