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First delivery c-section due to progression of labor. Planning for second pregnancy. What supplements should I take?

Mar 2013
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Practicing since : 1998
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I turned 43 in july this year. I had my first child when i was 29 through C section due to non progression of labour . I m interested in having second one. What supplements should I have apart from Folic acid? How many hours of exercise will boost fertility? and finally what are the odds of me having a normal delivery? and also what genetic testing should we get done? I m Rh-ve and husband isRh+ve. I got my injection after my first child was born . She is Rh+ve.

Posted Sun, 3 Nov 2013 in Getting Pregnant
Answered by Dr. Aarti Abraham 42 minutes later
Brief Answer:

Detailed Answer:
Hello Mrs. XXXXX
Thanks for writing to us with your health concern.
At 43, firstly the odds of conception are very less, the odds of having a normal delivery are next to nil, with a previous C section.
Firstly, please consult an Infertility specialist.
Have thorough assessment of Ovarian Reserve, that is , the capacity of the ovaries to produce good quality and number of oocytes ( eggs ).
At 43 , this capacity drastically reduces.
Ovarian Reserve is tested by estimation of AMH anytime in the cycle.
Also, estimation of FSH and LH on day 2 of the menstrual cycle should be done.
In addition, baseline ultrasound on day 2 of the cycle will show the AFC ( antral follicular count ) that is basic number of eggs contained in each ovary.
After this, if your ovarian reserve is alright, you would still need follicular monitoring ( ultrasound throughout the menstrual cycle ) to know if you are ovulating regularly.
Give yourself maximum 3 months of trying naturally if ALL these tests are normal ( my guess is they wont be ).
If they are abnormal, please think of using ART ( assisted reproductive technologies ) which will greatly increase your chances of conceiving at this age.
As far as genetic testing is concerned, there is no need of any testing BEFORE conception, only after conceiving ( if you get pregnant with your own eggs, without using donor eggs ), then thorough genetic testing in each trimester as per guidelines should be done, as at this age, risk of Down's syndrome etc in the baby increases.
Exercise for atleast 30 minutes daily for 5 days a week.
Eat sensibly and take DHEA supplements if Ovarian Reserve is documented to be suboptimum.
Take care.
Please feel free to ask for further clarifications.
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