To reveal or not to reveal: That is the question!

To reveal or not to reveal: That is the question!

by Prati A. Sharma, author on The Conception Diaries Prati A. Sharma 15 January 2017

After all the poking, the meds, the monitoring and many two-week waits, you finally get the news! It worked! You are pregnant! The test is positive!

Now, while your initial instinct may be to text every one of your iPhone contacts and post the beta level on Facebook, after the initial “Wow,” most of us take a step back and think, “Now what?”

When do you tell family and friends? When do you reveal to your workplace?

These are very common questions that we as fertility doctors are asked on a daily basis. There is not one correct answer. Often, it’s a personal choice.

You may want to tell your close friend or parent about the positive test to have someone to share the every-two-day mini-hurrah with for appropriate doubling levels, or you may feel better not being bothered about whether you are eating enough in the initial phases and just share the secret with a select few.

Many patients ask, “When do you know if the pregnancy is a ‘good’ one?”

Miscarriages usually occur early on, usually in less than 12 weeks, and in 15 to 30% of all pregnancies. They do, however, increase with age, and at 42 the miscarriage rate can be up to 50%.

Genetic abnormalities are also a possibility, and usually this risk is what worries patients most. Down syndrome risk is 1 in 250 at the age of 35 and rises steadily afterwards. Fortunately, there are accurate screening tests to quantify these risks.

The NIPT (non-invasive prenatal screen) is a new blood test that can be done at around 10 weeks, and it is 99% sensitive for the three types of Down (Trisomy 13, 18 and 21). It is covered by OHIP for those women who will be 40+ at delivery, and for younger patients it is approximately $500.

At around 12 weeks, under OHIP coverage, all pregnant patients undergo an NT (nuchal translucency), followed by IPS (integrated prenatal screen) blood work.

These tests are about 85 to 900% sensitive in detecting for Down syndrome risk. Although certain patients may need an amniocentesis or CVS (chorionic villus sampling, where the placenta is sampled) to 100% determine genetic risk, these are more invasive tests that carry a loss risk to the pregnancy of 4 to 5%.

Fortunately, with the really accurate non-invasive tests we have now, having to undergo one of these invasive tests is rare.

Can we know the gender? You are pregnant and ready to decide between the pink versus blue wallpaper and start nesting! And, of course, you’re ready to plan your gender-reveal party! So, when will you know boy or girl? Usually patients will find out at the 18 to 20 week anatomy scan, but with the NIPT blood test you can find out the gender by 12 weeks, if you opt to do this test.

So, as fertility specialists, we say, resist the urge to speed-dial your contact list or send out a tweet, and pause and take a deep breath till 12 weeks, when the genetic screening is usually complete, and then feel free to reveal!