What tests need to be taken after a frozen pregnancy?

A frozen pregnancy is an abnormal cessation of fetal development, which most often occurs in the early stages of pregnancy. The loss of a child due to any violations entails a huge number of consequences. Firstly, with a frozen pregnancy, curettage of the uterus and subsequent therapy are inevitable. Secondly, women's tears and fears about the further chance of having a baby.

To avoid a repetition of the unpleasant situation, it is necessary to establish the cause of the pathological process and identify health problems in the woman. To do this, the patient must go through a difficult but extremely necessary path, which begins with therapy and subsequent full clinical examination.

Preparing for a new pregnancy

After an unsuccessful pregnancy, a woman wants to get pregnant again and finally realize herself as a mother. But doctors strongly recommend waiting at least six months before conceiving again. This is true, because in this situation you should not be guided by emotions, because a weakened body requires time to recover.

When planning a new pregnancy, approach carefully and follow two points:

1. Talk to your gynecologist and consult with an endocrinologist to confirm the number of necessary tests that should be taken after fetal death.
2. The upcoming pregnancy must be planned.

If the married couple has finally decided to expand their family, now all that’s left to do is find out what tests need to be taken in case of a missed pregnancy.

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When can you start planning for another pregnancy?

After an unsuccessful pregnancy, the body needs rehabilitation. Gynecologists suggest not to rush into conception, but to wait at least 6 months. This period is determined by the body’s need for recovery. Violation of this deadline may lead to a new failure. Although there have been cases when a woman successfully became pregnant after 3-4 months. After all, everything is individual. During this time, you can have time to undergo a full examination and, if necessary, treatment. You should know that about 85-90% of women who suffered a frozen pregnancy were able to become pregnant again and give birth.

Where should you start preparing for another pregnancy?

Before deciding to conceive again, you should undergo all the necessary tests, because infections disrupt the proper development of the fetus and cause various anomalies that provoke its death.

Pregnancy preparation includes:

• consultation and examination with a gynecologist;
• Ultrasound of the pelvic organs;
• genetic testing;
• taking tests to determine a woman’s hormonal levels.

Preparing for conception involves not only passing all the necessary tests, but also strengthening the health of the expectant mother. You should exercise, eat right, take vitamin complexes, get enough sleep and avoid even minor stressful situations. After carrying out all the necessary preventive and medical procedures, the gynecologist will be able to choose the most favorable time for conception.

Hormonal status is the most important component of a successful pregnancy

Hormonal imbalance is far from a harmless phenomenon; behind it lies serious dysfunction of the body. To determine hormonal levels, blood tests are performed in laboratory conditions. Based on the data obtained, the doctor can determine the condition of the woman’s reproductive system and, if necessary, prescribe appropriate treatment.

It is mandatory to submit:

• follicle-stimulating hormone, which is responsible for ovulation. Its maximum level can be observed in the middle of the cycle.
• luteinizing hormone. It stimulates the production of prostegerone, which is considered the main hormone of pregnancy.
• prolactin. The hormone plays an important role in ovulation. Obstetrician-gynecologist about prolactin when planning pregnancy.
• estradiol Responsible for preparing the uterus for pregnancy.
• progesterone.
• testosterone.
• for 2 or more missed pregnancies - analysis for homocysteine. An obstetrician-gynecologist on the importance of homocysteine ​​when planning pregnancy.

Not only the woman, but also the future father should undergo examination. He must undergo a consultation with a urologist, and also take a spermogram to determine fertilizing ability. Usually, during the recovery period after fetal death, a woman is prescribed hormonal medications to restore the balance of hormones.

What tests should be taken?

Conceiving a child always involves a thorough examination of two partners at the same time.

• The first thing you should do is take a blood test for various hidden infections. If possible diseases are detected, undergo a full course of treatment, and only then begin conception.
• Often a couple needs to consult an endocrinologist and undergo some endocrine tests. Having such an analysis, in any case, will not hurt, and if it turns out that the pregnancy was terminated due to hormonal deficiency, it will even be a priority.
• Thyroid hormones, arriving outside the normal range, can cause a number of complications, ranging from early toxicosis to intrauterine hypoxia of the embryo.
• If fetal fading occurs due to a genetic mutation, then you should make an appointment with a geneticist who can finally find out the reasons.

But do not forget that the main specialist is a gynecologist. It is he who, if necessary, will refer you to the right doctor, based on the results of the tests obtained.

Questions for a specialist

Question: What is the risk of repeated embryo death if the first pregnancy was frozen. What examinations need to be taken and passed to prevent this?

Answer: If the first pregnancy is frozen, then the risk of subsequent fetal death during pregnancy is about 20%. Each subsequent frozen pregnancy increases the risk of recurrence of this situation.

To avoid this, you should not rush, you need to restore your physical and emotional state, get tested, find out the cause of the problem and try to eliminate it. The exact list of tests is prescribed by the doctor who is treating the couple.

Question: What factors can affect the death of the embryo and how to avoid them?

Answer: To reduce the risk of developing this pathology and embryo death, conception must be planned, i.e. take tests for infections, check for the presence of inflammatory pathology, give up bad habits, etc. It should be remembered that some medications increase the risk of embryo death, for example, aspirin.

All these recommendations cannot guarantee to protect you from this condition, but they will significantly reduce the possible risk.

Question: How long after can you try to get pregnant again if the first pregnancy ended unsuccessfully (the fetus died at 6 weeks).

Answer: If the cause of the death of the embryo was a genetic anomaly, then six months is enough for you to recover and try to become parents again. If the cause of a missed abortion is still unclear, then you should wait and be thoroughly examined. If the cause is an infection or other problem, it should be eliminated and only then try to get pregnant again.

Question: When can I start training in the gym after a frozen pregnancy?

Answer: If you have a miscarriage, it is recommended to return to physical activity no earlier than after a month. At the same time, monitor your diet and, if necessary, take a course of vitamins.

A frozen pregnancy is a difficult test for a couple. Sometimes it is just a genetic accident, and sometimes it is the irresponsibility or ignorance of the spouses about their diseases. To prevent this, it is better to plan conception and undergo all the necessary examinations in advance.

When is the best time to conduct an examination?

There are several recommendations that you should rely on when preparing for a new pregnancy:

• Tests are taken after the cycle is restored. From the day of curettage to the first day of menstruation, on average, 25 to 30 days pass.
• In the first cycle, they are examined for various TORCH infections (cytomegalovirus, toxoplasmosis, herpes simplex, rubella, syphilis, hepatitis B). If none of these infections have been detected, the gynecologist will recommend vaccination against rubella, which should be done several months before the planned conception of the baby.
• For preventive purposes, you should stay in the same room with cats as little as possible and avoid street animals.
• In the second phase, they safely donate blood for hemostasis.

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The gynecologist takes various smears a month after stopping the antibiotic drugs that were prescribed after the cleansing. Hormonal tests are taken during the second cycle of menstruation. Tests required for both spouses

• Testing for genital infections such as chlamydia, ureplasmosis, mycoplasmosis, candidiasis. This diagnostic process is very important, because most unsuccessful pregnancies occur due to a woman contracting a sexually transmitted infection. Analysis is necessary for both partners in order to prescribe synchronous treatment, which only in this case will be effective.
• Donating blood to determine the Rh factor and blood type. It is carried out to exclude or confirm incompatibility according to this principle.
• A test for genetic predisposition should be taken by spouses who have experienced fetal death more than once. And also for couples whose age exceeded 35 years, and those whose heredity was already burdened with genetic diseases.
• Taking a routine general blood and urine test, which will give a general assessment of the health of the expectant parents.
• Blood test for karyotype. This study determines the number of chromosomes that is characteristic of a certain biological type. It is enough to take it once in your entire life, because the indicators of this analysis are unchanged.

Treatment after a frozen pregnancy - strictly individual - Examination

February 22, 2014

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Examination after a frozen pregnancy

If a frozen pregnancy develops again, the woman must undergo a full examination and, based on its results, treatment. First of all, all biological material extracted from the uterus is sent for histological and cytogenetic examination. Histology after a frozen pregnancy allows us to identify hereditary genetic fetal anomalies incompatible with life that led to the miscarriage.

Hidden infectious and inflammatory processes of the female genital organs must be identified. Tests after a missed pregnancy are necessarily carried out for latent sexually transmitted infections (chlamydia, mycoplasmosis, ureaplasmosis) as well as for TORCH infections (toxoplasmosis, rubella, herpes simplex. Herpes simplex - in fact, everything is not so simple, cytomegalovirus infection).

The woman's hormonal background is carefully checked. The amount of sex hormones in the blood (estrogens, progesterone Progesterone - norm and pathology, androgens), pituitary hormones (FSH, LH, prolactin), adrenal and thyroid hormones. Hormones sometimes do not immediately return to normal after a frozen pregnancy.

Genetic studies include karyotype examination, including determination of the frequency of spontaneous chromosomal aberrations (for both spouses).

Based on the results of immunological studies, the issue of compatibility of spouses is decided. A blood test for antibodies to phospholipids in a woman’s blood and a test for blood clotting allows for the timely detection of antiphospholipid syndrome, which is often the cause of missed pregnancy. The causes of missed pregnancy are a complex of factors.

An ultrasound examination of the pelvic organs is required, and, if necessary, an endoscopic (hysteroscopy) and X-ray (hysterography) examination of the uterus and its appendages.

Treatment after a frozen pregnancy

After curettage for a missed pregnancy, the woman’s body needs restorative treatment. Treatment after curettage of a frozen pregnancy is the prescription of antibiotics to prevent infection and medications that help contract the muscles of the uterus (for example, oxytocin), which helps stop bleeding and quickly restore the uterus.

Restoring the body after a frozen pregnancyFrozen pregnancy - don’t lose faith in yourself includes a protective regime (lack of physical and neuropsychic stress), proper nutrition, vitamins after a frozen pregnancy are especially important, as they help restore normal metabolism, and also immunity and hormonal levels. It is also recommended to restore immunity through maximum exposure to the fresh air, and subsequently through hardening procedures and physical therapy or sports.

Rehabilitation after a frozen pregnancy also means treatment of all infectious and inflammatory processes identified during the examination - this can be a long process.

Recovery after a frozen pregnancy is also required by the woman’s hormonal background. For this purpose, hormonal correction is carried out based on the results of a blood test for hormones. In order to give the body a rest and restore hormonal levels, a woman is prescribed combined oral contraceptives (COCs) for 3-6 months, which are selected individually for each woman in accordance with her age and hormonal levels.

What to do after a frozen pregnancy

A frozen pregnancy is not that common and in most cases it is accidental, however, pregnancy immediately after a frozen pregnancy is not desirable - the body must rest and recover. Re-conception after a frozen pregnancy is recommended no earlier than six months later. Therefore, it is advisable to plan a pregnancy after a frozen pregnancy. If you follow all the doctor's recommendations, pregnancy usually proceeds without any complications.

If the frozen pregnancy was not the only one, planning a pregnancy after the frozen pregnancy with a preliminary full examination and, if necessary, treatment is a necessary condition.

Getting pregnant after a missed miscarriage is usually not a problem. But how to maintain a pregnancy after a frozen one is really a problem. But in most cases, if you follow all the doctor’s recommendations, you can cope with it.

If the cause of the current situation was an infectious-inflammatory process of the female genital organs or hormonal disorders, then after treatment with mandatory laboratory monitoring, pregnancy after a frozen pregnancy in most cases is not a problem.

How to get pregnant after a frozen pregnancy, if the cause of miscarriage is hereditary genetic problems, is also known today. The problem can be solved with the help of donor cells, replacing the germ cells of one of the spouses with them.

Childbirth after a frozen pregnancy in most cases is uneventful. If any complication is expected during childbirth, then the doctor delivering the birth draws up a plan for its management in advance. This allows almost any woman to hope for the birth of a healthy child.

Only the attending physician can tell you in detail how to recover from a frozen pregnancy.

• basal temperature during frozen pregnancy decreases;
• The general temperature during a frozen pregnancy may be elevated.

A frozen pregnancy in the second trimester and a frozen pregnancy in the later stages is determined by the cessation of fetal movements.

How to determine a frozen pregnancy - diagnosis

As mentioned above, if a woman finds signs of a frozen pregnancy, an Internet forum, advice from friends and attempts at self-diagnosis will not be the best way out of the situation. Even if the basal temperature is low (with a frozen pregnancy, this is one of the symptoms), if a woman is pregnant for the first time, whether this pregnancy is frozen or not can only be determined by a specialist doctor. By what methods is the diagnosis of “frozen pregnancy” made (in the second trimester or in the early stages and “frozen pregnancy in the later stages”)? 1. Analysis for hCG. The level of this hormone during a frozen pregnancy is lower than it should be during a normal pregnancy at this stage (first or second trimester) - thus, the test will show a frozen pregnancy. However, it must be borne in mind that high levels of hCG can persist for several weeks after the first or second frozen pregnancy has occurred. The fetus froze - but the hormonal levels did not change.2. Ultrasound. If an ultrasound examination reveals a frozen pregnancy, the video “shows” the absence of a heartbeat in the fetus.3. Gynecological examination. Reduced basal temperature during a frozen pregnancy, compliance of the size of the uterus with the duration of pregnancy - all this is determined by the doctor. Also, it is the gynecologist who prescribes the necessary treatment after a frozen pregnancy, prescribes tests after a frozen pregnancy, and determines pregnancy planning after a frozen pregnancy. If a woman is diagnosed with a frozen pregnancy, an Internet forum is unlikely to help in treatment; All prescriptions must be made by a doctor.

Treatment after a frozen pregnancy.

Unfortunately, when a pregnancy ends, it is no longer a matter of preserving the fetus, but of restoring the woman’s health. A fetus that has stopped developing can cause intoxication of the body, so it must be removed from the uterus. Often, in the very early stages, a woman experiences a spontaneous abortion; It even happens that a woman does not suspect that she had a frozen pregnancy; her periods come with a slight delay. If a diagnosis of “frozen pregnancy” is made, treatment is carried out using the following methods: 1. Medication. Used for less than 8 weeks. Drugs that cause miscarriage are prescribed. 2. Vacuum aspiration (mini-abortion). The operation is usually performed under anesthesia using vacuum suction to clean the uterine cavity. It also happens that doctors take a wait-and-see approach; If for some reason a frozen pregnancy occurs, the woman’s body performs treatment on its own, through spontaneous abortion. But in any case, medical supervision is necessary. If a spontaneous miscarriage does not occur, it is necessary to cleanse (curettage after a frozen pregnancy) the uterine cavity. Also, curettage after a frozen pregnancy is necessary if, after one or two weeks, an ultrasound shows the presence of remnants of the fertilized egg in the uterus.

Planning a pregnancy after a missed pregnancy

How can you get pregnant after a frozen pregnancy? When to get pregnant after a frozen pregnancy? This issue is resolved individually in each specific case - depending on the duration of pregnancy, the general health of the woman, examination results, etc. To the question of when to plan a pregnancy after a frozen pregnancy, an Internet forum is unlikely to be able to give a definite answer - only the impressions of women who have had one or even two frozen pregnancies. According to doctors' recommendations, the minimum period is to wait six months. During this time after the diagnosis of “frozen pregnancy”, the consequences of such a pathological condition will decrease. One, and especially two, frozen pregnancies have a negative impact on a woman’s body. It is necessary to carry out a number of preventive measures in order to prevent fetal fading in the future.

What tests should I take after a frozen pregnancy?

Before becoming pregnant after a frozen pregnancy, it is recommended to undergo the following tests:

• blood test for hormone levels (progesterone and estrogen);
• vaginal smear for STDs;
• Ultrasound of the pelvic organs;

After a missed pregnancy, it may also be necessary to conduct a genetic examination to determine the compatibility of partners.

What tests should the expectant mother undergo?

Naturally, when planning a pregnancy, a woman should first of all think about her health, both physical and psychological. A failed pregnancy created some kind of imbalance in the body. Therefore, it is necessary to qualitatively assess the condition of the body and determine its readiness for subsequent pregnancy.

Initially, a number of activities are carried out:

• A smear to determine how favorable the vaginal flora is.
• Ultrasound of the pelvic organs.
• Sampling for bacterial culture from the cervical canal.
• Analysis for a number of thyroid hormones, sex hormones: progesterone level, TSH level, prolactin, testosterone.
• Coagulogram - the results of which reflect the speed of blood clotting.
• Biochemistry analysis.

An example of a coagulogram
There are cases when the above tests are not enough for the doctor, and in order to compile a complete history with further correct treatment, the gynecologist prescribes some additional studies:

An analysis that will exclude the presence of antiphospholipid syndrome in a woman. Through the analysis, you can determine the presence or absence of your own immune system producing antibodies to the fetus. In simple terms, isn’t the body itself trying to get rid of the embryo, perceiving it as foreign?

Analysis for compiling an immunogram, which displays the main indicators in the immune system.

What tests should the future dad take?

The obstetrician-gynecologist observing and preparing the couple will definitely recommend that the man undergo some laboratory tests and studies. This list usually includes:

Spermogram. The main purpose of the examination is to assess the state of men's health, or more precisely, his capacity to conceive. It will also help identify some urological diseases.

The MAR test is the most important method for determining the factor of immune infertility. If confirmed, the man should consult an andrologist.

The main reasons for fetal freezing

Doctors refer to a frozen pregnancy as a stoppage of fetal development within a period of up to 27 weeks. Usually, the stop occurs much earlier, in the first trimester, before 13 weeks. Statistics show that in the world, every eighth pregnancy has such a sad outcome in the form of spontaneous abortion.

The key reasons include several points:

• Infectious diseases severely suffered in the first trimester. Such as chickenpox, rubella, influenza, which could affect a fetus that is not sufficiently strengthened.
• Various genetic mutations in the embryo, which led to freezing.
• Lack of the hormone progesterone, which stimulates intrauterine consolidation and development of the corpus luteum.
• Conflict of Rh factors in mother and fetus.
• Disturbances in the blood clotting system.

External harmful interventions in the form of drug abuse, alcohol and smoking. Moreover, their influence is possible not only when consumed during pregnancy, but also negative consequences are noted many years later.

The main danger of a frozen fetus is that a woman becomes aware of such an outcome when the process of miscarriage has started, when the dead fetus has caused a blood clotting disorder in the uterus and severe bleeding has occurred.

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In such situations, the mother herself is at risk. Often, the body begins to perceive a frozen fetus as a foreign body after a long time, and cannot always reject it naturally. And at this time, the frozen embryo triggers the decomposition mechanism inside the uterus - there is a risk of general infection of the body (sepsis).

The most important point is the timely detection of a frozen pregnancy in order to take the necessary measures in time, in the form of curettage of the uterus, if the body itself has not resorted to getting rid of dead tissue.

Fetal freezing is also detected during routine ultrasound. If the diagnosis is in doubt, then undergo an ultrasound again from another specialist or in another center. But take it seriously and complete the study that day.

If the gestational age is 6-8 weeks, then a diagnosis error is quite possible. But if the examination still shows a frozen pregnancy, you should immediately consult a doctor or the nearest hospital.

Pregnancy after a frozen pregnancy: do not repeat mistakes

May 30, 2014124028 Category: Pregnancy

Unfortunately, not every pregnancy ends successfully - it is not so uncommon for the fetus to die. It is clear that this is always a trauma, primarily for the woman herself. She is interested in how and why this happened, and most importantly, whether a new successful pregnancy is possible after a frozen pregnancy. We will try to answer all your questions in this article.

What is a frozen pregnancy?

A frozen pregnancy is the cessation of fetal development and its subsequent death at a maximum of 28 weeks (most often up to 13, since during this period the connection between the fetus and the mother’s body is still very weak). There can be many reasons.

Experts note that in 60% of cases these are single genetic mutations of the embryo, that is, at conception or a little later, some kind of genetic failure occurred that prevented it from developing further. This happens mainly in normal, healthy parents. If they themselves have any genetic disorders, then the likelihood of mutations in the embryo increases, which means the risk of miscarriage increases.

Other reasons include exacerbations of infectious diseases, bad habits, stress, etc. It is infections (chickenpox, rubella) that often cause pregnancy to fail in the 3rd trimester, that is, in the later stages.

The fact that the fetus has frozen is found out in two cases: during a miscarriage or with the help of an ultrasound. The first option, of course, is psychologically difficult, but in the event of a miscarriage, the body at least gets rid of necrotic tissue in time, but quite a lot of time can pass from the moment the fetus freezes to the first scheduled ultrasound. Read more about frozen pregnancy >

Planning a pregnancy after a missed pregnancy

It is difficult for a woman who has experienced a frozen pregnancy to get used to the idea that she is no longer pregnant, that all expectations are in vain - and therefore many of them immediately ask doctors the question of how to get pregnant after a frozen pregnancy. Be that as it may, you will have to wait, because in such cases cleaning is carried out, and this is not only an unpleasant, but also a rather traumatic procedure. The uterine cavity is scraped out under local anesthesia.

Time must pass, as a rule, at least six months - this is how long it takes to restore the endometrium. After this period, you must undergo an examination by a gynecologist - in addition to other indicators, he must assess the condition of the cervix, which is very vulnerable to mechanical damage and, as a result, susceptible to erosion.

Remember : a pregnancy that follows a frozen one must be planned. This is the only way you can properly prepare and protect yourself as much as possible.

What tests should be taken after a frozen pregnancy?

First of all, you need to find out the reason why the fetus has stopped developing. For this purpose, you need to check for the presence of sexually transmitted infections in the body - they may well have a negative impact on the embryo. You will also need to undergo an ultrasound and blood test to determine your hormone levels.

Another, more serious examination is a chromosome analysis to determine the karyotype: the doctor must make sure that the parents do not pass on to the child any genetic disorders that lead to miscarriage. Fortunately, there are not many such cases, but consultation with a geneticist in such a situation is a necessary procedure, because you need to find out for sure whether you will pass on any genetic disorders to your child.

Another important indicator is the histology results after a frozen pregnancy. Histological analysis is the study of embryonic tissue under a microscope after curettage. It allows you to determine the cause of the fading, but this result can only serve as a guide: additional tests will be required to confirm it, so be prepared for this.

Treatment after a frozen pregnancy

If you have experienced a frozen pregnancy, you will have to take doubly care of your health. First of all, the cause must be eliminated.

If your hormones have not worked correctly (most likely, you have had problems with your cycle and conception before, and you also have male-type body hair), you will need hormonal therapy. Don't be alarmed: properly selected medications do not give any side effects such as fullness or deterioration of the skin.

If the cause of fetal death is a sexually transmitted infection, both you and your regular partner need to be treated. Treatment for one of you will not work, because you are almost guaranteed a secondary infection. Most likely this will be a course of antibiotics. After treatment, take repeated tests to make sure that infections no longer threaten your health.

Rehabilitation after a frozen pregnancy

Of course, a frozen pregnancy becomes a tragedy for the family. This includes pity for the unborn child, collapse of hopes, and depression. There are often cases when it becomes very difficult to see women with children or with a belly on the streets.

There is only one piece of advice here: don’t get hung up . Focus on the fact that you need recovery from a missed pregnancy, and stress and apathy do not contribute to this. After all, this, in any case, is not a death sentence, which means there is a chance to correct something.

Pay attention to your physical health: if you are interested in planning a pregnancy after a missed pregnancy, you need to prepare for it as best as possible. Take a course of vitamins recommended by your doctor (most often these are balanced complexes intended for pregnant women), eat right.

A month after surgery, you can gradually return to moderate physical activity - this is a good way to increase the overall endurance of the body. More positive emotions! During this period, the support of loved ones is very important for a woman.

Correct diagnosis and comprehensive treatment are the key to a successful pregnancy after a frozen pregnancy. Don't despair, everything will definitely work out!

Finding out the cause of a missed abortion

When preparing for a new pregnancy, it is necessary to find out the reason for the failure of the previous one. Only by learning about the source can one prevent a recurrence of the situation by taking various measures.

The search for pathologies at the genetic level in a dead embryo is usually the first step towards identifying the causes. To conduct this examination, fetal tissue is needed for histological analysis after a frozen pregnancy.

Even before curettage, inform the doctor that you intend to conduct a histological examination and that biomaterial is needed. Relatives take it to the laboratory after it is properly packaged.

After genetic mutations, the analysis shows a number of hormonal disorders, chronic and infectious diseases, the presence of which led to the death of the embryo.

A frozen pregnancy is a test for a woman and the family as a whole. But don't despair. If you continue to follow the doctor’s recommendations for taking medications, vitamins, and undergo the necessary examinations, then soon the birth of a healthy baby will serve as a new start in life.

When to plan a baby

If the dead fetus was removed by vacuum or with the help of medications, the restoration of sexual activity may not begin for several weeks.

After death, you are allowed to have sex a month later, so that the reproductive system has time to fully recover. It is recommended to take birth control pills for at least a month.

The best option is to conceive a child 6 months after a frozen pregnancy, because a woman must recover not only physically, but also mentally for a certain time.

But only after passing the necessary tests and consulting with a doctor: it is he who must allow conception.