Trying to Conceive: Feeling Frustrated

WebMD Live Events Transcript

Getting frustrated with not getting pregnant? How long should it take? What tests do you need? How do you know if you're ovulating? Amos Grunebaum, MD, medical director of the WebMD Fertility Center, joined us to help you take the right baby steps to pregnancy.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

MEMBER QUESTION:
After two years of trying to get pregnant, we were able to do so. In the third month we lost our baby and have been trying again for over a year. Should we see a specialist?

DR. AMOS:
I am so sorry to hear about the miscarriage. Most doctors do not suggest seeing a specialist until at least two to three miscarriages in a row. But it mostly depends on your individual circumstances and possible reasons for the miscarriage. I usually suggest sending in a miscarriage for chromosome evaluation. If, for example, as is the case in most miscarriages, the reasons were a chromosome anomaly then you should not be at increased risk of having another miscarriage. Good luck.

MEMBER QUESTION:
Our ob-gyn told us to try to conceive in days 12, 14, and 16 after my wife's period starts. Is that our best bet?

DR. AMOS:
Your best and most fertile days to make love are the four to five days prior to ovulation and the day of ovulation. So it really all depends exactly when your wife ovulates. If she has regular 28-day cycles then the fertile days are day 15 and days 10-14. Those are the best days for making love in a regular 28-day cycle. With cycles that are shorter or longer, fertile days change accordingly. In longer cycles ovulation happens later, and earlier in shorter cycles.

MEMBER QUESTION:
I have PCOD/PCOS. Is this aggravated with stress?

DR. AMOS:
Stress is a very individual issue. Some people are affected by it; others are not. In general, stress is likely to have a more negative than positive effect on fertility. You should see your doctor and describe your stress levels to see whether they could affect your fertility.

MEMBER QUESTION:
When do I need to start worrying about infertility? My husband and I started trying 5/2003, got pregnant 10/2003, and miscarried at five weeks at the end of November. It's now been four months since our miscarriage and we're not pregnant yet. At what point should we start taking tests to make sure everything is normal again?

DR. AMOS:
It all depends on how old you are. Under 35 and with regular cycles, most doctors suggest waiting one year. Over 35, they suggest six months before you see a specialist. Only about 50% of couples normally get pregnant within four to five months of trying, and 85% take up to one year.

MEMBER QUESTION:
We have been TTC a total of 28 months with a miscarriage in November. My doctor says that it is not necessary to do any testing as I got pregnant in November and we know that everything is OK. Should I get a second opinion? Because I also have brown spotting from day 7-9, and in the book Take Care of Your Fertility it says that it could indicate that there is a problem with the shedding of the uterine lining. Is this something to be concerned about?

DR. AMOS:
I agree with your doctor to see a specialist. Most women with spotting will have no problem, and spotting in and by itself is rarely if ever the cause of fertility problem. But only an examination and some basic tests can provide you with the right answers.

MEMBER QUESTION:
What happens when one sees an infertility specialist? What are the steps?

DR. AMOS:
Many, many things happen at the specialist. Unfortunately this chat here is too short to mention all. A history is taken, you get examined, and some basic tests are done. There are three major causes that the specialist evaluates:

  • Sperm problems
  • Ovulation problems
  • Fallopian tube problems
There is usually a step-by-step approach, and depending on your history the specialist will decide which tests to do next. Most tests are usually completed within four to six weeks. At the end of that time you should know the answers to those three questions.

"You cannot tell exclusively from cramps exactly when ovulation happened."

MEMBER QUESTION:
I took birth control pills for eight years and stopped taking them in February 2003. I never got my period after that. My periods were regular before I started taking birth control. Blood tests have shown I have a very low progesterone level, even after taking Clomid. I am wondering if the birth control pills could have caused the problem, and if low progesterone can cause weight gain? I've been referred to an infertility specialist and want to know what to expect.

DR. AMOS:
Births control pills from the past rarely if ever cause fertility problems. But there is one important word missing in your description. Unfortunately, it's missing from many women's description of their problems. It's what I like to call the BIG O -- OVULATION. In all of your description you fail to mention whether you ovulate or not. Anovulation is the No. 1 infertility problem and it's the first thing women should know about. The next steps usually depend on whether you ovulate or not.

MEMBER:
I am not ovulating.

DR. AMOS:
Aha! That makes all the difference in the world. Progesterone does not go up unless you ovulate. So "low progesterone" is not the problem; it's anovulation that is the problem. Clomid started at 50 milligrams a day for five days then increased the next month to 100 milligrams a day for five days then to 150 milligrams if you don't ovulate. Once you find out that you don't ovulate at higher Clomid levels an infertility specialist usually gets involved and tries finding out what the cause is and whether giving you 'injectable' medication will help you ovulate.

MEMBER QUESTION:
How can you tell if you ovulate if you have PCOD?

DR. AMOS:
There are several ways to identify ovulation. Regular periods usually mean you ovulate. Other methods for identifying ovulation include:
  • Temperature charting
  • Cervical mucus checks
  • Ovulation predictor kits
  • Ultrasounds
  • Progesterone blood tests
MEMBER QUESTION:
Are the home ovulation tests accurate?

DR. AMOS:
OPKs are pretty accurate if you use them correctly, but I do not suggest that you use them exclusively to decide when to make love. If you wait to make love only when the OPK first turns positive then you could miss your most fertile period. Your most fertile days for making love are one day and two days prior to ovulation.

MEMBER QUESTION:
I saw two types of home ovulation tests; one was urine and the other saliva. Which is more accurate?

DR. AMOS:
They are both different. The urine OPK tests for the rise in LH hormone, while the saliva microscope tests for changes in saliva predicting ovulation, that's the estradiol hormone. You can use both of them at the same time and the information you collect with both can help you identify your fertile days.

MEMBER QUESTION:
I experienced ovulation cramps for the first time this month while taking 100 milligrams of Clomid. They began on CD 12 and ended on CD 14. Without charting or OPKs is it possible to tell when I ovulated by the cramping?

DR. AMOS:
Ovulation usually happens from five to nine days after you stop taking Clomid. But you cannot tell exclusively from cramps exactly when ovulation happened. The best methods to find the day of ovulation would be by taking your temperature and charting it at the WebMD fertility center. Watching your temperature rise can help you identify the ovulation day best.

MEMBER QUESTION:
Is FSH level of 10MIU/ML on day 3 too high?

DR. AMOS:
Most doctors do not consider this FSH level elevated.

MEMBER QUESTION:
Dr. Amos, what is your opinion on Vitex, or chasteberry, and its effects on the hormone balance? Is it relatively safe or should I not take it?

DR. AMOS:
Vitex has been around for some time and it's been found to have a positive effect on women's hormone levels. There are a few studies showing that it can improve fertility if used by the right women. I usually suggest starting off with a sperm count, because if he has not enough sperms then your chances getting pregnant are not improved if you take Vitex.

"A lot of fertile mucus is better than little to no mucus at the time of ovulation."

MEMBER QUESTION:
I recently started taking Clomid. The first cycle on 50 milligrams I did ovulate. However, my period was very light. I have heard that Clomid can reduce the amount of lining that you have. Is this true and should I be concerned about having a light period?

DR. AMOS:
Light periods are not unusual on Clomid. But the most important information is that you did ovulate, no matter how light the period was. In addition, many doctors check your cervical mucus at the time of ovulation to make sure you have enough fertile mucus for sperms to pass though. It's more likely that insufficient mucus as side effect of Clomid prevents a pregnancy than a light period. That's why some doctors like to do IUI to bypass the cervix when you take Clomid.

MEMBER QUESTION:
So having a lot of cervical mucus is a good thing? Rather than having not enough mucus.

DR. AMOS:
Exactly. A lot of fertile mucus is better than little to no mucus at the time of ovulation.

MEMBER QUESTION:
I am 28 years old and my cycles are very irregular. They range in length from 36-47 days. I am having difficulty determining if and when I ovulate. We have been TTC for six months and just don't know what to do next. What can we do to help our odds and should I see my doctor?

DR. AMOS:
Irregular cycles are usually a sign of ovulation and hormone problems. If your periods are that irregular it's not suggested to continue TTC without finding the cause. You can only improve your odds by seeing a doctor and finding the cause of the ovulation problems. Your doctor can then help you ovulate and improve your chances of getting pregnant.

MEMBER QUESTION:
I have heard that sleeping in pitch black every night, and then with the lights on when you want to ovulate can regulate ovulation. Is this true?

DR. AMOS:
Not true. I never heard this before.

MEMBER QUESTION:
My husband and I would like to conceive but at the age of 14 I was told I have ovarian cyst and I've always had irregular periods. The doctor advised me to take contraceptives to regulate my period, which I did, but I stopped about a year ago and it's still irregular. My husband has a child from previous relationship. What do you suggest? We've been trying for a year and no luck. Should we go to a fertility clinic?

DR. AMOS:
Irregular periods and not ovulating with ovarian cysts could be a condition called PCOS (polycystic ovarian syndrome). PCOS is the No. 1 reason women have ovulation problems. You should see a specialist who needs to do some tests and find out why you have ovulation problems. Once a diagnosis is made, your doctor can treat you appropriately.

MEMBER QUESTION:
Would you still ovulate if you had a cyst on your ovary?

DR. AMOS:
A cyst on the ovary in and by itself is unlikely to prevent ovulation. Some women with PCOS have cysts, but cysts do not prevent ovulation.

MEMBER QUESTION:
A question about pregnancy symptoms: I have had breast reduction surgery and I do get tender breasts, but I don't know if I would get any other symptoms such as the darkening of the areola.

DR. AMOS:
It really all depends what kind of breast reduction surgery was done. Some are very extensive, others not that much. You may want to ask the doctor exactly what was done. But in general most women will have the same symptoms as women who had no reduction.

MEMBER QUESTION:
Are there any indications that a successful implantation has happened?

DR. AMOS:
Most women who are pregnant have no symptoms at the time of implantation. Some women who are not pregnant have some spotting. In general, there are no specific symptoms at implantation and until the pregnancy test is positive you won't know for sure.

MODERATOR:
Thanks to Amos Grunebaum, MD, medical director of the WebMD Fertility Center, for joining us. If Dr. Amos wasn't able to answer your question, try posting in his Trying to Conceive message board . You can also find dozens of archived Dr. Amos chats in our Live Events archive. Those transcripts will answer many, many of the unanswered questions from today.

And now you can learn even more about getting pregnant by joining the WebMD Fertility Center . Sign up for support, expert chart review, and tons of great TTC information. You'll learn everything you need to know about increasing your chances of conceiving.

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