Drugs and Fertility: What Works, What's Safe

WebMD Live Events Transcript

From prescribed fertility drugs, like Clomid, to over-the-counter cold medicine, you want what you put in your body to be effective and safe for you while trying to conceive, and for your baby after you get pregnant. We talked about it with Amos Grunebaum, MD, medical director of the WebMD Fertility Center, on April 5, 2004.

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:
Do you know anything about the effectiveness or safety of a supplement called Fertility Blend? I'm wondering if I were to try this supplement if I can safely take it for six months or more.

DR. AMOS:
Fertility Blend is a combination of many different herbs and vitamins. Likely the most important ingredient in this is Vitex, an herb also known as "monk's pepper." This herb has been used for some time in Europe, especially in Germany, where it's been successfully used for menstrual disorders.

Before you use any supplement to improve your fertility you first should try finding out why you are having trouble getting pregnant. If it's his low sperm count, then no matter what supplement the woman takes, you won't improve your chances getting pregnant. And if you have problems with your fallopian tubes, then taking supplements will not change your chances of getting pregnant. I suggest you get some initial tests done to find the possible causes of your infertility before you resort to any supplements.

MEMBER:
I've been told I have unexplained infertility and husband's sperm was in normal range. Thank you.

DR. AMOS:
Good luck!

MEMBER QUESTION:
We have been TTC for about 16 months now. I have an appointment to see my gynecologist for a consultation on Wednesday. I am usually 28/29 days long in my cycle but lately it has been 25-30 days. I wonder what kind of fertility meds she may put me on and what does it sound like could be wrong with my cycles? Thanks!

DR. AMOS:
Sounds like your cycles are irregular. Irregular cycles are cycles that deviate by more than two to three days, and yours deviates by five days. Your menstrual cycles, the length and regularity of the cycles usually depend on when and if you ovulate. So the first step would be to check for ovulation. This can be done, among others, by doing a BBT chart. The BBT chart, a temperature chart, will help you identify any possible ovulation issue. And once you have that information you can assess the next steps. There are generally no specific 'fertility medications' without addressing what the specific issue is.

MEMBER QUESTION:
If TTC, is it OK to take ibuprofen for pain relief?

DR. AMOS:
Ibuprofen is among the medication not suggested when you TTC. When you have any specific issues or pain, the first step and before you take anything is to ask your doctor. There are different kinds of pains in different parts of your body and first finding out what it could be helps you find the best medication.

"Robitussin can possibly help improve cervical mucus in women who ovulate and have thick mucus. However, most CM problems happen in women who do not ovulate. If you don't ovulate then taking Robitussin will not improve your chances of getting pregnant."

MEMBER QUESTION:
I am 35 and plan on start TTC this month. I am nursing my 15-month-old son during evenings and mornings. I couldn't chart because I d have to get up in the middle of night and pick up my son sometimes. How long should I keep TTC before I take Clomid? I took 50 milligrams of Clomid and it did get me pregnant after six months of unsuccessful attempts to conceive with charting.

DR. AMOS:
It's unclear from your description whether you are ovulating or not. If you are ovulating, then taking Clomid in and by itself won't improve your chances getting pregnant and if you do not ovulate, then the cause is likely that you breastfeed. Breastfeeding can prevent ovulation, and taking Clomid when you breastfeed and don't ovulate is generally not suggested.

MEMBER QUESTION:
Yes I was ovulating before I got pregnant and my menstruation resumed when my son was 7 months old last summer.

DR. AMOS:
I suggest you talk to your doctor first and discuss whether taking Clomid while you breastfeed is OK. I know many doctors who don't suggest Clomid to breastfeeding mothers.

MEMBER QUESTION:
Are you saying that I have to stop nursing in order to increase my chances of conceiving? I only nurse between 8 to 10 hours and my menstruation seems to have been regular for the last eight months. Does that mean I am fertile again? I had been TTC for six months while charting but was unsuccessful and that's why I took 50 milligrams of Clomid and it got me pregnant despite that I was ovulating. My husband had his sperm checked and everything was fine, too.

DR. AMOS:
When you nurse your chances getting pregnant are statistically decreased. You can get pregnant while nursing, but you are less likely to get pregnant than when you do not nurse.

MEMBER QUESTION:
What is the correct way of using Clomid? Does it have to be taken on the second day of the period for five days or after the period and also the dosage (50,100,150 milligrams)? After taking Clomid, which days are the best days in the cycle for intercourse? Does Clomid ensure that you ovulate on the 13th day or 14th day? Thanks so much for answering my questions.

DR. AMOS:
First about the dosage: The lowest possible dose that makes you ovulate is the best. So most start at 50 milligrams a day for five days and then increase it the next month if ovulation does not take place. The first goal of Clomid is to help you ovulate, so if you ovulate on the lowest possible dose then the medication is successful. Many doctors first do a sperm count to be sure it's not him that has the problem. Unfortunately I have seen many women taking Clomid for many months only to find out too late that her partner had a sperm problem. So a sperm analysis is suggested before you take any medication.

The next is the timing of Clomid, when do you start taking it. The traditional timing is to start on cycle day 5 for five days (CD 5-9.) Ovulation then happens as early as five days and as late as nine days after the last pill. So if you take it last on CD 9, then ovulation can happen on CD 14-19. Some doctors start Clomid on CD 2. So you would take in CD 2-6. In that case ovulation happens CD 11-CD 15. There is no absolute which day to start is better, and different women react differently. But most doctors still suggest taking it CD 5-9.

MEMBER QUESTION:
Is there an increased risk of ovarian cancer etc. from Clomid use? Secondly, is taking Robitussin three to four times a day for a few days prior to ovulation (when on Clomid) safe and effective in increasing cervical mucus?

DR. AMOS:
Clomid should be taken no longer than for three to six ovulatory cycles. Studies have shown that if you take it as suggested then there is no increased risk of ovarian cancer. Robitussin can possibly help improve cervical mucus in women who ovulate and have thick mucus. However, most CM problems happen in women who do not ovulate. If you don't ovulate then taking Robitussin will not improve your chances of getting pregnant.

MEMBER QUESTION:
I seem to be spot bleeding for four to five days before I start a heavy flow for my periods. It is the same each month, (three to four months). I called my nurse to see if it was OK and she said it is fine, but not normal and I can go on BCP to get regular. I am TTC and obviously don't want to do that. Is there something else I can do and could this cause a problem with TTC? I charted my BBT last month and it showed that I ovulated. Any ideas about the spotting? I stopped BCP in mid-December.

DR. AMOS:
Spotting before a menstrual period can be a sign of hormone issues. For example, the progesterone hormone is supposed to maintain the endometrial lining and prevent you from bleeding until at least 12-14 days after ovulation. If you start spotting less than 12 days after ovulation then you may want to discuss with your doctor whether checking progesterone levels and the endometrial lining is a good next step.

MEMBER QUESTION:
Can you tell me a little about progesterone? My cycles are off. I have been told by people that had the same problem that they had troubles with progesterone.

DR. AMOS:
Progesterone rises after ovulation, and is supposed to be at least 15 ng/ml about seven days after ovulation. If it's too low then it cannot maintain the lining of the uterus and prevents implantation. That also goes together with a shorter corpus luteum (CL) phase. That's the time between ovulation and the next period. You can check your CL phase by doing a BBT chart, a temperature chart. A CL phase below 12 days may indicate a progesterone deficiency and needs further testing.

"Unfortunately I have seen many women taking Clomid for many months only to find out too late that her partner had a sperm problem. So a sperm analysis is suggested before you take any medication."

MEMBER QUESTION:
I was told when I was 17 that I have a tilted uterus. I have since changed doctors and the doctor I have been using the last five or six years has never mentioned it to me. Could I out grow that? I am 27 now. Also I have heard when having sex while TTC, it is good to do it rear entry in the case of having a tilted uterus. Is that true?

DR. AMOS:
A tilted uterus is normal and rarely if ever causes infertility. The three major causes for infertility are:

  • Ovulation issues
  • Sperm problems
  • Fallopian tube problems

A tilted uterus is not among the usual problems when you have trouble getting pregnant.

MEMBER QUESTION:
If I get a positive while using an ovulation predictor, does this positively mean that I ovulated? I ask this because I got a + OPK but then my temperature only showed a rise for two days (97.9 to 98.5) then fell back to 98.3. So according to my temperature chart I didn't ovulate.

DR. AMOS:
If you get a positive that does not necessarily mean that you ovulate. In order to do the OPK properly, you need to start several days before ovulation. You first get negative tests, but then they turn positive. Once you have a FIRST positive after the negative ones then ovulation is likely to happen within 12-34 hours. The OPK is not supposed to stay positive for longer than two to three days. And just by looking at the three days of temperatures you mentioned you cannot conclude with enough certainty that you did not ovulate. You must take your temperature for longer than two to three days after presumed ovulation to conclude with more certainty what happened.

MEMBER QUESTION:
Assuming I did the test correctly, would that then mean that a + OPK means I ovulated?

DR. AMOS:
As I said before just one single positive test means nothing if it's taken out of context and without knowing when it was taken and what the prior tests where.

MEMBER QUESTION:
I have a history of benign breast lumps, and my mother had breast cancer. Do fertility drugs put me at any risk for increased risk of breast cancer? My breast surgeon seems to think so. She cautioned against using fertility drugs, but is there any basis for this?

DR. AMOS:
There is a lot of controversy about certain medications used to induce ovulation and breast cancer. This question can be answered only conclusively by talking to your ob-gyn and finding out which specific medication is indicated. There are many different drugs that are prescribed for inducing ovulation. And some have different potential problems than others. You should have your ob-gyn discuss this with your breast surgeon.

MEMBER QUESTION:
If I stop nursing, how long do I have to attempt to conceive before I can take Clomid to help boost my ovulation? I am 35 and I am concerned about my fertility decreasing dramatically because of age.

DR. AMOS:
It usually takes up to two to three months after stopping breastfeeding for the effects of the breastfeeding to be diminished.

MEMBER QUESTION:
A surgery has been performed on me for the removal of fibroid and ovarian cysts that I suspect is as a result of taking Clomid. My doctor again recommended Clomid two months after the surgery because I am trying to conceive, but it was discovered that I have developed a cyst again. Please what can I do to shrink the cyst, as I do not want to go through another surgery?

DR. AMOS:
It really depends on what kind of a cyst it is. Some cysts are more likely to be caused by Clomid than others. You also need to find out exactly how big the cyst is and what it looks like on ultrasound. These questions need to be answered first by your doctor.

MEMBER QUESTION:
What are some signs of fibroid tumors? My mom has them & I have heavy bleeding on my second cycle day.

DR. AMOS:
The first way to diagnose a fibroid is to do an ultrasound. Most women with fibroids have no specific symptoms, and a physical examination by your doctor together with a sonogram will help you make the diagnosis.

MODERATOR:
Thanks again to Amos Grunebaum, MD, for talking TTC with us.

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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