Trying to Conceive with a Chronic Condition

WebMD Live Events Transcript

Do you have diabetes, PCOS, hypertension, or another chronic condition? How could your illness and the medication you may take affect your attempt to conceive? Amos Grunebaum, MD, medical director of the WebMD Fertility Center, joined us on May 10, 2004, to answer your questions.

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:
At age 25 I have had three miscarriages. After the third miscarriage a septum in my uterus was found. Can I be sure the miscarriage was caused due to septum, and if I do surgery to take it out will I have a complete pregnancy? Also, what shall be the treatment for me after the surgery to conceive, since I have PCOS and type 2 diabetes? I have tried Clomid up to 150 milligrams with 1,500 milligrams of glucophage.

DR. AMOS:
Sounds to me like there are several issues you need to be concerned about. First it's the diabetes, which can increase your risk of having a miscarriage. The best thing to do is to make sure it's well controlled. Well-controlled diabetes with low HgBA1C levels decreases your risk of having a miscarriage. And most doctors like diabetic patients to be on insulin and not on pills to control the diabetes.

The next problem is the septum in the uterus. That could also cause a miscarriage. The best doctor to see is an infertility specialist, a reproductive endocrinologist. These specialists are best trained to check for this problem and treat it if necessary. They are also best trained to supervise your PCOS and treat your ovulation problem to ensure that you get monitored and not get too much or too little of this medication.

MEMBER QUESTION:
I may be pregnant, and suffer from moderate hypertension that we are still working on getting under control. Should I call my doctor and let her know that I may be pregnant?

DR. AMOS:
The first thing to do is call your doctor right away and find out if you are pregnant or not. Even if you are not pregnant, with this medical problem you should see your doctor. I usually suggest that women with medical problems see their doctor before they start trying to get pregnant. This allows you to review your condition, review the medication, and ensure you are in best shape as you are trying to get pregnant.

MEMBER QUESTION:
I have type 2 diabetes and have eight losses. I'm trying again with the assistance of 2,000 milligrams metformin and 5 milligrams folic acid for elevated homocystein level. My RE thinks I possibly have a clotting problem and will start me on heparin shots when I receive a positive pregnancy test. Do you think this will benefit me?

DR. AMOS:
Heparin is a commonly used medication with this medical problem. I have seen many women with this problem who were successful in having a healthy baby. You may also want to discuss with your doctor the use of "Lovenox." It's similar to heparin, but the injection is only once a day, and it works the same way. Good luck.

MEMBER QUESTION:
My RE wants to wait until the second hCG test to administer heparin shots. Do you think this is too long to wait?

DR. AMOS:
The second hCG test usually takes only a couple of days, and it's reasonable to wait to make sure the pregnancy is progressing well.


"Mild endometriosis is not as much a problem as severe endometriosis. Severe endometriosis can totally close the fallopian tubes and make it impossible to get pregnant on your own."

MEMBER QUESTION:
I may be pregnant. I am two weeks late, but two pregnancy tests say negative. Do you suggest a blood test?

DR. AMOS:
Urine pregnancy tests are usually very reliable, and if you have done several over a period of several days after you miss your period then it's highly unlikely that you are pregnant. Doing a pregnancy blood test will likely confirm your urine tests. Good luck.

MEMBER QUESTION:
My girlfriend is eight weeks pregnant and has a rip between her uterus and placenta. She is currently on bed rest. Does this condition heal itself?

DR. AMOS:
What you are describing sounds like a 'subchorionic hematoma.' You may want to confirm this diagnosis with her doctor. A subchorionic hematoma is a blood clot between the placenta and the uterus. It's a common finding in a woman who has some bleeding early in pregnancy. Most of these are small, and they have no effect on the future pregnancy. If they get bigger then the risk of a miscarriage increases. The reason for this hematoma is usually unknown. Good luck.

MEMBER QUESTION:
I am 44 years old and suffer from endometriosis. What are the chances of getting pregnant at my age?

DR. AMOS:
After 40 the chances of getting pregnant decrease significantly, but it's by no means impossible to get pregnant. I just delivered on Mother's Day the first baby of a 45-year-old woman. This was her first pregnancy after 18 years of marriage and trying.

I would suggest you see as soon as possible an infertility specialist. They can best decide how severe the endometriosis is. Mild endometriosis is not as much a problem as severe endometriosis. Severe endometriosis can totally close the fallopian tubes and make it impossible to get pregnant on your own. If it's that severe then you can get pregnant with IVF.

MEMBER QUESTION:
Would Femera or Clomid cause endometriosis to thicken or grow at a quicker rate?

DR. AMOS:
Both of these medications can occasionally worsen the symptoms of endometriosis. They induce ovulation, and ovulation increases your estrogen levels, which can make endometriosis grow. Most doctors usually make sure they monitor their patients to ensure that endometriosis does not grow too much.

MEMBER QUESTION:
I'm 30 years old. I donated my right kidney to my brother when I was 21. I've been married for four years and still no child. Am I at risk of trying to conceive since I only have one kidney?

DR. AMOS:
First of all let me congratulate you for having helped your brother. This is one of the biggest presents anyone can give! I applaud you! Having one kidney does not affect your chances getting pregnant, and it's unlikely that it will affect your pregnancy. Women with one kidney get pregnant all the time and have healthy babies.

There are three reasons for problems getting pregnant: ovulation, sperm, and/or fallopian tubes. If you are ovulating normally, the next step is to check his sperms and then your fallopian tubes. Doing these tests will quickly establish whether there is a problem and how to treat it.

MEMBER QUESTION:
I weigh 220 pounds and I have been trying to get pregnant for about a one year. I have been on several diets and pills to lose weight and haven't lost any so I am going to a fertility doctor. Do you think I will get pregnant quicker using some type of fertility medicine instead of nothing?

DR. AMOS:
Being overweight is one of the major problems getting pregnant. There is no question that losing weight will significantly improve your chances getting pregnant and it will also decrease your risks of a miscarriage, premature delivery, and pregnancy complications such as diabetes and hypertension. So I support your attempts to lose weight; this should be the first step.

When you see the infertility doctor you must decide what the problem is. If it's that you don't ovulate (do you?) then the doctor can help with ovulating-inducing medication. This medication is not really a 'fertility' medication; it just makes you ovulate if you did not ovulate before. Good luck.

"It's completely common for general doctors to not know which medication is safe or not during pregnancy. Your best source for this kind of question is a high-risk ob."

MEMBER QUESTION:
I am about seven weeks pregnant and I am spotting (not much) and I've had pregnancy loss before. Could this be a bad sign?

DR. AMOS:
About one in three women have some spotting early on in pregnancy and most will go on and deliver a healthy baby. The best thing to do is to let your doctor know about it and make sure you have no other complication such as an ectopic pregnancy.

MEMBER QUESTION:
My daughter-in-law who has had four miscarriages, has been diagnosed with PCOS, and is now being told she has fibroids. They had a son, but after 2.5 years we lost him to heart disease. They desperately want to have a child. Is it still possible with a fertility specialist? Please tell me yes.

DR. AMOS:
First of all let me offer my condolences for losing your grandson. The condition you are describing is a common problem, and many women with this problem seeing an infertility specialist will be able to have a healthy baby. The doctor will usually do some tests and determine exactly which approach to take. It all depends on how severe each of these conditions is before a decision can be made. I wish you and your DIL good luck.

MEMBER QUESTION:
I have severe migraines, which most doctors don't think of as a chronic condition in relation to TTC. However, I would like to go to a high-risk doctor because of the meds that I have to take while pregnant to ward off headaches. How can I communicate this to the ob-gyn next time I get pregnant?

DR. AMOS:
Most general ob-gyn doctors have no problems referring high-risk patients to a high-risk ob. In the meantime, you may want to do some research and find a high-risk ob yourself. Be open with your ob-gyn and straightforward. That's usually the best approach.

MEMBER QUESTION:
Is it possible to have children if you have genital warts? If so, will the virus be passed to the baby?

DR. AMOS:
Many people have a history of genital warts. The virus responsible for genital warts is the HPV virus. In general, there is no concern of the HPV being passed to the baby, and there is no need to do a cesarean section to prevent transmission. The risk of transmitting the virus is extremely low and usually no reason for major concern.

MEMBER QUESTION:
During my last pregnancy, as my asthma got worse, my ob sent me to the pulmonary doctor. He prescribed meds that he didn't know were safe during pregnancy or not and told me to call my ob back and check. Is this common?

DR. AMOS:
It's completely common for general doctors to not know which medication is safe or not during pregnancy. Your best source for this kind of question is a high-risk ob. They are best trained to care for high-risk women and advise them about which medications are safe and which ones are not.

Medications are usually classified in categories from A,B,C,D, and X. A and B are usually safe in pregnancy, while X (there are very few Xs) are never indicated. In specific cases of other categories your doctor must decide how important it is for the medication to be taken.

MODERATOR:
If Dr. Amos wasn't able to answer your question in this forum, try posting in his TTC message board, or join us again next time. You can also find dozens of archived Dr. Amos chats in our Live Events archive.

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