Trying to Conceive: When to Get Help

WebMD Live Events Transcript

Trying to get pregnant with no success? You may be thinking about seeing a doctor. When is the right time? And who is best equipped to help you conceive quickly? We discussed OB's, RE's, and helping the birds and bees get moving with Amos Grunebaum, MD, medical director of the WebMD Fertility Center, on April 19, 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:
Hi Dr. G. My DH and I have been TTC for four months. I got off birth control pills in December. and my cycles came back pretty regular. I have a 28- to 29-day cycle and ovulate around CD 14-16. I have been using BBT and OPKs. Usually around CD 17 of every cycle I get light pink spotting often with little pink clumps and some itchiness. After about two days it turns to brown CM and usually continues until about five days before AF in which I spot red blood. I am worried about this and my chances of conceiving. Is this normal? Should I see my doctor? I hate to be an annoying patient since we have only been TTC for four months. What should I do?

DR. AMOS:
First of all let me tell you that it's great you are watching your body so closely. When you TTC it's important to watch all of your body and get ready for a healthy pregnancy. It is important that you also take your daily prenatal vitamin, including at least 400 micrograms folic acid. Taking daily folic acid is suggested to decrease the risk of fetal malformations.

What you experience sounds like "ovulatory spotting." To confirm this observation, the first step includes making sure you know exactly when you ovulate and then make sure you know when this spotting happens in relation to OD, the day of ovulation. Instead of then saying you spot on CD 17, you can better say I spot on OD 3 or so. This provides more information about the spotting.

Ovulatory spotting can be a sign of hormone problems or it could be normal. You should let your doctor know about it, get examined, and then check the corpus luteum phase. That's the time between ovulation and the next period. If the CL phase is abnormal, then this may explain the spotting.

Your doctor can also do a progesterone level about a week after ovulation and confirm that it is normal.

MEMBER QUESTION:
I don't think it came across clearly. I spot red blood for five days before AF flow starts.

DR. AMOS:
But you said it starts on CD 17, no? That would be right after you ovulate. Again, try observing the relationship between the spotting and ovulation. That will help identify the timing better.

MEMBER QUESTION:
When do we stop working with the ob-gyn and start working with a reproductive endocrinologist? How long should we TTC before we change doctors?

DR. AMOS:
There are general rules when the RE is suggested:

1. When you already have problems such as when you don't ovulate, your fallopian tubes are closed, or when the sperm count is low.
2. When you are over 35 and you have been unsuccessful for more than six months.
3. When you are under 35 and you have tried for more than 12 months.

"The most important question to answer is: 'Am I ovulating and when?' Your periods are regulated by ovulation. Irregular periods usually mean that you have problems with ovulation."

MEMBER QUESTION:
How long should we try to get pregnant and keep doing the progesterone screenings on day 21 before we go back to the doctor for help? I keep getting low progesterone readings each month (12). I am on Clomid as well as prenatal vitamins and my periods are about one week late at the end of each cycle. We do the Ovulite test to know when my ovulation days are. Should we seek more info or just wait?

DR. AMOS:
There is one important word missing here; it's the "O" word. Are you ovulating or not? That is the all-important question. If you do a BBT chart then you should know whether you ovulate or not.

I am also unclear how long you have taken Clomid, how much you take, whether it worked (did you ovulate?), how old you are, and whether his sperm count is normal or not. All of this information is crucial to suggest the next step.

A progesterone level above 10 usually means that you ovulate, but it must be done seven to 10 days after ovulation. If it's done earlier, then the results are invalid.

MEMBER QUESTION:
I have had irregular periods after my miscarriage in June 2003. I did also take Provera to regulate my periods. It is usually a 40- to 45-day cycle. It makes it hard to find out my days of ovulation. I am scared and want to know if I am ovulating. I am only 27. Should I go to an ob-gyn or an infertility doctor?

DR. AMOS:
The most important question to answer is: "Am I ovulating and when?" Your periods are regulated by ovulation. Irregular periods usually mean that you have problems with ovulation. Taking Provera will make you bleed, but it will not make you have a regular period.

How can that be? A regular period comes from ovulating regularly, and Provera has no effect on ovulation. So you must first find out whether you ovulate or not, and if you do not ovulate then your doctor should find out why. Once you know the reason for not ovulating your doctor can decide on the treatment (which is not Provera). Helping you ovulate will improve your chances getting pregnant.

MEMBER QUESTION:
I have been off the pill for two complete cycles now. Both cycles have been regular and I know that I ovulated both times based on BBT and OPK. I know it is not a problem to worry about now, but how long should I wait before I see a doctor?

DR. AMOS:
If you are under 35, you have no other medical issues, and his sperm count is fine then it's suggested to wait a year before seeing a specialist. But I also suggest that you see your ob-gyn as soon as you know that you want to get pregnant. Your doctor can review your history and examine you to make sure everything is fine. Also, don't forget to take your daily folic acid.

MEMBER QUESTION:
I am a 28-year-old married woman. I got married three years ago. I had my first pregnancy last year and had D&C in December 2003 when I was eight weeks pregnant. Now I am trying again to conceive for the last two months. All the tests are normal and regular menstrual cycle. Please let me know how should I proceed. What should I do?

DR. AMOS:
Sounds to me like you have been trying now for two months. It takes the average couple four to five months to get pregnant, and 85% of couples take up to one year. If you did get pregnant before then your chances of getting pregnant again are excellent. Good luck!

MEMBER QUESTION:
When should you start taking prenatal vitamins?

DR. AMOS:
Every woman trying to get pregnant should take a daily prenatal vitamin and folic acid. Taking prenatal vitamins, especially folic acid, decreases your risk of having a fetus with malformations. It takes one to two months for the folic acid level to rise sufficiently, so the best time to start is one to two months before getting pregnant. This ensures that your folic acid levels are adequate when you conceive.

"Every woman trying to get pregnant should take a daily prenatal vitamin and folic acid. Taking prenatal vitamins, especially folic acid, decreases your risk of having a fetus with malformations."

MEMBER QUESTION:
My husband frequently has to take antibiotics for cysts/boils that he gets. I have read on WebMD that antibiotics are not good for sperm count. What do antibiotics do to the sperm? Is it possible to conceive when he is on antibiotics so often? I have been charting and do know that I ovulate.

DR. AMOS:
I have not heard that antibiotics are bad for sperms. It's usually the condition that necessitates taking antibiotics that can be a problem. I have not seen a problem in the fetus because he took antibiotics. But you may also want to verify exactly which antibiotic he takes, to make sure they are OK. Ask his doctor about the specifics of the antibiotics he takes.

MEMBER QUESTION:
I am going to be 33 on April 26. Am I too old to have a baby? What are my chances? I had a chemical pregnancy just last week. Thank you for answering my question.

DR. AMOS:
Thirty-three is clearly not too old to have a baby. Many, many women each year have healthy babies well above 33. The first step is to see your ob-gyn and discuss your desire for getting pregnant. Your doctor can then examine you and discuss your circumstances specifically, first if there are any barriers to a healthy pregnancy, and also discuss with you personally how to improve your chances of getting pregnant.

MEMBER QUESTION:
I have been TTC for two months. I was diagnosed with moderate endometriosis in November 2002. I am worried about being able to conceive. Any reassuring advice? I am only 26.

DR. AMOS:
Moderate endometriosis is usually not a major impediment of getting pregnant, though it also depends exactly how the diagnosis was made. Was it made by a laparoscopy or any other tests? The answer to this question determines how to proceed.

MEMBER:
The diagnosis was made through a laproscopy.

DR. AMOS:
A laparoscopy is usually the best way to make a diagnosis and to decide on the next steps. Sometimes where the endometriosis is located decides on your chances getting pregnant. Your doctor who did the laparoscopy can best explain to you the chances of having problems.

MEMBER QUESTION:
What about the miscarriage rate for women with endometriosis? I hear it is much higher.

DR. AMOS:
The major problem with endometriosis is not necessarily the miscarriage rate; it's usually the problem of the fallopian tubes and transportation of the sperms and the egg. This problem usually prevents you from getting pregnant, but doesn't cause a miscarriage.

MODERATOR:
Thanks for joining us, members, and thanks to Amos Grunebaum, MD, for being our guest.

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