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 Sept. 29, 2004, as part of the Preserving Your Fertility Cyber Conference, 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:
What can I do to help my doctor help get me pregnant? I have insulin resistance, possibly PCOS, and medications are failing.

DR. AMOS:
The first thing to do is clearly to be in your best possible health. That also means to be at your best weight. Women who are at their best weight, at a BMI of 20-25 or so, have a better chance getting pregnant.

Then the next step is to see an infertility specialist, a reproductive endocrinologist. They are best trained to help you get pregnant.

If you ovulate, then you should also make sure that his sperm count is fine and that your tubes are open. Women with PCOS oftentimes have a better chance getting pregnant with IVF so that would be your final option if all else has failed.

MEMBER QUESTION:
What is PCOS?

DR. AMOS:
PCOS = polycystic ovarian syndrome. It's the No. 1 reason for infertility in women who do not ovulate.

MEMBER QUESTION:
Can you have PCOS in only one ovary?

DR. AMOS:
If you only have one ovary then it's possible that this ovary has PCOS. But PCOS is really not just a disease of the ovaries; it's a general medical condition involving the whole body. So it's not the ovary in and by itself that's "diseased," but it is a general hormonal condition involving different organs and body parts. Anovulation and infertility is just one, though an important aspect, of PCOS.

MEMBER:
I understand, but I am only ovulating from one ovary, per ultrasounds, and my other ovary that is not ovulating is surrounded by cysts. I was concerned why one side would be affected and not the other.

DR. AMOS:
What you describe has little to do with PCOS; it doesn't just affect one ovary. If one ovary has cysts then this doesn't mean there is PCOS. PCOS is diagnosed with different blood tests, a physical examination, and laparoscopy. You would need those tests before making the diagnosis.

"Women with PCOS oftentimes have a better chance getting pregnant with IVF so that would be your final option if all else has failed."

MEMBER QUESTION:
I recently found out I have endometriosis and I was also treated for it via a laparoscopy. What more can be done for me to conceive? My tubes are open.

DR. AMOS:
It really all depends on whether the endometriosis is the cause of your infertility. If your tubes are open, then the cause of infertility is less likely to be endometriosis, but it also depends on how severe of endometriosis there is. Your doctor can best explain to you what was found on the laparoscopy and then suggest the right approach.

MEMBER QUESTION:
So if you have had a lap, your tubes are open, and you have been pregnant at least once, you are telling me there is nothing more they can do for me except IVF.

DR. AMOS:
I don't know enough about your medical history to make that suggestion. There is so much information to take into consideration like your age, his sperm count, your examination, and whether you ovulate or not. Seeing an infertility specialist more likely than not will improve your chances getting pregnant.

MEMBER QUESTION:
Would a low dose of Synthroid affect my chances of conception or, later, the fetus?

DR. AMOS:
It's unclear why you take the Synthroid, so I really can't say much about this. Synthroid is unlikely to affect the fetus, and if you have hypothyroidism then you need it, and not taking it may adversely affect the fetus. Women with untreated hypothyroidism are more likely to have pregnancy complications. Treating it will usually improve pregnancy outcome.

MEMBER QUESTION:
I've had four IVFs and get about 12 eggs each time, which mostly fertilize and grow. A doctor suggested a Clomid challenge test. I'm unclear about its purpose, given that we already know I have eggs.

DR. AMOS:
The Clomid challenge test is done to see whether the eggs have a good quality or not. Eggs of "bad" quality are less likely to fertilize and implant than those of "good" quality. I suppose that's what your doctor is looking for, but only your doctor can best explain his reasons for suggesting this test in your circumstances.

MEMBER QUESTION:
What does it tell us about egg quality? I thought it was just a test to see if a woman has eggs remaining in her ovaries.

DR. AMOS:
An abnormal test shows you that your egg quality isn't good. It's not a test to check the numbers of eggs, but their quality. So while you may ovulate, you have a lower chance getting pregnant if the eggs aren't of good enough quality.

MEMBER QUESTION:
Do recurring benign sebaceous cysts cause complications with pregnancy?

DR. AMOS:
I am unsure what it is you are talking about. Sebaceous cysts are skin issues and those rarely, if ever, cause infertility problems.

MEMBER:
I am speaking of cysts on the vulva such as cutaneous staphylococcal lesions.

DR. AMOS:
I have not heard that this condition affects fertility.

MEMBER QUESTION:
I have lupus with nephritis but do not have the coagulation problems. Do I still have a risk for infertility with the lupus diagnosis?

DR. AMOS:
Lupus is one of the conditions that can affect fertility. It's an "autoimmune" problem, which decreases chances of conception and implantation, and it increases your risk of having a miscarriage or other pregnancy problems. The best thing to do is to see a high-risk obstetrician, get examined, and find out how you can improve your chances of having a healthy baby.

MEMBER QUESTION:
Is depression a side effect of Clomid, or just an emotion in the whole fertility process? I feel like I'm going crazy and can't seem to quit crying.

DR. AMOS:
Women who are infertile go through a lot of emotions. So that in and by itself is a good enough reason for depression. That's why it is a good idea to see a psychiatrist if that's what you feel. But Clomid in and by itself is unlikely to increase your risk of depression. Seeing a doctor and getting the right treatment may help you improve your chances of getting pregnant.

MEMBER QUESTION:
I have had a tubal reversal, and only one tube could be reattached. That is the only side I am ovulating from. The other side is clear through an HSG. Blood work indicates I am borderline diabetic and PCOS. I started Glucophage and will start Clomid shortly. I am just concerned if I really have a chance of conceiving or not.

DR. AMOS:
You are correct in being concerned. There are many different reasons here that will decrease your chances of getting pregnant. As long as you are with a reproductive endocrinologist then you know your chances are better and that you will get the best treatment. If you are unsuccessful, then the ultimate step would be IVF. IVF will likely provide you with the highest chance getting pregnant considering all of these issues. Good luck!

"As long as you are with a reproductive endocrinologist then you know your chances are better and that you will get the best treatment."

MEMBER QUESTION:
I'm 28 and have been TTC for about eight years now. I suffer from endometriosis as well as ulcerative colitis. I finally got pregnant on a nonmedicated cycle in July. However, it ended up being a chemical pregnancy. Could my conditions have caused it? Is there hope for a future pregnancy?

DR. AMOS:
A chemical pregnancy is the same as a miscarriage, and a miscarriage can happen in up to 50% of pregnancies. The fact that you now know you can get pregnant is very positive, and it likely improves your chances having a healthy pregnancy in the future.

MEMBER QUESTION:
I just had my second miscarriage in a year. I am on Metformin and I am also type 1 diabetic. Are there any tests that I should ask for before trying to get pregnant again?

DR. AMOS:
It all depends on how old you are. Many doctors do a chromosome test on the miscarriage to see if that was the problem. If the chromosomes were abnormal then you know it was a fluke and it had little to do with your medical condition.

MEMBER QUESTION:
I have been trying to conceive for 16 months now. On Monday I went to my GP about acne. He asked about facial hair, which I do have in moderation. He said that he "bets" that I have PCOS. He sent me in for a pelvic ultrasound and did some blood work. He prescribed a month of Fortamet. Should I take the Fortamet? I have regular periods. Would it do me harm to take the meds if I do not have PCOS? I have called the doctor several times to find out my test results, but I am not getting a call back. Thanks for your help.

DR. AMOS:
Fortamet is Metformin. This is a medication usually given to women with PCOS who have trouble ovulating. Before giving this medication most doctors want to make sure that the diagnosis is correct. So if you had the right tests done you should soon find out if PCOS is the right diagnosis or not. And if you have PCOS and don't ovulate, then Metformin may help you ovulate and get pregnant.

MEMBER QUESTION:
I have PCOS and do not menstruate on my own. I've taken Provera multiple times, but I feel like I am always ragging while on it. Is Prometrium better then Provera, since it is bioidentical?

DR. AMOS:
Neither Provera or Prometrium will help you get pregnant. The problem with not menstruating in women with PCOS is that they do not ovulate. So if you want to get pregnant, then you first have to ovulate. Your doctor should help you figure out what medications you can take to improve your chances of ovulating. Once you ovulate then your cycles will return and, with ovulation, your chances getting pregnant.

MEMBER:
I know that Provera will not aid in getting pregnant. I meant I have had to take Provera to bring on menses, and since I suffer such ill side effects (ragging feeling), I wondered if Prometrium would be better then the Provera, since Prometrium is a bioidentical hormone and Provera is synthetic.

DR. AMOS:
I am unsure why you would take either. If you want to get pregnant then neither will improve your chances getting pregnant. And if one medication doesn't agree with you then you should discuss with your doctor what your options are.

"The first step is to check for ovulation. If you ovulate then the next step is to check his sperm count. And if that is OK, too, then the next step is to check your tubes."

MEMBER QUESTION:
I was diagnosed with a moderate to severe case of endometriosis approximately six months ago, which they discovered while removing some lemon-size ovarian cysts. I've been pregnant twice before but never been able to hold one, and since this surgery I have not been able to conceive again, and the last six weeks I have not received a period although all pregnancy tests come up negative. Do you think I should seek help from a specialist at this time rather than continue seeing my ob-gyn?

DR. AMOS:
You absolutely should see a specialist. There are two main problems:

1. You have endometriosis
2. You haven't had a period and likely do not ovulate

The infertility specialist can help you figure out which steps to take next and improve your pregnancy chances.

MEMBER QUESTION:
I am worried about the possibility of endometriosis due to symptoms I am having and my strong family history of it (my mother, grandmothers, and an aunt have all had it severely). I have been TTC for almost a year unsuccessfully. Should I request tests from my doctor?

DR. AMOS:
The infertility workup usually goes through clear steps. The first step is to check for ovulation. If you ovulate then the next step is to check his sperm count. And if that is OK, too, then the next step is to check your tubes. That is often done with a laparoscopy, and during this test you can check for endometriosis.

MODERATOR:
We are just about out of time. Do you have any final comments for us, Dr. Amos?

DR. AMOS:
I wish everyone the very best success in having a healthy baby. Thanks for coming today. Being educated will help you in your plight.

MODERATOR:
Thanks to Amos Grunebaum, MD, for joining us this hour. You can also explore the RESOLVE web site at www.resolve.org.

Amos Grunebaum, MD, also reviews charts and answers questions on the message boards of the WebMD Fertility Center, our one-stop site dedicated to helping couples conceive faster by helping women understand their bodies and get in synch with their cycles. Go to fertility.webmd.com for more info.

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