Pregnancy: Conceive High Risk Conditions (cont.)

MEMBER QUESTION:
Does having children late in life (age 40 -- she is now 4 years old) help prolong fertility for a second child (I am now 45 -- still appear to be ovulating, also taking Clomid)?

DR. AMOS:
Unfortunately, having a child late doesn't necessarily improve your chances. You may want to get a test done to check your ovarian function. The first step would be to do an FSH test on CD 3.

MEMBER:
I did -- it's OK.

DR. AMOS:
If the FSH is normal then your chances conceiving are better then if the FSH is elevated.

MEMBER QUESTION:
I have read that pregnant women with hypothyroid have an increased chance of having a child with autism. Is there valid research on this topic? Also, if this is true, do the chances of that occurring decrease as long as thyroid levels are monitored during the pregnancy?

DR. AMOS:
There is a lot of research being done on causes of autism. If I understand it correctly then hypothyroidism is not a major cause for autism. Most cases of autism have an unknown etiology.

MEMBER QUESTION:
I had an ectopic pregnancy seven ago. I have now been TTC since January 2004 with one miscarriage. I went for HSG and it showed that my tubes were clear. Why did I have the ectopic, and am I at risk for another?

DR. AMOS:
The major cause of PID is having had an infection in the tubes. The infection creates scar tissue and prevents the tube and the egg from moving normally. That increases the risk for the egg to "get stuck" in the tube and implant there. Having had an ectopic increases your risk 20-fold to have another ectopic. That's why it's crucial that you see a doctor as soon as you find out that you are pregnant, and to evaluate your pregnancy for another ectopic pregnancy.

MEMBER QUESTION:
But why were my tubes clear when I did the HSG just this past Friday?

DR. AMOS:
Having a good hCG is a good first step finding out that you are OK. But there still could be scar tissue on the outside of the tubes, and that scar tissue cannot be seen on the HSG. Rather, a laparoscopy is needed to see that scar tissue.

"Up to 50% of infertility cases have a male factor. So he should get tested before you do. What better test could there be than one that ensures the person gets to have an orgasm?"

MEMBER QUESTION:
My fiance has hypertension. How will that affect our chances?

DR. AMOS:
If his sperm count is fine then male hypertension shouldn't affect your chances of getting pregnant.

MEMBER QUESTION:
It is known that excessive ejaculation and excessive abstinence both decrease sperm count. How often should a man ejaculate to maintain healthy sperm count?

DR. AMOS:
Ejaculating once a day on average usually provides you with reassurance that he makes enough healthy sperm and that he won't deplete his reservoir too much. However, you also want to make sure he has enough sperm to start with. Doing a spermanalysis will answer this question best. If he has enough sperms then once a day is fine. If he has somewhat less sperm then every other day is better.

MEMBER QUESTION:
How can we know about the sperm count, because the doctors don't recommend doing the tests during the initial phase of TTC?

DR. AMOS:
You simply need a sperm count to know that he is OK, too. Many specialists start off testing him. Up to 50% of infertility cases have a male factor. So he should get tested before you do. What better test could there be than one that ensures the person gets to have an orgasm?

MODERATOR:
And a spermanalysis is not necessarily part of the "wait a year" recommendation, right?

DR. AMOS:
Exactly!!

MODERATOR:
You can have that done any time.

DR. AMOS:
I usually start all my TTC patients off with a spermanalysis. That way you don't waste any unnecessary time.

MEMBER QUESTION:
I have been on 150 milligrams of Clomid and metformin for the past two months. Nothing seems to be happening. I had endometriosis in 2002. Do you think it has come back? I had surgery for it. Could this be why I am not getting pregnant?

DR. AMOS:
I am unsure what you mean by "nothing seems to be happening." Does that mean you don't ovulate or that you ovulate but didn't get pregnant?

MEMBER:
I'm not ovulating. My progesterone at day 21 is 7.89.

DR. AMOS:
If you don't ovulate then many doctors may increase Clomid or they move on to other medications such as injectables. In either case, you also may want to see a specialist, an RE. They can help you best with these problems.

MEMBER QUESTION:
I was diagnosed with mild endometriosis two years ago. We have been TTC for 14 months, I've had four IUIs and my RE has diagnosed us with unexplained infertility. Even though I am not having any problems with the endo (no pain and I ovulate regularly) is it possible the endo is causing problems?

DR. AMOS:
Endometriosis is one of the top reasons for infertility. It prevents the tubes from moving normally and thus prevents the egg and sperm from meeting or the egg from moving into the uterus. Having a laparoscopy done is usually the first step in diagnosing the severity of endometriosis. If endometriosis is the cause of infertility then IUI is less likely to work. Women with endometriosis are more likely to get pregnant with IVF.

MEMBER:
The endo was found on the cul-de-sac, I've had a SHG and HSG and they both came back clear.

DR. AMOS:
So I assume it was diagnosed by laparoscopy.

MEMBER:
Correct.

DR. AMOS:
Things can change over time, and it can get worse. You may want to discuss the next steps with your doctor.

"Endometriosis is one of the top reasons for infertility. It prevents the tubes from moving normally and thus prevents the egg and sperm from meeting or the egg from moving into the uterus."

MODERATOR:
Unfortunately, we have to wrap up for today. Thanks for joining us. If Dr. Amos wasn't able to answer your question, 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, which can be found on our boards and chats page, "Member Central." 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. Go to fertility.webmd.com for more info.

DR. AMOS:
Thank you for visiting today.



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