Pregnancy: Trying to Conceive: Is Something Wrong? (cont.)

MEMBER QUESTION:
If the air conditioner is on, does that affect BBT?

DR. AMOS:
Even if the AC is on, if you take your temperatures as you should -- first thing in the morning, not moving or getting up before, and around the same time -- then you should have a reliable curve.

MEMBER:
I take it while I'm still in bed in the a.m. before movement or eating. Thanks for your help.

DR. AMOS:
You are welcome.

MEMBER QUESTION:
I've been TTC for three years now with two miscarriages. Each pregnancy takes over a year to get pregnant. I have had HSG, post-coital, and several doses of Clomid. My DH has not had a SA. Would you recommend that, or since we have achieved pregnancy twice is that not necessary?

DR. AMOS:
The first thing to know is how old are you and if your cycles are regular with normal ovulation.

MEMBER:
Thirty-five and yes.

DR. AMOS:
If you ovulate regularly then the next step in the infertility work-up is always the sperm count. The sperm count is a very easy test. In fact it's the only test I know off which guarantees the person getting examined an orgasm! About 50% of infertile couples have a "male" factor and it's usually diagnosed too late. Many women will first have many tests and surgeries done before he gets tested. His sperm count must be the very first test done to make sure that you won't get all tests done and take medications before you find out it's him.

"Surgery is rarely, if ever, the first step in improving male fertility. Sometimes it's just lifestyle or improving diet."

MEMBER QUESTION:
Do hot flashes affect BBT? I'm experiencing some on Clomid.

DR. AMOS:
Hot flashes are a side effect of Clomid. That's because Clomid is an "anti-estrogen," and with less estrogen you can experience hot flashes. While on Clomid your temperatures can be erratic, so someone evaluating your chart should know that you are taking Clomid. It's difficult to interpret the chart on your own and you should have an expert look at it so it makes more sense.

MEMBER QUESTION:
Dr. Amos, I miscarried on 6/13/04, and lasted about nine weeks. I still haven't had an AF since. This past week I have had very small amount of blood when I wipe after a bowel movement, but it is definitely coming from the vaginal area. Could my cervix possibly be blocked and not letting AF out?

DR. AMOS:
It's possible, but unlikely, that your cervix is responsible for not getting AF. It's more likely that you haven't ovulated yet. I am unsure what you mean by "lasted nine weeks," but if you haven't ovulated two to three months after a miscarriage then you should discuss this with your doctor.

MEMBER QUESTION:
I spotted for nine weeks and took that long for HCGs to reach zero.

DR. AMOS:
So it finished, what, three weeks ago?

MEMBER:
Five weeks ago.

DR. AMOS:
In that case you need to wait for a couple more months for ovulation to return.

MEMBER QUESTION:
A couple more months? Is there any cause to worry?

DR. AMOS:
Seems like you just finished the miscarriage five weeks ago. It can take several months for your body to readjust.

MEMBER QUESTION:
If a male factor is diagnosed, what are some of the possible solutions? I know this is a broad question, but DH equates "testing" with "problem" with "surgery" and is VERY apprehensive.

DR. AMOS:
Surgery is rarely, if ever, the first step in improving male fertility. Sometimes it's just lifestyle or improving diet. A urologist will usually do the examination, take a history, and find out what can be done about it.

MEMBER QUESTION:
Are there higher risks of miscarriage when using Clomid?

DR. AMOS:
Women on Clomid are more likely to miscarry, and on Clomid you are not more likely to miscarry. Clomid in and by itself does not increase the risk of a miscarriage. However, women who take Clomid, e.g. women with a condition called PCOS, are more likely to have a miscarriage.

MODERATOR:
Ah, now we get it! Thanks for the clarification.

DR. AMOS:
So it's not the Clomid, but the person who needs it in the first place.

MEMBER QUESTION:
Hi, Doc, I have been diagnosed with ovarian dysfunction and am currently under the care of a reproductive endocrinologist. I did two cycles of Gonal F, six amp a day, in combination with Lupron in the second cycle, which produced one mature and good-sized follicle. We did an IUI, which failed. What options do I have at this point besides a donor egg? I am 38 years old and going to be 39 in November. My husband's SA was done last December, which was fine, and I did get pregnant early this year but miscarried at five weeks.

DR. AMOS:
Most REs likely will suggest IVF as the most successful way to get pregnant. With IVF your chances of getting pregnant with these conditions are likely the highest.
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MEMBER QUESTION:
Last month was my first cycle on Clomid. I experienced a long list of side effects and I knew that was possible going in. I wanted to know, are their any side effects or level of severity that should be cause for concern?

DR. AMOS:
Not knowing exactly your medical history and your side effects makes it impossible for me to make a specific comment. However, there are many potential side effects of Clomid and you need to first make sure that you get Clomid for the right indications. If Clomid is given for wrong indications then it's not unusual to have more side effects. In addition, it should preferably be given by an infertility specialist who can monitor you very closely to make sure you just get the right amount and not too much. Most doctors start on 50 milligrams Clomid in the first month.