Pregnancy: Trying to Conceive: Ovulation Issues

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Trying to Conceive: Ovulation Issues

WebMD Live Events Transcript

Are you ovulating? Are you sure? How can you best track your fertility and deal with out-of-synch cycles? Amos Grunebaum, MD, medical director of the WebMD Fertility Center, joined us on July 12, 2004, to talk about understanding and charting your ovulation as well as some of the causes of and treatments for ovulation problems.

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:
I am having problems ovulating and my husband has a low sperm count. My doctor prescribed Clomid. I had my cycle on July 5-8 of this month but I haven't taken the Clomid yet because of the things I've heard, and I'm scared to take it. When does it become too late in a month to take Clomid and what should I be aware of? Is there anything else I can do to make sure I ovulate?

DR. AMOS:
Clomid is usually started on CD 2, 3, 4, or 5 and given for five days. Starting Clomid after CD 5 is less effective. Clomid is, for most women, the best initial medication to induce ovulation. The other medications are stronger and have more side effects. You may want to talk to your doctor about your concerns, and make sure you understand the issues when you take Clomid.

MEMBER QUESTION:
What does it mean that I'm still cramping also, even though I've been off my cycle since the 8th of this month?

DR. AMOS:
There could be so many causes of cramping, including a bladder infection, ovarian problems, bowel issues, and problems with the uterus. To find out what the cramping could be, you need an examination. Only the examination can figure out the exact cause of cramping.

MEMBER QUESTION:
I saw my period between July 7th and July 10th. My cycle is by the way 28 and 29 days. When is it likely I ovulated?

DR. AMOS:
Ovulation usually depends on the length of your cycle. You haven't told us how long your usual cycles are, but in general ovulation happens about two weeks before the expected next period.

MEMBER:
It is btw 28, 29, and 30 days.

DR. AMOS:
So with a 28-day cycle ovulation is around CD 14. And with a 35-day cycle it's around CD 21.

MEMBER QUESTION:
Dr. Grunebaum, I have PCOS at 319 level. My RE recommended 1,500 milligrams of metformin three times a day, but my hands, legs, and feet experience a painful numbing/falling asleep type of feeling and the doctor told not to use it anymore. What should have the next step to help my ovulation occur more frequently? I usually ovulate late around day 26.

DR. AMOS:
Women with PCOS are usually overweight.

MEMBER:
I'm 5 feet 7 inches tall and 182 pounds.

DR. AMOS:
Studies have shown that losing weight can help you improve symptoms of PCOS and can help you ovulate again. Based on your height and weight, your BMI is 28.5. Getting to a BMI below 25 helps you improve your condition and you should lose 23+ pounds to get to that level.

MEMBER QUESTION:
What med should I use now since metformin doesn't agree with me?

DR. AMOS:
Only your doctor can decide on the right medication. There is no single "best" medication in women with PCOS. Seeing an infertility specialist may also help you get pregnant faster.

"Clomid is, for most women, the best initial medication to induce ovulation. The other medications are stronger and have more side effects."

MEMBER QUESTION:
Is it true that you always start your period 14 days after ovulation? I am on a 28-day cycle and I started using the OPK this month. Today is day 16 and it was positive today. I always thought that I ovulated on day 14 since I am a 28-day cycle. Is it possible that I am ovulating later?

DR. AMOS:
There is a condition that can prevent you from getting pregnant. It's called corpus luteum insufficiency. With it, you ovulate but don't make enough progesterone after ovulation. This can lead to a shortening of the time between ovulation and the next period. If that time is less than 12 days then you may have this condition. Keeping a BBT chart will help you identify this problem.

If the CLP is less than 12 days then you should see a doctor as soon as possible to find out whether this is the problem and how it can be treated.

DR. AMOS:
Can anything be taken to help this condition?

DR. AMOS:
Yes, but first you need to make the diagnosis. Once the diagnosis is made, your doctor should check for other problems. In some women, giving Clomid may help with this.

MEMBER QUESTION:
I don't believe that I always ovulate this late. Is that possible that it is late some months and not others?

DR. AMOS:
Anything is possible, and until you have done several months of BBT charts you can't be sure what could be going on.

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MEMBER QUESTION:
Are there any ovulation predictor kits that you would recommend using?

DR. AMOS:
Most OPKs are pretty much the same. You may want to read the latest Consumer Reports . They have reviewed OPKs and list what they consider the best ones.

MEMBER QUESTION:
Is early menopause treatable/reversible? Does that mean the end of ovulation completely?

DR. AMOS:
If you truly have menopause then it's not reversible. However, you want to make sure that the right diagnosis was made. Unfortunately, many women are wrongly diagnosed with irreversible menopause when in fact there could be other medical conditions. Seeing an infertility specialist will help you make the right diagnosis.

MEMBER QUESTION:
Hi. I was on birth control pills (Kariva) for 3.5 years. I stopped taking the pills from January 2004 until April 21, 2004, (my first day of period). I was having my periods regularly. However, I did not get my period in May and thought I was pregnant, but the test was negative. I finally got my period on June 4, and then have not gotten my period till today, though I seem to be very close to getting it now. The only new thing I have noticed is that I have very slight spotting in the last few months, which are about 15-16 days from the first day of my period's beginning. Over the last two periods my cycles have been 43 days and 37+ days (and counting). Due to this issue, I am now confused as to the number of days in my cycle and hence when I am ovulating. Would you please provide any answers to determine my ovulation days as we are trying to conceive?

DR. AMOS:
Irregular and absent bleeding usually indicates that there is a problem with ovulation. Most of the time there is no ovulation. Keeping BBT chart will help you find out whether and when you ovulate, and if it continues you may want to see your doctor and make the right diagnosis and also get treated.

MEMBER QUESTION:
Is Clomid only meant for people who don't ovulate? Can I take Clomid even when I ovulate on my own?

DR. AMOS:
If you already ovulate and there are no other problems then Clomid is not indicated. In fact, women who take Clomid without a reason are less likely to get pregnant. Clomid is not a "fertility" medication. Taking Clomid without a reason will not improve your chances of getting pregnant.

MEMBER QUESTION:
My husband and I recently started trying to conceive. We are both 42. I had several early signs of being pregnant already, and apparently yesterday, started an early miscarriage, according to the nurse I talked with this morning. She said I would start counting yesterday as the first day of my new cycle and ovulation would take place two weeks from then. Following a suspected miscarriage, will ovulation proceed as normal and can my husband and I again try this same month to conceive?

DR. AMOS:
First of all how do you know it's a miscarriage? Only if you had a positive pregnancy test can you assume that you were pregnant. Without a positive pregnancy test you just don't know. After a miscarriage it can take between two and six weeks on average for ovulation to return to normal. And as soon as ovulation happens it's possible to get pregnant.

MEMBER QUESTION:
I have heard that if you ovulate late in your cycle then the egg may not be viable. Is this true?

DR. AMOS:
If ovulation happens after CD 21 then your chances of getting pregnant are lowered. There are several reasons. The egg is older and less able to get fertilized, then the lining of the uterus is less likely to allow implantation, and you also ovulate less often over time when ovulation happens that late.

MEMBER QUESTION:
I had a miscarriage in April and had a D&C. My cycles have been very heavy and long. We want to get pregnant, but is this a sign of fertility problems? My doc has ordered blood work and hormone levels. I should get then back today. Would another D&C help clear up the heavy cycles?

DR. AMOS:
It all depends on why the menstrual periods are so heavy. Your doctor should first try finding out the exact reason. If, for example, there are uterine problems then doing a D&C won't improve anything. Also, if the bleeding is from hormonal issues then a D&C won't help.

"After a miscarriage it can take between two and six weeks on average for ovulation to return to normal. And as soon as ovulation happens it's possible to get pregnant."

MEMBER QUESTION:
My doctor prescribed me Provera to jump-start my period; however since then I haven't had another cycle. I have been off birth control pills for the last eight months and have only two cycles. What would be the next step in terms of conceiving (i.e. taking meds)?

DR. AMOS:
If your menstrual periods won't come then you likely don't ovulate. Taking Provera does not help you ovulate. You first need to ovulate so that your regular periods can come. Your doctor should try finding out why you don't ovulate and treat you. Once you ovulate then you can get pregnant.

MEMBER QUESTION:
I've been using one of those digital ear thermometers to take my temp. I've been using it for a year and it seems to give me the up and down you look for when ovulating. Feeling stupid, I recently found out there is a digital thermometer that is specifically for BBT. I feel like an idiot, but the one I am using seems to be giving me results that I see other people's charts giving. Have I been charting in vain for over a year?

DR. AMOS:
I have no idea what your charts look like, but it all depends on the pattern. An ear thermometer can sometimes be accurate. But internal ones like in mouth are usually better.

MODERATOR:
The actual temps don't matter, right Dr. Amos?

DR. AMOS:
What matters is that you take your temperatures correctly in the morning before you get up and don't change thermometers in the middle of your cycle. And also you should plot temperatures on a reliable site. At the WebMD Fertility Center we provide you with all the help to make sure you know what to do.

MODERATOR:
So it sounds like you haven't been charting in vain. But if you want to switch to another kind of thermometer, you should do it between charts/cycles.

MEMBER QUESTION:
Is there any value in keeping a BBT chart if you are on a fertility drug already?

DR. AMOS:
Yes, keeping a chart is especially helpful when you are inducing ovulation. It shows you beyond any doubt whether the drug worked and whether you ovulated or not.

MEMBER QUESTION:
My cycles were very regular (28 days) while I was taking the pill and even up to three months after I stopped taking the pills. However, now they are erratic. Any reasons why this might be happening?

DR. AMOS:
Likely there is a problem with ovulation. As I mentioned before, keeping a BBT chart helps identify the issue.

MODERATOR:
Unfortunately, we have to wrap up for today. Dr. Amos has to run to deliver a baby. Let's all wish him and the new mom good luck! Thanks for joining us.

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. Bye for now. And good luck in all your TTC attempts!



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Reviewed on 11/9/2004 4:58:52 PM

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