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.


STAY INFORMED

Get the Latest health and medical information delivered direct to your inbox!