Conceive, Trying to

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TTC: Trying to Conceive

WebMD Live Events Transcript

Are you trying to conceive? Amos Grunebaum, MD, medical director of the WebMD Fertility Center, joined us on March 14, 2005 and answered your questions about getting pregnant.

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
We lost our baby at just four months gestation due to Amniotic Band Syndrome in November 2004. I had two periods in November and December of 2004 but nothing since then. My OB doesn't seem concerned with this. He said to keep trying because he believes that since I've gotten pregnant in the past without any fertility assistance that it can happen again. But, if I don't have a period I'm not ovulating, right?

DR. AMOS
I am so sorry to hear about your loss. Not having a period without being pregnant usually means that you do not ovulate. By now it's five months after the prior pregnancy and you should be ovulating. Keeping a temperature curve will also help you find out if you ovulate or not. Your doctor can do some simple tests to find out why you don't ovulate, and then try and help you to ovulate and get pregnant. Good luck.

MEMBER QUESTION
Can you help me interpret the results of my husband's semen analysis?

  • Total volume 9.0
  • Sperm count 60.0
  • Motility 66
  • Morphology 37
  • Ph 8.1 (this is abnormal)
  • Liquefication Comp 1 hr, Specimen liquefied upon request

DR. AMOS
It's impossible to completely interpret any test results online. I do not know the circumstances or your medical history. You should really discuss any results with your doctor to better understand what's going on. The results you submitted are incomplete and there is not enough information there. For example a normal volume is about 3-6 cc or not and then a count can be reported as "per cc" or "total" so it's not clear what you mean by "Sperm count 60."

"Unfortunately manufacturers of pregnancy tests are not as straightforward as I'd like them to be. They advertise with things like "Our test can be positive before you miss your period." "Can be" doesn't mean that it will be. Most tests will NOT be positive until after you miss your period."

MEMBER QUESTION
I am three months off
birth control pills, had two 28-day cycles and was due March 11. Still no sign of my period, only brownish spots when I pee (on Saturday) and cramps. Now it's as clear as day. This was the first month we are trying to conceive (TTC). I took a home pregnancy test on Sunday and it was a big, fat negative. What are the chances it was incorrect? If I'm not pregnant and I don't get a period, how will I know if I'm ovulating correctly (I did have egg-white cervical mucus (EWCM) the last 3 months)?

DR. AMOS
In general, a normal count is well over 20 million per cc and over 40 million total. If you just missed your period then you may have taken the pregnancy test too early. In general, many pregnancy tests will not be positive until several days after you miss your period. I suggest you repeat the test with first morning urine (FMU).

MEMBER QUESTION
Have you heard of tamoxifen being used if Clomid didn't work to conceive?

DR. AMOS
I have heard of it but it's experimental at the present time.

MEMBER QUESTION
Does the brand of pregnancy test make a difference (I used CVS)?

DR. AMOS
Yes, the brand makes a big difference. I suggest you carefully read how sensitive it is. If it picks up a human chorionic gonadotropin (hCG) of 20-25 milliunits (mU) then it's sensitive enough. But even the best pregnancy tests are usually not positive until after you miss your period.

Unfortunately manufacturers of pregnancy tests are not as straightforward as I'd like them to be. They advertise with things like "Our test can be positive before you miss your period." "Can be" doesn't mean that it will be. Most tests will NOT be positive until after you miss your period.

MEMBER QUESTION
I am charting my cycles using BBT and CM, but have had frequent spotting the last two cycles. Is this something I should be concerned about?

DR. AMOS
Spotting can be a first sign of hormone or other problem. I suggest that you write down when exactly in the cycle your spotting happens and how long the luteal phase lasts. This information will help your doctor decide if something needs to be done about it or not. Sometimes it's a hormone issue, other times it's the cervix or vagina or uterus. Your doctor can carefully examine you and review the BBT chart to help you find the reason.

MODERATOR
We have follow-up questions about pregnancy testing:

MEMBER QUESTION
So, if I was due Saturday or Sunday, I should wait until this Saturday if it doesn't come?

MEMBER QUESTION
Do you mean the day after you miss the first day of your period or the day after you miss the 5-7 days after your period?

DR. AMOS
The day that you expect your period to come and it doesn't come is the first day you miss your period. That day is usually 14-15 days after ovulation.

Quick GuideInfertility: Types, Treatments, and Costs

Infertility: Types, Treatments, and Costs

MEMBER QUESTION
How often do you recommend BDing (baby dancing or love making) during ovulation? Every day or every other day?

DR. AMOS
Ovulation is only on one day. The day of ovulation and the two days before ovulation are your most fertile days to make love on. However it's often difficult to predict with enough certainty exactly when ovulation will happen. If you make love only on the day of presumed ovulation you can actually decrease your chances of getting pregnant because making love after ovulation is unlikely to get you pregnant. In general it's recommended to regularly make love 2-3 times a week, every week during your cycle. In addition, making love once a day, every day of your five fertile days before and the day of ovulation will maximize your pregnancy chances.

"In 50% of couples with fertility issues there is a male problem."

MEMBER QUESTION
I've been trying to conceive for the past 10 months. I get my periods every 28 days. I had an HSG (hysterosalpingogram) done in January of this year. My OPKs (ovulation predictor kit results) always show a surge 14 days prior to my next cycle, but my BBT (basal body temperature) doesn't rise until five days later. Is this a possible luteal phase defect?

DR. AMOS
I hope your husband also had a normal sperm count. I would have to take a closer look at your BBT curve; a description is insufficient to understand whether it's normal or not.

MEMBER QUESTION
I have three pregnancies with my husband. Would his sperm count change?

DR. AMOS
If you join the WebMD Fertility Center then I can take a closer look and answer your question better. You did get pregnant three times and you did not have a problem, so why should the problem now be with you?

Doing a hysterosalpingogram is an X-ray and a big test, and a sperm count must come before a woman has invasive testing. It's the first test to be done when a couple can't get pregnant. I would suggest you do a sperm count before you assume anything else. In 50% of couples with fertility issues there is a male problem. Until you know that he is OK you should not have more invasive tests done.

MEMBER QUESTION
Will those male home fertility kits work? My husband is uncomfortable going to the doctor's office.

DR. AMOS
The male at-home fertility kits are insufficient -- they don't give enough information. A sperm count requires that he have an orgasm. I am sure that many women would sign up for a similar test if it would exist.

MEMBER QUESTION
I had my first hCG shot Thursday afternoon, and my second IUI (intra-uterine insemination) on Friday morning. Will the shot cause false positives on the OPKs too?

DR. AMOS
The shot can cause a false positive urine test for up to three weeks. The best indication that you are pregnant after an hCG shot is a rising blood hCG titer.

MEMBER QUESTION
I have been TTC for over a year now. I think my doctor is about to put me on Clomid. What kind of side effects can I expect?

DR. AMOS
There are many side effects of Clomid including a 10% twin rate and lower abdominal pain. In addition, many women's chances of getting pregnant are actually decreased on Clomid unless there is a good enough indication. Your doctor should monitor you closely for any side effects and you should make sure it works. That means you need to make sure you ovulate, because that's the reason Clomid is usually given.

MEMBER QUESTION
I am charting and it has confirmed that I ovulate around the time I have ovulation pains. Is it possible to have ovulation pains in the middle of a three-day temperature rise?

DR. AMOS
Lower abdominal pains can have many different reasons; ovulation is just one of them. Other reasons include a condition called endometriosis. So, if you have pain several days after ovulation then your doctor should examine you to make sure it's nothing more serious.

"BBT charting -- if done and interpreted correctly -- is tremendously helpful. It can identify the number one problem which is a problem with ovulation."

MEMBER QUESTION
My husband and I have been TTC for 12 cycles now. I have regular cycles, ovulate around the same time each month, and my LP (luteal phase) is long enough. My husband had an SA and that is fine as well. About two years ago I had a cone biopsy to remove cervical cancer. Could this be affecting my fertility?

DR. AMOS
A cone biopsy is usually not done for cancer itself but for precancer. Cervical surgery can sometimes affect your cervical mucus and create scar tissue. Both of these problems can affect your chances of conceiving.

Your doctor can find out easily whether cervical stenosis after the surgery or not having enough cervical mucus may affect your fertility. The next test is also usually a test to see if your fallopian tubes are open, a hysterosalpingogram or a laparoscopy.

MEMBER QUESTION
How reliable is BBT record keeping? Does
green tea really increase CM?

DR. AMOS
BBT charting -- if done and interpreted correctly -- is tremendously helpful. It can identify the number one problem which is a problem with ovulation. It can also identify other issues such as problems with CM at the time of ovulation, the luteal phase, and whether you make love at the right time. But, doing BBT charting at home on a piece of paper is unsatisfactory -- that is why I created an online Fertility Center on WebMD.

Keeping a BBT chart is only the first step. We have doctors like myself who interpret your charts and help you identify other problems. No other online BBT charting site will offer you this convenience. In addition, there are many boards and tools which help you get pregnant at the WebMD Fertility Center.

MEMBER QUESTION
How much of a temperature increase should there be on the morning after ovulation to indicate ovulation has happened?

DR. AMOS
This question cannot be that easily answered without looking at your chart. In some women there should be a 0.4 degree rise, but in others it's different. In addition, it's not a single- day rise that indicates ovulation but a sustained rise over at least three days or more. That's called a "biphasic chart" which indicates that you ovulated.

MEMBER QUESTION
We have been trying for 10 months to have a child. We were able to conceive before, about two years ago, but the pregnancy did not go to term. My doctor told me there was nothing to worry about since we have conceived before. Is this true?

DR. AMOS
It all depends on how old you are and whether you have medical problems and you ovulate regularly. Different circumstances require different interventions. If you have no medical issues and you ovulate normally and you are under 35 then it's usually after about a year before you should see a specialist. If you are over 35 years of age it's after 6 months. With any problems, or if you don't ovulate, then you should see a specialist right away.

Quick GuideInfertility: Types, Treatments, and Costs

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MEMBER QUESTION
I am 12 DPO (days past ovulation) with a normal LP of 11 days. I am going to have a beta hCG test today. Should the results be accurate or could it still be too early for accurate results?

DR. AMOS
The normal LP is 12+ days. If you are pregnant then a blood pregnancy test is usually positive 11-12 DPO independent of your LP. Good luck.

MEMBER QUESTION
I recently had a fibroid removed via laparoscopy. I was told that my uterus was cylindrical shaped and will not be able to conceive. Is it possible that my uterus took this shape from being under trauma from fibroid removal? Is there a procedure that will aid the implantation of a fertilized egg into the uterine lining (away from fibroids in the wall) to help with conception?

DR. AMOS
I would suggest that you see an infertility specialist to assess exactly what's going on. A fibroid can often make the uterus misshapen and after the surgery it's important to assess it again.

"Clomid can decrease your cervical mucus and decrease your chances of getting pregnant; that's why it should only be taken with the right indication."

MEMBER QUESTION
Is there such a thing as doing too much? I conceived last year, twice, and VERY easily (got it first month TTC w/no OPKs or charting) but had miscarriages due to progesterone deficiency. Now I'm on Clomid (for four months) with no luck at all!

DR. AMOS
I suppose if you mean by "doing too much" that it may not be the right thing to take Clomid -- then you are right. Taking Clomid when there is no indication can actually decrease your chances of getting pregnant. Clomid can decrease your cervical mucus and decrease your chances of getting pregnant; that's why it should only be taken with the right indication.

MEMBER QUESTION
I've been diagnosed with Graves disease but my physician does not think treatment is necessary at this time. Will this affect my ability to conceive and/or pregnancy? I have one child already, nearly 2 years old.

DR. AMOS
Graves disease is usually treated if indicated. If you are not ovulating because of the Graves disease then you may benefit from getting treated. I am unsure about your lab results so I can't assess whether treatment is indicated or not. Most doctors go by thyroid function tests and then decide if treatment is needed.

MEMBER
I think I'm still ovulating. I still have regular periods (every 24-28 days).

DR. AMOS
It's usually the severity of the thyroid condition which decides on treatment. If it's not severe and you ovulate regularly then treatment often doesn't make a major difference. In addition, I hope your husband had a sperm count to make sure that it's not him with the problem.

MEMBER QUESTION
My husband has a low morphology number of 3% and I have been diagnosed with mild endometriosis. After surgery for endometriosis how long do we have to wait to start IUI/IVF?

DR. AMOS
It all depends on exactly how extensive the surgery was. The doctor who did the surgery knows exactly what was done and can then suggest how long to wait.

MEMBER QUESTION
Do products like Pre-Seed really work, especially if you have little CM from Clomid?

DR. AMOS
Pre-Seed is known to be "sperm friendly." However, if there is not enough CM then many doctors feel IUI is the best way to help you get pregnant. In fact, I know many doctors who give Clomid only together with IUI.

"The Surgeon General suggests that while TTC you behave the same way as if you were already pregnant."

MEMBER QUESTION
Will a doctor typically do an IUI without an SA being done, first?

DR. AMOS
A sperm count is essential with any fertility work-up. No serious doctor should ever do a fertility work-up without starting first with a sperm count.

MEMBER QUESTION
What nutritional needs should I especially attend to during planning and pregnancy given that I have a history of anorexia?

DR. AMOS
You should always take a prenatal vitamin supplement which usually includes about 600 mcg (micrograms) folic acid. This will decrease the risk of miscarriage and decrease the risk of fetal malformations. In addition, no smoking or drinking while you TTC -- drinking alcohol decreases your fertility. The Surgeon General suggests that while TTC you behave the same way as if you were already pregnant. You should also be at your optimal weight, not too little or too much.

MODERATOR
Our thanks to Dr. Amos Grunebaum for joining us today. And thanks to you, members, for your great questions. I'm sorry we couldn't get to all of them. For more information, check out the WebMD Fertility Center.



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Reviewed on 3/29/2005 5:12:26 AM

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