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 April 11, 2005 to answer 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.

MODERATOR:
Welcome to TTC: Trying to Conceive with Dr. Amos Grunebaum. On to our first question.

MEMBER QUESTION:
I'm 40 years old, have been TTC for one year and had a trisomy 16 miscarriage. My temperatures are usually from 96.2 to 97.1 preovulation and 97.2 to 97.6 postovulation. I'm also on Clomid 50 milligrams. Are my temperatures especially low or indicative of a problem?

GRUNEBAUM:
In general, it's important to first make sure that you ovulate. A typical ovulation BBT curve shows a biphasic temperature chart.

So if you have a lower temperature during the first two weeks or so and then it goes up and it stays up, then that's called a "biphasic" curve. A biphasic curve means that you did ovulate.

Your temperatures typically rise and stay up about 0.4 or so degrees after ovulation. So it seems that your temperatures are OK, though I really would have to look at the total curve.

MEMBER QUESTION:
I'm 27 years old. I was on Ortho Tri-cyclen for three months but have not taken any since March. Is there a good chance I can become pregnant this month?

GRUNEBAUM:
The birth control prevents you from ovulating. Once you stop the pill, ovulation usually happens within 2-3 months. Once you start ovulating again there is a good chance that you could become pregnant.

I hope that you follow the suggestions and take a daily supplement of folic acid. Folic acid is known to prevent fetal malformations and it's recommended for every woman who is trying to conceive. For folic acid to work, you must start it no later than 1-2 months before conception. Good luck.

"Your fertile days are generally the five days before and the day of ovulation. So with a 28-day cycle, ovulation happens on cycle day15 or so and the fertile days are cycle day10-15. On those days you should make love once a day."

MEMBER QUESTION:
I had my period on March 1, 2005. On March 18, I went off the pill in order to try for baby number three. On March 20, I had what they call "breakthrough" bleeding for about three days. In order to calculate when my next period is due, do I refer to the earliest period or the "breakthrough" period?

GRUNEBAUM:
In general it's recommended to not stop the pill in the middle of your cycle. It seems that's what you did, and that can create many problems.

Spotting and irregular bleeding is one of the problems. It may take several months for ovulation to begin and for your cycle to get regular. An "official" menstrual period is defined as bleeding after ovulation. So the bleeding you saw was not a regular period, just bleeding. Once you ovulate then your regular periods will return.

MEMBER QUESTION:
I've been TTC since last October and I'm really clueless about when the best time is to get pregnant. What do you recommend as the best way to find out when you are most fertile?

GRUNEBAUM:
First you need to write down exactly when your period comes. Your fertile days are generally the five days before and the day of ovulation. So with a 28-day cycle, ovulation happens on cycle day15 or so and the fertile days are cycle day10-15. On those days you should make love once a day.

In general it's also recommended to make love 2-3 times a week, every week. This ensures that you won't miss your fertile periods.

MEMBER QUESTION:
Can you be on Clomid and still need to take progesterone supplements, or does the Clomid also assist with progesterone deficiencies?

GRUNEBAUM:
Whether you take progesterone or not depends mostly on your medical history.

Many doctors feel that progesterone supplementation is unnecessary most of the time and won't improve pregnancy outcome. In addition, taking progesterone at the wrong time may actually decrease your fertility. I would therefore suggest that you discuss the specifics with your doctor who knows you best.

MEMBER QUESTION:
Are there ways to test the health or viability of eggs before conception in women over 40?

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GRUNEBAUM:
The "good egg" test is an FSH test done on CD 3. A low FSH on CD 3 means the eggs are good.

MEMBER QUESTION:
Does having a tipped uterus prevent one from getting pregnant?

GRUNEBAUM:
A tipped uterus is also called a "retroverted uterus." A retroverted uterus does not play a major role in fertility problems unless it's from endometriosis. Endometriosis can prevent you from getting pregnant, but not the retroverted uterus in and by itself.

"After 40 the rate of infertility decreases significantly. If you ovulate regularly then the next step is to test the quality of your eggs."

MEMBER QUESTION:
I was diagnosed with polycystic ovarian syndrome. Can you suggest a way I can conceive without taking medicine?

GRUNEBAUM:
PCOS is the leading cause of infertility in women. It is a condition associated with many different problems and each needs to be addressed individually.

Your best chance of getting pregnant with PCOS is to see an infertility specialist or reproductive endocrinologist. The RE is best trained to review your information, examine you, and decide on an optimal treatment plan.

For example, if you are overweight, then losing weight to an optimal BMI will improve your chances of getting pregnant.

MEMBER QUESTION:
Can egg whites really be used safely as a replacement for cervical mucus? A friend swears it worked for her but she's definitely not a doctor!

GRUNEBAUM:
It all depends on why you want to use egg whites. If you ovulate regularly and you don't have enough cervical mucus then pasteurized egg whites may help sperms enter the uterus.

But I would suggest you first have your doctor examine you to find out whether that's the problem. I would never suggest you use anything unless there is a clear indication.

MEMBER QUESTION:
I am 43; what are the chances of getting pregnant on my own?

GRUNEBAUM:
After 40 the rate of infertility decreases significantly. If you ovulate regularly (do you?) then the next step is to test the quality of your eggs.

This is usually done with a CD 3 FSH test. You may also want to have him do a sperm count so you won't lose unnecessary time. I also suggest that women at this age see their OB/GYN or an infertility specialist. Time is important and even waiting six months will likely decrease your chances of getting pregnant.

MEMBER QUESTION:
Does a spike in your temperature indicate ovulation? My OPK was positive on Saturday and I noticed my temperature was higher than normal on Sunday. What do you think?

GRUNEBAUM:
You can't tell anything from just one spike. For ovulation to be diagnosed you must see a "biphasic" temperature chart. It's lower then goes up and stays up for at least three days.

MEMBER QUESTION:
My period came seven days early this month and lasted seven days. Is that normal?

GRUNEBAUM:
Your period depends on when you ovulate. If you ovulate then it comes 14 or so days later. So you first need to determine exactly when you ovulate. This will provide you with the right answer.

It's not normal to get a period seven days after ovulation But if you ovulated 14 days before then, that's normal. That's why many women join the WebMD Fertility Center where you can keep a BBT chart. This will help you identify exactly what's going on each cycle.

"Keep a BBT chart and find out whether and when you ovulate. The knowledge of ovulation will help you determine each time what's going on when you miss your period."

MEMBER QUESTION:
I recently had my second miscarriage in six months. I have a bicornate uterus and for each pregnancy the zygote has been on the right or left respectively. This past miscarriage concerned me. It has not expelled and I heard the heartbeat twice in one week via transvaginal ultrasound. On March 28 it was 114 and on April 1 it was 120; then within 24-48 hours the baby died. Is this normal in a bicornate uterus or should I have any specific tests before trying to conceive again?

GRUNEBAUM:
I am so sorry to hear about your miscarriage. There are many different reasons for a miscarriage, but well over 50% are due to chromosomal anomalies. A chromosomal anomaly can be diagnosed by checking the chromosomes of the miscarriage.

Doing a special test can help you identify where the problem is. A miscarriage happening when a fetus has a heart beat and then dies inside the uterus is rarely due to an abnormal uterus. I would suggest that you ask your doctor to do some tests and try finding out what's going on.

MEMBER QUESTION:
I am four days late; I am never late -- always early or on time. A home test is negative, but still no cycle. I am having slight cramping. Could I be pregnant or is my cycle preparing to come?

GRUNEBAUM:
You could be pregnant, but until you have a positive pregnancy test you won't know for sure. The number one question I get on WebMD is: "I missed my period, could I be pregnant?"

And my answer is the same: Keep a BBT chart and find out whether and when you ovulate. The knowledge of ovulation will help you determine each time what's going on when you miss your period. Join the WebMD Fertility Center where we can all help you identify what's going on with your cycle.

MEMBER QUESTION:
Can someone who had an abortion have difficulties later TTC?

GRUNEBAUM:
A past uneventful, uncomplicated abortion never affects your future fertility.

MODERATOR:
Dr. G., I know you have to go to see patients. Thanks for joining us.

GRUNEBAUM:
Thank you so much for visiting. Good luck to everybody!



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Reviewed on 4/22/2005 8:58:59 PM

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