Conceive, Trying to

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TTC: Trying to Conceive

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Are you trying to conceive? Amos Grunebaum, MD, medical director of the WebMD Fertility Center, joined us on May 16, 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.

MEMBER QUESTION:
I have had a luteal phase (LP) of just 10 days for the past two cycles (with spotting for about three days before the start of menses with one cycle). I have only charted for two cycles (and never before this time), so I don't know what my LP has been all along. I do have an almost 3-year-old, so I was able to conceive without any problems once. Does a 10-day LP indicate a luteal-phase defect?

DR. AMOS:
The luteal phase is the time between ovulation and the next period. The normal luteal phase should be at least 12 days, and on average it's about 14 days.

A short luteal phase (LPD -- luteal phase deficiency) can be responsible for problems getting pregnant. That's because the uterine lining needs time to get ready for implantation.

You may want someone else to confirm the short CL phase (corpus luteum phase), and if that's true then you should discuss with your doctor what the next steps should be.

MEMBER QUESTION:
I have had three early losses and am being treated for a clotting disorder with baby aspirin. We have had timed intercourse for six months and I know I am ovulating. Since my last loss (and D & C) my periods have been very heavy, thick and painful. Could this be something that is preventing us from getting pregnant?

DR. AMOS:
A heavy period could sometimes be a first indication of an underlying problem. It could be due to hormonal or uterine problems. The first step would be to identify and make sure exactly if and when you ovulate. Your doctor should examine you and do some tests and see if everything is OK otherwise.

"Any serious medication can affect his sperm count. But only a sperm analysis can tell you for sure."

MEMBER QUESTION:
I have been trying to get pregnant for about seven months now. I am due to start my period around May 22. My husband and I tried every other day during ovulation and now I am having pain, like cramps. They aren't bad, they are just enough to notice and be a nuisance. I'm also kind of tight. Could this mean that I am pregnant or could it be something else?

DR. AMOS:
You may be pregnant but it's much too early to tell; it's only one week or so after ovulation. Only a pregnancy test can tell you for sure. A urine test is usually positive around the time of a missed period.

MEMBER QUESTION:
My husband has been taking medications for Addison's for the past 15 years and I was wondering if they can affect his sperm count and my chances of getting pregnant. He takes
Prednisone (5 milligrams), Synthroid (150 milligrams), and Fludrocort (0.1 milligrams).

DR. AMOS:
Any serious medication can affect his sperm count. But only a sperm analysis can tell you for sure. Why not do it and confirm that he is OK (or not)?

MEMBER QUESTION:
My husband and I just recently started TTC. I'm 19, have endometriosis and PCOS (polycystic ovary syndrome). How long should someone in my shoes try for until they should get worried?

DR. AMOS:
These two conditions are very serious and can prevent you from getting pregnant differently. Women with PCOS often don't ovulate, and women with endometriosis have "tubal" problems -- the tubes don't transport the egg and/or sperms properly. With these 2 conditions it's optimal to see a specialist right away and find out how to improve your chances of getting pregnant.

MEMBER QUESTION:
I don't have regular periods (my last one started April 7) and I haven't had one since. We have been trying to conceive only since April 30. I took a test on Saturday and it came up negative. Since I don't have regular periods - I sometimes go a month or two without one then have one every month for a few months -- is there anything I can do to regulate myself and still continue to try and conceive?

DR. AMOS:
Your regular periods come from ovulating regularly. Irregular cycles usually mean no or irregular ovulation. Doing a BBT chart on the WebMD Fertility Center will quickly tell you if that's the problem.

If you don't ovulate, then your doctor will usually do some tests to find out what the problem is. Once the tests are reviewed, your doctor can advise you what to do next and if treatments are necessary.

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MEMBER QUESTION:
My question is how well does the saliva ovulation test work?

DR. AMOS:
The saliva ovulation test can tell you when your more fertile days are. Saliva changes from hormonal changes as your ovulation approaches. That test together with other signs can help you improve finding out when you ovulate and when your fertile days are.

MEMBER QUESTION:
I am currently on the Yasmin birth control pill and my husband and I always have sex unprotected. My chest is very tender lately and I sometimes spot after sex or in between my periods. Am I pregnant? I took a pregnancy test but it was negative. We are trying to conceive but I don't know if I should stop taking the pills because it regulates my periods. Should I get a blood test? What's the best way to get pregnant?

DR. AMOS:
Birth control pills are very effective at preventing you from getting pregnant. A negative pregnancy test means that you are usually not pregnant. A pregnancy blood test should confirm that you are not pregnant.

"The best way to figure out if and when you ovulate is to do the BBT chart at the WebMD Fertility Center. Once you plot your chart and do your daily temperatures you can pretty quickly identify what's going on."

MEMBER QUESTION:
After getting off birth control pills two years ago I was diagnosed with a microprolactinoma. I've been on bromocriptine ever since. I was told this wouldn't have an effect on my TTC, but haven't been able to for the past two years. Ovulation normally occurs between days 17-19, with an LP of about 10 days. Is there any way that my meds are causing such late ovulation and short LP?

DR. AMOS:
Your medication could result in these problems, though it could be something different. If you ovulate regularly, and you cannot get pregnant, then the next step is to check his sperm count. How would you know otherwise if it's your problem or his unless he gets tested first?

MEMBER QUESTION:
If my husband's motility and morphology are both 8%, sperm count 20 million, hormones normal, what may be the problem (besides a varicocele)?

DR. AMOS:
There are different ways to identify a sperm count. There is the total count and there is the count per cc. You didn't mention which it is, so it's not possible to answer your question whether the count is normal or not.

MEMBER QUESTION:
My husband and I are trying to get pregnant. However I am unsure as to when I am ovulating. My last two cycles have been 91 days long. I stopped taking Ortho TriCyclen in March 2004 (I was on the pill for about 4 years) and it was about four months before had a period. I am supposedly due for my next period around June 16. Is there any way for me to have an idea as to when I may be ovulating? I knew that it would take me awhile to get back to normal after getting off of the pill but I didn't think that it would take over a year and I am nowhere close to normal. Can you help? I am 25 years old.

DR. AMOS:
The best way to figure out if and when you ovulate is to do the BBT chart at the WebMD Fertility Center. Once you plot your chart and do your daily temperatures you can pretty quickly identify what's going on.

MEMBER QUESTION:
The last Depo-Provera shot that I took was in July 2004 and we have been trying ever since. My periods have been regular since December. I'm having pains on and off, and tightness since ovulation. Could this mean that I am pregnant? How soon can I test? The only other symptom that I have is tender breasts, but I know that is normal before your next cycle as well. How soon do you start having symptoms?

DR. AMOS:
You may be pregnant, but symptoms in general are not a good enough indication of pregnancy. Only a pregnancy test can tell you whether you are pregnant or not. Do one today and find out for sure.

MEMBER QUESTION:
At what point in time are blood clots in your period a concern? I have been told they are normal but the ones I have are extremely large?

DR. AMOS:
I am unsure what you mean by "extremely large". You may want to discuss with your doctor how to measure the clots and maybe show them to your doctor. That's the best way to figure out whether your period bleeding is too heavy or not.

MEMBER QUESTION:
Can HPV or trichomoniasis prevent pregnancy?

DR. AMOS:
Neither HPV (human papilloma virus) nor trichomonas are known to affect your fertility.

"Only a pregnancy test can tell you whether you are pregnant or not. Do one today and find out for sure."

MEMBER QUESTION:
I am 33 years old and have never been pregnant. I discontinued birth control (Depo-Provera) about one month ago and would like to conceive. I understand conception probably won't occur for four to eight months. I take Norvasc and Cozaar for hypertension. My doctor has advised me to inform him as soon as I become pregnant, but are these drugs safe to take while trying to conceive? Please talk a little about pregnancy and hypertension.

DR. AMOS:
It's unclear what you mean by "discontinued Depo-Provera." The important question to answer is: When did you get the last shot? It can take 9-12 months after the last shot for ovulation and your fertility to return to normal again.

As to the hypertension medication, before you stop them I would suggest you see a high-risk obstetrician. This specialist can review your history, assess how important those medications are and then advise you whether to continue taking them or to switch to others. Never stop medication on your own without first discussing it with a doctor.

MEMBER QUESTION:
Could the
stress of unsuccessfully trying to conceive (for a year now) contribute to our failure to conceive?

DR. AMOS:
If you now ovulate normally then stress is unlikely to affect your fertility.

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MEMBER QUESTION:
I'm 35 years old and my husband and I have been trying to conceive for about a year. My menstrual cycles have been ranging anywhere between 27 and 38 days. Is this unusual?

DR. AMOS:
You have irregular cycles. Any time your cycles differ by more than 2-3 days, you are considered "irregular." Ovulation makes them regular so with irregular cycles you should first find out if and when you ovulate. That can be done best by keeping a temperature chart at the WebMD Fertility Center. Once you do your chart you can quickly identify whether there is a problem or not.

MEMBER QUESTION:
My son will be 4 years old at the end of July, my daughter would have been 2 this August, and I had no problems getting pregnant with either one. I had my tubes tied right after my daughter was born and I regret it. I had a reversal last June and we have been trying since then. I'm not one to check temps or to check cervical mucus. I guess my question is: is it too soon to think I won't get pregnant after a reversal?

DR. AMOS:
Your chances of getting pregnant depend mostly on whether the surgery was successful. By successful I mean whether your tubes are now open or not. This is usually confirmed with a hysterosalpingogram. If the tubes are open, you ovulate regularly, and he has enough sperms then you have a great chance getting pregnant.

MEMBER QUESTION:
Without going on actual fertility drugs, is there anything that will boost my fertility?

DR. AMOS:
There is a HUGE misconception about "fertility drugs." There are NO "fertility drugs." There are no drugs that make you fertile when you are not. Certain drugs help you ovulate when you are not, but that's about it.

How do you know where the problem is without getting him his sperm count checked? No matter what's wrong or right with you, if his sperm count is too low then you won't get pregnant.

So the questions to answer are: Am I in ovulation, are my tubes open, and does he have enough sperms?

"Clomid is usually the first drug of choice. It makes 50% of women who do ovulate get pregnant within the first three months."

MEMBER QUESTION:
Are there any other ovulation drugs besides Clomid that we can use? I am anovulatory and 29 years old.

DR. AMOS:
Clomid is usually the first drug of choice. It makes 50% of women who do ovulate get pregnant within the first three months. All other drugs are more complicated and often require an injection.

MEMBER QUESTION:
My wife's fallopian tubes are blocked. We are happily married for eight years. Can you advise the best possible treatment, please?

DR. AMOS:
Blocked tubes prevent the egg from meeting the sperm. One way to treat this problem is by doing surgery to "unblock" the tubes. But a better and more successful treatment is usually IVF, in-vitro fertilization. IVF has a very high success rate with blocked tubes.

MEMBER QUESTION:
I have some hormonal problems that have been addressed using medication (dexamethasone, Follistim and Clomid). My husband has spermatocele causing antisperm antibodies and a varicocele. What are the options? Will IVF work?

DR. AMOS:
I'm not sure what the hormone-problem diagnosis is, but with sperm problems many doctors feel that IVF and ICSI (intracytoplasmic sperm injection) will work best getting you pregnant.

MEMBER QUESTION:
I bought a basal thermometer. Do you take your temperature at the start of your period or when the period stops? This would be my first time taking my temperature to check ovulation.

DR. AMOS:
You usually start taking your temperature on cycle day number one -- that's the first day of your period.

MEMBER QUESTION:
My husband is an avid bike rider. We have been TTC for almost 1 year, and did conceive in January, but miscarried at five weeks. Is it possible that normal bike riding could be affecting my husband's sperm?

DR. AMOS:
You are absolutely correct. Using a bike can increase his scrotum temperature and affect his sperm production. Do a sperm count and find out for sure.

MEMBER QUESTION:
Does the fact that I had a C-section mean I will have trouble conceiving again?

DR. AMOS:
An uneventful cesarean section should not affect your future fertility.

MEMBER QUESTION:
We are an example of a couple where both husband and wife have issues. I have PCOS, although I have successfully ovulated on dexamethasone and Clomid also have been successful on Follistim. My husband has a small spermatocele and a small varicocele -- therefore he has tested positive for sperm antibodies and his morphology is a bit low (6%). Surgery has been suggested for him, which we are open to. While we are waiting for surgery and since we are impatient (we are told the results from the surgery will take 3 months and the surgery is not for another 2 months) is IVF a viable option? Can IVF get around the low morph and the positive sperm antibodies?

DR. AMOS:
Sounds to me like IVF would be optimal for this kind of a problem, specifically if ICSI is being done, which can overcome the antibody issue. Good luck.

"Many doctors suggest that you should stay on your back for about 10-15 minutes after making love."

MEMBER QUESTION:
I first took my hCG on a Monday -- it was 240. Then on Wednesday it was 439, on Friday 749, on Monday 2162, and then on Wednesday it was 2617. I had a sonogram at 2162 and saw egg sac, but no baby. The doctor said it might be blighted ovum. How do your levels rise when there is no baby? Can I still have a healthy baby if the numbers keep going up slowly? There is no bleeding and nothing else to indicate miscarriage.

Quick GuideInfertility: Types, Treatments, and Costs

Infertility: Types, Treatments, and Costs

DR. AMOS:
The levels between Monday and Wednesday did not rise as fast as they should. They should rise at least 60% in two days, but you really can't be sure from just these two tests. I suppose this was last week, so at this point you should be able to see something on ultrasound. Good luck.

MEMBER QUESTION:
Is it a bad thing to use the bathroom and clean myself after we have sex? I usually will lay there for a few minutes afterward just to be safe but is that long enough?

DR. AMOS:
Many doctors suggest that you should stay on your back for about 10-15 minutes after making love. You could get pregnant without that, but you may improve your chances by staying longer on your back.

MEMBER QUESTION:
I'm 27 and for about 2 weeks now I've been very tired and my breasts are tender. If I don't get a chance to eat, my stomach cramps up on me until I do eat. Last week, after being with my mate, I had some slight staining that didn't last long. I also have pelvic pressure and am backed up. I'm not due for a cycle for a week and a half yet. My partner is tired a lot and hungry more too. We are together about three times a week and we don't use protection. Is there a good chance I could be expecting?

DR. AMOS:
You didn't mention when you ovulated and if you missed your period. If you missed your period then a pregnancy test should be positive now if you are pregnant. Only a positive test can tell you for sure.

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 8/12/2005 4:19:35 AM

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