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 July 18, 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:
Hello Dr. Grunebaum. How are you today?

DR. AMOS:
Hello everybody, I am fine, thank you.

MEMBER QUESTION:
We are trying to have a baby. As per my ovulation chart I will ovulate this Thursday. I bought an OPK (ovulation predictor kit) to make sure. When should I start testing?

DR. AMOS:
The OPK usually turns positive within one to two days prior to ovulation, so what you should do is to start testing about four to five days before expected ovulation.

Ovulation usually happens within 12-34 hours after the OPK first turns positive. Some women choose to test every 12 hours, to make sure they won't miss the first positive. However, you really don't want to start making love only for the first time after it turns positive because at that time it may already be too late to optimize getting pregnant. You should make love regularly two to three times a week, every week and in addition, every day during the four to five days leading up to and the day of ovulation.

MEMBER QUESTION:
I wanted to know when it is OK to start TTC (
trying to conceive) after a miscarriage and D&C at 10 weeks. Some doctors say one cycle. What do you recommend?

DR. AMOS:
Ovulation can happen as early as 2 weeks after a miscarriage and studies have shown that there is no increased adverse outcome if you get pregnant early on. But many doctors suggest waiting for at least one period. That ensures that the uterine lining has shed at least once and hopefully improves implantation.

"I always suggest to do an official sperm count in an approved laboratory when you want to know for sure."

MEMBER QUESTION:
Where can women read the research on trying to conceive after a miscarriage? What does the research say about how long it is necessary to wait? What are the risks if you don't wait?

DR. AMOS:
The best research place is PubMed (www.pubmed.com). You can search for publications there and find out the most recent information on an issue.

MEMBER QUESTION:
I am on my third cycle of Clomid and my husband did a home sperm count test. He got a negative on the first test and a positive on the second test four days later. When should he be tested by a doctor? My doctor originally said not until I was on Clomid for six months, assuming I was the only problem.

DR. AMOS:
I am unsure what you mean by positive or negative. A home sperm test is much less reliable than an "official" sperm analysis.

MEMBER:
The test, new on the market, tells you whether the sperm count is over 20 mil (positive) or under (negative).

DR. AMOS:
I always suggest to do an official sperm count in an approved laboratory when you want to know for sure. The total count doesn't tell you enough about his sperms. There is much more information in the sperm analysis than just the count, like mobility and morphology. The home test does not give you that information. Do an "official" sperm analysis and find out for sure.

MEMBER QUESTION:
I'm on my eighth month TTC. My doctor says we need to wait one year before seeing him. Is there someone else we can see? I'm beginning to feel like we're wasting time and that there may be a problem. I experience pains on one side following ovulation. Should this be a concern as well?

DR. AMOS:
If you are ovulating (are you?) then the next step is to do a sperm count. If your doctor told you that she doesn't want to see you until one year there is a solution: find another doctor who is willing to see you earlier.

MEMBER QUESTION:
Is there such a thing as implantation cramping? Could the cramping I started having seven days past ovulation be implantation? I am still having dull cramping -- more like pressure. Is that normal if pregnant?

DR. AMOS:
Most pregnant women have no symptoms at implantation. No matter what you feel, the only way to be sure that you are pregnant is a positive pregnancy test. Everything else is pure speculation.

MEMBER QUESTION:
How likely is it that you would miss your LH (luteinizing hormone) surge using OPKs (i.e. never get a positive OPK, but actually ovulate)?

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DR. AMOS:
It's very unusual to not have a positive OPK and ovulate, but it's possible. If your BBT (basal body temperature) chart shows a clear biphasic pattern and/or you have elevated progesterone levels then that's your very best indication that you ovulated.

MEMBER QUESTION:
My son passed away due to a blood clot at 30 weeks. Two months ago and two weeks ago, I had blood work done to see if I have a clotting disorder. Last week the tests' results were negative for clotting. I want to get pregnant and my doctor said I have the green light to try again. I want to know the percentage of succeeding in bringing a baby to term. I have two healthy girls now -- one is 20 and the other is 7. I am 38 years old.

DR. AMOS:
I am so sorry to hear what happened. However, from your description it's unclear where the blood clot was and without knowing the full history and what happened it's impossible to provide you with more information.

I suggest you see a high-risk obstetrician -- a maternal-fetal medicine specialist. This specialist can review your history and chart and then give you the best advise on what to do next.

"I cannot emphasize this enough -- knowing for sure when and if you ovulate, preferably with a BBT chart, is crucial to help you get pregnant faster."

MEMBER QUESTION:
I have been trying for three months now. I'm actually due for my period today but I didn't get it. I took a pregnancy test this morning and it was a negative. Could it still be possible that I am pregnant?

DR. AMOS:
The most important question to answer is: Did I ovulate or not? If you did ovulate for sure and your period did not come 15+ days later, then chances are you are pregnant. If you miss a period with repeatedly negative pregnancy tests and they are negative, then chances are that you did not ovulate.

I cannot emphasize this enough -- knowing for sure when and if you ovulate, preferably with a BBT chart, is crucial to help you get pregnant faster.

MEMBER QUESTION:
I had a progesterone test done last cycle at seven days past ovulation (DPO). It came back at 9.5. This was a medicated (tamoxifen) cycle. My doctor doesn't seem to think it's a big deal that it wasn't that high. Any thoughts? I do have type 2 diabetes.

DR. AMOS:
On 7 DPO, ovulation the progesterone should be over 10. You either ovulated and tested too early or you did not ovulate at all. Keeping a BBT chart will help you identify the exact ovulation day.

MEMBER QUESTION:
I will be starting Clomid in a few weeks if I'm not pregnant by then, and I hear it is better to take it at night. Is this true?

DR. AMOS:
There is no research I am aware of that says taking Clomid at night is better than in the morning. Ask your doctor and find out her opinion, but I am not sure it will make a difference.

MEMBER QUESTION:
I am on my second month of Clomid -- the 50-milligram dose. My cycle length was 35 days. Should I expect to ovulate around the 21st day again? Or is there a possibility I won't follow the same pattern?

DR. AMOS:
How sure are you that you ovulated? As I mentioned before, it's crucial, especially if you take Clomid, to know the exact day of ovulation. Going by cycle length isn't enough when you take Clomid.

If you take Clomid on CD (cycle day) 5-9, the ovulation is expected on CD 14-18. So CD 21 sounds late for ovulation on Clomid.

MEMBER QUESTION:
I've been TTC for over a year and just had a LAP (laparoscopy) and hysteroscopy to clear mild endometriosis. My doctor suggested that I try Clomid again, but he's not concerned with blood test results even when I've heard that there could be progesterone, etc. issues. Why isn't he concerned?

DR. AMOS:
That's a very good question. I would be concerned about progesterone and whether you ovulated or not, but the very best person to answer that question is your doctor.

MEMBER QUESTION:
I've been off the pill since March 5 of this year and still have not menstruated, but I'm not pregnant. I've been pregnant two times before, after the pill, and without a problem. Do you think this is still postpill amenorrhea or another problem?

DR. AMOS:
After four months you should have started to ovulate again. I usually suggest seeing your doctor after four to five months off the pill to find out why your period hasn't come. You also want to make sure that you are not pregnant.

"The best pregnancy tests are those that have a low sensitivity, usually around 20-25."

MEMBER QUESTION:
I'm 37 with three failed pregnancies (two unexplained ectopic). Should I skip IUI (intra-uterine insemination) and go for IVF (in vitro fertilization) if finances are not a factor?

DR. AMOS:
After two ectopic pregnancies there is a very high chance to have another ectopic. With IVF your chances improve significantly to not have an ectopic, so I agree that IVF sounds like the best solution.

MEMBER QUESTION:
What do you think about Preseed and other CM (cervical mucus) enhancing products?

DR. AMOS:
Preseed, as far as I know, is the only "approved" lubricant that's sperm-friendly. Most other lubricants are known to destroy sperms. I am not sure what you mean by "other CM- enhancing products."

MEMBER QUESTION:
My OB said that if I get pregnant before one to two cycles after a miscarriage, I may have spotting or light bleeding during the first trimester. Does this cause any harm or pose any risks?

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DR. AMOS:
I am not sure I agree with that statement. As I mentioned before, there is no scientific evidence that getting pregnant early after a miscarriage increases your future pregnancy risks.

MEMBER QUESTION:
What is the best early pregnancy test to take and how soon can you take it?

DR. AMOS:
The best pregnancy tests are those that have a low sensitivity, usually around 20-25. That means they turn positive earlier on. Most pregnancy tests are not positive until the time when you expect your period, about 13-14 DPO. Good luck.

MEMBER QUESTION:
Can going on a low-carb diet and putting your body in ketosis affect fertility?

DR. AMOS:
There is not much research on this issue, but when you are TTC it's recommended to have the same healthy diet as if you were already pregnant. You can do damage by not keeping a healthy diet around the time of ovulation/implantation. It's also important to take a daily folic acid supplement with around 600 mcg folic acid a day.

MEMBER QUESTION:
I went off BCP (birth control pill) in January and have had fairly regular 28-day cycles ever since. I temped this month, so I believe I ovulated, but I get red spotting for about five to six days before my period fully arrives. Is this "normal," and could it prevent me from conceiving?

DR. AMOS:
Early spotting before ovulation is usually not a major fertility issue. To make sure you may want to confirm that your progesterone levels are OK around 7 dpo. Levels above 120 are usually considered good.

MEMBER QUESTION:
Is there any truth to lying in a certain position to conceive? My uterus is tilted downwards.

DR. AMOS:
The best position is usually considered the "missionary position" -- she on her back and he on top. This position allows the vagina to slightly tilt backwards and for sperms to flow towards the cervix and enter the uterus.

The woman should also try and stay on her back for about 10-15 minutes afterwards.

"There are many herbals available which can improve your chances of getting pregnant. The one that's been researched the most is called Vitex."

MEMBER QUESTION:
I recently starting suffering from irritable bowel syndrome (IBS) and also have lots of hypothyroid symptoms. I had my TSH (thyroid stimulating hormone) tested and it came back at 2.38. My doctor didn't seem concerned, but I have been trying to conceive for five months after a loss and am afraid I won't get pregnant if suffering from hypothyroidism, which runs in my family.

DR. AMOS:
The TSH levels are normal. Hypothyroidism usually prevents you from ovulating so if you now ovulate normally and the TSH is normal then you should not be concerned about hypothyroidism.

MEMBER QUESTION:
Do you recommend any herbal/natural remedies for regulation of hormones and ovulation or to help boost your fertility?

DR. AMOS:
There are many herbals available which can improve your chances of getting pregnant. The one that's been researched the most is called Vitex. Vitex has been shown to regulate hormones, especially if you have corpus luteum problem.

MEMBER QUESTION:
Is a history of an eating disorder (anorexia) associated with increased risk of miscarriage? I am now at a normal weight with healthy eating habits.

DR. AMOS:
Just having had the history of anorexia is unlikely to affect future fertility. If you are now at your normal weight, have a BMI (body mass index) between 20 and 25, and you ovulate normally, then you should be fine.

MEMBER QUESTION:
This weekend I had my cousin come over and while I was playing with her she hit me with her elbow in the side of my stomach. I felt a cramp for a few seconds. I'm 14 weeks pregnant. Did this harm my baby? Should I go see my doctor?

DR. AMOS:
Babies are usually very well protected inside the uterus and it's highly unlikely that this has harmed the baby, especially if you had no bleeding or cramps.

I also suggest you let your doctor know what happened, so that you can be followed appropriately.

MEMBER QUESTION:
My doctor has told me that if I get pregnant again I will have to take a shot of progesterone everyday or take a vaginal suppository three times a day. I have had three miscarriages and no answers as to why they happened. Is taking the progesterone normal in situations like mine?

DR. AMOS:
I suggest you ask your doctor why you need this medication. If you do not get a satisfactory answer then I suggest you find another doctor to help you.

MEMBER QUESTION:
How soon do early detection HPTs (home pregnancy tests) show positive after fertilization and implantation?

DR. AMOS:
HPTs usually become positive within a day or two after you miss your period, though sometimes it can take a couple of days longer.

MEMBER QUESTION:
How safe is it to take B vitamins, cough syrup, baby aspirin, progesterone, herbs, or other OTC (over-the-counter) substances to aid in having a normal cycle and getting pregnant? Which, if any, of these tactics would you recommend?

DR. AMOS:
None! I would suggest you talk to your doctor first.

"I wish you the best and hopefully everybody will have a BFP (big fat positive) next month!"

MEMBER QUESTION:
Is there anything OTC that tests progesterone levels?

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DR. AMOS:
There are no OTCs than can measure adequately your progesterone levels.

MEMBER QUESTION:
Do you think a hormonal imbalance that causes hyperpigmentation, almost like a pregnancy mask, could also cause infertility? If so, what would the hormone be and should I start with requesting a certain blood test?

DR. AMOS:
I am not sure of any connection between hyperpigmentation and infertility problems.

MODERATOR:
Dr. Grunebaum, we are out of time for today. Do you have any final comments for our members today?

DR. AMOS:
Thank you so much for visiting today. I wish you the best and hopefully everybody will have a BFP (big fat positive) next month!

MODERATOR:
Thank you Dr. Grunebaum.


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Reviewed on 8/13/2005 5:21:18 PM

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