Trying to Conceive 05/29/02: Amos Grunebaum, MD

By Amos Grunebaum
WebMD Live Events Transcript

The opinions expressed herein are the guest's alone. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Are you trying to conceive? Amos Grunebaum, MD, answers members' questions every week about conception issues and concerns of both fertile couples and couples dealing with infertility.

Dr. Amos: Hello, everybody. Welcome to today's Trying to Conceive chat.

Member: I am six days late and took a pregnancy test yesterday that was negative, but I have been spotting the last four or five days. Could it be possible that I am pregnant? My back has also been hurting the last few days.

Dr. Amos: You could be pregnant, sometimes it take longer for the pregnancy test to become positive. However, most tests are positive two to three days after you miss your period. If the test remains negative for over a week, chances are that you are not pregnant.

Member: When should I try testing again -- next week?

Dr. Amos: A repeat test is usually advised two to three days later if your period hasn't come yet.

Member: I want to get pregnant and I have hyperthyroid disease. What kinds of risks can one expect if they have hyperthyroidism and borderline Graves? Are the risks the same for that person if they have the hyperthyroid treated, then become hypothyroid? Which thyroid problem is more of a danger?

Dr. Amos: If you have hyperthyroidism that means you thyroid produces too much thyroid hormone. Your doctor will usually give you medication to decrease the thyroid hormone levels. Once they are normal, you would not usually expect a problem during pregnancy.

Member: I took Clomid, became pregnant through IUI, then miscarried. I have had done two more IUIs and have not gotten pregnant. Do you think that statistically, my chances of still getting pregnant with IUI are good since it worked once? Is it worthwhile for me to try a few more times with IUI before moving on to something else?

Dr. Amos: There are no simple guidelines for doing IUI or using Clomid. I assume you have had Clomid with both IUI attempts.

Member: Yes.

Dr. Amos: Most doctors will probably not do more than three to four ovulatory cycles of Clomid because the chances of getting pregnant do not improve after that time. I also assume his sperm count is fine and your tubes are open. If not, then this would be the next thing to check for.

Member: Yes, I have unexplained infertility.

Dr. Amos: Unexplained infertility has a very high success rate with IVF. Most women with unexplained infertility will be helped with IVF.

Member: What are the chances of Clomid working and is it unusual to take it on days five through nine of one's cycle?

Dr. Amos: It's normal to take Clomid for five days and to start on CD 5, though some doctors start it a couple of days earlier. About 50% of women who ovulate will get pregnant within the first three months, as long as he has a normal sperm count and your fallopian tubes are open.

Member: My right tube is blocked. This month I had ovulation spotting. Does this mean that I ovulated from the left ovary?

Dr. Amos: From your description, I can't tell. If you want to know from which ovary you ovulate, only an ultrasound can tell. Shortly before ovulation, the leading follicle measuring 18+ mm can be seen in the ovary where ovulation will happen.

Member: I was hoping that since my cervical mucus was spotted with blood on CD 15, that it would indicate that the blood must have traveled down the open tube.

Dr. Amos: Good theory. Unfortunately, it's not reliable enough to tell.

Member: I am currently trying to conceive and temping every morning at the same time. What should I look for in temperature changes to signal ovulation?

Dr. Amos: Before ovulation, your temperature can fluctuate for several tenths of a degree. Within one to two days after ovulation, your temperature rises by at least 0.2 degrees and stays up until your menstrual period has come. That part after the temperature rise is also called the corpus luteum phase, and normally lasts at least 12 days.

Member: Is Clomid known to cause mood changes?

Dr. Amos: Clomid can have many side effects, and mood changes can be among them.

Member: Is it safe to use real egg white if you are lacking egg-white consistency cervical fluid?

Dr. Amos: There are no studies that show the safety of real egg white introduced into the vagina. And eggs can contain bacteria called salmonella. That's why some are concerned about getting infected when you use raw egg white. In practice I am not aware of any woman who has become infected vaginally by using egg white.

Member: What is a normal level of progesterone?

Dr. Amos: Progesterone is usually below 10. After ovulation it usually goes up to over 10. Progesterone levels over 10 are usually achieved about a week after ovulation.

Member: So that means a person is ovulating?

Dr. Amos: If progesterone is over 10 chances are that ovulation has happened.

Member: I have a dermoid cyst on the only ovary I have left. It's about quarter-size. From what the doctors can tell, my ovary is still working. Is it safe to attempt pregnancy now with this cyst?

Dr. Amos: That's not an easy question to answer. Most doctors will probably suggest the removal of dermoid cysts. In making the decision, however, it's important to check out how the diagnosis was made and how big the cyst is. Most doctors will probably want to take out a cyst that's over 5 cm in size.

Member: Could the dermoid cyst affect a pregnancy?

Dr. Amos: A small dermoid cyst in and of itself does not usually affect the pregnancy. However, the dermoid cyst can grow during pregnancy and should be followed regularly with ultrasounds.

Member: Does using tampons in any way affect my fertility? Does it have anything to do with my chances of TTC?

Dr. Amos: You should take out the tampon during sexual intercourse. If you do, then the tampon use in and of itself should not interfere with your fertility. Many studies have shown no difference in fertility between tampon users and those who don't use tampons.

Member: Have you seen many successes using a fertility monitor?

Dr. Amos: I have not seen more success with fertility monitors than without. Before you buy a fertility monitor you need to ask yourself, "Why?" The reason for buying a fertility monitor differs from one woman to another. If you want to buy it just to find your fertile days to make love on, then I must disappoint you. No one has ever proved that making love based on fertility monitors actually improves pregnancy rates. In fact, if you only make love when that light says, "go" then you may actually decrease your chances of getting pregnant. Northing beats good old-fashioned, regular sex two to three times a week, every week, when you are TTC.

Member: Is using a fertility monitor better than charting basal body temperature? Which has more success?

Dr. Amos: Both have different purposes. Again, you need to ask yourself why you are doing these. With a BBT you can establish the day of ovulation, afterward, pretty well. The monitor gives you your fertile days, but it does not necessarily diagnose ovulation. For that, a BBT chart done in the correct way is much better.

Member: Have been TTC for 14 months. My husband's sperm count came back at 29 mL but low motility. Is having blood work and ultrasound to check for varicocele. I am fine per my ob-gyn. Am I correct in assuming that with low motility we will not conceive at all on our own or is it still possible?

Dr. Amos: Not 29 mL? Was it 29 million per cc or total?

Member: 29 million per cc.

Dr. Amos: If his count is OK, and 29 million per cc is fine, then you still can get pregnant on your own. Sometimes doing IUI may improve your chances of conception if motility is low.

Member: We were told by my ob-gyn that they may not be able to swim to the egg, even with IUI.

Dr. Amos: Nothing is impossible. It may take you longer, and if you can't wait, then doing IVF with ICSI can be very successful in getting you pregnant.

Member: Is 116 million total sperm count good?

Dr. Amos: Yes, anything well over 40 million total is fine.

Member: Do you recommend waiting a couple of months after getting off of the pill before trying to conceive?

Dr. Amos: There is no medical need for waiting after going off the pill. As soon as you stop the pill, the hormones are out of your body and if you get pregnant right away, no increased risk to the pregnancy is to be expected.

Member: My temperatures before ovulation are in the range of 36.2-36.5 degrees C, is that OK if I was TTC?

Dr. Amos: The absolute temperatures are not as important as the rise after ovulation. If you have a normal rise after ovulation, and it stays up for 12+ days, then the temperatures before ovulation are less important. If you do not ovulate regularly with these temperatures, you may want to get tested for a low thyroid or hypothyroidism.

Member: Is one type of thermometer (for example, digital vs. mercury) better than another for tracking temperature for purposes of predicting ovulation?

Dr. Amos: I usually suggest a mercury thermometer. I find it more reliable than the digital ones, and you never run out of batteries. Just make sure that you shake down the temperature before going to sleep at night.

Member: Does having an HSG help in conceiving? Does the balloon that is inserted in the cervix help open the cervix, allowing sperm to go in and any blockage in the tubes to be removed?

Dr. Amos: The chance of the HSG opening up significant closures of the fallopian tubes is very low. The HSG is usually not used as therapy to open up closed tubes.

Member: Is it better not to have sex everyday when TTC? Is the every-other-day method better?

Dr. Amos: Every day is fine if his sperm count is fine. Every other day is OK, too, but every day slightly improves your chances of conceiving.

Member: I had a baby five months ago and my husband and I are trying for another one. My problem is that I did not ovulate until now. Actually, I was put on 50 mg of Clomid three months ago. I will be starting my third cycle this Friday. I have not been monitored by my ob-gyn and I am considering seeing an infertility specialist who will monitor me. I have no idea if I have ovulated or not. Is this common for women who had babies five months ago?

Dr. Amos: If you had your baby five months ago, that was December. I don't expect you to ovulate during and shortly after pregnancy. It's common to not ovulate for many months after delivering a baby. I don't know why you were given Clomid two months after delivery.

Member: I just turned 35 and we have been trying to conceive since August of last year. We are also both overweight. Can this be the reason we have not conceived?

Dr. Amos: There are many reasons for difficulties getting pregnant. If you ovulate regularly, then being overweight is usually not the major cause of difficulties getting pregnant. At 35 and over it's suggested to see an infertility specialist if you haven't been successful for 6+ months.

Member: Is it really difficult to conceive after being on Depo-Provera for less than a year?

Dr. Amos: It takes on average six to nine months after the last shot of Depo-Provera to start ovulating again. And many women take a year or even longer to ovulate.

Member: I went off birth control pills in December. My last three cycles were normal at 30 days. This cycle just began early at 26 days. What could have affected the cycle change?

Dr. Amos: Cycle lengths are affected by when you ovulate. When you want to know why your cycles are different, then you should try finding out exactly when you ovulate. This can best be done with a basal body temperature chart. Charting your temperatures helps you identify the day of ovulation and how it relates to the cycle length.

Member: I am starting my second cycle of injectable hormones with timed intercourse. The last cycle did not work because I ovulated on my own and was unable to tell I was ovulating. Since I get my LH surge very early in my cycle (day 10 or 11) should my fertility doctor be giving me a higher dose of the Follistim than 75 IU for the first five days? My husband was concerned that we were going to run into the same problem as last month and my ultrasound will only show a few small follicles developing instead of the larger ones we need for the HCG injection.

Dr. Amos: I am not sure what's going on here. In general, timed intercourse is not as successful getting you pregnant as regular intercourse two to three times a week. In fact, in more than 20% of women, the cause of difficulties getting pregnant is that they don't make love enough. It's not so important to make love exactly on time as it is to make love regularly. Ovulation can happen any time. Studies have shown that even in women with clockwork cycles, ovulation can happen any time -- earlier or later. Trying to time sex based exclusively on when it may happen prevents more women getting pregnant than many other causes.

Member: How can ovulation happen any time when your period is supposed to come after ovulation?

Dr. Amos: Your period doesn't always happen exactly on time after ovulation. There could be many days' difference. And because your period comes after ovulation, you can't always predict when ovulation will happen.

Moderator: Unfortunately, we have to wrap up for today. As always, too many great questions to get to. Thanks for joining us. If Dr. Amos wasn't able to answer your question, don't worry! He is here every week. You can also post questions in his TTC message board here at WebMD. Bye for now!

Dr. Amos: Thank you very much for joining us today.



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