Trying to Conceive 8/28/02: Amos Grunebaum, MD
Trying but frustrated? Ask about fertility problems and treatments.
By Amos Grunebaum
The opinions expressed herein are the guest's 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.
Are you trying to conceive? Amos Grunebaum, MD, joined us on Aug. 28, 2002, to talk about conception issues, treatment options, and to answer questions from both fertile couples and couples dealing with infertility.
Dr. Amos: Hello everybody; signing in from New York.
Member: I would like to know when the temperature rises after ovulation -- immediately or after one or two days? I have irregular periods. This is my 28th cycle day and my temperature this morning was 97.9 degrees. For the past four days the temperature was between 97.4 and 97.1. When would I have ovulated?
Dr. Amos: The temperature usually rises within 24 hours after ovulation. It can occasionally take somewhat longer, and sometimes there is a slower than usually rise. But the general rule is that the temperature will go up, and most important stay up, the day after ovulation. Having said that, you cannot determine just from a single day's rise that you have ovulated. The temperature should stay up at least three days (biphasic curve) to confirm ovulation with more certainty.
Member: My reproductive endocrinologist claims that The World Health Organization uses a flawed standard for semen analysis. He wants my husband to have another semen analysis done at his clinic using another standard. Our insurance will not cover this semen analysis. Although we can afford this test, we are wondering if there really are different standards for semen analysis, particularly concerning morphology and motility.
Dr. Amos: Your RE is correct and not. There are several different standards for reading the semen analysis. A semen analysis is very important when checking the man's fertility. It usually costs around $150-200 and is well-spent money. I suggest that all my patients who start TTC have it done from the outset. It provides very valuable information about the man's fertility.
Moderator: So, is any one standard considered the "best?"
Dr. Amos: There is no "best" standard. The standard usually comes in when interpreting the results, not necessarily when doing the test.
Member: I have just finished my first IVF, which resulted in a chemical pregnancy. My egg quality was poor. Eight eggs were retrieved with three fertilized by two sperm and three fertilized normally. One egg was a 4-6 cell grade 4, and three eggs were 2-4 cell grade 5. How can I improve egg quality?
Dr. Amos: You cannot improve egg quality by yourself and there is no medicine to do it either. It's usually a function of your age and your body, not anything you can do about.
Member: Are all cycles different or will I always have poor egg quality? Can fertility medicines cause poor egg quality?
Dr. Amos: Not all cycles have the same egg quality. You are sometimes lucky to get a 'good' egg.
Member: When is ovulation considered late?
Dr. Amos: Most doctors consider ovulation 'late' when it happens after CD 21. Many women do get pregnant with late ovulations, but chances of getting pregnant are decreased. For one, the egg is not as good when you ovulate later in the cycle. A 'not good' egg is less likely to be fertilized and become an embryo. In addition, the lining of the uterus, the endometrium, is where the fertilized egg, the blastocyst, has to attach and implant. If the endometrium is too old, it is less likely to provide sufficient nutrition for the blastocyst, so implantation is decreased. And finally, with 'late ovulation,' you ovulate less often than with earlier ovulation.
Member: Is there a CD that is too early for ovulation?
Dr. Amos: Imagine, let's say a 38-day cycle with ovulation on CD 24, and compare it with a 28-day cycle with ovulation on CD 14. Over one year, women with 38-day cycles ovulate maybe nine times or so, while women with 28-day cycles ovulate 13 times or so, nearly 50% more often. Ovulating somewhat more increases you chances of getting pregnant.
Member: I have been TTC for 5 months now, but only charting for two. If I'm not pregnant, would I go see my doctor a year from when I began charting or a year from now?
Dr. Amos: If you ovulate regularly and there are no other medical problems, then a woman under 35 should see a doctor after 12 months (over 35, after 6 months) of trying unsuccessfully. That does not mean you should not see your doctor now. I usually suggest that all patients who are TTC see their doctor right away, get a Pap test, get examined, and let the doctor know that they are TTC. This give you and the doctor an opportunity to discuss any other issues and it also allows you to ask questions. And do not forget to take your daily folic acid. It's crucial to take while you are TTC. Anybody want to tell me why folic acid is crucial?