Trying to Conceive -- Amos Grunebaum, MD.

Are you trying to conceive? Amos Grunebaum, MD, joined us on Oct. 16, 2002, to talk about trying to conceive, discuss treatment options, and to answer questions from fertile couples as well those dealing with infertility.

By Amos Grunebaum
WebMD Live Events Transcript

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.

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

Member: What are the chances of having an ectopic pregnancy if conceived using Clomid, metformin, IUI?

Dr. Amos: In general, the risk of an ectopic pregnancy is about one in 80. However the risk increases with several factors, which include previously having an ectopic pregnancy, having had surgery on the fallopian tubes, and previous infection in the tubes.

Member: I am suffering from hypothyroidism. I am on medication but currently my TSH is quite high. It might take a couple of months for thyroid to be normal. How would this affect my chances of conceiving?

Dr. Amos: Hypothyroidism is a frequent cause of infertility. That's why checking the TSH on CD 3 is an important part of routine testing. With hypothyroidism you are less likely to ovulate. Once you get medication, and once it becomes more normal, your chances of ovulating and getting pregnant significantly improve.

Member: Can I TTC while TSH is high?

Dr. Amos: Yes, you can still make love while the TSH is high.

Member: My husband and I want to have a child, but he really enjoys using the withdrawal method. Is there still a good chance that I could get pregnant while we still use this method? Or should I tell him we need to go the other route for a while? Thanks for the advice.

Dr. Amos: You cannot use the withdrawal method if you want to get pregnant. Most of the ejaculate spills out of the vagina, leaving only a small amount of sperm for insemination. The withdrawal method is not a good contraceptive -- you can get pregnant with it. But it's also not a good method if you are really trying, as it decreases your chance of conceiving.

Member: I have been TTC for about five years now and I haven't got pregnant yet. I have had a few tests done to make sure every thing is fine. My tubes are open, I am ovulating, and the doctor also put me on Clomid but still nothing is happening. I also had laparoscopy done for an ovarian cyst, and they found a slight amount of endometrial tissue outside of the uterus. Lately I haven't had any cysts but a lot of cramping the first day of my period -- enough to make me not very functional that day. Also, I had cervical cancer and they did a procedure where they froze the cancer cells. My husband has a child by a previous relationship. We want a child of our own. Why can I not get pregnant?

Dr. Amos: You must first do a sperm count to make sure he is OK. Just because he made someone pregnant before does not necessarily mean he now has enough sperm. It likely happened many years ago and much can happen in the intervening time. Doing a sperm count should be among the very first tests done when you have problems conceiving. It's useless to have all the tests done on her only to find out much later that he is the problem. About 50% of couples have a male problem. That should be evaluated before you have all the invasive tests done or take any medication.

Member: My doctor gave me a referral to an infertility specialist. But they do not have any appointments until December or January. I asked my ob-gyn if an ultrasound would help detect any blockage, etc., and she told me no. Is she correct?

Dr. Amos: The best way to find out if there is a blockage is a laparoscopy or a hysterosalpingogram. But while you wait you should be able to answer right away whether you ovulate regularly and what his sperm count is. This information is crucial when checking your fertility.

Member: Also, is there anything that my regular ob-gyn can give me in the meantime to help with fertility?

Member: Are you ovulating? Is his sperm count OK? Are your tubes open? Those three problems are the major issues when you cannot get pregnant. If you take fertility medication it won't help his sperm count or open your tubes.

Member: I have been trying to conceive my third child for three years now. I have had several IUIs, an IVF, and an embryo transfer. Twice in the past 12 months I was diagnosed with ureaplasma and given antibiotics. I am not sure the condition has completely gone away. Would this be a cause of infertility?

Dr. Amos: Ureaplasma can influence the fallopian tubes. But if you had IVF then this problem is not a major issue anymore.

Member: Additionally, how does one contract ureaplasma? Could all my procedures, sonograms, etc., be the reason?

Dr. Amos: Ureaplasma can be transmitted through sexual intercourse, not through these procedures.

Member: Does Lupron affect energy levels? How much can one exercise during an IVF cycle?

Dr. Amos: Lupron can have many different side effects including affecting your energy level. Every IVF center has a different recommendation for exercise and it also depends on what kind of exercise you do. The best thing to do is to ask your RE.

Member: I am a 29-year-old woman having problems conceiving. My period has been non-existent since March of this year. I had laparoscopic surgery for endometriosis two years ago. Although I was told I could conceive, I still have not. At this point, what are my options? I am running out of patience and the doctors can't seem to tell me what the problem is.

Dr. Amos: A non-existent period usually means that you don't ovulate. Without the big O you cannot get pregnant. Your doctor must find out why you don't ovulate and then treat the cause. Sometimes it helps if you get certain medications to induce ovulation. But which ones to take depends on why you don't ovulate.

Member: Do you have an opinion on the benefits of acupuncture while going through IVF?

Dr. Amos: I am not aware of any significant studies showing that acupuncture works with IVF.

Member: I've been diagnosed with PCOS and am currently taking Glucophage. My periods are getting to be pretty normal. What are the chances that I'm actually ovulating, too?

Dr. Amos: There are several ways to make sure that you ovulate. Doing fertility charting and taking your temperature every day helps you identify if and when you ovulate. Your doctor can do serial ultrasounds to see the follicle develop and disappear. That confirms ovulation. And then if your progesterone is elevated seven and more days after ovulation, that's a good sign it happened. Plus you can also do an OPK ovulation predictor kit to identify if you ovulate, though the OPK is less reliable with PCOS.

Member: Do I need to go to an infertility specialist to do that or can my ob-gyn take care of that?

Dr. Amos: The RE, the infertility specialist, is best trained to get you pregnant faster.

Member: Does it matter what kind of thermometer I use?

Dr. Amos: As long as it measures one-tenth of a degree and you use the same one all month, then it doesn't matter. Some women prefer a special digital thermometer just for taking the BBT [basal body temperature].

Member: How good is an ovulation kit if you miss your periods regularly?

Dr. Amos: The OPK isn't so good with irregular cycles, because you don't know for sure when to start testing. Also, women with irregular cycles often have hormone issues and those make the OPKs less reliable.

Member: What if you have regular periods, but the ovulation predictor kits never change color?

Dr. Amos: That problem can be resolved by doing a BBT chart. The temperature chart can help you identify ovulation if the OPK won't work well.

Member: I have two children, my youngest is 3. My husband and I are TTC and I have noticed a clear, and sometimes milky, discharge from my breast. It is not a lot though. Could I be pregnant?

Dr. Amos: Yes, you could be pregnant and a pregnancy test should be positive if you are. Having milky discharge is usually not among the first pregnancy signs. And if your cycles are irregular then this could also indicate other problems like an elevated prolactin hormone level.

Member: I'm hoping I'm pregnant now and very anxious to find out. Are there any early symptoms to look for? I have been taking my BBT and my temperature has been elevated for nine days now.

Dr. Amos: An elevated biphasic temperature for 16+ days usually is the first sign that you are pregnant, besides missing your period. Good luck!

Member: How important is the presence of estrogen when trying to conceive? Could not having enough also be the reason for an irregular period?

Dr. Amos: Too much estrogen can prevent you from ovulating. It's usually not the estrogen per se that prevents you from getting pregnant, but an abnormal estrogen level could indicate other problems.

Member: My girlfriend has had her tubes tied and now she wants to have another baby, but she keeps telling me that it is reversible. I'm not sure it is. Is this something that can happen if and when we decide to get married one day?

Dr. Amos: There is surgery done called 'tubal reversal surgery.' In general, a tubal ligation can be reversed only with difficulties and many times it's not that successful.

Member: I'm 36; my wife is too. We're just starting to try to have a baby. She's checking her temperature to see when she ovulates. What kind of time window surrounds the ovulation period?

Dr. Amos: The best time to make love is the week before ovulation. During the four to five days prior to ovulation and the day of ovulation it's generally suggested to make love every day. However, with the temperature chart you cannot predict ahead of time when ovulation will happen. That's why it's generally suggested to also make love regularly two to three times a week, every week, to make sure you won't miss anything.

Member: My ob-gyn did an ultrasound two years ago to investigate painful periods and told me that I have "many, many fibroids." I have been trying to conceive for a year but have not yet seen my doctor to discuss fertility testing. Can fibroids impair fertility?

Dr. Amos: Fibroids can impair fertility, especially if there are many of them and they are inside the uterus.

Member: Another problem -- when I was a child we discovered that I only have one functioning kidney. I don't know the medical name for my condition, and I have never had a problem with it. The doctor assures me that this will not be a problem during pregnancy, but could I find myself in a bad situation if I developed complications?

Dr. Amos: One kidney in and of itself is not a major problem. But if you had only one kidney then it's possible that there are other issues with your uterus and fallopian tubes. The kidneys and the genitalia develop around the same time. So if something is going on with one then the other should also be investigated.

Member: Can a colposcopy be done safely while in the early stages of pregnancy? My doctor detected an abnormal Pap and wants to do one but I have been nervous it in case I conceived that month. What do you suggest?

Dr. Amos: A colposcopy can be done safely in pregnancy.

Member: My ob-gyn did an ultrasound and determined that my right ovary is turned a bit sideways. Can that hinder my getting pregnant?

Dr. Amos: Most ovaries are positioned differently, so a 'sideways' positioning is not unusual.

Member: We've been TTC for six months. I've read that EWCM [egg-white cervical mucus] is important for conception. I never have any EWCM. Could this be a problem, and what could I do about it?

Dr. Amos: The first question is whether you ovulate or not. EWCM comes from ovulating, and if you don't ovulate then you wouldn't expect EWCM at that time. But if you do ovulate and have no EWCM then you should get checked. Your doctor can do a test called a 'postcoital test' and check the CM during ovulation. At that time, your doctor can determine what's going on.

Member: From BBT and my regular period, I do ovulate. I did see a nurse practitioner, and she said not to worry about it.

Dr. Amos: Sometimes not having enough mucus even though you ovulate can be a cause for infertility.

Member: What is EWCM?

Dr. Amos: EWCM is egg-white cervical mucus at the time of ovulation.

Member: Is EWCM clear or white?

Dr. Amos: It's stretchy and usually clear, though it can also be less clear.

Member: I've just recently come off the pill after being on it for 14 years. How long before my periods become regular? I'm trying to conceive.

Dr. Amos: It can take on average two to three months for ovulation to return after you stop the pill.

Member: I'll be attempting IVF for the first time next month. Is there any advice you can give me? Anything I can do to help increase my chances for success?

Dr. Amos: Every IVF center has different recommendations and policies. And there is no single best thing to do. You may want to discuss specifics with your IVF doctor.

Member: How soon after conception can you take a home pregnancy test and get accurate results? I think it has been about eight days; should I go out and buy one?

Dr. Amos: Patience is one of the more important virtues of life. A home pregnancy test is usually not positive until 14+ days after ovulation. That would be around the time you miss your period.

Member: I am spotting today, that is why I ask. I am not due to get my period for another eight to 10 days.

Dr. Amos: It's unusual to get a positive urine pregnancy test on 8 dpo.

Member: Hello. I am 39, I've had one miscarriage, stillbirth of twins, and have a 4-year-old. I did injections last November and Clomid before that. Before we go the donor egg or adoption route, is there any thing else?

Dr. Amos: I don't have enough information about you or your husband to make that decision. And it's unclear if you have tried IVF or not. That would be the next choice if injections failed.

Member: My periods have never been exactly regular; sometimes they are every 30 days, sometimes every 45 days. How can I calculate my fertile time?

Dr. Amos: You cannot calculate your fertile time because there is a possibility that you don't have one. In order to be fertile you need to ovulate. And with irregular cycles there is a chance that you do not ovulate. Taking a BBT chart will help you find out what's going on. It will tell you more about if and when you ovulate.

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, try posting in his TTC message board, or join us again next week. Same time and place.



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