Trying to Conceive -- Amos Grunebaum, MD.

Are you trying to conceive? Amos Grunebaum, MD, joined us on Oct. 23, 2002, to talk about trying to conceive, discuss treatment options, and to answer questions from both fertile couples as well as couples 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.

Grunebaum: Hello everybody!

Member: I have irregular periods (once in two or three months), PCOS, and also hypothyroidism for which I'm taking medicine; it's within limit now. When I went to my country for a vacation, I went to a hospital and did the blood tests, checked fallopian tubes, and husband did semen analysis. Everything seems to be fine except no ovulation. The doctor put me under Clomid 100mg for five days and did the scanning on 14th day and got the following result: "Showed a Dominant follicle of 25*24mm on left side." Doc asked to me to take Clomid alternate months for three courses. After joining my husband here, I started taking medicine but I got my periods only on the 42nd day, hence, I assume I might have ovulated around day 28. The next time without taking medicine I got my periods only on 55th day. This time again I took Clomid. Today is the 30th day of my cycle and basal body temperature (BBT) chart shows I haven't ovulated yet. Why is the medicine not working properly here?

Grunebaum: Unfortunately the treatment of PCOS is very involved. And many doctors feel that Clomid does not work as well as other medications to induce ovulation in women with PCOS. I hope that you are seeing an infertility specialist: a Reproductive Endocrinologist. They are best trained to adjust the right treatment for you, and maybe consider other medications when you don't respond to Clomid. Many doctors feel that the optimal way for PCOS patients to ovulate and get pregnant is with IVF.

Member: I've been diagnosed with PCOS and was wondering if I could use a home ovulation kit? I am on no medication for follicle stimulation, only Metformin, but I haven't reached my 1000 mg yet. I don't want to waste the money if it won't work.

Grunebaum: It seems that ovulation predictor kits (OPKs) don't work as well in patients with PCOS. That's because it tests for the LH hormone, which goes up just before ovulation. But in patients with PCOS the LH hormone is often elevated even without ovulation. So you can get a false positive OPK for many days even if you don't ovulate.

Member: What can you tell me about the drug Ponstel? I was given a scrip yesterday and was told that it will lighten my periods, but the pharmacist said it's just a higher dose of Aleve. Is this something I can take while trying to conceive?

Grunebaum: Ponstel is a nonsteroidal anti-inflammatory medication. It's often used against pain. I am not sure what your indication is and why you would take it. I would not suggest taking it for specific complaints without first talking to your doctor.

Member: Hello, Dr. Grunebaum, I have been trying to conceive for over a year now. I've been doing the ovulation cycle for a couple of months, but still haven't gotten any results. Should I be concerned that there may be something wrong?

Grunebaum: I am not sure what you mean by "no results." Did you or didn't you ovulate?

Member: I haven't gotten pregnant.

Grunebaum: Ahhhhhhhhhhhhhhhhhhhhhhhhhh. That's a result, too. So you are ovulating or not?

Member: Yes, but not pregnant

Grunebaum: I understand. If you are ovulating regularly and you have not gotten pregnant for a year or more then you should start seeing a specialist. The next step is usually a sperm analysis to see if he has enough sperms. And if he has enough sperms then the next step is usually to check the fallopian tubes. This can be done with a hysterosalpingogramm or a laparoscopy. Within a couple of months your doctor can then know what's going on and then suggest the right treatment.

Member: Is it worth going through the temperature cycle or should I go see a specialist already?

Grunebaum: That all depends if you know whether you are ovulating or not. With regular 28-day cycles you can assume that you ovulate. And doing a BBT chart will help you identify when you ovulate. And with irregular cycles doing a BBT chart helps identify IF you ovulate.

Member: I've been trying to conceive for the past year. I had two abortions many years ago; could that be the reason I am having trouble conceiving?

Grunebaum: Safe uncomplicated abortions are unlikely to affect future fertility. For example they do not affect ovulation (25% of all fertility problems), and they do not affect his sperm count (another 35% of fertility problems).

Member: I think that I am ovulating today and won't see my husband until midnight tonight is that too late?

Grunebaum: I don't know when you usually go to sleep. I am usually in bed at 10, so midnight would be late for me! I am not sure though what you mean by "too late." Maybe you mean 'too late to make love to get pregnant'?

Member: Yes.

Grunebaum: Making love after ovulation is less likely to get you pregnant. Have you made love at all over the last days?

Member: Two days ago.

Grunebaum: So that's great. Making love 1-2 days before the day of ovulation is likely to get you pregnant. But making love only once on the presumed ovulation day is less likely to get you pregnant, because if you wait to the last moment, the door to fertilize that egg may close quickly. It's better to board the plane 10 minutes earlier than one second too late after the door has closed. That doesn't mean you should not make love tonight!

Member: Is it recommended to make love as often as possible for the days during ovulation and before?

Grunebaum: You can really never be completely sure at what time you ovulate. And making love every day improves your chances significantly. Once a day every day is optimal.

Member: I need an estimate as to how early a person can get pregnancy symptoms. I am 12 days away from being able to take a test with any accuracy. I ovulated already and am experiencing some major symptoms. I have been sick since about six hours after we last had sex. I feel cramping, headache, and major nausea. I cannot take a test this soon but am dying of curiosity. Maybe I just have the flu. I realize this is a waiting game and there are no definite answers. Thanks

Grunebaum: Having pregnancy symptoms six hours after ovulation would be a little early to have typical symptoms. You may be pregnant, but until you miss your period and have a positive pregnancy test it's unlikely to have pregnancy symptoms.

Grunebaum: Hello Dr. Grunebaum. I am trying to conceive for the first time at age 40 and am charting my BBT as well as using OPKs. I am very frustrated with the OPKs because they seem to give inaccurate results that don't match up with my BBT. For example, they sometimes say I don't ovulate even though BBT says I do, or they say I ovulate after I'm already several days into an obvious thermal shift. I found an article here on WebMD that says asthmatics on steroidal inhalers (as I am) will get inaccurate results with OPKs and shouldn't use them. I haven't been able to corroborate this anywhere else. Can you give me any help? Thanks!

Member: I suggest you run and see an infertility specialist right away. At 40 you can't lose any more time speculating about OPKs. Many tests are not so accurate, but what is more important is to find out how you can improve your chances of getting pregnant. At 40 there could be problems, even with the most perfect BBT chart. Doing some hormone tests will quickly determine what's going on.

Member: I am about to attempt my first IVF cycle. I currently take the anti-depressant Paxil. Should I discontinue use of this drug during my attempt? What about the weight loss herbal supplement, Hydroxycut?

Grunebaum: You should never discontinue any prescription drug without first consulting your doctor. Stopping a medication that you need may lead to complications. I would ask your ob-gyn if you should continue it or not. Paxil is not known to have significant adverse pregnancy complications, and many women can continue taking it throughout pregnancy.

Member: I've recently stopped taking the pill and have had regular periods (26 day cycle). This month I started to use the OPK and didn't get a positive reading. Does this mean that I'm not ovulating?

Grunebaum: I don't know which cycle days you used the OPK. It's normally negative 95% of the cycle and only positive up to 2-3 days in the cycle. If you test on the wrong days, then you can expect a negative result.

Member: I started to use the test on day 9 of my cycle.

Grunebaum: With a 26-day cycle you expect to ovulate on cycle day 12. So starting on cycle day 9 was good. In addition to the OPK you may want to do BBT charting. Your temperature curve can help you identify better if and when you ovulate.

Member: I recently experienced a miscarriage at five weeks. I didn't go to the doctor -- HMO advice was that it was very early so there wasn't much to do. I have normal cycles (30 -31dys), good thermal shift (14-15 day LP). How long should we wait before trying to conceive again (I'm 38 and feeling the tick of the clock). Thanks

Grunebaum: Most doctors suggest waiting for the next menstrual period before you can start trying to conceive again. However, even if you happen to get pregnant earlier there are no increased complications expected.

Member: Ok here's my question that I have asked a few of the ladies earlier. This is my first month on Clomid and I got a ++ on an OPK on the 18th and 19th, my nipples have been hurting for a few days, and I have never felt this before. Could this be from the Clomid (ovulation) or is it a possible sign of pregnancy?

Grunebaum: Which cycle day are you on right now?

Member: I started my cycle on the 5th.

Grunebaum: That did not answer my question. I assume you are on cycle day 18 and you ovulated on cycle day 13/14. Using clear cycle days makes understanding what's going on easier. It's too early to have typical pregnancy symptoms five days after ovulation. Most typical symptoms aren't felt until after you miss your period, until after 15+ OD.

Member: I have been charting since January and all my cycles up until September I ovulated on cycle day 16 or 18. In September, I ovulated on cycle day 22 and got pregnant but miscarried early. The next cycle I ovulated on cycle day 24 and had a positive home pregnancy test 13 days past ovulation, but started my period on time the next day. Do you think I was pregnant? Does my doctor need to be aware of my late ovulation the last two cycles? Should I be on Clomid or anything?

Grunebaum: Your doctor definitely should know about the late ovulations. Reviewing your BBT chart is an important part of a doctor's fertility assessment. Late ovulation can decrease your fertility. A positive home pregnancy test 13 days after ovulation nearly always means that you are pregnant.

Member: I have been trying to conceive for four months now with no luck yet. I have been taking my temperature and bought an ovulation kit but am still not pregnant. I am pretty irregular. My cycle is anywhere from 28 to 32 days. I know I ovulate on day 18. Will it always be day 18 even if my cycle is different in length each month?

Grunebaum: Four months isn't long enough to be concerned. If you are under 35 and you ovulate regularly then it's suggested to wait up to 6-12 months before you start getting concerned. Your cycle length depends on the day you ovulate and if you always ovulate on cycle day 18 then you would expect a cycle of about 32 days (18+14).

Member: I am currently taking Parlodel; my prolactin levels were over twenty. I have been taking this for over four weeks and I've been spotting for almost the entire time, along with headaches that sometimes turn into migraines. My doctor says these are not normal side effects, but I shouldn't worry. But I am! Any advice? Is this normal?

Grunebaum: It may or may nor be normal to have headaches. Your doctor can assess it better than I can. The spotting could come from not ovulating. Many women with elevated prolactin do not ovulate, and spotting goes together with not ovulating. You may want to start a BBT chart and see if and when you ovulate.

Member: My husband and I just found out that he has a low count of healthy sperm. Is there anything he can do to raise his healthy sperm count?

Grunebaum: How low is a low count? It's important to know the exact number, both total and per cc.

Member: His low count was 23 healthy sperm.

Grunebaum: This can't be. The count is usually in millions per cc or in millions total.

Member: His sperm count was good but his healthy sperm is 23. The nurse said that it should be 30-100.

Grunebaum: You need to find out more information on his count. It should be in the millions, and it depends whether it's the total count or the count per cc.

Moderator: We have to wrap up early today. Dr. Grunebaum has to go deliver a baby! If Dr. Grunebaum wasn't able to answer your question, try posting in his TTC message board. Bye for now, and good luck in all your TTC attempts!

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