Trying to Conceive 01/08/03 -- Amos Grunebaum, MD.-- 01/08/03
By Amos Grunebaum
Are you trying to conceive? Amos Grunebaum, MD, joined us on Jan. 8, 2003, to talk about trying to conceive, discuss treatment options, and to answer questions from both fertile couples as well as couples dealing with infertility.
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, happy New Year, belatedly. Are there any TTC'ers here today?
Member: I am.
Grunebaum: How about BBT charters?
Member: Me too!
Member: Me too.
Grunebaum: OK, that's great!
Moderator: Let's get right to the questions:
Member: I saw my OB/GYN after having very irregular cycles and not having conceived after four months. She wants me to take Provera, begin monitoring my temperature, get hormone tests done, and then take 50 mg of Clomid. I am also hypothyroid and take Synthroid and Cytomel. I would like to know if my thyroid is affecting my ability to conceive and if these fertility drugs will affect my thyroid.
Grunebaum: Hypothyroidism is a major cause of anovulation. If you do not ovulate, several tests are done to find the reason. And one of these tests is for thyroid function. A low thyroid can be responsible for not ovulating, and treating it will often make you ovulate again. But I have one question: Did your husband have a sperm count?
Member: He is having one done on Saturday.
Grunebaum: There are many possible side effects of Clomid, and giving you Clomid to make you ovulate won't help if his count is low. That's why it's a great idea to start any infertility evaluation with his spermanalysis.
Member: How long should I wait before we start trying after quitting birth control pills?
Grunebaum: You can start "trying" right away. There is no need to wait, and if you are lucky you may ovulate and get pregnant the first month. It may take some time to ovulate, so why not practice until it's for real?
Member: Without causing any defects?
Grunebaum: Without causing effects. The pill can't hurt the fetus and it's out of your system anyway as soon as you stop it.
Member: About four years ago I didn't have a period for a year. I had endometrial hyperplasia and was put on birth control pills to make me have a period. After a year on the pill, I went off and still couldn't have periods on my own. For the last year and a half I've been taking natural progesterone and have been able to have about seven periods a year. I've been trying to get pregnant now for five months with no success. The doctor says she's not sure that I ovulate but can't test it without me going off the natural progesterone. What actions do you advise me to take before having to decide about fertility drugs?
Grunebaum: If you are not ovulating, then you cannot get pregnant. And even if you ovulate the progesterone can change the cervical mucus and make it hostile so sperms have difficulties passing through the cervix. While on progesterone getting pregnant is going to be difficult.
Member: But I don't know if I'm ovulating and the doctor says the progesterone will make the tests false.
Grunebaum: The number-one thing to find out when you are trying to conceive is whether you ovulate or not. Besides a blood progesterone level other tests include a BBT chart and ultrasound examination. These are usually reliable to find out more about whether you ovulate or not.
Member: Hello Dr. Grunebaum. I have been trying to conceive for the past two years. And every month I hope and pray that my dream will come true, but the only thing that comes is my menstruation, and I cry!!!! I'm healthy, my husbands sperm is OK, and I'm OK, I just don't understand what is wrong. I drink orange juice all day, I take all the vitamins; I just don't understand.
Grunebaum: If his sperm count is perfect and you ovulate regularly, then the next step is to check your fallopian tubes. About one in four women with fertility problems have problems with the fallopian tubes. These are next to be checked either with an HSG or a laparoscopy. Checking the fallopian tubes is essential as part of a fertility workup if ovulation and sperms are OK.
Member: If that is what's wrong, can it be fixed??
Grunebaum: Yes, it can be fixed, but you first have to find out what's going on.
Member: I am 38 and have been TTC for over two years. I have been diagnosed with endometriosis stage 4. The only course of treatment we've tried is IVF, which failed in September. I responded well to the medications and produced 21 eggs. My question is, do I try again? What can I do to prepare my body for this? Exercise? Diet? Thank you!
Grunebaum: Most doctors suggest at least two cycles of IVF, though some will do three IVF cycles. Less than 50% of women get pregnant during the first IVF cycle, and with endometriosis IVF is usually very successful.
Member: Why would basal temperature say I ovulated and an ovulation test kit did not indicate it?
Grunebaum: Good question. Not seeing your BBT chart makes it difficult to comment. The OPK is usually but not always positive when you ovulate. Reasons could be you missed the positive OPK window (it's sometimes less than 24 hours). Or your urine was too diluted and the LH in the urine was too low to be detected.
Member: I definitely am having a high shift in temperatures.
Grunebaum: No argument from me here, I just like to see the chart myself.
Member: I am 33 and went off the pill in November. I have two boys, 10 and 5. Will it be hard to conceive at my age? I have been charting starting this month. Also, I am on Prevacid for acid reflux. Will this cause any interruption in TTC?
Grunebaum: Prevacid shouldn't affect your ability to get pregnant. If you are now ovulating regularly and everything else is OK then you have an over 50% chance getting pregnant over the next five to six months. At 33 fertility isn't yet enough impaired to be too concerned about the age.
Member: Would I still be able to take it if I get pregnant?
Grunebaum: Prevacid is not contraindicated in pregnancy.
Member: I'm in the middle of my third IVF. Do the FSH/LH drugs tend to have less of an effect the more you use them?
Grunebaum: You should still be able to ovulate if you ovulated before. Your doctors usually monitor you very closely in order to make sure you get the right amount. Not too much or too little.
Member: My husband had mumps when he was 18, and I was just wondering, how rare is infertility due to mumps?
Grunebaum: It's not so rare to have a low sperm count after having had mumps. I usually suggest to all of my TTC patients to start off with a spermanalysis. It's much more important than, let's say, a Pap test and more fun, too. So have him tested first.
Member: Could you please tell what a short period, one day, could mean? My periods are always short but usually about three days.
Grunebaum: It all depends whether and when you ovulated. You should find out what's going on with your ovulation first. A menstrual period depends on ovulation, and if it's abnormal then the cause could be an ovulation problem.
Member: I've been trying to have a baby for four years now and have had four spontaneous abortions and one ectopic pregnancy. What can I do to prevent the spontaneous abortions? Also, after the surgery for the tubal pregnancy, my period has been consistently late. Is that normal?
Grunebaum: You have had what's called "recurrent abortions" or miscarriages. When this happens you require additional tests to find out what the cause could be. These tests include chromosome tests for you and your DH, some immunologic and hormone tests, and they also include tests to look at the uterus and see if there is a malformation. Oftentimes a specific cause is found with these tests. Treatment can often get you pregnant successfully.
Member: Hello. [After I stopped Depo], I finally had a period in October 2001 for 25 days straight, and haven't had one since. I've had a few pregnancy symptoms, but two tests both had negative results. Can you advise what may be going on?
Grunebaum: If I understand you correctly, you haven't had a period in 14 months. The main cause for this is that you don't ovulate. Do you? Your doctor must find out why you don't ovulate and do some examinations and tests first. If a cause is found then it can be addressed. For example, PCOS, polycystic ovarian syndrome, is a major cause of anovulation. Then your doctor can treat you and help you first ovulate, then get pregnant.
Member: My doctor wants to put me on birth control for my irregular periods but I really want to have a baby. Is there anything that the doctor can give me that will still allow me to get pregnant?
Grunebaum: Same as above. If you do not ovulate and you want to get pregnant then the only thing to do is to make you ovulate. And before that happens, the reason for the anovulation should be found. Inducing ovulation is usually the best path to pregnancy if you do not ovulate.
Member: How long after conception can a blood pregnancy test be taken?
Grunebaum: Implantation usually happens nine or so days after ovulation. The blood test is usually positive three to four days after implantation. If implantation happens earlier, then the blood test is positive earlier (and vice versa).
Member: How about urine test?
Grunebaum: The urine test is positive usually five to six days after implantation.
Member: I had not been pregnant until 2000 and it was an ectopic pregnancy. After that I worked with my gynecologist for about a year and she thought that my prolactin level was too high. I took Dostinex for this but I did not get pregnant. Finally, I went to a fertility specialist and had a fertility workup done. I took Clomid for two months and had two unsuccessful IUIs. Should I proceed with IVF?
Grunebaum: The next step after unsuccessful IUI is usually IVF. With IVF your chances of getting pregnant are usually more than double when compared to IUI.
Member: Dr. Grunebaum, what do you think of the Fertility Awareness Method in helping with conception?
Grunebaum: I think anything that helps you figure out more about your fertility works. If you use it to find out more about your fertility and ovulation then it's great. But it doesn't work at all unless he has a good sperm count and your tubes are open. No matter how much you learn about FAM, he still has to have enough sperm. Also, there is no proof it works well if you use it solely for timing intercourse. Timing intercourse based on FAM is likely to decrease your chances getting pregnant. That's because by the time you first develop fertile mucus and start making love only then, it may already be too late and ovulation may already have happened.
Member: I had an abortion three years ago. I'm trying to have a baby now. Is my chance of miscarriage rate higher? I think that I've had three spontaneous in four months. I'm 33 years old. Is there a possibility of not being able to carry a baby after having an abortion?
Grunebaum: There is no conclusive proof that having had abortions increases your risk of future miscarriages.
Member: Why would I get a positive result from a home pregnancy test one day and the next a negative? Did I do something wrong?
Grunebaum: The test depends on the concentration of HCG in the urine. This concentration can change from one day to the next. You may have done it at a different time, or your urine was more diluted, or you may even have used a different test from a different company. Different tests have different sensitivities. Consumers Report in this month's issue has a review of different pregnancy tests.
Member: How does doing drugs affect your sperm count?
Grunebaum: Anything can potentially impair sperm production. It also depends exactly which drug is being used; some do more harm than others. In general it's not a good idea to use drugs, if you are trying to conceive or not.
Member: Doctor, I'm confused about something. Can an HSG test possibly OPEN your tubes?
Grunebaum: Yes, an HSG can sometimes open them a little. If they are completely closed, then it's unlikely the HSG has an effect. But if there are only a few small adhesions, sometimes chances of getting pregnant may be improved shortly after the HSG.
Member: I am in my first month of trying to conceive after a miscarriage at 12 weeks. I just had my first period and now am trying again. Is it possible to get pregnant right away? Does the body usually start ovulating again so soon?
Grunebaum: You may ovulate as early as one to two weeks after a miscarriage.
Member: Is there a procedure that opens your tubes up?
Grunebaum: Unfortunately there are no really efficient procedures. It also depends where there is a problem with the tube. If there is scar tissue around the tubes then sometimes removing them can open up the movements. But if the tubes are completely closed, trying to open it up is not very successful.
Member: Can you ovulate even if your tubes are closed? Is that possible?
Grunebaum: Your tubes have little to do with ovulation. You still ovulate with closed tubes; the egg and sperm just cannot meet. If you don't ovulate with closed tubes, then these are usually separate problems.
Member: Where would the egg go if the tubes where closed then?
Grunebaum: It just whittles away; it dies as it would die when there is no fertilization. The lining of the abdomen will absorb it sometimes.
Member: Does having sex in the morning really help when trying to conceive?
Grunebaum: If you have it instead of having no sex then YES! But in general there doesn't appear much to the myth that you are more likely to get pregnant from making love in the morning.
Member: I had an abnormal Pap, they gave me medications, I ovulated [while taking them] and we still tried to conceive. Do you think it would hinder that process?
Grunebaum: There are many different abnormal Paps. You may want to tell us what was abnormal about it and what medications you took.
Member: Last month, after being off the pill for one month, I had a very heavy period for five days. Then 14 days after the first day of that period I had three days of spotting. My next period was 42 days after the heavy one -- 28 days from the spotting. Which would I use for calculating ovulation?
Grunebaum: It's too early to calculate the first period. You still don't know if you are really ovulating or not. You also may want to let us know why calculation is important.
Moderator: Unfortunately, we have to wrap up for today. As always, far too many great questions to get to! Thanks for joining us. If Grunebaum wasn't able to answer your question, try posting in his TTC message board, or join us again next time. Bye for now, and good luck in all your TTC attempts!
Grunebaum: Thank you very much for visiting today.
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