Trying to Conceive: Getting Started -- Amos Grunebaum, MD -- 09/25/02

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.

Are you trying to conceive? When should you see a specialist? What tests should you have? As part of National Infertility Awareness Week, WebMD joined with RESOLVE: The National Infertility Association to bring you the Trying to Conceive Cyber Conference. Amos Grunebaum, MD, joined us to talk about your first steps in trying to conceive.

Moderator: Joining us now is WebMD's own in-house pregnancy expert, Amos Grunebaum, MD. Let's get right to some questions.

Member: When is ovulation considered too late? Is an 11-day luteal phase cause for concern?

Dr. Amos: Let's first talk about a "late" ovulation. Ovulation normally happens from CD 10 to CD 21. Ovulation that happens regularly after CD 21 is not considered normal. That does not mean you cannot get pregnant with late ovulation. Women get pregnant all the time even when they ovulate late. But your chances of getting pregnant are decreased significantly when you ovulate late. This is for several reasons:

  • The lining of the uterus is too old for implantation.
  • The egg is considered not as good as when ovulation happens earlier.
  • When ovulation happens late you ovulate less often over time, further decreasing your chances of conceiving.

The corpus luteum phase is the time between ovulation and the next menstrual period. If it's often less than 12 days then there may be a problem and your doctor should do some further testing.

Member: What is the name of the procedure to clean out tubes to help get pregnant?

Dr. Amos: Actually there is a procedure called HSG or 'hysterosalpingography.' It's not a procedure to clean up the tubes, per se. It's a test where dye is injected into the uterus and the patency (how open they are) of the tubes is checked with X-rays. Sometimes there is a slight improvement of fertility after this test. But it's not enough to suggest doing the test for that reason. If your tubes are closed then other procedures are necessary to open them up and to get you pregnant.

Member: How long does your cervix actually stay open during ovulation?

Dr. Amos: It's [not the cervical opening but] actually the cervical mucus that changes around ovulation. And that change allows sperms to penetrate and get more easily into the uterus. This cervical mucus is also known as EWCM, or egg-white cervical mucus. That's because it stretches during the fertile days, like fresh egg whites. EWCM appears usually several days before ovulation and disappears usually within one to two days after ovulation.

Member: If the cervical mucus does not change, but a BBT chart shows ovulation, do you need to time intercourse better to achieve pregnancy?

Dr. Amos: I am not a strong proponent of timed intercourse. No study has conclusively shown that timing intercourse improves your chances of getting pregnant. The reason is that ovulation can happen on many days during the regular menstrual cycle. And making love based only on calculation or cervical mucus may actually achieve the opposite. It may decrease your chances of getting pregnant. Most studies show that making love two to three times a week or more improves your chances of conceiving. If, in addition to that, you want to make love daily during the four to five fertile days and the day of ovulation, then you probably have done the best thing.

Member: My husband and I are going to our first fertility consultation on Monday. What will occur first? What should we expect to happen?

Dr. Amos: Without knowing your history and why you are seeing the doctor, it's difficult to tell you what will happen. In general, the doctor will first take a history, find out your age and prior pregnancies. Then the next step is to find out if you ovulate regularly and how long you have been TTC. The tests that are usually done are a CD 3 test for LH, FSH, prolactin, and TSH (thyroid function). And then a sperm count is usually done. When they come back OK, the next step is to check your fallopian tubes, either with an HSG or a laparoscopy.

Member: I've been on the pill for six years, and just recently went off. What is the average time it will take for the hormones to leave my body so I can get pregnant?

Dr. Amos: I have difficulty understanding the word 'can' in your question. I get this question all the time, but it's unclear what it is that you are concerned about. You 'can' get pregnant as soon as you stop the pill. Once you stop the pill, ovulation usually happens within two to six weeks. And you do not have to wait to TTC after stopping the pill because there is no increased risk to the pregnancy if you happen to ovulate right away and get pregnant right away.

Member: I have irregular periods (two to three periods of five to seven days). One doctor states that I have endometriosis while the doctor I visited for a second opinion states that it is not. When do you visit a specialist? What are the common signs of endometriosis? The first physician also felt that I have high testosterone; however, no tests were formally completed. What are the signs of high testosterone?

Dr. Amos: I don't understand your cycles. Irregular cycles are cycles that are different by more than two to three days. So one cycle may last 24 days, the other 30 days, and so on. Your cycles are directly related to ovulation. So the first thing to do with irregular cycles is to find out when and if you ovulate. This can be done, for example, by doing a basal body temperature [BBT] chart. The chart will help you a lot in figuring out why you have irregular cycles. One sign of too high testosterone can be problems with ovulation. And seeing a specialist right away will decrease the time for you to get pregnant.

Member: If you have a period do you necessarily ovulate?

Dr. Amos: No, just bleeding doesn't mean that you ovulate. But having regular cycles lasting about 28 days likely means you ovulate regularly. So the question is whether your cycles are regular or not and how long they last. Just having a period doesn't mean in and of itself that you ovulate.

Member: I have been trying to conceive for three years now. My cycle is very irregular and long at times. Have you heard of the "Clear Plan Fertility Monitor" and should it be a fist step? I'm 24.

Dr. Amos: The fertility monitor is unlikely to help you improve your chances of getting pregnant. In fact, it doesn't make you 'fertile' even though it's called a fertility monitor. This monitor measures some of your hormones, but the manufacturer does not suggest using it with irregular cycles. You should head to your doctor immediately and find out why your cycles are irregular. You may also do a BBT chart and find out whether you ovulate at all. Seeing your doctor or an infertility specialist without further delay is the only way to ensure that you get pregnant soon with irregular cycles.

Member: I usually have a five-day cycle, my last one was only for two days -- my shortest cycle ever, could that be a sign of pregnancy?

Dr. Amos: Let's talk about definitions. A cycle lasts from the first day of your bleeding to the day before your next bleeding begins. Your bleeding is also called 'menstrual period' and it usually lasts two to six days, while a menstrual cycle lasts on average 28 days. I suppose you are talking about your menstrual period. A short period, short bleeding, can be a sign of hormone problems. It's also called hypomenorrhea. Hypermenorrhea is when you bleed more days than usual. So the first thing you want to find out is when you ovulate and how long your cycles last. This will help your doctor identify the problem better and help you get pregnant faster.

Member: If I determine after just a couple of months (through taking my temperature) that my luteal phase is less than 12 days, should I go ahead and see my ob-gyn?

Dr. Amos: Absolutely! I always suggest you see your doctor right away before you TTC. This will help you identify any problems, get some 'hot tips' from your doctor, maybe even get free prenatal vitamins!

Member: If I've had an STD is the past how do I know if I'm still able to conceive?

Dr. Amos: That depends on which STD you had and what happened. Some STDs can infect the fallopian tubes and create scar tissue in and around them. That scar tissue could prevent the egg from reaching the sperm (and vice versa). If you have problems getting pregnant with regular ovulation and sperm count then the next step is usually to check the fallopian tubes for scar tissue and signs of old infections.

Member: I am 15 DPO and due to start AF [Aunt Flo = menstruation] tomorrow. I have been having pregnancy symptoms for a while now and the test I took this morning had the faintest of a positive line. How long should I wait to retest?

Dr. Amos: Congratulations! We seem to have a pregnancy in this room. A faint positive HPT [home pregnancy test] is as good as a strong positive. If you have done it correctly, then a faint positive test means you have hCG in the urine. And the only way this can happen is by being pregnant. Make sure you take your folic acid (if you haven't already started). Your test usually becomes stronger positive in several days.

Member: I feel like I possibly might have conceived one week ago (I have been keeping track of my cycle and fertile days). Two days ago, my nipples started feeling very sore and I have been feeling nauseated since then, which lasts all day. Is it too soon to be feeling this way, or is it all in my head?

Dr. Amos: It's not too soon to feel pregnant. But it's too soon to feel typical pregnancy symptoms from being pregnant. Your symptoms are usually related to the pregnancy hormone hCG, and hCG is usually not in your system until 11-12 days after ovulation. And most women do not typically feel pregnant until after they miss their period. You could be pregnant (and I hope you are) but you still need to wait for confirmation with a positive pregnancy test.

Member: What is the No. 1 cause of lack of ovulation? And how is it treated?

Dr. Amos: The No. 1 cause of anovulation is PCOS (polycystic ovary syndrome). Your doctor can do some tests and examine you to find out if you could have it. Once it's diagnosed there are specific treatments helping you to ovulate and get pregnant faster.

Member: What is PCOS?

Dr. Amos: PCOS = Polycystic Ovary Syndrome. It's a syndrome with many different things going on. There is no single test to diagnose it, only some abnormal lab results, examinations, and symptoms.

Member: Is it possible to skip a month of ovulation? I usually have symptoms (cramping, etc.) but this month I didn't feel anything.

Dr. Amos: It's not unusual to sometimes skip ovulation. However if it happens more than one to two times a year, then this could be a problem in getting pregnant. If you chart your temperature you can often see if and when you ovulate. This is a better indicator of what's going on than symptoms, which can be too nonspecific.

Member: I am 26 and have two children already. After the second, I found out I have hypothyroidism which is under control. I've been trying for five months to conceive. Could my thyroid be the reason I am not getting pregnant?

Dr. Amos: All depends whether you ovulate or not. If you ovulate, then the cause of your problems is unlikely to be your hypothyroidism. But if you do not ovulate then it may be because of the thyroid. Controlling your hypothyroidism often improves your chances of getting pregnant and ovulating.

Member: If my DH [dear husband] and I have sex on the day of ovulation, is it possible to get pregnant, or does it have to be before ovulation?

Dr. Amos: You can get pregnant by making love on ovulation day. But I do not suggest doing it only on that day. You improve your chances by making love regularly during the four to five days leading up to the day of ovulation. Sperm takes 12 hours to get ready. So making love too late is less likely to be successful.

Moderator: Thanks to Amos Grunebaum, MD, for joining us this hour. For more information on fertility issues, be sure to explore all the TTC info here at WebMD, including our message boards and regular live chats with Dr. Amos.



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