Trying to Conceive 03/05/03 -- Amos Grunebaum, MD -- 03/05/03

By Amos Grunebaum
WebMD Live Events Transcript

Are you trying to conceive? Amos Grunebaum, MD, joined us on March 5, 2003 to talk about conception concerns, 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.

Member: Hi, I am 23 years old and I have PCOS. Husband and I are trying to concieve. I have taken only Provera in the past and it makes me feel horrible, I also was on my cycle for 30 days straight after that. That might have been because I had not had a cycle for at least three years prior to that. My question for you is: I have a doctor's appointment on next week and I need to know what should I request from him? In the past when I went I was not trying to conceive, so I haven't really taken a lot of action with my PCOS. I am lost and don't know where or how to start. Can you offer any advice?

Grunebaum: The most important question to answer here has something to do with the BIG "O." Are you ovulating or not? Women with PCOS usually do not ovulate and that makes it difficult to get pregnant. You need to make sure your doctor specializes in infertility (reproductive medicine/endocrinologist). And you need to find out what your doctor plans to do to help you ovulate and get pregnant.

Member: Does Clomid cause your ovaries to produce better quality eggs? Also, what are the chances that you will produce multiple eggs? I am asking because my doctor is putting me on Clomid 50mg CD 5-9 (ovulate on my own already) and I will be having back-to-back IUI's (first time). I am 25 and DH is 26.Thanks again.

Grunebaum: Many doctors feel Clomid somehow makes eggs better and thus improves the chance of fertilization. There is a 10% or so chance having multiples on Clomid, but it may be higher if you already ovulate.

Member: Does drinking by husband cause infertility?

Grunebaum: Drinking what? Water, beer, tea, coffee?

Moderator: Let's assume alcohol, I guess.

Grunebaum: Alcohol can decrease sperm production and thus decrease his fertility.

Member: I got off the pill August 2002 and my husband and I are now ready to conceive. I know that it hasn't been that long but I've gone to my ob-gyn and she has suggested Clomid. I've taken one round without success. Is there is a correlation between the Clomid and the development of cysts?

Grunebaum: I am not sure why you need Clomid. I assume you don't ovulate. When a woman doesn't ovulate, many doctors will first run some tests to find out why there is no ovulation. In addition, many doctors will insist on doing a sperm count before you get Clomid. This ensures that you do not take a medication without first finding out if he has a problem or not. Even the very best BIG "O" will not get you pregnant unless he has enough sperms.

Member: I am TTC, and am taking low dose aspirin for APA. Is there is increase of bleeding during pregnancy when taking aspirin? Are there any other side effects that I should know about?

Grunebaum: A single baby aspirin a day is not expected to affect your bleeding. It's only when you take many normal doses of aspirin a day that your bleeding may be affected.

Member: My husband and I have been trying to conceive for about 16 months. We just started seeing a specialist in January (after a waiting list of five months), and so far have found no problems with me (blood tests and hysterosalpingogram). My husband's test came back (in their words) "on the lower end of normal, but not at levels that would make conception impossible." He is now seeing a urologist and has gone (just this morning) for a scrotal ultrasound and has to have another sample tested next week. My doctor wants me to start Clomid next cycle. Why am I the one being put on drugs if the problem doesn't appear to be with me?

Grunebaum: You are right in asking this question. That's why it's essential to find out the exact result of his sperm count. Looking at the result will help you find out how much of the low count is his responsibility. If it's very low, then even taking Clomid won't significantly improve your chances getting pregnant. And if you already ovulate then taking Clomid may in fact decrease your chances getting pregnant, because it can negatively affect your cervical mucus and possibly prevent sperms from entering the uterus.

Member: For a person whose periods are induced with Provera how will she check when she is ovulating using the WebMD ovulating calendar?

Grunebaum: You cannot use a calculation method when the period is induced with Provera. That's because you likely do not ovulate and cannot calculate something that's not going to happen.

Member: What are the chances of conceiving when not tracking your cycle? My husband wants to have a child but is convinced tracking ovulation is unnatural and makes intimacy mechanical. It's been five months without tracking and no baby. I'm 30 and this would be our first child. Of note, I experience painful periods when not on the pill so I'm currently on painkillers and promethezine to control it. Any advice? I'm at the point of getting back on the pill because I don't know how long I can deal with the discomfort while we try to make conceiving less "mechanical."

Grunebaum: First, it's important to know that your menstrual cycles are regular (you did not tell!). If your periods are regular then you pretty much know when you ovulate. And making love two to three times a week, every week ensures you will not miss the important day. But five months isn't yet too long to give up. In fact, only about 50% of normal couples get pregnant within five months. In the meantime you may want to talk to your doctor and find out what to do next. You may want to check his sperm count to make sure it's OK. If his count is too low, then no matter how long you try, you won't get pregnant without additional help.

Member: What if you have an incompetent cervix? What can be done for a successful pregnancy and birth?

Grunebaum: An incompetent cervix is treated with a cerclage. That's a procedure where a stitch is placed in the cervix around 12-14 weeks of the pregnancy.

Member: Can I still be pregnant even though I got my period today? I had pregnancy symptoms, sore breasts, I felt a little nausea yesterday and now I have my period.

Grunebaum: Yes, you can still be pregnant, but a better question is what your chances are being pregnant. If you have a regular menstrual period, your chances being pregnant are very low, especially if your pregnancy test is negative. Now you may have heard that women can have a period and be pregnant. That actually happens very rarely. Women who bleed and are pregnant usually do not have a regular period. It's irregular and more like spotting. Having a regular period on time and in regular strength usually means you are not pregnant.

Member: Is it true that there is really only a day or two of true conception - even though it is thought that days 13 to 16 are the true days?

Grunebaum: Actually there is only a 12-hour period of conception. The time after the egg pops out from the ovary (ovulation) until it dies 12 hours or so later. Fertilization, when the sperm enters the egg, can only happen during that 12-hour period.

Now you probably wanted to know something different, I think. You wanted to know during which period you can make love in order to get pregnant. Here is the calculation: sperms live on average one to three days. And they need about 12 hours inside the uterus in order to get "prepped" to fertilize the egg. Those 12 hours are also known as "capacitation." In order to get pregnant live sperm must be inside the woman's uterus at or before ovulation. Making love after ovulation is unlikely to get you pregnant. If you make love regularly every day or every other day during the five to six days prior to ovulation, then you can make sure enough sperm is there to fertilize the egg.

Member: I am 29 years old this is the first month I started taking Clomid 50mg. Before I ovulated I had cramping really bad; now I just get it maybe every other day. Is this normal?

Grunebaum: Clomid can change your boy in either direction. It can make ovulation more or less painful, that's normal.

Member: After you stop ovulating what are your chances of ovulating again? I have not ovulated in eight years and have been told there was no chance is there

Grunebaum: It all depends on why you don't ovulate. If your ovaries were taken out, for example, then you have a zero chance ovulating. And if you are postmenopausal then you also have a zero chance ovulating.

Member: I still have them but my tubes had to be put back into place. I am only 27.

Grunebaum: If you are only 27 and not ovulating you should try finding out why you do not ovulate. At this age there are still some possible solutions to make you ovulate.

Member: I am 42 and trying to conceive. I actually had a successful IVF cycle last fall but lost the baby two days after the pregnancy was confirmed. At that time I seemed to have a discharge. Could the progesterone have caused that?

Grunebaum: I am sorry to hear about your loss. Most early miscarriages are because of abnormal chromosomes. Something had gone wrong with the fetus. Low progesterone is responsible for less then 5% of all early losses, if at all.

Member: I'm 39 with irregular periods past year, went every 21-26 days up to July, then skipped two months and had a period in October and November with help from Provera. Had EMB (negative), BW (prolactin 7.8, TSH 1.54, HCG (negative), FSH 53.0!!) My doctor says I'm menopausal, would need egg donor. My last pregnancy was three years ago. I had twins 10 years ago. My last period was 1/11/03 and a home pregnancy test on 3/1/03 was negative. I'm healthy, have no symptoms except irregular periods and low back pain. Mom went through menopause at 51. What can I do to initiate ovulation and is it too late to conceive on my own?

Grunebaum: I am so sorry to hear about the high FSH level. These high FSH levels usually indicate ovarian failure, which is different than premature menopause. With these high levels, if they are confirmed your chances getting pregnant on your own are minimal. You may want to see a second opinion, preferably an infertility doctor to review your issues.

Member: I've been charting my BBT for a while now and I'm fairly certain I'm not ovulating. Can my doctor do anything for me, or do I have to wait the typical one year before getting fertility help?

Grunebaum: You must see your doctor or even better an infertility specialist as soon as you find out that you do not ovulate. The doctor will usually do some tests to find out the reason. Once a reason is found, you can get treated and hopefully get pregnant soon.

Member: Is there such thing as too high of a progesterone level after IVF?

Grunebaum: Not really, too low is a problem, not too high.

Member: I was irregular. I took Clomid for one time and I got pregnant but it ended in miscarriage in six weeks. Does this have anything to do with Clomid? Can I take Clomid once again?

Grunebaum: Clomid induces ovulation; it's unlikely that it is responsible for a miscarriage. Most miscarriages are due to abnormal chromosomes. Clomid does not increase the risk of chromosome problems.

Member: Is there any hope for women with elevated FSH (day 3 - 20, day 10 -30) to get pregnant?

Grunebaum: The FSH levels you describe are elevated and make getting pregnant really difficult. Much higher levels make it impossible, but yours are in a range that if they come down somewhat makes it still possible to get pregnant.

Member: Anything I can do to make FSH lower?

Grunebaum: Not really. Unfortunately the FSH levels in and by themselves are not the problem. The problem is your eggs. They make the FSH levels go up, so you would have to improve your eggs to make it then go lower. And I am not aware of something that does that.

Member: I have tested positive for APA twice and miscarried once last September. I have had one normal pregnancy with a normal birth. I am currently TTC -- my ob-gyn's only instructions were to take a baby aspirin every day and to come in as soon as I know I'm pregnant. She will then send me to a perinatologist to get a recommendation on Heparin or not since I have not been diagnosed with APA syndrome. Should I see the specialist prior to conception? Also, I have read that there is a correlation to infertility and APA, is there any truth to that? Any information on APA is helpful. My pregnancy loss was at 9 1/2 weeks -- it could not be confirmed if it was due to the APA.

Grunebaum: You absolutely should see a specialist before pregnancy. That allows you to shop around and find someone you feel comfortable with The issue of Heparin is somewhat controversial, especially if there is no clear-cut APA syndrome. Some doctors suggest taking it, before you have too many miscarriages; others feel it's not necessary.

Member: My wife stopped taking the pill in early October 2002, then did not have her period in October, but did have one in November. Since then she has not gotten her period and she is NOT pregnant. Is this normal?

Grunebaum: No, it's not. Not having a period likely means that there is no ovulation. And without ovulation the menstrual period won't come regularly. A doctor should check her to find out why she does not ovulate.

Moderator: Unfortunately, we have to wrap up for today. Bye for now, and good luck in all your TTC attempts!

Grunebaum: Thank you very much for visiting us today. Until next week.

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