Trying to Conceive 03/12/03 -- Amos Grunebaum, MD -- 03/12/03

By Amos Grunebaum
WebMD Live Events Transcript

Are you trying to conceive? Amos Grunebaum, MD, joined us on March 12, 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: My hubby and I have been TTC for 10 months. His sperm count was 311 mil total (111 x 2.8ml) with a 65.5% forward progressive motility. Morphology was only 15.5% (doctor days 30% is normal) but we've gotten conflicting info on whether or not this is bad -- some say with his high concentration and motility, he should be OK (approx 20 mil normal, motile sperm). Do you think his 15.5% is OK, considering his other numbers?

Grunebaum: You are right, there are many conflicting opinions on this issue. An abnormal sperm count is best evaluated by a urologist, a specialist in male issues. I hope you can see a urologist who specializes in male infertility. They are best trained to answer and take care of your concerns.

Member: Dr. Grunebaum, I have (usually) 27-day cycles and ovulate on day 13-14. Since my last child was born in August 2002, I have a bloody, streaked discharge for about four days before my period. My first baby died one hour after delivery due to bilateral CDH, and we are trying to conceive again. We have been trying for the last few months with no success. Could this spotting around day 24 be a problem with my luteal phase, or is it just a normal variant?

Grunebaum: If you ovulate regularly with a normal CL phase then spotting in and by itself is unlikely to be the reason for problems getting pregnant. Spotting can be caused by many different problems, including hormone issues, polyps, tumors, and infections. Your doctor needs to get a good history and examine you then do a step-by-step approach if a specific cause of the spotting is found. Most of the time it's unrelated to problems getting pregnant, but it's also important to get checked out, sometimes it could be something that can be treated.

Member: I am 33 years old and have had three normal pregnancies. I decided after a seven-year break to try for a fourth. I had blood work that said my FSH level was 6.68 but my estrogen level was very high at 142 on fourth day of cycle. I have very normal 28-day cycles. Any idea what it could be?

Grunebaum: Again, there is no complete information on what an elevated estrogen level means. Some believe it's normal, especially if the FSH is normal and especially if you ovulate normally. So in and by itself it's not something that is a major cause of infertility.

Member: So if an ovulation predictor says I'm ovulating normally and I have regular menstrual cycles the high estrogen shouldn't prevent pregnancy

Grunebaum: You may want to repeat the test and see if it persists. Seeing an infertility specialist (reproductive medicine doctor) will help you better understand what's going on.

Member: Hi Dr. Grunebaum, I'm 27 and my husband and I have been trying to conceive for the first time for three months. I know that's not a very long time, but I've been charting and am worried because I've noticed that around 6 dpo my CM becomes pinkish, then brown and reddish. This "light spotting" continues all the way until AF arrives around 14 dpo. My temps look great, and I'm ovulating regularly. But can this prolonged spotting be a problem for conception?

Grunebaum: As I have said before, spotting can have many different reasons. You need a speculum examination by your doctor to find out where the blood is coming from. It could come from the vagina, cervix, or the inside of the uterus. Each source requires a different approach.

Member: When do I do ovulation test? I am taking Clomid 50mg and I have irregular periods.

Grunebaum: With Clomid you would expect to ovulate 5-9 days after the last pill. It's generally suggested to start testing three days after the last pill of Clomid.

Member: Hello, Dr. Grunebaum. I had a miscarriage in October of 2001 after a year of trying. I was 10 weeks along. Now my husband and I have been trying for 16 months with no luck. I just went to see an infertility specialist last week and during a vaginal ultrasound he found what he thought were fibroids in the uterus. Could they have been present when I was pregnant and caused the miscarriage? It seems far-fetched, since I had several ultrasounds when I was pregnant, and then a D&C when I miscarried, and nothing was said about anything being wrong with me. But it's haunting me now. Thank you.

Grunebaum: Most miscarriages are due to chromosome problems, unrelated to fibroids

Fibroids are rarely the cause of infertility and of miscarriages. But you also should find out where they are, how many there are, and how big they are. This will help you further understand this problem.

Member: I have PCOS. I had insemination with my first baby. Will I have the same problem with the next one? I tried for six and a half years. Will it happen again?

Grunebaum: PCOS usually stays with you all your life. It cannot be completely treated. Having PCOS makes it more difficult to get pregnant, especially if you do not ovulate. So if you want to get pregnant again you may want to see a specialist for PCOS.

Member: Can you help me with some home remedies?

Grunebaum: I don't quite understand the question, home remedies for what?

Member: The PCOS.

Grunebaum: You first need to identify where the problem is. There is no 'home remedy' for PCOS.

Member: I've had spotting between periods, irregular periods, severe cramping, mild cramping for long periods and heavy bleeding since I was young. I was given birth control pills to correct it. Since I stopped the pills three and a half years ago when we first tried to conceive some of the symptoms have come back. I just found out I have fibroids, and these are preventing me from becoming pregnant. Why would no one have checked for fibroids before, since it seems the symptoms I had are typical of fibroids? I'm 27 now, by the way. Thank you.

Grunebaum: Your question is valid. But it can be only answered by the doctor who has previously examined you.

Member: Hello, I had IUI done on March 3; how soon before I can take a pregnancy test and get a positive result. My next menses is due on March 18. Thank you.

Grunebaum: If you are pregnant a blood pregnancy test is usually positive 11-12 days after fertilization.

Member: I am 36 years old and have been trying to conceive for seven months. I am on CD1 of my second month on Clomid (50mg). I have fibroids -- all outside the uterus (3-6cm), except one small 2 x 4mm inside. Will Clomid cause these to grow and do you recommend that I see an RE at this point? I have a clear HCG, good progesterone, thyroid and prolactin numbers and DH's numbers all look good as well! My only other symptom is that I have spotting on days 24-28 of my cycle. My cycles are very normal 28-day cycles.

Grunebaum: I always recommend seeing an RE when you have infertility problems. Reproductive endocrinologists are best trained to fins the problem and get you pregnant faster.

Member: If I typically test + on the OPK on day 11, should I still start Clomid on day 5? It appears to be making my cycles longer (testing+ on day 14 and having 31-day cycles).

Grunebaum: You usually ovulate 5-9 days after the last pill of Clomid. Clomid in and by itself doesn't make your period longer. It just makes you ovulate on a certain day and your period then comes 14 days later. It's possible that you ovulate on CD 14 and your period comes 17 days later.

Member: I'm 26 and my husband is 33 and we have been trying to conceive for one month. My doctor prescribed Clomid... after three months if it has not worked she asked to make appointment and go for next step. What would it be? I am having irregular periods.

Grunebaum: With irregular periods it's possible that you have problems with ovulation

Many women choose to chart their fertility. Charting your fertility will help you find out if and when you ovulate. And it also helps you often identify problems. Fertility charting will help your doctor find out more about your body and how to treat any problems.

Member: This may be a silly question, but can you have a regular period and not have ovulated? Also should I be worried about cycles that range from 33-38 days? Occasionally a real weird cycle that goes up to 50 days?

Grunebaum: Seems to me like your cycles are not regular. This usually means you have a problem with ovulation. As I mentioned before, charting your fertility will help identify what's going on in your body. Ovulation problems are the No. 1 infertility problem in women. So when you chart you can quickly identify the issues and treat them.

Member: Can you please tell more about fertility charting? Do I have to monitor my basal body temperature?

Grunebaum: Taking your basal body temperature every morning is just one part of fertility charting. Other parts include checking the cervical mucus and cervical position.

Moderator: There is a lot of charting info here at WebMD, more than can be covered in this chat. Just do a search on fertility charting or temperature charting. Good luck!

Member: I have been trying to conceive for 16 years. They said everything looks all right. I even tried Clomid but nothing happened. (What's next?)

Grunebaum: Seems to me like 16 years is a long time to try getting pregnant without finding out the cause. I hope you are seeing an infertility specialist; they are best trained to help find the cause and get you pregnant.

Member: I am 22, I have been off the pill since Nov. 1, 2002; my husband and I wonder how long it usually takes a person to conceive. I'm not pregnant yet.

Grunebaum: If you are ovulating now then at your age it's usually suggested to see a doctor after one year. But if you do not ovulate then you may want to see a doctor two to three months after stopping the pill.

Member: I had a blighted ovum in July 2002 and I a have been TTC for four months now. I ovulate (temperature charting), but I start spotting usually 4-5 days before AF and my luteal period is 12-13 days. I also observe very small amount of CM. Do I need to see a specialist now, or should I wait a few more cycles. I am 31; DH is 37.

Grunebaum: You may want to start by seeing your ob-gyn and get examined and see what's going on. Most doctors suggest seeing an infertility specialist at your age after being unsuccessful for one year. Women over 35 should see a specialist after six months.

Member: For the last three months I have been keeping track of my menstrual cycles; my cycles have been 24, 26, and 32 days (which is the first time that I experienced this long of a cycle). Do you foresee any problems with these types of cycles in trying to get pregnant? Based on the ovulation calendar, my next ovulation period will March 24-29.

Grunebaum: First of all, these are irregular cycles. You have not answered the No. 1 question, "When do you ovulate?" This is an important question to answer when you want to know more about your body. And it will tell you whether or not there is a problem with your cycles and fertility. Doing a BBT chart will help answer this all-important question.

Member: If fibroids are located outside the uterus, how often is surgical removal advised? I have had one doctor suggest that they are hindering implantation. Your thoughts?

Grunebaum: It all depends how many and how big the fibroids are. Rarely if ever is a removal necessary to improve fertility. In fact, some studies show less fertility after fibroid removal.

Member: I have a question about corpus luteum phase; based on my BBT chart I ovulated ib CD 14, my period started CD 27, however I started spotting CD 22 (very very little). Should I calculate the luteal phase based on my period start or when I started spotting?

Grunebaum: Your corpus luteum phase ends when you next period begins, independent of spotting in between.

Moderator: Thanks for joining us.

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