Trying to Conceive. Amos Grunebaum, MD. June 2, 2003.

WebMD Live Events Transcript

Are you trying to conceive? Amos Grunebaum, MD, joined us on June 2, 2003 to talk about the first baby steps to parenthood, from understanding your cycle to the ABC's of fertility charting.

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. Welcome to today's chat, again live from New York!

Member: I have been trying to conceive for almost a year. I've been diagnosed with mild endometriosis (the doctor said it shouldn't affect fertility). My husband has had recent SA done and showed abnormal morphology (not sure of the percentage). I am going on Clomid in a few weeks. Is this the right path?

Grunebaum: You usually cannot overcome an abnormal spermanalysis by giving Clomid. In addition, if there is also a problem with the fallopian tubes, then Clomid won't improve your fertility either. Clomid is given to improve ovulation; it won't increase your chances if there are sperm or tubal problems.

Member: I know. We're looking into other options also. I have fine tubes. I had a laparoscopy to check everything out.

Grunebaum: Then you should check and make sure what the numbers of the sperm count are. A very low morphology cannot usually be overcome by giving Clomid.

Member: Will do. Thanks!

Member: I did one cycle of 100 mg Clomid, had a trigger shot to ovulate on May 19; my progesterone was 14.8 on May 29. When could I do a pregnancy test?

Grunebaum: Most pregnancy tests are positive 15+ days after ovulation. Good luck!

Member: Will charting your temperatures tell you if you have a low progesterone level? I have very irregular cycles; this cycle I'm already in day 36 with no sign of ovulation. What tests do you suggest I get done. I'm 24 and had a miscarriage in March, had a D&C performed. Thank you!

Grunebaum: Charting helps you identify when and if you ovulate, and if you BD the right days. It will not tell you much about actual progesterone levels. Progesterone levels can best be checked by doing a blood test 7-10 days after ovulation.

Moderator: For all you new folks, "BD" means baby dance, or making love.

Member: I had an abortion three years ago and now have been TTC for four to five months. I'm really worried if an abortion will reduce my chances to conceive. What are chances of conceiving after abortion? I hear abortion can damage your cervix. If so, what are the chances of becoming pregnant?

Grunebaum: A safe uncomplicated abortion in the past won't affect your fertility at all.

Member: Dr. G, I have had long (38-44days) cycles since a miscarriage last November. I have started charting this cycle and now am on CD 50 with no AF and no BFP. I am sure I ovulated, but not sure if the day is correct. FF says CD 32. I am confused on what to think about being 18 DPO and still not getting a positive HPT. What do you think about this??

Grunebaum: Without seeing your chart it's impossible to assess what's going on. FF is wrong a lot, and only having your chart checked by an expert will help identify what's going on. If you really ovulated on CD 32 and it's now CD 50 without AF and the pregnancy test is negative then there is only one answer: You did not really ovulate and FF is wrong.

Member: What do you think about my long cycles since miscarriage?

Grunebaum: Long cycles usually mean problems with ovulation. It usually means you don't ovulate. Have your doctor check your chart and confirm it.

Member: Does having a long luteal phase hurt you in TTC? I have a 35-day cycle and I ovulate around day 14. I have had one miscarriage so does having a longer cycle hurt my chances of conceiving?

Grunebaum: It's highly unusual (and unlikely) to have long CL phases. The normal CL phase is 12-16 days and it rarely lasts longer. I would suggest you have an expert check your charts and see what's going on with your chart. Charting in general is not so easy, and only experienced experts are able to identify a problem. You should not try self-interpretation of your chart without adequate support.

Member: What is CL?

Grunebaum: Corpus luteum -- the area in the ovary where the egg comes out.

Member: You keep speaking of having an "expert" check out charts. Are you speaking of an ob-gyn? If not, who?

Grunebaum: Your ob-gyn would be the first expert that I can think of. But I am also thinking about someone trained to look at your chart. Some of the fertility sites allowing you to store your chart also provide you with an automatic assessment of ovulation. Unfortunately that automatic assessment is often wrong. That's why a real person, for example your ob-gyn, can provide you usually with a much better assessment.

Member: Hello Dr. Amos. I turned 30 last month; my husband is 32. We've been TTC for four to five months seriously; my cycles are 30-33 days. Using Clearplan OPK from last two cycles. Cycle 1: LH Surge on CD 15,16; BD timed on CD 13,15. Cycle 2: LH Surge on CD 17,18; BD timed on CD 15,17,18; But no pregnancy last two cycles with OPK help also. Need to use lubricant, without which we cannot. We are using Pre-Seed. I am anxious -- what might be the problem? Are we missing anything or using a lubricant causing any issue? Thanks very much for your response.

Grunebaum: I don't see much of a problem here. It takes the average couple four to five months to get pregnant, and up to 85% take up to one year. First of all, I would suggest to not completely try timing BD but instead relaxing and regularly making love two to three times a week. In addition, making love once a day during the four to five days prior to ovulation and the day of ovulation would be optimal. Unfortunately, many women try to time sex too perfectly and many times that's exactly the opposite of what's suggested.

Member: Is using Pre-Seed ok?

Grunebaum: Pre-Seed is a new moisturizer that claims to be "sperm-friendly." I have heard of many couples that have successfully become pregnant while using Pre-Seed.

Member: Can using saliva as a lubricant kill sperm?

Grunebaum: Saliva is a great sperm-killer. It's NOT suggested to use saliva as a lubricant.

Member: I am 28 years old, and was diagnosed with PCOS at age 15. I stopped taking birth control pills at the end of April 2003, and have engaged in unprotected sex with my husband every other day since that time. My question is: How many months of attempting to conceive without assistance must we endure before we can begin fertility therapy, (e.g., Clomid)? I don't want to wait longer than necessary, as I ideally prefer to become a mother before age 30. Thanks.

Grunebaum: First of all I don't like that word "endure." Making love should be a pleasure, not something you have to endure.

The first question to answer is: "Am I ovulating?" You should ovulate regularly by two to three months after stopping the pill. If you haven't ovulated by that time (seems it's only six weeks by now) then you should see your doctor. Six weeks is really much too early to have enough of an idea of what's going on.

Moderator: One more lubricant question:

Member: Somebody suggested baby oil? What about that?

Grunebaum: Some doctors suggest baby oil, others say it's not perfect, either. Perfect would be natural lubrication, and the best way would be very long foreplay. Making a baby is not only about having quick sex; it's about making love. And that should take some time; enough time for you to lubricate enough. Try finding new positions, try making it interesting, and stop thinking about it purely as baby-making.

Member: Can you explain implantation pain/AF pain, or are both the same?

Grunebaum: Implantation happens about eight to nine days after ovulation, while AF pain usually happens when you start your period. Those are two different things. Many women who are pregnant do not have implantation pain. In fact, it's not something that has been scientifically proven. So I would not expect you to have this pain during implantation. It's more likely an exception, not the rule.

Member: What about the implantation dip myth?

Grunebaum: Same thing.

Member: What is implantation dip?

Grunebaum: It's a myth. Some claim the temperature goes down a little during implantation. I looked at thousands of pregnancy charts. Most pregnancy charts had no dip, and oftentimes when there was a dip there was no pregnancy. What this is about is that many women just want to know early on if they are pregnant. There are simply no specific enough early pregnancy signs or symptoms to show you conclusively that you are pregnant. There is only one way: a positive pregnancy test. Every thing else is simply hopeful wishing.

Member: What about a temperature drop before ovulation; is that a myth also?

Grunebaum: The best way to diagnose ovulation is by having a bi-phasic temperature chart. Your temperature goes up by .2+ degrees and stays up for at least three days. That's really the only way to diagnose ovulation peaks and valleys. You should not over-interpret your charts.

Member: What does it mean to have flatlined temperatures after ovulation (after the initial biphasic rise)?

Grunebaum: A flatline is when there is no change in temperature over several days. If your thermometer is working well, then this should not be a major issue. As much as temperatures usually change a little over days, in some women it's the same. What is most important is that you look at the chart overall, over time, not just at a couple of days only.

Member: If I check my BBT every morning, but not at the same time (who wants to wake up at 6 a.m. on Saturday to check their temperature?) Will the chart still be accurate?

Grunebaum: It may still be accurate if you still sleep enough and do it at a different time occasionally. I would just enter the temperature then look at the complete graph. Some suggest to adjust the temperature if you take it at a different time. I completely disagree that it invites a lot of fudging. Just do the best you can, enter your real temperatures, then take a look overall. Even with the very best charting, doing it always exactly on time, you may see unusual temperatures. But if you chart it over weeks and look at the trend, then it should not significantly affect the interpretation.

As I mentioned before, have a person with experience look at your chart. That's usually far superior to having a program trying to tell you what's going on.

Member: Thanks, I feel more "normal" already!

Member: If you ovulate regularly and you know almost exactly when you do, do you think charting is still necessary?

Grunebaum: I often suggest charting even to women who think they ovulate regularly. It's like having several clocks in your apartment. You know your kitchen clock shows the right time, but having other clocks confirming it feels good, and helps you confirm what's going on. Charting also helps you show your doctor in no uncertain terms what's going on. Doctors like to look at numbers and want proof. Charting gives you the necessary proof to go to your doctor and say: "I am ovulating, now what's next?" It helps you save many months of unnecessary workups.

Member: My doctor doesn't seem to put much stock in charts, though.

Grunebaum: Many doctors don't. They learn a lot about obscure diseases in medical school, diseases they may never see in their office. We all learn a lot about how to prevent getting pregnant. But there is no class in medical school about trying to get pregnant. This is one time when women should teach their doctors something and tell tem, "I know more about my body then you do!"

Moderator: For our new visitors today, the last few questions have been about fertility charting, also called BBT charting (basal body temperature). There is a lot more info on charting here at WebMD and in Dr. Amos' message board. Check it out! Here's our next question.

Member: What is the best treatment for infertility with a diagnosis of hypothalamic amennorhea?

Grunebaum: That is actually something an infertility specialist needs to evaluate. There are several tests to do first before you can assess the right treatment. And the list of causes is very long, each requiring a different approach. Your best bet would be to see a reproductive-endocrinologist (RE).

Member: Hi doctor. I was taking Clomid 100mg for five months before getting pregnant, I lost the baby after only seven weeks. I just started the new cycle of Clomid on the 15th of May. I am getting pains throughout my midsection for the last two weeks and the pains have gotten worse within the last three days, the last time I had pains like this I found out I was pregnant a week later. Could that be, or is there something more that I should worry about? Also, could I get pregnant that quick after it taking five cycles last time?

Grunebaum: Clomid stimulates the ovaries. It makes them literally swell up by creating several cysts, which eventually leads to ovulation. There is a potentially dangerous syndrome called OHSS -- ovarian hyper stimulation syndrome. If you have a lot of pain, you should let your doctor know about it right away. Your doctor can examine you and find out what's going on.

Member: I asked a question about CP not changing. You answered that I might not be ovulating, but according to my BBT, I have a typical biphasic chart. I went off birth control pills in January and have had 27-34 day cycles since then. Could my CP not changing during my cycle affect my chance of conceiving?

Grunebaum: The best indication that you are ovulating is the biphasic curve. If you do not have enough cervical mucus despite ovulating then this could be a problem. Your doctor can test the mucus during ovulation and find out if it's an issue. It's called the post-coital test and it's indicated if your doctor feels there is a cervical problem.

Member: My fiancee and I have been trying to conceive for three years now. I had a suspicion that I may have a low sperm count. I saw how 66 mg of zinc and folic acid could increase sperm count. The highest mg of zinc I could find was 60. Is this still going to be as effective?

Grunebaum: Suspicion isn't good enough. I don't know why you suspect the low sperm count. But before you try treating it yourself, have it tested and find out for sure.

Member: Looks like tapioca pudding.

Grunebaum: It's impossible to make that diagnosis from looking at the ejaculate. Test it and get the exact answer.

Member: Does your chances of getting pregnant change if you start your period naturally versus starting using pills when using Clomid?

Grunebaum: I am not sure which pills you are referring to. But if you take progesterone, for example, to make you bleed then that usually means you did not ovulate. And inducing bleeding with progesterone is unlikely to increase the chance of ovulating in the next cycle. I hope that is the answer you were looking for.

Member: I just wanted to thank the doctor for taking time out of his day to answer questions.

Grunebaum: You are welcome.

Moderator: You can find dozens of archived Grunebaum chats in our Live Events archive, which can be found on our boards and chats page, " Member Central." Those transcripts will answer many, many of the unanswered questions from today. Bye for now. And good luck in all your TTC attempts!

Grunebaum: Bye everybody and thank you for visiting WebMD today.



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