Trying to Conceive: Getting Started 07/21/03 -- Amos Grunebaum, MD-- 7/21/03

WebMD Live Events Transcript

Are you trying to conceive? Amos Grunebaum, MD, joined us on July 21, 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!

Member question: I read on your site, under the ovulation calendar, that if I'm trying to conceive I shouldn't have an orgasm before my husband. I thought female orgasm helps the process!

Grunebaum: You definitely should have an orgasm, as much as you can and want I am not sure where in the calendar you read this.

Member: On the ovulation calendar it said that you shouldn't have an orgasm before if you want to have either a boy or girl. I can't remember which it was

Grunebaum: There is a theory that a female orgasm can propel the male sperm through the uterus. So according to Dr. Shettle's theory, if you want a boy you should have an orgasm just before his and if you want a girl, you should withhold your orgasm until after he ejaculates.

Member question: I had an IUI done on CD 17 after doing Clomid and Repronex shots. I had little cramping afterwards until CD 22 and a small amount of creamy white discharge. Is this normal or should I be concerned?

Grunebaum: Cramps are not unusual after these medications. Clomid stimulates your ovaries and makes them swell a little. Many women have some discomfort after this medication, so that's an expected side effect.

Member question: I went off the pill on May 24, 2003. I am going to start charting my temperatures when AF arrives in one to two weeks. Any suggestions for someone new to this?

Grunebaum: First of all, you won't know exactly when AF comes. Your first normal AF after stopping the pill comes about two weeks after you first ovulate. You may want to start charting now, because this is a good way to practice and also find out when ovulation happens. You may actually ovulate and become pregnant before your first AF arrives and without it ever arriving. Doing a fertility chart right after stopping the pill helps you find out more about your body and can identify ovulation early on.

Member question: How long after stopping birth control pills should AF be normal? Or is it going to be? It's been 10 months and I'm still irregular.

Grunebaum: It can take two to three months after stopping BCP for ovulation to return. If it hasn't returned three to four months after stopping BCP then you should see your doctor and find out what's going on. Having an irregular AF usually means problems with ovulation. So starting fertility charting helps you quickly identify a problem.

Member question: Is it safe to stop taking birth control pills during the middle of a cycle, or is it best to wait until the completion of a full month?

Grunebaum: Most doctors suggest waiting until the end of the cycle. This ensures that you bleed normally and that ovulation can start soon thereafter. Stopping the pill in the middle increases your risk of spotting and bleeding irregularly.

Member question: Why do doctors make you wait one year before testing for infertility?

Grunebaum: They shouldn't really. The theory is that it takes about 85% of couples up to one year to get pregnant. But that should not ever stop you testing your own fertility the very first month you start trying. Charting your fertility is a sort of fertility test and answers the question about ovulation. I also suggest that each couple starting out TTC does a sperm count right away. Getting the results saves you time in case he has a problem. Why try in vain for a year when you can find out immediately if he is fertile or not? In addition you should see your doctor and also see if there are any medical problems potentially preventing you from getting pregnant.

Member question: My husband has not had a sperm count done for religious reasons. Because we don't know what his count is, how often should we have intercourse? I am using an OPK to plan intercourse better.

Grunebaum: If he has a low count then no matter how few times you make love, you won't get pregnant.

Member question: How do you do a sperm count?

Grunebaum: The man ejaculates into a clean container and it's then brought to a special lab. Some labs provide a private space to masturbate and obtain the ejaculate. It's usually done by a urologist.

Member question: My husband's SA didn't come back so great. He's been taking more vitamins and living a more healthy lifestyle. How long should we wait before getting another SA to see if our changes have made any difference?

Grunebaum: It all depends on what "not so great" means. You need to look at the absolute count to try and see whether it can be improved or not. Unfortunately there is no magic medicine that improves the sperm count. In general a "bad" count is repeated about six to eight weeks later to see if it has improved. But an extremely low count is not likely to get much better.

Member question: If my DH is young and has already produced one child with someone else is it possible he could now be infertile

Grunebaum: Yes, it's possible. I assume it didn't happen within the last month, and is a while back, likely a couple of years. A lot can happen in that time, and if you can't get pregnant despite ovulating normally. Then his sperm count needs to be checked.

Member question: Since I've started temp charting, I've noticed I start light bleeding (spotting, really, but red) two to five days before real flow. Is this "pre-bleeding" normal, or indicative of a problem that may prevent me from conceiving?

Grunebaum: Many women can have a little spotting several days before AF starts for real. You may want to have your doctor check your complete cycle and calculate the corpus luteum phase. In addition doing a blood progesterone level seven to ten days after ovulation may help you find out more what's going on.

Member question: I have been TTC for 10 months. Last month I used my first OPK because I have been so irregular I wanted to make sure I was ovulating. I got a positive result on CD12 so I figured I ovulated on CD 13. I am now 19 days past ovulation and no sign of AF. I took a HPT on DPO 12, 14, and this morning, 19 DPA and all negative. Don't you think this is a long LP and could I still be preg if I got a negative at 19 DPO?

Grunebaum: A negative HPT so long after a positive OPK likely means that you did not ovulate. OPKs can be falsely positive meaning they are positive even without ovulation. Adding a temperature fertility chart to your evaluation helps you find out more about your ovulation. This is especially important when your menstrual cycles are so irregular. In that case doing OPKs only won't often tell you enough about the exact day of ovulation.

Member question: I have been TTC for only three months now. My last AF was on July 10 but very light compared to normal -- more like heavy spotting and more of a brown than any red. For the past two weeks, I have been constantly tired, nauseated, and lack any energy at all. I have taken HPTs, all negative and am wondering if I could actually be pregnant and just need a blood test.

Grunebaum: Repeatedly negative HPTs usually mean that you are not pregnant. This can be confirmed very reliably by a blood hCG test. If you think you may be pregnant, do a blood pregnancy test and find out for sure.

Member question: I have been on Depo for four years and am trying to conceive. I know in order for implantation you need new lining. My cycle starting on July 9 is the first since I stopped my shots in November 2002 that I shed lining. Will this make a difference? I have a 29-day cycle.

Grunebaum :Once you stop Depo and start ovulating again, then the uterine lining builds up quickly. This usually comes from the hormones produced by the ovary and the developing egg. So once you ovulate and have an AF then the lining is sufficient for implantation. Bleeding with your menstrual period 14 days after ovulation is the same as shedding the lining of the uterus.

Member question: My husband is on methotrexate for rheumatoid arthritis. Since there's little research out there, we're wondering if you've had any experience with couples such as us TTCing? Were they able to conceive, and were the babies healthy? Thanks so much!

Grunebaum: Methotrexate can impair sperm production. So you may want to do a sperm count and see what's going on. It's generally presumed that if you get pregnant under these circumstances then the sperm was healthy, because unhealthy sperms from the methotrexate are very unlikely to fertilize the egg.

Member question: Hi Dr. G., I am 35, and have been TTC for 10 months now with no luck. I have conceived successfully without any medical assistance. This was eight years ago, and right after my son's birth I developed thyroid problems and I've been taking Synthroid ever since. Before TTC I was taking BCP, but I've been off of them for 11 months now. My doctor has suggested Clomid, but I haven't started it yet. What are the risks? (My DH had an SA and everything looked good, so the problem seems to be with me.)

Grunebaum: Most doctors feel that Clomid is a safe way to induce ovulation and improve your chances of getting pregnant. You just need to make sure that there is no overstimulation of the ovaries. So your doctor needs to monitor you carefully and make sure not too many follicles develop. In general the risk of having twins with Clomid is about 10%.

Member question: What happens if there is overstimulation?

Grunebaum: Overstimulation creates too many follicles and eggs. It also makes your ovaries swell. This can be very painful and occasionally requires admission to the hospital. It's a rare event as long as the dose of Clomid is not too much.

Member question: Could my thyroid issues be the source of infertility at this point?

Grunebaum: A thyroid problem can cause anovulation. If you ovulate regularly then the thyroid is unlikely to be the problem.

Member question: How important is it to chart your temperature at the exact same time every day?

Grunebaum: It's essential to do it within the correct hour. If you do it at very different times each day then you may not be so accurate. Deviating from the time a couple of times each month does not necessarily have to be a problem as long as you can see the overall trend in the chart. Some people advocate adjusting the temperature based on when you took it. I really think that's a bad idea, as you will never know exactly what's going on. Try taking the temperature regularly and at the cycle end have it evaluated.

Member question: Does it have to be first thing in the morning?

Grunebaum: Absolutely. Taking the temperature before you get up is essential and likely somewhat more important than the exact time. Once you get up your body metabolism increases and the temperature you get is very inaccurate.

Member question: Is it true that a woman should lie on her back after intercourse? I tend to use the restroom immediately after because of past UTI. Will this lower my chances of conceiving?

Grunebaum: There are not good enough studies on this subject. You can definitely get pregnant even if you get up right away. But staying on your back for 10-15 minutes may be helpful and increase the sperms that can enter the cervix. You may want to talk to your doctor and see if urinating right before making love may allow you to stay on your back longer.

Member question: DH and I have been TTC for the second time for almost a year now. Back in February, my ob-gyn did a test on CD 21 to find out my progesterone level. It was really low. He suggested Clomid. What steps can I take to improve my pregnancy chances before resorting to Clomid?

Grunebaum: I am not sure how low the progesterone was. But a low progesterone level, below 10, usually means that you do not ovulate. And without ovulation you won't get pregnant. Clomid is usually given to women who do not ovulate. If his sperm count is fine (test it first) and you ovulate on Clomid then there is a 50% chance getting pregnant the first three months.

Member question: Dr. Amos, I am 34 and gave birth to my first child 10 months ago. I am breastfeeding four times a day but AF has not returned. 1) Can ovulation occur without resulting in pregrancey or AF? 2) What can I do/take to induce ovulation? 3) Is Clomid safe to take while breastfeeding? 4) I've heard of Vitex (an herb?). Is this effective? Thank you for your help.

Grunebaum: Ovulation happens usually before you first get AF. In fact, AF results from ovulating. Breastfeeding does often prevent ovulation, and stopping it will bring ovulation back. There is no scientific proof that Vitex helps you ovulate, but Clomid does.

Member question: How do the recently released studies indicating that women often ovulate more than once a month effect fertility charting? Would it be obvious from your temps when this had occurred or are eggs sneaking out during the month without a temperature increase?

Grunebaum: The recently released studies show that some but not all women can ovulate more than once. That's where twins often come from, and we knew that. Ovulation can also happen sometimes at a different time then you anticipate. Doing a fertility chart may help identify the first ovulation, not necessarily the other one. So it's important that you make love regularly, two to three times a week, every week of your cycle if you want to improve your chances getting pregnant.

Moderator: If Dr. Amos wasn't able to answer your question, try posting in his TTC message board, or join us again next time. You can find links to our Live Event calendar as well as dozens of archived Dr. Amos chats at our boards and chats page, Member Central.

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