Trying to Conceive: Starting Out-- Amos Grunebaum, MD-- 12/15/03
By Amos Grunebaum
Are you trying to conceive? Amos Grunebaum, MD, medical director of the WebMD Fertility Center, joined us on Dec. 15, 2003 to talk about the first baby steps to parenthood, from understanding your cycle to the ABCs 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.
Member question: I have been off of birth control for two years now and have not been able to conceive. I had been on Depo-Provera for three years and then I stopped taking it for about six months before I went back to it for another two years. I know that it sometimes takes several months for the Depo to be completely out of my system but shouldn't I be able to conceive by now? I have a son who is 7 years old. Could I be infertile from being on the Depo-Provera shot for so long? My menstrual cycle was back to normal after my first month of not receiving the shot. What should I do now? The thought of not being able to conceive naturally is frightening.
Dr. Amos: It's unclear when you last received Depo-Provera.
Member: October of 2001.
Dr. Amos: If you now ovulate regularly (are you?) then your difficulties have nothing to do with having received Depo.
Member: I have a normal menstrual cycle.
Dr. Amos: So the next step in the infertility assessment of a woman who has been unsuccessful is a sperm analysis. In about one-third of all cases there is a "male" factor. That means everything is fine with the woman, but his sperms are not OK.
If he has normal sperms then the next step would be to check your fallopian tubes. This is usually done with a hysterosalpingogram or laparoscopy. Once you have done these tests you should know which steps to take next.
Member question: OK, great, so a sperm analysis should be the next step. What does that consist of?
Dr. Amos: The man ejaculates into a cup usually during masturbation and the ejaculate is examined in a special lab.
Member question: How do I know if his sperm count is down?
Dr. Amos: The sperm analysis is needed for determining the sperm count.
Member question: Can we try every day? Or is every other day better?
Dr. Amos: With a normal sperm count once a day during the 5 to6 fertile days is the best way to achieve pregnancy.
Now let me ask a question to our members: What is folic acid good for, when should it be taken, and how much is needed?
Moderator: OK, ladies, let's hear those replies!
Member: Folic acid should be taken before trying to conceive.
Dr. Amos: CORRECT!
Member: I know it helps to strengthen the baby's nervous system.
Member: It's for preventing spina bifida, 400 milligrams per day, three months prior to pregnancy and during.
Member: It helps to prevent birth defects.
Member: 400 micrograms, to help prevent birth defects, should be taken when you begin TTC.
Dr. Amos: Most of you are correct. It should be 400-600 micrograms per day. Not milligrams, but (micrograms). Then it should be started at least one to two- months before conception. It's suggested to decrease births defects. It's been shown that women taking the right amount of folic acid can decrease their risk of neural tube and heart defects by more than 50%.
In addition, studies have shown that Down syndrome is more likely in women who have less folic acid.
Another question: What's the difference between prescription multivitamins and over-the-counter prenatals?
Moderator: About 40 bucks.
Dr. Amos: That's one right answer.
Member: Prescription multivitamins are given when you have a serious deficiency but OTCs are for regular people; plus OTCs are much cheaper.
Member: No difference?
Dr. Amos: Sorry, incorrect. Other than price, there is only one difference, usually. Both OTC and prescription prenatals have similar compositions, except for one single ingredient: In order for a multivitamin to be a prescription it has to have at least 1 milligram of folic acid. So a vitamin with 1+ milligram folic acid has to be given by prescription. If there is less than 1 milligram of folic acid, then it can be over-the-counter. Manufacturers who want to make more money therefore put 1- milligram folic acid in their multivitamins. This allows them to be prescribed and for the drug company to make more money.
Here's the problem: The CDC says pregnant women should not take more than 1 milligram folic acid per day. That includes a supplement AND food combined. So, if you take a prescription 1-milligram folic acid multivitamin and you eat healthy food then you get much more than the upper suggested limit.
So just make sure the next time you take a supplement it does not have more than the 600-microgram suggested dose.
Member question: So a prescription is not necessarily better?
Dr. Amos: Correct. In fact it may be worse for you. In addition, some prescription prenatals have artificial coloring agents. Next time you take a prenatal, read the label carefully.
Moderator: And just to drive the point home: No matter how much you take, folic acid is not related to fertility; it doesn't increase your chances of conception. Correct?
Dr. Amos: Correct!
Moderator: OK, the inbox is filling with good questions, so we'll let Dr. G go back to being the answer man, instead of the question man. Thanks for the lesson, Dr. Amos.
Member question: I had a c-section with my first and my husband and I are trying to conceive baby No. 2. How do you know if your tubes are blocked? Also, does scar tissue interfere with conceiving?
Dr. Amos: A prior uncomplicated cesarean section is unlikely to affect future fertility.
One way to know whether your tubes are open is to get pregnant, which would mean they are open. Or you can do a test called a hysterosalpingogram or a laparoscopy. These tests can confirm whether the tubes are open or not.
Member question: I am 41. What are my chances of getting pregnant with a high FSH of 34?
Dr. Amos: One single FSH reading in and by itself doesn't really tell much. But your doctor can do some additional tests to find out if you have "good" or "bad" eggs. If the FSH is continuously elevated then fertility is significantly decreased, and it's difficult to get pregnant without additional help.
Member: She said my eggs are old.
Dr. Amos: Well, that's one way of putting it. But with high FSH, that's a signs that the eggs are not as able to get fertilized. Seeing an infertility specialist immediately should provide you with more information.
Member question: Can I assume that I am ovulating normally if my periods go from 31 days one month, then 35 days, and then around 40 days? They then start over the next month at 31 days and continue like that. I am 35 years old and have had one miscarriage (blighted ovum).
Dr. Amos: Cycles are considered irregular when they are more than 2-3 days different. So you have irregular cycles. With irregular cycles there is a good chance that you have ovulation issues. Doing a fertility chart will help you find out quickly what's going on, and the fertility chart will then help your doctor figure out what to do next.
Member question: What's a fertility chart?
Dr. Amos: A fertility chart is when you check several fertility signs, including your basal body (morning) temperature. You then enter the data into a chart where it can be interpreted. At WebMD we have a fertility center where you can be taught how to do it and where the chart can be interpreted.
Member question: Is there a recommended limit on how long a woman can take Clomid when TTC?
Dr. Amos: The recommended time depends on whether you ovulate or not. Most doctors will not give it for more than three ovulatory cycles.
Member question: How soon after ovulation and conception is a home pregnancy test effective?
Dr. Amos: Most pregnancy tests are positive when you have missed a period. So that's about 14-15 days after ovulation. Some pregnancy tests may be positive a couple of days earlier. But you can most reliably test only after you miss your period.
Member question: Is there anything a woman can do prior to getting pregnant, or when she is newly pregnant (other than taking prenatals), to lessen the chance of a miscarriage?
Dr. Amos: No smoking, including no secondary smoking, no alcohol, no drugs, no exposure to toxic substances. This behavior could decrease the risk of a miscarriage. However, you should know that most miscarriages are due to chromosomal anomalies, and there is nothing you can do to prevent a chromosomal anomaly, other than maybe taking folic acid.
Member question: What are the chances of getting pregnant after laparoscopic surgery for endometriosis?
Dr. Amos: That all depends on the degree of endometriosis and how much of it was present and removed. In addition, the mother's age is important. If there was a lot of endometriosis then chances of getting pregnant are low.
Member: The endo was mild. Most of it was removed and there is a significant improvement in the periods since then (less pain). The mother is 30.
Dr. Amos: If there was little, then chances may be better.
Member question: How long does it take to get pregnant when you go off of an IUD?
Dr. Amos: The IUD stops working the moment you take it out. There is really no time delay because of the IUD.
Member question: Even if the IUD had hormones in it?
Dr. Amos: Yes, once it's out the hormones are gone.
Moderator: If Dr. Amos wasn\'t able to answer your question in this event, try posting in his TTC message board , or you can also find dozens of archived Dr. Amos chats in our Live Events archive, which can be found on our boards and chats page. Those transcripts will answer many of the unanswered questions from today.
And now you can learn even more about getting pregnant by joining the WebMD Fertility Center (a WebMD subscription service). Sign up for support, expert chart review, and tons of great TTC information. You'll learn everything you need to know about increasing your chances of conceiving. Go to fertility.webmd.com for more info.
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