Trying to Conceive: Starting Out-- Amos Grunebaum, MD-- 01/12/04
By Amos Grunebaum
Are you trying to conceive? Amos Grunebaum, MD, medical director of the WebMD Fertility Center, joined us on Jan. 12, 2004 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: If a woman has only one fallopian tube, does she only have a chance of conceiving on the "good" side every other month? I've heard that sometimes the "good" side picks up the slack from the bad side, and a woman can ovulate every month.
Dr. Amos: Even with one fallopian tube (but two ovaries) ovulation is still expected to happen every month. You can still get pregnant every month.
Member question: I was on 1500 milligrams glucophage and 150 milligrams Clomid. They did ultrasounds and found out my lining was not good, so they put me on 100 milligrams progesterone suppositories. I ovulated with hCG shot on day 15 of my cycle. I have had two previous miscarriages and I was wondering if the progesterone delays miscarriages? Does improving the lining prevent miscarriage?
Dr. Amos: One of the side effects of Clomid is that the uterine lining is less. With less lining there is a decreased chance of implantation. Some doctors give additional estrogen to improve the lining and conception. Progesterone in and by itself is not expected to have a positive effect on the lining.
Member question: I just got off birth control a little over a month ago. I have missed my period. Is that normal after you get off the pill?
Dr. Amos: Your period comes in response to ovulation and after the pill it can take two to three months for ovulation to return to normal. Until you ovulate you can expect to not get your period. There is one problem, though: It's possible to ovulate before you get your period and then get pregnant. You may want to do a pregnancy test regularly until you get your next period to make sure you know right away that you are pregnant.
Member question: I am 23 years old and my husband is 36. We have been trying to conceive for five years now with no success. I have had two laser lapros. (I have severe endometriosis), three IUI's, and have tried Clomid with all my IUI's and depot lupron, once for three months and again for six months. I have had a regular period for the past six months (I have started the same day every month). I have never been regular for the 11 years I have had my periods. I was to start my period on the 10th of this month and have not. My breasts are tender, but no other signs of anything. What are my chances of being pregnant?
Dr. Amos: The first thing to do if you think you may be pregnant is to do a pregnancy test. If your pregnancy tests are repeatedly negative then it's unlikely that you are pregnant. Without doing a pregnancy test you won't know for sure.
Member question: Are the urine tests taken at the doctors more accurate than the home pregnancy tests?
Dr. Amos: No, they are not. Most home pregnancy tests have the same level of detection as those in the doctor's office. Just make sure you know at which level your home pregnancy test detects the hCG.
Member question: I had PROM with my two pregnancies (32 and 29) weeks. My ob-gyn says they will put in a cerclage and monitor me closely but my chances of another premature are greater than 75%. Should we even run the risk of having a third premature baby? The doctor feels that this time it would be around 28 weeks or sooner without the cerclage. Will the cerclage help?
Dr. Amos: That's a tough question. I cannot answer the question completely without knowing your complete history and examination. What I can say is that you are best taken care of by a high-risk specialist: an obstetrician trained in maternal-fetal medicine. They know best what to look for and how to best treat you. There is no question that you are at increased risk of this happening again, and a complete review of your history and an examination may best help you answer your concerns.
Member question: When you miss your period and are not pregnant, how do you know when you will ovulate next (when you are fertile)?
Dr. Amos: There are several ways to know about ovulation. I usually suggest doing a fertility and temperature chart. The temperature chart will help you best find out when and if you ovulate if you have irregular cycles.
Member question: I have a twin sister who has a 2 year old and is seven months pregnant with twins. I have severe endometriosis and have had two laps and been trying for five years. Is this common for one twin to have so many problems and the other to have none?
Dr. Amos: I suppose this is an identical twin?
Member: Yes she is.
Dr. Amos: Unfortunately the origin of endometriosis is not completely known. And while genes may play a small role, they are not always responsible. Identical twins have many things in common, and many things they do not have in common. And endometriosis is clearly one condition that the two of you do not have in common.
Member question: Does marijuana affect a guy's sperm count?
Dr. Amos: Yes it does; it decreases male fertility, and is illegal in the United States.
Member question: I need to know if I could possibly be pregnant. I had my last period, or what I thought was a period, on the 14th of December and it lasted until the 16th. That's not normal and it didn't look like a regular period; it was kinda spotty. Now I have had to use the bathroom more and more than usual but I haven't had any other signs and now I am getting this sharp breathing pain in my chest. I was wondering could it possibly be pregnancy? I don't get my next period until February because I get it every other month. What can I do?
Dr. Amos: No matter what symptoms you do or don't have, the only way to answer your question is to do a pregnancy test. A positive test means that you are pregnant; a repeatedly negative test means that you are not pregnant.
Member question: Also I don't know if I am even ovulating because of the way my period is, and I don't have any insurance to go see a doctor or specialist. Is there any other way I can find out?
Dr. Amos: Clearly, seeing a doctor will help you best find out what's going on. Many big university hospitals provide special clinics to provide help to those who cannot afford it otherwise. With irregular cycles chances are that you have problems with ovulating. A doctor can examine you, do some tests, and find out what's going on. Also, doing a temperature/fertility chart will help you find out quickly whether and when you ovulate.
Member question: Then what can we do to get regular ovulation?
Dr. Amos: If you don't ovulate, the first thing to do is find out WHY you don't ovulate. There are many different reasons for not ovulating, and each is treated differently. You may want to start by reading on WebMD about 'anovulation.' There are several articles on WebMD describing reasons for not ovulating, and the tests needed. Once you find the reason you can consider how to treat it best.
Member question: When you are TTC is it OK to exercise, raising your heart rate?
Dr. Amos: Moderate exercise does not affect your fertility. Most doctors feel it's OK to exercise while you TTC.
Member question: I am having trouble monitoring my CP. One day it will be closed and the next it will be open. I know when I ovulate because I have a normal 28-day cycle. Can you help me?
Dr. Amos: The examination of the cervix is one of many aspects of fertility monitoring. Not every woman is able to check the cervix all the time, and the cervix does not change the same in each woman. If you already have regular cycles and you know when and that you ovulate, then the cervical findings are of lesser importance.
Member question: Sometimes I have midcycle spotting/bleeding. It lasts two to four days, and usually happens about three days before I ovulate. Could this be the reason I'm not getting pregnant?
Dr. Amos: Unlikely. Midcycle spotting can have many reasons, but if you ovulate normally and your corpus luteum phase is over 11 days, then the spotting is unlikely responsible for fertility problems. Some doctors like to confirm this with a progesterone level as well as an endometrial biopsy. Both tests will confirm whether there is a problem or not.
Member question: Hello, doctor. I have been off of the pill since July, 2003, I have had four cycles: Cycle one was 50 days, cycle two was 36 days, cycle three was 25 days, and cycle four was 45 days. Is this normal? And how do I know when to check for ovulation if my cycles are so different?
Dr. Amos: Your cycles are highly irregular. This usually points to ovulation problems. Doing a fertility chart (sign up at the WebMD Fertility Center) will help you figure out what's going on. The fertility chart identifies ovulation and when it happens and it allows you to see your doctor earlier to find the problem and treat it quicker.
Member question: Will more intake of estrogen increase the chances of ovulation?
Dr. Amos: Not really. Estrogen does not improve your chances of ovulating. In fact, estrogens are part of most birth control pills and may actually prevent ovulation if not taken properly.
Member question: This is my first month charting BBT and my temps show that I ovulated three days ago, but I'm still having egg white CM. I thought fertile CM was supposed to dry up after ovulation?
Dr. Amos: You can have EWCM for several days after ovulation. Not seeing your chart makes it impossible to tell you more. Have your chart checked by an expert to verify exactly when ovulation took place.
Member question: Which is more accurate for determining ovulation -- charting basal temps or using a fertility monitor or OPKs?
Dr. Amos: Both methods are great in detecting ovulation. The best, though, is the BBT chart. You can have a positive OPK and not ovulate, but if you have a typical biphasic chart then ovulation has pretty much happened.
Member question: I had a miscarriage this year at age 38. Up until that time my periods were the same and to the hour every month. Since the miscarriage my periods are very irregular. Would the miscarriage cause this?
Dr. Amos: After a pregnancy it may takes several months for ovulation to return to normal. Sometimes it can take two to three months. If your menstrual cycles and ovulation have not returned to normal after three months it's usually suggested to see a specialist.
Moderator: Thanks to Amos Grunebaum, MD, for chatting about TTC with us.
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