WebMD Live Events Transcript

Who can you turn to with questions about your fertility cycle? How about yourself? Charting your daily temperatures can help you determine if and when you ovulate, which is a big key to successful conception. Amos Grunebaum, MD, medical director of the WebMD Fertility Center, talked about charting a course to pregnancy on June 21, 2004.

The opinions expressed herein are the guests' 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 saw my period on the June 9. I think I should be ovulating and am not. When do you think I will ovulate? My cycle is 29 days.

DR. AMOS:
With a regular 29-day cycle you would expect ovulation to happen around CD 15-16. Ovulation usually happens about 14 days prior to cycle's end so the calculation would be 29-14=15. If your period started on June 9th then you would expect ovulation around June 24 (9+15).

One way to determine that you are about to ovulate is to do an OPK. An OPK is an Ovulation predictor kit, which tests the presence of the LH hormone in your urine. LH increases about one to two days prior to ovulation. So when you detect first LH in the urine (a negative test followed by a positive test) then you can expect to ovulate within the next 12-36 or so hours.

However, you are wrong if you schedule making love only after the OPK is positive. In order to get pregnant you must make love before ovulation, preferably 24-48 hours prior to ovulation. So making love only after the OPK is first positive may be too late for conception. The best way to ensure conception is to make love regularly two to three times each week.

In addition, if he has enough sperms it's suggested to make love every day during the five to six fertile days. Your fertile days are the five days prior to ovulation as well as the day of ovulation.

MEMBER QUESTION:
I am 42 years old trying to conceive for the past three years. My fertility doctor told me that my follicles are not growing. What does that mean?

DR. AMOS:
In order for you to get pregnant, you must ovulate. Ovulation is usually at the end of a follicle developing in the ovaries, and if a follicle does not develop then you can't ovulate, and without ovulation you can't get pregnant.

In addition, even if you ovulate (do you?) the egg must be of a good quality. "Bad-quality" eggs are unlikely to get fertilized and implant. One way to determine the quality of the eggs is to check the FSH value on CD 3. A high FSH value usually means "bad-quality" eggs and low chance of getting pregnant.

MEMBER
I have very high FSH.

DR. AMOS:
I thought so. That usually means that your eggs aren't "good" enough for fertilization. Unfortunately, that means it's difficult to get pregnant with your own eggs.

"If you count 16+ days after ovulation and AF hasn't come, you can pretty much assume that you are pregnant."

MODERATOR:
Both of these chatters questions raise the issue of whether they are ovulating, Dr. G. So it sounds like charting their fertility would help. Since our "main" topic today is charting, can you tell us about it and how it might help them?

DR. AMOS:
I agree. The most important question to answer is first: "Do I ovulate or not?" Keeping a temperature chart will not only tell you whether you ovulate or not, it also tells you exactly when in the cycle ovulation happens and then how long the corpus luteum phase lasts. The CL phase is the time between ovulation and the next period. If the CLP is less than 12 days then even if the egg is fertilized it doesn't find enough time and environment to implant.

Another test to determine ovulation is to do a progesterone blood test about a week after ovulation. An increased progesterone means that ovulation has taken place.

MEMBER QUESTION:
Is making love every day around ovulation time bad? My DH had a normal SA.

DR. AMOS:
I am unsure what you mean by "bad." Could you explain?

MEMBER QUESTION:
Is that enough time to rebuild a healthy specimen!

DR. AMOS:
If the sperm count is fine, then once a day is usually suggested when you TTC. Once every 36-48 hours also has a high likelihood of pregnancy, but once every 25 hours has the highest likelihood. That's during the five days prior to and the one day of ovulation. Making love after ovulation is unlikely to get you pregnant.

MEMBER
OK, thank you. I think we may have hit it right this month! Thanks.

DR. AMOS:
Good luck!

MEMBER QUESTION:
How much of a change in temp is considered an implantation dip? Example: 98.5 down to 97.9 at six days past ovulation?

DR. AMOS:
I hope I don't disappoint you when I say that the "implantation dip" is a myth. Most pregnant women have no dip in temperature about a week after ovulation, and most women with a "dip" are not actually pregnant. You can speculate whether you are pregnant as much as you want, but the only (really!) way to find out that you are pregnant is a positive pregnancy test.

If you want to find out from your temperature curve whether you are pregnant, count the days after ovulation. If you count 16+ days after ovulation and AF hasn't come, you can pretty much assume that you are pregnant. But no dip or any other change in temperature is reliable enough to diagnose a pregnancy.

MEMBER QUESTION:
I recently had a miscarriage and my doctor told me to wait for one normal cycle before trying again. I am approaching "O" now and was wondering if I did try what could happen if I did conceive?

DR. AMOS:
I am sorry to hear about your miscarriage. I am unsure how you know that you are approaching ovulation and how long ago you miscarried. Most doctors suggest waiting for at least one bleeding after a miscarriage to ensure that the uterine lining has had at least one chance to "cleanse" itself. Nevertheless, if you do get pregnant even before the first bleeding, chances are that you will have a healthy pregnancy with no increased risk of a miscarriage.

MEMBER QUESTION:
My husband is diabetic and he is on insulin. Sometimes he takes medication for erection dysfunction. Will it affect our making babies?

DR. AMOS:
Diabetes can have many negative effects on his fertility. First thing you may want to do is to check his sperm count. Men with diabetes often have a lowered count. In addition, the medication he takes (what medicine he takes is also important) could affect his count. As long as his sperm count is fine, you should not have difficulties getting pregnant because of his diabetes.

MEMBER QUESTION:
What can be done when you don't ovulate?

DR. AMOS:
If you do not ovulate, you first must find out why before thinking about the right treatment. Your doctor can do some tests and examine you to find the cause. The No. 1 reason for not ovulating is called PCOS, or polycystic ovarian syndrome. An examination and some blood tests and sometime a laparoscopy can find out if that's the diagnosis.

When you do not ovulate the best doctor to see is an infertility specialist. Another name is an RE, a reproductive endocrinologist. This doctor is usually best trained to help you find quickly the reason for not ovulating and then deciding how to treat it.

MEMBER QUESTION:
I don't get a period, so will the treatment help me get one? I have tried to conceive for four years.

DR. AMOS:
Good question. Most women focus on their period more than on the underlying cause. A regular period usually comes from ovulating. If you do not ovulate then your period doesn't come regularly or not at all. If you want to get pregnant, then your doctor must first find out why you don't ovulate. Only inducing ovulation will help you get pregnant or get a regular period.

"With irregular and absent periods you likely do not ovulate or ovulate so irregularly that you can't predict. Keeping a temperature chart may help you identify if and when you ovulate."

MEMBER QUESTION:
I have PCOS and no such thing as a regular period. I started my period on Friday, after a four-month absence. How do I know when I'm ovulating?

DR. AMOS:
As I mentioned before, PCOS is the No. 1 reason for not ovulating. With irregular and absent periods you likely do not ovulate or ovulate so irregularly that you can't predict. Keeping a temperature chart may help you identify if and when you ovulate.

MEMBER QUESTION:
How effective is Clomid? And does it affect temps? Mine are much lower this month than ever before.

DR. AMOS:
Clomid given to the right woman with the right indication will make you ovulate 50% of the time within three months. And if you ovulate (and he has a good sperm count and your tubes are open) then there is a 50% chance getting pregnant.

MODERATOR:
And how about Clomid's effect on temps?

DR. AMOS:
Clomid or no Clomid, if you ovulate then you would expect to see the typical biphasic temperature. That means with ovulation your temperature goes up and stays up until your next period (or stays up if you are pregnant). Before ovulation your temperature can sometimes be "erratic" with temperature being irregular, but once ovulation happens you should see the typical sustained rise in the curve.

MEMBER QUESTION:
Dr. G, a temp drop is normal before AF starts, right? But what about a temp rise? My temp jumped up today at 12 dpo. Is that normal?

DR. AMOS:
The drop in temperatures can happen shortly before or after AF. A rise in temperature is sometimes called a "triphasic" curve, first rising at ovulation and then again later on. A triphasic chart has been interpreted by some as an early indication of pregnancy. However, in my experience it may often give you false hope. The only way to diagnose a pregnancy is a positive pregnancy test.

MODERATOR:
Unfortunately, we have to wrap up for today. Thanks for joining us. You can also find dozens of archived Dr. Amos chats in our Live Events archive. A link to the archive is on page one of this transcript.

DR. AMOS:
Thank you so much for visiting us today.

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