Pregnancy: Trying to Conceive: Is Something Wrong?

View the Infertility Slideshow Pictures

Trying to Conceive: Is Something Wrong?

WebMD Live Events Transcript

If you're trying to conceive but keep getting 'big fat negatives', what should you do? How long should this take, anyway? Amos Grunebaum, MD, medical director of the WebMD Fertility Center, joined us to discuss when to worry and when to just keep trying, on Aug. 30, 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:
We have been trying to get pregnant for four months. I have noticed my menstruation cycles range from 22-28 days. Is the only way to tell when I ovulate is charting my basal temp? I have not done this yet because I thought getting pregnant would be easier! Ha!

DR. AMOS:
Menstrual cycles that differ by more than two to three days are considered irregular. Yours differ by six days, so you are considered to have irregular cycles. Just some background: The regularity of your cycle is determined by when and if you ovulate. So the first thing you need to figure out is when and if you ovulate. Finding out about ovulation helps you deciding quickly whether you should see a doctor or not.

MEMBER QUESTION:
How do I do that?

DR. AMOS:
At WebMD we have a great "Fertility Center," which allows you not only to keep a fertility chart, but we also teach you everything you need to know about fertility. No more open questions once you go through our great tutorial. After a couple of months of charting and reading you should know whether it's worthwhile to continue trying or whether you should see a doctor right away.

MODERATOR:
Go to fertility.webmd.com for more info.

MEMBER QUESTION:
So it's possible that I'm not even ovulating?

DR. AMOS:
Let's take your 22-day cycle for example. With that short of a cycle you either ovulate on CD 8, which is very early, or you ovulate later. But in that case the corpus luteum phase, the time between ovulation and the next period, is too short, and that can prevent you from getting pregnant. So it's not necessarily about not ovulating, but it's also about not normally ovulating.

"If you haven't ovulated for three to four months after stopping the pill then you should see a doctor and find out more about what's going on."

MEMBER QUESTION:
Hi, Dr. Grunebaum. I was recently diagnosed with mild endometriosis via a lap. It was removed; however, I'm wondering if there is any relation between early miscarriage and endometriosis. I've suffered two early losses over the past year. I'm currently seeing a reproductive endocrinologist.

DR. AMOS:
There is some relationship between mild endometriosis and miscarriages. Most of the time endometriosis will prevent you from getting pregnant in the first place because it prevents the egg from meeting the sperm. But it can also occasionally lead to a miscarriage or even an ectopic pregnancy.

MEMBER QUESTION:
I have a follow-up question. My doctor is suggesting we move on to an injectable IUI cycle. How successful are IUI cycles using injectable meds? All my other testing has come up normal aside from the endometriosis. Thanks!

DR. AMOS:
Not having all the medical information makes it impossible for me to be more specific. However, even with injectables your chances are likely under 10%. I am just wondering what number your doctor gave you.

MEMBER:
He said up to 30%. Right now he puts me at 10% without intervention.

DR. AMOS:
Thank you.

MEMBER QUESTION:
I was on Ortho Tri-Cyclen Lo for two years. I've now been off for two months, and on prenatal vitamins for three months. We're TTC, but even though I got what seems to be a period both months, I have no sign of ovulation. There's no clear discharge or temp changes. Also, first month was on CD 29, the next came CD 31. I've always had normal 28-day cycles prior to the pill. Could I have had two periods with no ovulation? I've had sex every other day for the past two months with no luck! Can you offer any advice?

DR. AMOS:
If I understand you correctly, then you did keep a temperature curve and I hope that you had someone experienced look at that curve and confirm that there was no ovulation.

MEMBER:
Yes, it always seemed to be 97.9.

DR. AMOS:
Again, I hope you showed it to someone experienced, but let's assume you did not ovulate for a second (though I am not sure about this). Yes, it's possible to have these cycles and not ovulate. In that case you may want to wait another couple of months, because that's what it sometimes takes for your body to recuperate from the pill and to start ovulating on your own again. If you haven't ovulated for three to four months after stopping the pill then you should see a doctor and find out more about what's going on.

Quick GuideInfertility: Types, Treatments, and Costs

Infertility: Types, Treatments, and Costs

MEMBER QUESTION:
If the air conditioner is on, does that affect BBT?

DR. AMOS:
Even if the AC is on, if you take your temperatures as you should -- first thing in the morning, not moving or getting up before, and around the same time -- then you should have a reliable curve.

MEMBER:
I take it while I'm still in bed in the a.m. before movement or eating. Thanks for your help.

DR. AMOS:
You are welcome.

MEMBER QUESTION:
I've been TTC for three years now with two miscarriages. Each pregnancy takes over a year to get pregnant. I have had HSG, post-coital, and several doses of Clomid. My DH has not had a SA. Would you recommend that, or since we have achieved pregnancy twice is that not necessary?

DR. AMOS:
The first thing to know is how old are you and if your cycles are regular with normal ovulation.

MEMBER:
Thirty-five and yes.

DR. AMOS:
If you ovulate regularly then the next step in the infertility work-up is always the sperm count. The sperm count is a very easy test. In fact it's the only test I know off which guarantees the person getting examined an orgasm! About 50% of infertile couples have a "male" factor and it's usually diagnosed too late. Many women will first have many tests and surgeries done before he gets tested. His sperm count must be the very first test done to make sure that you won't get all tests done and take medications before you find out it's him.

"Surgery is rarely, if ever, the first step in improving male fertility. Sometimes it's just lifestyle or improving diet."

MEMBER QUESTION:
Do hot flashes affect BBT? I'm experiencing some on Clomid.

DR. AMOS:
Hot flashes are a side effect of Clomid. That's because Clomid is an "anti-estrogen," and with less estrogen you can experience hot flashes. While on Clomid your temperatures can be erratic, so someone evaluating your chart should know that you are taking Clomid. It's difficult to interpret the chart on your own and you should have an expert look at it so it makes more sense.

MEMBER QUESTION:
Dr. Amos, I miscarried on 6/13/04, and lasted about nine weeks. I still haven't had an AF since. This past week I have had very small amount of blood when I wipe after a bowel movement, but it is definitely coming from the vaginal area. Could my cervix possibly be blocked and not letting AF out?

DR. AMOS:
It's possible, but unlikely, that your cervix is responsible for not getting AF. It's more likely that you haven't ovulated yet. I am unsure what you mean by "lasted nine weeks," but if you haven't ovulated two to three months after a miscarriage then you should discuss this with your doctor.

MEMBER QUESTION:
I spotted for nine weeks and took that long for HCGs to reach zero.

DR. AMOS:
So it finished, what, three weeks ago?

MEMBER:
Five weeks ago.

DR. AMOS:
In that case you need to wait for a couple more months for ovulation to return.

MEMBER QUESTION:
A couple more months? Is there any cause to worry?

DR. AMOS:
Seems like you just finished the miscarriage five weeks ago. It can take several months for your body to readjust.

MEMBER QUESTION:
If a male factor is diagnosed, what are some of the possible solutions? I know this is a broad question, but DH equates "testing" with "problem" with "surgery" and is VERY apprehensive.

DR. AMOS:
Surgery is rarely, if ever, the first step in improving male fertility. Sometimes it's just lifestyle or improving diet. A urologist will usually do the examination, take a history, and find out what can be done about it.

MEMBER QUESTION:
Are there higher risks of miscarriage when using Clomid?

DR. AMOS:
Women on Clomid are more likely to miscarry, and on Clomid you are not more likely to miscarry. Clomid in and by itself does not increase the risk of a miscarriage. However, women who take Clomid, e.g. women with a condition called PCOS, are more likely to have a miscarriage.

MODERATOR:
Ah, now we get it! Thanks for the clarification.

DR. AMOS:
So it's not the Clomid, but the person who needs it in the first place.

MEMBER QUESTION:
Hi, Doc, I have been diagnosed with ovarian dysfunction and am currently under the care of a reproductive endocrinologist. I did two cycles of Gonal F, six amp a day, in combination with Lupron in the second cycle, which produced one mature and good-sized follicle. We did an IUI, which failed. What options do I have at this point besides a donor egg? I am 38 years old and going to be 39 in November. My husband's SA was done last December, which was fine, and I did get pregnant early this year but miscarried at five weeks.

DR. AMOS:
Most REs likely will suggest IVF as the most successful way to get pregnant. With IVF your chances of getting pregnant with these conditions are likely the highest.
of
MEMBER QUESTION:
Last month was my first cycle on Clomid. I experienced a long list of side effects and I knew that was possible going in. I wanted to know, are their any side effects or level of severity that should be cause for concern?

DR. AMOS:
Not knowing exactly your medical history and your side effects makes it impossible for me to make a specific comment. However, there are many potential side effects of Clomid and you need to first make sure that you get Clomid for the right indications. If Clomid is given for wrong indications then it's not unusual to have more side effects. In addition, it should preferably be given by an infertility specialist who can monitor you very closely to make sure you just get the right amount and not too much. Most doctors start on 50 milligrams Clomid in the first month.

"Inducing AF with medication rarely if ever helps you ovulate normally in the next cycle, so it's not just about making you bleed but also about helping you ovulate better and earlier."


MEMBER QUESTION:
What percentage of women gets pregnant on 50 milligrams of Clomid?

DR. AMOS:
That all depends on whether you ovulate or not. If you do ovulate, and his sperm count is normal, then about 50% get pregnant within three months.

MEMBER QUESTION:
I had a miscarriage at 14 1/2 weeks last October and after that I have had just one regular AF in December. After that, my cycles have become really long. Now I am on CD 58 with no AF. I have been O (as I chart) though pretty late in the cycle, having luteal phase of about 15 -16 days. However this cycle my temps have been hovering around 97.7 -97.8 flat. After what I thought was a rise from 97.3 - 97.5. I thought I had high cervical position and EWCM on CD 30. The chart showed no O, though. Today my temp went up to 98.1 (at CD 58). Should I ask for inducing my AF? Or should I wait?

DR. AMOS:
Seems to me like you have problems with your ovulation. Late cycle ovulation usually decreases your chances getting pregnant. So the major question here is to make sure that you ovulate earlier in the cycle. This is an issue you should discuss with your doctor. Inducing AF with medication rarely if ever helps you ovulate normally in the next cycle, so it's not just about making you bleed but also about helping you ovulate better and earlier.

MEMBER QUESTION:
With IVF do they not need more than two or three mature follicles?

DR. AMOS:
In general there are many more than two to three mature follicles with IVF. With IVF you usually get hyperstimulated, so there are often more than 10 follicles, allowing the doctor to choose the best ones for fertilization.

MODERATOR:
Unfortunately, we have to wrap up for today. Thanks for joining us.
And now you can learn even more about getting pregnant by joining the WebMD Fertility Center. 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.

DR. AMOS:
Thank you so much for visiting us today and good luck in your baby quest!



©1996-2005 WebMD Inc. All rights reserved.

Subscribe to MedicineNet's Pregnancy & Newborns Newsletter

By clicking Submit, I agree to the MedicineNet's Terms & Conditions & Privacy Policy and understand that I may opt out of MedicineNet's subscriptions at any time.

Reviewed on 11/15/2004 6:20:29 PM

Health Solutions From Our Sponsors