Trying to Conceive: Just Starting Out

Last Editorial Review: 12/3/2004

WebMD Live Events Transcript

Are you trying to conceive? Amos Grunebaum, MD, medical director of the WebMD Fertility Center, joined us on Nov. 8, 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 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 am trying to get pregnant for the first time so as you can imagine I am very paranoid. I was on the patch up until the 5th of last month. When I took off my last patch I immediately got my period. My husband and I started trying to get pregnant right away. As of today I am seven days late according to my schedule when I was on the patch. I have, however, no other symptoms of pregnancy other then random nausea. Could anything else be causing my period to be so late or could I be pregnant?

DR. AMOS:
The patch works similarly to the pill. It emits hormones regularly into your body and thus it prevents you from ovulating. After you stop the patch, your body normally takes some time to readjust, so it's normal for ovulation to take some time to show up again. That may take 2-8 weeks. Until ovulation returns, your period may not come or they may be irregular.

In the meantime you may want to start charting your temperature. Keeping a BBT temperature chart will help you identify early on when ovulation returns.

MEMBER QUESTION:
I am a 28-year-old who has been trying to conceive for six months. I was on the pill (Alesse) for about five years. We are actively trying and I believe I have a tilted uterus. Would that make conception harder? I have gotten ovulation tests and we have tried to conceive on the days that I was ovulating but nothing happened. I am scared that I cannot have children. Am I being paranoid? What do I need to do to make me pregnant really soon??

DR. AMOS:
A tilted uterus is also known as a "retroverted uterus." A retroverted uterus is normal; maybe 1 in 3 women have it. It rarely if ever causes fertility problems.

Making love only on the days of ovulation is less likely to get you pregnant. It's generally suggested to make love regularly two to three times a week, every week. In addition, you should make love every day or every other day during the five days prior to and the day of ovulation. If that didn't help you get pregnant within six to 12 months then the next step is to see your ob-gyn.

You may also want your husband to have a sperm count done. That's usually a good idea before you get any further tests. In about 50% of infertile couples there is a male problem, and finding out about it early on will improve your chances of getting pregnant sooner.

MEMBER QUESTION:
I am a 20-year-old female and I have no children. I have been on the pill sine I was 17. I am currently on no form of birth control and I haven't been for seven months. Am I going to have problems conceiving a child due to being on the pill for a long time?

DR. AMOS:
The pill is rarely the reason of fertility problems. If you now ovulate regularly (do you?) and his sperm count is fine (is it?) then the next step would be to test and see if your tubes are open

MEMBER QUESTION:
Is it normal not to ovulate although you get a period every month?

DR. AMOS:
If you have a regular menstrual cycle around 28 days, then it's likely that you ovulate. Keeping a temperature chart will confirm it for sure.

"In about 50% of infertile couples there is a male problem, and finding out about it early on will improve your chances of getting pregnant sooner."

MEMBER QUESTION:
I am 23 and this is our 2nd month at TTC and I was just wondering what the percentage of getting pregnant was when you BD on all fertile days? I've been charting and everything is normal. Just wondering.

DR. AMOS:
Your chances getting pregnant are about 20% each month, and about 50% of couples get pregnant within four to five months, 85% within a year.
Good luck!

MEMBER QUESTION:
I was on the pill for 15 years. I went off birth control pills in June 2004. I have been trying to get pregnant since then. No luck so far. I am 35 years old. I use OPK monitor. Anything else I should try?

DR. AMOS:
Before we take this further, you should let us know whether you are ovulating or not. That's the very first step in assessing fertility.

MEMBER QUESTION:
From what I see on the OPKs I believe I am ovulating. I have had irregular periods since going off the pill. They range from 20 to 25 days apart. Is this a problem for TTC since they are not 28 days?

DR. AMOS:
OPKs are not a good enough sign of ovulation. With irregular and such short cycles, chances are that you have problems with ovulation. The very best next step is to keep a fertility and temperature chart. That should tell you within a short time period whether you ovulate or not. Once you know this information you should be able to proceed to the next steps.

MEMBER QUESTION:
I have an appointment with my doctor tomorrow to talk about conceiving. Is there anything I should be asking her to check?

DR. AMOS:
Unfortunately, we don't have enough space here to bring up all questions, but the most important ones would be to ask what could be wrong and what you can do now to find out. If you have a temperature chart you would already have some answers.

MEMBER QUESTION:
Is it possible for me to become pregnant if my temperatures drop after ovulation? My temperatures were between 97.6 and 97.7 for four days after ovulation, then dropped to 97.2.

DR. AMOS:
I would have to see your chart to find out more. However if you know for sure that you ovulated and the chart is clear, then it's unlikely that you can get pregnant. Making love after well-established ovulation won't get you pregnant. The egg only lives about 12 hours, so several days later it will be dead and you can't get pregnant.

MEMBER QUESTION:
So you have to make love prior to ovulation and not after?

DR. AMOS:
You can only get pregnant from making love during a six-day period -- the five days prior and the day of ovulation. Your best chances are the one to two days prior to and the day of ovulation.

MEMBER QUESTION:
I made love six days prior to ovulation and did not get pregnant. Even with the right timing I have been unable to get pregnant. Why do doctors still wait one year before infertility is discussed?

DR. AMOS:
Maybe you can elaborate. You made love only six days prior to ovulation or each day during the six days?

MEMBER:
I made love every day for six days prior to ovulation and ovulation day.

DR. AMOS:
There is usually no major reason to wait exactly one year. You may want to start taking to your doctor now to see which basic tests to do now. If you ovulate regularly then the tests would include a sperm count and blood tests on CD 3 to test the egg quality.

MEMBER QUESTION:
Would it be too soon to go over my chart with my ob-gyn? I've been TTC for five months.

DR. AMOS:
It's never too soon to discuss TTC with your ob-gyn. In fact, I usually suggest discussing it prior to starting TTC.

"Making love after well-established ovulation won't get you pregnant. The egg only lives about 12 hours, so several days later it will be dead and you can't get pregnant."

MEMBER QUESTION:
I have been on metformin for a little over a month, for helping with PCOS, and this last week (my period was due a week ago) I have gotten really bad gas and abdominal pains. My side effects from metformin had been slight. Is there a reason for the changes? I have taken a pregnancy test and it is negative. I have been doing the Ovulite OPK for the month that I was on metformin and had several sets of days that showed fertile.

DR. AMOS:
The reason why you take metformin is to help you ovulate. So the single and most important question to answer is: Did you or didn't you? It makes no sense to take a medication and then not know whether it worked or not. Knowing whether you ovulated or not (for sure!) answers many questions.

MEMBER QUESTION:
What should I be asking my doctor to tell me?

DR. AMOS:
Did the metformin work? Did I ovulate or not? What should I do to find out? Again, keeping a temperature chart answers these questions.

MEMBER:
She suggested the OPK to see if I ovulated.

DR. AMOS:
An OPK is a good additional test, but it won't give a complete answer.

MEMBER QUESTION:
My DH and I have TTC for 5 five months; is it too soon to have semen analysis test done?

DR. AMOS:
It's never too soon for a semen analysis. It's a fun test, and he has an orgasm. It would never be too soon to have an orgasm.

MEMBER QUESTION:
I have a 27-day cycle, regular, per all the calendars, and I ovulate day 12-13. Are there times when ovulation occurs early in the cycle, like two days after or before your period?

DR. AMOS:
There is usually a 14-day interval between ovulation and the next period. So CD 12/13 is to be expected with a 27-day cycle, not much earlier. Why would you expect earlier ovulation?

MEMBER:
Hope.

DR. AMOS:
I see.

MEMBER QUESTION:
I have recently been diagnosed with homozygous MTHFR after two miscarriages and one live birth. What are your treatment recommendations?

DR. AMOS:
There is no clear-cut suggestion for this condition, but some doctors have found good results with heparin. This is something you may want to discuss with your doctor.

MEMBER QUESTION:
Will vitamins improve sperm quality? Or is it a myth?

DR. AMOS:
It all depends on what the reasons are for the sperm quality and what the exact results were. If he has an unbalanced, not so healthy diet, then taking vitamins and zinc may help his body produce good enough sperm. In fact, more and more doctors suggest that patients take a supplement of vitamins.

MEMBER QUESTION:
Can you take prenatal vitamins for a long time when you're trying to conceive?

DR. AMOS:
You can (and often should) take a vitamin supplement all your life. If it's the right amount then it will also help your body in general, not just prior to pregnancy.

MEMBER QUESTION:
If I made love to my wife on 11/6, one day after she completed her menstrual cycle, is it safe to say that it is impossible for her to be pregnant?

DR. AMOS:
Anything is possible. If she ovulates within 5-6 days after you make love then she can get pregnant. For example if she has a five-day period, and you make love on cycle day six, then she can get pregnant if she ovulates on CD 12 or before.

"Fibroids rarely if ever cause infertility, but it also depends on how many you have, where they are located, and how big they are."

MEMBER QUESTION:
I am 35 years old and recently remarried. My husband and I want to have a baby. I have had two successful pregnancies. I have a history of genital herpes, but no complications with my two other pregnancies. My periods are regular. What are my chances of becoming pregnant?

DR. AMOS:
If you ovulate regularly, then you should have good chances of getting pregnant. After six months of trying unsuccessfully you may want to see your ob-gyn, do some basic tests, including a sperm count, and make sure that everything is fine and no specific treatment is needed.

MEMBER QUESTION:
I was diagnosed with uterine fibroids. Although my cycles have been 28 days, my period is only two days long. I've been TTC for six months. Is there a way to determine whether my uterus is capable of supporting a pregnancy?

DR. AMOS:
You first must become pregnant to find out whether the uterus is OK. Fibroids rarely if ever cause infertility, but it also depends on how many you have, where they are located, and how big they are. So the next step would be to do a sperm count and find out whether he is OK or not.

MEMBER QUESTION:
This is going to be my third month in a row starting Clomid again. I was on 50mg (first month), 150mg (second month). I believe my OB will stay at 150mg because last month I had one follicle ready and I had a HCG shot on Oct. 18, but just got my period on Nov. 5th. Do you know the percentage of pregnancy by the third try on Clomid? Also, I got off the pill in January and didn't get a period until September. I am not regular and it has been between 31-34 days these last couple of months. My husband has already done a semen sample and everything was good.

DR. AMOS:
I am missing one important word here. Can you guess which it is (hint, it starts with an 'o')? Any time you take a medication, you must know if it worked or not. There is only one reason to give Clomid. The BIG O: OVULATION. Did you ovulate or not?

MEMBER QUESTION:
Yes I did, last month.

DR. AMOS:
When you take Clomid you must find out for sure if it worked. And once you are on the right dose of Clomid about 50% of couples get pregnant within three months. Unfortunately, Clomid also worsens the mucus and can prevent you from getting pregnant. That's why many doctors suggest IUI with Clomid.

MODERATOR: 
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, "Member Central." Those transcripts will answer many, many of the unanswered questions from today.

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