Trying to Conceive: Getting Help

Last Editorial Review: 12/7/2004

WebMD Live Events Transcript

If you have been trying to get pregnant but haven't been successful, when do you look for professional help? What questions do you need answered to determine what's wrong? Amos Grunebaum, MD, medical director of the WebMD Fertility Center, joined us on Oct. 25, 2004, to talk about it.

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 went off the pill in January and cycles and ovulation had been regular. Then in September we started TTC and no period. So my last period was in August. I think I may have ovulated on Wednesday, but then on Friday and part of Saturday I had a brownish discharge. What is that from?

DR. AMOS:
The most important information to gather when you TTC is whether you ovulate or not. So you need to be clear if it happened, because everything in your cycle points towards whether and when you ovulated. Keeping a temperature chart helps you identifying this all-important information, and it will help you find out why you are spotting or missing a period.

Spotting generally can have many different reasons. They include hormonal issues, polyps, or infections, to just name a few. Having a temperature chart will help you find out more whether it's hormonal or not. And having your doctor examine you will help you find out if it's an infection or something else.

MEMBER QUESTION:
I'm almost certain I did ovulate. I had midcycle pain and clear egg white cervical mucous.

DR. AMOS:
I understand, but the temperature chart is a little more precise. Just pain or EWCM point in the right direction, but a biphasic curve is better.

MEMBER QUESTION:
How does Clomid work for low sperm count on men?

DR. AMOS:
There is a lot of controversy about Clomid for men. Instead of asking, "How does it work" you may first want to ask, "Does it work?" And the simple answer is that there is no sufficient evidence that Clomid works to improve the sperm count. There are no good studies showing it's effective.

MEMBER QUESTION:
I was on Depo-Provera for seven years (since I was 15) and I've been off it now for 18 months. My cycles are irregular, every 17 to 21 days apart, lasting 7 to 10 days with dark to brown blood. Is this normal? And can I still conceive? I'm only 22 years old.

DR. AMOS:
Your cycles are clearly not normal. Normal cycles last around 21 days, and there is normally ovulation with each cycle. So the first thing to do is find out whether and when you ovulate. You can do this (see above) by keeping a temperature chart.

Once you have charted and found out that there is a problem with ovulation, you should see your doctor, do some tests, and find out why you don't ovulate. Once the reason is found you can get treated to make you ovulate and help you get pregnant.

"Once you have charted and found out that there is a problem with ovulation, you should see your doctor, do some tests, and find out why you don't ovulate."

MEMBER QUESTION:
What are some supplements that my husband and I can take in order to increase sperm count and mobility for my husband, and also help with my hormone levels, etc.?

DR. AMOS:
First you should make sure his diet is OK, no alcohol, no smoking, and he is at the best weight. Then there are generally multivitamins and zinc, which can be helpful, and then there are some herbal supplements like FertilAid, which has a product for men and women. This herbal supplement includes all essential vitamins as well as some natural herbs that support fertility.

MEMBER QUESTION:
What about Ovulex and Amberoz?
MEMBER QUESTION:
I just turned 35. I've been trying to have a second child since 1999 with no luck, I've tried Clomid; my husband and I have been tested. We already have an 11-year-old so I know we could make babies. I just don't get what's happening. What are my chances now that I've turned 35?

DR. AMOS:
The first question to answer is, "What's the reason?"
  • Are you ovulating normally (Y/N)?
  • Is his sperm count OK (Y/N)?
  • Are your tubes open (Y/N)?
MEMBER:
It's unexplained infertility, and yes I'm ovulating. I do the temp thing. And yes to those questions.

DR. AMOS:
OK (should have said that right away). Unexplained infertility is diagnosed when everything seems OK; all tests are OK, and still no reason. Women with unexplained infertility can still get pregnant, but it takes longer. The fastest way to get pregnant with unexplained infertility is IVF. With IVF your chances are over 50% having a baby.

MEMBER QUESTION:
It was so easy with our first on our wedding night while on birth control!

DR. AMOS:
I understand. But all of our bodies change over time and, unfortunately, not always for the better. Good luck!


DR. AMOS:
As far as I know neither of these include a full vitamin supplement. The vitamin supplement helps you replenish you body if it's missing the essential nutrition.

MEMBER QUESTION:
Can you have multiple negative test results, even past your expected period and still be pregnant? If so, how common is this?

DR. AMOS:
I suppose you mean negative pregnancy tests?

MEMBER:
Yes.

DR. AMOS:
The newest home pregnancy tests are very sensitive. They usually pick up a pregnancy within 12-16 days after fertilization. If you have repeatedly negative tests after having missed a period then it's unlikely that you are pregnant. If in doubt do a blood test. The blood test usually confirms the pregnancy test results.

MEMBER QUESTION:
Dr. Amos, I am confused about how many days I ovulate. My periods usually last five days, and my periods aren't regular because of my BC pills. Does that affect my ovulation now and when I'm off them?

DR. AMOS:
I am unsure whether you still take birth control pills or not.

MEMBER:
Yes, I do.

DR. AMOS:
Birth control pills prevent you from ovulating. In other words, when you are on birth control pills you do not ovulate. Once you stop the pills your body usually recovers quickly and ovulation returns normally within two to eight weeks.

MEMBER QUESTION:
I read an article that said DHEA increases egg quantity and maybe quality. Is this true? On the bottle, it said do not take if you are a women of childbearing age.

DR. AMOS:
I am not aware of any reliable studies showing that DHEA has a positive effect on egg quality. As far as I know there is no safe way to improve egg quality. It's more often than not a function of age. The older you are, the more eggs lose quality and no medication can change that.

MEMBER QUESTION:
I was trying to conceive for some time but nothing yet. I have gone to a doc and found nothing was wrong, but I did an HSG X-ray and found my left side tube is open, but in my right the liquid went in and did not come out, so they think it might be blocked from the edge. Do you think it is a problem for getting pregnant?

DR. AMOS:
Having a blocked tube can be a sign of a problem. Many doctors therefore do a laparoscopy to look at the other tube to make sure it works well. I assume you ovulate regularly and his sperm count is fine?

MEMBER:
Yes.

DR. AMOS:
OK, then many doctors likely will do a laparoscopy as a next step. Sometimes there is scar tissue around the tubes that cannot be seen unless you do a laparoscopy.

"Having a blocked tube can be a sign of a problem. Many doctors therefore do a laparoscopy to look at the other tube to make sure it works well."

MEMBER QUESTION:
I am 33. I have an 8-month-old son. I want to conceive another before 35 if possible. I still have 35 pounds of pregnancy weight left over. Could this be a hindrance in conceiving? I went to an RE and my husband and I are normal.

DR. AMOS:
The first question to answer is whether you ovulate or not.

MEMBER:
Yes

DR. AMOS:
If you do ovulate regularly then the weight should not be a major issue.

MEMBER QUESTION:
I am about to turn 25. When I was 14 I had a miscarriage. Ever since then I have not gotten pregnant. But I also was told that I had ovarian cysts. Is that why I can't have kids?

DR. AMOS:
You can't know why you don't get pregnant until some testing is done. Are you ovulating? Is his sperm count fine? Are your tubes open? Those tests must be done prior to answering the question. Once you have the answer you can plan the next steps to get pregnant.

MEMBER:
But the doctor said because of the cysts that I am not ovulating, but it has been two or more years since the last cyst was found.

DR. AMOS:
There is a condition called PCOS: polycystic ovarian syndrome. It's associated with having many small cysts and prevents you from ovulating and getting pregnant. You need to find out if that's what the doctor saw. If you have PCOS then only certain treatments can improve your chances getting pregnant.

MEMBER QUESTION:
If you have PCOS but do not have the cysts, is there a better chance you will get pregnant than someone who does have the cysts?

DR. AMOS:
The diagnosis of PCOS is made in many different ways. With or without cysts, your chances getting pregnant are lowered and your chances ovulating are lowered too, even when you don't have the typical cysts.

MEMBER QUESTION:
My husband and I have been trying for five months to conceive. Why is it taking so long to get pregnant? We only had to try one month before I was pregnant with my previous miscarriage.

DR. AMOS:
In general only 50% of couples get pregnant after four to five months of trying. Many more will get pregnant within a year. If you still didn't get pregnant after one year then you should see your doctor and discuss your options. If you are not ovulating now or you have other medical problems then you should see your doctor earlier.

MEMBER QUESTION:
My husband and I have been trying for almost two years with two miscarriages occurring before 10 weeks. I am 28 but my husband is 58. His sperm was verified as sufficient quality and quantity. My doctor's policy is not to do any testing until after three miscarriages, but I'm afraid of waiting for that to happen. Should we go to a fertility specialist? I chart every month, I ovulate every month, and am in pretty good health! Any advice?

DR. AMOS:
Many doctors only start testing after three miscarriages in a row. However, your miscarriages were somewhat later than usual. Seeing a specialist, a reproductive endocrinologist, is not a bad idea. It will definitely save you time and help you get on your way to pregnancy more quickly.

MEMBER QUESTION:
I have endometriosis. Will this make it harder for me to conceive, and does it increase my chances of having a miscarriage?

DR. AMOS:
Endometriosis is a major cause of infertility. It prevents the egg and sperms from moving normally inside the tubes. If endometriosis causes infertility then you can have surgery done to remove it. Or you can have IVF, which has the highest chance getting you pregnant.

MEMBER:
I know I CAN get pregnant because I was recently. I want to know if my chances of miscarriage are higher.

DR. AMOS:
After only one miscarriage your chances of having another one are not increased.

MODERATOR:
But, women with endometriosis have a higher risk of ectopic pregnancy and miscarriage.

"If endometriosis causes infertility then you can have surgery done to remove it. Or you can have IVF, which has the highest chance getting you pregnant."

MEMBER QUESTION:
A question about luteal phase: Is it constant or does it change from cycle to cycle? If it does change how many days can it vary?

DR. AMOS:
Unless there is a problem, the luteal phase is usually around 14 days, give and take one to two days. A luteal phase that's shorter than 12 days can be a problem when you TTC.

MEMBER QUESTION:
I have heard mixed things regarding late ovulation. I haven't been ovulating till CD35-40 in my cycle. I have officially been off birth control for a year, so I don't know if that has something to do with it. I actually ovulated on CD27 this cycle. Does a late ovulation mean my eggs aren't good? I have heard things about too much time passing for AF to O could mean an egg might not be able to implant because of the lining or something.

DR. AMOS:
There shouldn't be any mixed information on this issue. Regularly late ovulation decreases your chances getting pregnant. You ovulate less, statistically, and the endometrial lining is not optimal anymore to allow implantation. If you are TTC and ovulate late then it's suggested to see a doctor to find out how to improve your chances of getting pregnant.

MODERATOR:
Thanks to Amos Grunebaum, MD, for joining us. If Dr. Amos wasn't able to answer your question, try posting in his TTC message board, or join us again next time.

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