WebMD Live Events Transcript

Are you ovulating? Are you sure? How can you best track your fertility and deal with out-of-synch cycles? Amos Grunebaum, MD, medical director of the WebMD Fertility Center, joined us on Nov. 29, 2004, to talk about understanding and charting your ovulation and other conception concerns.

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:
Would making love two times a day, prior to and through ovulation, deplete the sperm and work against me?

DR. AMOS:
It is suggested in general to make love once a day, no more than once a day, during the five fertile days prior to and the day of ovulation. Making love more frequently is not suggested and has not been shown to improve your chances of getting pregnant. For couples with known sperm problems it's suggested to make love less frequently, maybe once every other day.

MEMBER QUESTION:
Is there an easy explanation why pregnancy is only a 20% chance per month for healthy couples?

DR. AMOS:
Getting pregnant is not as easy as you may have thought. There are a lot of issues involved in getting pregnant.

First, ovulation has to take place and the sperms have to be present in the fallopian tubes.
The egg as well as the sperm have to be in good shape and healthy for the sperm to fertilize the egg.
Both the egg and sperm cannot be too old; otherwise fertilization cannot take place.
Then the fertilized egg has to travel down the fallopian tube, a journey that can take about five days. A lot of things can happen during that week.
Finally when the fertilized egg, now known as a 'blastocyst,' has arrived in the uterus ready for implantation, the lining of the uterus has to be ready to accept it for attachment.

That's what makes getting pregnant not as easy as you may have thought.

MEMBER QUESTION:
I know the luteal phase can vary by one or two days, but can it be more than that?

DR. AMOS:
The corpus luteum phase usually lasts between 12 to 16 days. A shorter than 12-day CL phase is abnormal and is a possible cause for infertility. It's rare that it lasts longer than 16 days.

MEMBER QUESTION:
Generally, are women still ovulating at 35? I know it differs from person to person. My sister did get pregnant at 35, but I know that doesn't mean I will. Also, my two previous pregnancies were both C-sections. What are the chances of a VBAC after two C-sections?

DR. AMOS:
Those are actually two separate questions. First, let me address ovulation. Women over 35 usually continue to ovulate, and most women ovulate until their mid-40s or beyond. It's just that the egg becomes 'older' with the woman, so that conception becomes less likely.

As to the cesarean section question, there is an article in today's New York Times about that. It says that fewer and fewer hospitals allow a VBAC, even after only one cesarean section. There is an increased risk of complications after a cesarean section, including uterine rupture, which can harm both the baby and the mother. After two cesarean sections that risk is likely even more increased. Many doctors I know will likely not recommend a VBAC after two prior cesarean sections, because of increased complications.

MEMBER QUESTION:
Any risks with drinking 2.5 glasses of red wine if you didn't know you were pregnant, 1.5 weeks before a missed period?

DR. AMOS:
Alcohol is one of the strongest poisons known to have an adverse effect on pregnancy. Women who drink have an increased risk of infertility, miscarriage, and problems with the baby. That's why it's suggested to not drink any alcohol when you TTC and during pregnancy. That said, it's unlikely that two to three glasses of wine have a negative effect. But the earlier you stop drinking, the better your chances that you will have a healthy pregnancy outcome.

"Checking cervical fluid is not a reliable enough method to check for ovulation. Better methods include a temperature curve, progesterone blood tests, or ultrasounds."

MEMBER QUESTION:
I am not regular. My last period was on Oct. 16 and my temperature still has not changed. How can I know if I will "O"? Does your temperature have to change in order to "O"?

DR. AMOS:
Irregular periods are usually a sign of ovulation issues. The basal body temperature usually rises shortly after ovulation, usually within 24 to 48 hours (This pattern is also known as 'biphasic', lower before and higher after ovulation). If your temperature doesn't go up and stay up then it's unlikely that you ovulated.

MEMBER QUESTION:
After charting my temperatures for four months, I have noticed that my temperature only goes up one-tenth of a degree, from 97.6 to 97.7-98.1. I have hypothyroidism and take .025 mg of Synthroid. Am I ovulating? Am I able to get pregnant?

DR. AMOS:
One-tenth of a degree is usually not consistent with normal ovulation. But not being able to see your curve makes it impossible for me to further comment. It would be in your best interest to join the WebMD Fertility Center and let us take a look at your curve there.

MEMBER QUESTION:
I have been taking Clomid for three months and I have not seen any fertile cervical fluid. (I check internally daily). Should I have a postcoital done? Are there any things I can do to help increase fertile cervical fluid?

DR. AMOS:
The most important question you must answer when you take Clomid is: Did I ovulate or not? Checking cervical fluid is not, I repeat not, a reliable enough method to check for ovulation. Better methods would include a temperature curve, progesterone blood tests, or ultrasounds. So you may want to check for ovulation with these tests to get a better idea whether Clomid is working or not.

MEMBER QUESTION:
My husband and I have been trying to conceive for about seven months now, and nothing has happened. I just found out my cervix is really tight. But the doctor says he doesn't think it's a problem. Why is it taking so long?

DR. AMOS:
Less than 50% of couples get pregnant within four to five months of trying, and it takes 85% up to one year. The questions you need to answer are whether you ovulate regularly, does he have enough sperms, and are your tubes open. A tight cervix is rarely a major cause of infertility.

MEMBER QUESTION:
I am ovulating normally (between day 13 and 15) and have been since coming off the pill in October of 2003. I am still not pregnant after eight months of TTC. Would Clomid be prescribed for me? Preliminary tests - progesterone and SA are normal.

DR. AMOS:
With normal ovulation and SA, the next test to do would be to see if the tubes are open. That test is a hysterosalpingogram and/or a laparoscopy. Taking Clomid when you already ovulate normally is unlikely to improve your chances.

MEMBER QUESTION:
My husband and I are eager to start our family. Time is of the essence for us, as he is in the military and will be deploying next year. I am 25 and stopped taking the pill in March. My ob-gyn just started me on a fertility regiment. I took medroxyprogesterone for ten days. The tenth day was Aug. 13. Now I am to wait until my period begins and on the fifth day begin a five-day regime of Clomid. However, my period has not started. I have had severe cramps the past two days. Is this treatment helpful and are there any side effects? When my doctor prescribed this he was on his way out the door for a delivery and he did not have time to answer questions.

DR. AMOS:
Progesterone is given to induce bleeding, but it's not a 'fertility' regimen. Bleeding usually starts up to seven to 10 days after you stop the progesterone. If you don't bleed after taking it then there could be something else going on. Additional tests are necessary to find out what it could be.

MEMBER QUESTION:
I stopped taking birth control pills in May and have not had a period since. Would Clomid be the appropriate next step?

DR. AMOS:
Not having your period when you are not pregnant usually happens if you don't ovulate. Before taking Clomid you may want to ask your doctor to do some tests and find out why you don't ovulate. Taking Clomid without first trying to find the reason does not usually improve your chances of getting pregnant.

MEMBER QUESTION:
Would my doctor be able to tell if I can have children or not by doing a pap/pelvic exam? Every time I've had one, they've come back normal. Thanks!

DR. AMOS:
No, your doctor cannot find out if you can have children by doing a pap/pelvic examination. Your doctor can check if you ovulate regularly, if your tubes are open, and whether he has enough sperms. But for this information you need additional tests.

"Not having your period when you are not pregnant usually happens if you don't ovulate. Before taking Clomid...ask your doctor to do some tests and find out why you don't ovulate."

MEMBER QUESTION:
Back in June and November of this year I have gotten faint + on HPT but within a week AF showed. Blood tests confirmed the pg but they did not last. Do you know what could be causing this?

DR. AMOS:
You likely had a chemical pregnancy, which is similar to an early miscarriage. The reasons for a miscarriage are usually problems with the pregnancy and chromosomes. After two to three miscarriages in a row many doctors do some additional tests to find out if there is a specific cause.

MEMBER QUESTION:
I had a miscarriage in April and have well-timed intercourse after waiting two cycles and have yet to become pregnant. I noticed that that there are only 10 days in my luteal phase. Do you think this is a problem and should I have a progesterone test?

DR. AMOS:
A luteal phase that lasts less than 12 days is considered abnormal, and it can be the cause of problems getting pregnant. The test many doctors do is an endometrial biopsy about 10 days after ovulation. This test can help you find out what the problem is.

MEMBER QUESTION:
I noticed that I have some egg white cervical mucus around 7 or 8 DPO. Is this a sign that I have low progesterone?

DR. AMOS:
EWCM comes from an estrogen increase. That usually happens several days prior to ovulation. But it also happens about a week after ovulation. So seeing EWCM again at that time is not unusual.

MEMBER QUESTION:
How long can you detect your LH surge once it begins?

DR. AMOS:
The LH surge usually begins about 24 to 48 hours prior to ovulation. And you usually get a positive LH test for two to three days. If it's longer than three to four days then there's something that can be wrong. And you may want your doctor to do some additional tests to find out if something can be detected.

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