Conceive, Trying to

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TTC: Trying to Conceive

WebMD Live Events Transcript

Are you trying to conceive? Amos Grunebaum, MD, medical director of the WebMD Fertility Center, joined us on June 13, 2005 to answer your questions about getting pregnant. Whether you are taking the first baby steps toward parenthood or have been trying for a while, come check the discussion.

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.

MODERATOR:
Welcome Dr. Grunebaum.

DR. AMOS:
Hi.

MODERATOR:
How are you today?

DR. AMOS:
I am well, thank you. I'm a little tired, I was up delivering babies last night, but I'm ready to answer your questions.

MODERATOR:
Let's see what the members are asking about today.

MEMBER QUESTION:
I have a question about timing of ovulation. If my temps have now dropped for two consecutive days, where does that mean I am at as far as ovulation goes?

DR. AMOS:
A dropped temperature usually means nothing at all. When you ovulate your temperature goes up by 0.3 or more degrees and stays up for at least three days. That's called a biphasic curve. So you can only see from a sustained increase that ovulation has happened, not from a drop.

MEMBER QUESTION:
I am 31-years-old and have been trying to conceive for the past four months with no success. I have previously had an ectopic pregnancy which destroyed one tube. The other tube looked fine on the laparotomy. I was wondering how long it could take to get pregnant with just one tube and how long should I go back to my ObGyn if nothing happens. Also, what steps do I take if nothing happens? I seem to be ovulating fine. I have waited for one year for the laparotomy to heal. Will the one-year wait affect my chances of trying to conceive?

DR. AMOS:
Age is usually the major determining factor as well as prior complications. Most doctors will likely suggest that after six months of trying with a history of complications you should see a specialist. Checking his sperm count and the patency of your fallopian tube are usually the next steps if it has been determined that you ovulate regularly. Good luck.

"Unfortunately, with a history of an ectopic there is a significantly increased risk of it happening again and for you to have difficulties getting pregnant."

MEMBER QUESTION:
I recently suffered from an
ectopic pregnancy after trying to conceive for 18 months. We conceived without using assisted reproduction. I have none of the risk factors for ectopic pregnancy -- HPV, smoking, tube problems, etc. Will the ectopic pregnancy hinder my fertility even if my tube was saved? What are the chances that I will have another ectopic pregnancy?

DR. AMOS:
Unfortunately, with a history of an ectopic there is a significantly increased risk of it happening again and for you to have difficulties getting pregnant. The risk is 20 times higher of having another ectopic when compared to someone without that history. That's why it's important for a woman with a prior ectopic to see the doctor as soon as the diagnosis of the next pregnancy is made -- to ensure the pregnancy is now in the right place.

MEMBER QUESTION:
I know it takes the average couple about five to six months to get pregnant. How long does it take the average couple who is charting to get pregnant?

DR. AMOS:
If you ovulate regularly, he has a normal count, and by charting you mean you make love as you should, that means you make love 2-3 times a week every week as well as daily during the 5-6 fertile days, then your chances of getting pregnant are likely significantly improved and it takes a shorter time to get pregnant. Good luck.

MEMBER QUESTION:
Is the implantation dip a myth or does it really signify that something has happened?

DR. AMOS:
That dip is likely a myth. Most pregnant women have no dips and most dips turn out not to be implantation.

MEMBER QUESTION:
I have been an avid equestrian for over 23 years and my husband, doctor and I have been at odds at how long I can ride once I conceive. I'd say as long as I'm comfortable. My husband says to stop completely and my doctor says five months. Of course I would stop jumping, but what's the difference between riding and doing aerobic exercise anyway? I am 36.

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DR. AMOS:
Riding is a sport with increased injury risk. When you are pregnant you injure potentially two people, not one. So, you need to decide what's more important -- you enjoying the riding or you trying to protect the baby.

MEMBER QUESTION:
I've been charting my temps and they went from 97.6 to 98.1. They have been like that for five days. Does this mean that I am going to ovulate or that I already ovulated?

DR. AMOS:
The absolute temperatures mean little. If you are midcycle and you now have a biphasic chart then you likely did ovulate, but without seeing your complete chart it's impossible to know exactly what it is. Why don't you join the WebMD Fertility Center? You can store your charts there and learn more about TTC and getting pregnant -- and I can take a look at your chart too.

MEMBER QUESTION:
I am trying to conceive (TTC) and I am currently being tested for PCOS. I know that conceiving will be more difficult with PCOS and I am frightened by that. With that being said, my doctor is already talking about ovarian drilling and hSG testing. This seems rather aggressive as I've read many just go on Glucophage and try to lose weight. Is there anything she can do that is a little less aggressive to help me out? I want to get pregnant but I have never really had any surgery and I'm afraid to be put under the knife so soon.

DR. AMOS:
If you have PCOS and you don't ovulate, then losing weight will often improve your fertility. The treatment of PCOS is often difficult and requires a lot of expertise.

I hope you are seeing an infertility specialist who is best trained to improve your chances of getting pregnant.

MEMBER QUESTION:
I had a miscarriage in April. My next cycle was a normal 28 days. This month I have had some very light spotting (only once, when I went to the bathroom) that occurred last week. I am not expecting my period until the end of this week. What is happening?

DR. AMOS:
After a miscarriage it can take several months for your ovulation and your regular cycles to return to normal. Until you start ovulating again you may not have a period or you could bleed irregularly. By charting your temperatures you could identify early on when your ovulation has returned to normal.

MEMBER QUESTION:
Is it possible that you are not ovulating but have regular periods?

DR. AMOS:
If you have regular menstrual periods then you are likely ovulating. Why not chart your temperatures and find out for sure?

"The normal LP is 12-16 days, and a shorter, not a longer LP could cause problems conceiving."

MEMBER QUESTION:
I recently had my second chemical pregnancy in four months. The past two cycles my luteal phase (LP) has increased by more than three days. Is this normal? Should I be concerned?

DR. AMOS:
Not clear what you mean by the LP has increased by three days. From where to where? The normal LP is 12-16 days. Not seeing your chart or knowing the exact length of the LP makes it impossible to comment further.

MEMBER:
Luteal phase has increased from 14 days to 17 days.

DR. AMOS:
It's unusual to have an LP that long. I really would like to see your chart to comment further. Will you please show it to me on the WebMD Fertility Center and let me know it's from the chat?

MEMBER QUESTION:
So a luteal phase of 14 days or longer isn't good?

DR. AMOS:
It's unusual for a LP to be too long and be a cause of fertility problems. The normal LP is 12-16 days, and a shorter, not a longer LP could cause problems conceiving.

MEMBER QUESTION:
I would like to know how long is too long to bleed?

DR. AMOS:
The normal menstrual period is about three to five days. Much longer bleeding is not usual and needs to be evaluated by your doctor.

MEMBER QUESTION:
I am 27, my husband is 24, and we have been TTC for 16 months. I am now going to a reproductive endocrinologist (RE), who did an ultrasound (no PCOS) and an hysterosalpingogram (HSG) showing no blockage. I am on progesterone suppositories for the first time this month. Provided that my husband's count is OK, what are my chances now that I am on these suppositories? Are they increased?

DR. AMOS:
It's difficult to say without knowing your exact progesterone numbers. If he has a normal count, and you ovulate but with a lower progesterone level, then some doctors feel progesterone may help. Good luck.

MEMBER QUESTION:
I was wondering if it is fine to travel in the week after ovulation -- probably during the implantation phase. Is it OK to go on long road trips such as eight hours of driving? Is it dangerous to do so in the week after ovulation when the fertilized egg is traveling down the fallopian tube? I am worried because I had an ectopic pregnancy last year. Are my chances increased for another ectopic if I travel on the road for a long time in the summer? I am looking forward to the July Fourth long weekend.

DR. AMOS:
It's unlikely that traveling will prevent implantation. The fertilized egg is usually well protected and normal activity is unlikely to prevent implantation.

MEMBER QUESTION:
My husband and I are TTC. We will be taking a trip overseas in a month and my doctor says that I need to get a typhoid vaccination and take
malaria pills. Is there any danger of taking these vaccinations when you are TTC?

DR. AMOS:
There are many different kinds of pills with different pregnancy effects. You should decide with your doctor which is safest for your pregnancy. Alternatively you wait with trying to conceive for another couple of months until you are safely back.

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MEMBER QUESTION:
I am 24 and have been TTC for 2 years. The problem seems to be that I am not ovulating at times or the wrong times because my cycles are irregular. I also suspect that my cervical mucus (CM) might be rejecting the sperms. Can that happen? If so, why and what can be done?

DR. AMOS:
Anything is possible but you really need to find out much more than suspicions. If you don't ovulate regularly then your doctor should find out why and treat you. And there are some tests to check whether you reject sperms. Without doing these tests you just don't know for sure.

"By joining the WebMD Fertility Center you can quickly find out whether and when you ovulate."

MEMBER QUESTION:
I am bit over the body mass index (BMI) level and I am trying to reduce the weight. Will losing weight increase my chance of conceiving? I am doing exercise and dieting. Is that good or will that cause any problem if I conceive without knowing?

DR. AMOS:
What do you mean by "a bit over the BMI level"? If you are overweight and you don't ovulate because of this, then losing weight will help you ovulate and get pregnant. The optimal BMI is between 19 and 25.

MEMBER QUESTION:
I experienced two days of dizziness, a possible side effect from my Clomid and metformin. Should I be concerned and contact my ObGyn?

DR. AMOS:
You should always contact your doctor when you experience unusual symptoms. Some symptoms come from medications and you want to make sure there is nothing more serious going on.

MEMBER QUESTION:
I have been bleeding since May 22. It's now June 13. Is there anything that can be done for me to stop the bleeding? Will a D & C help?

DR. AMOS:
Prolonged bleeding is also called hypermenorrhea. It can be caused by many different problems including hormonal or uterine issues. Your doctor should examine you and find out what to do next.

Whether you should get a D & C or not depends on the cause of the problem. Once your doctor determines the cause she can suggest the right treatment.

MEMBER QUESTION:
I am trying to figure out if I ovulate or not. My doctor is checking prolactin, progesterone, TSH (thyroid stimulating hormone), and hydroxyprogesterone. Why is it a cycle day 23 test? My cycles are very irregular -- 28 to 44 days. He said he thinks I can do ovulation kits or Clomid, but didn't mention basal body temperature (BBT). What questions should I ask before deciding?

DR. AMOS:
BBT charting is a very good first step to determine whether you ovulate or not. Many doctors are not quite aware that it can be made easier by charting online. By joining the WebMD Fertility Center you can quickly find out whether and when you ovulate.

The CD 23 test could be a progesterone test. Progesterone rises after ovulation, so an increased level confirms ovulation.

MEMBER QUESTION:
Should I change doctors? Or just chart on my own?

DR. AMOS:
You may choose to do both. There is nothing wrong to get a second opinion if you are uncomfortable with your doctor.

MEMBER QUESTION:
Is it possible to conceive the day after your period starts?

DR. AMOS:
If your question is whether you can get pregnant from making love while you are bleeding then the answer is YES! Sperm can survive for up to five days and if you ovulate within five days after making love then it's possible to get pregnant.

MEMBER QUESTION:
When a woman has her period, do they count the first day of red blood as day number one or do you also count spotting?

DR. AMOS:
The first day of red blood is cycle day one. Brown spotting doesn't count.

MEMBER QUESTION:
Can a low-carb diet have a negative impact on TTC?

DR. AMOS:
We know very little about diets and pregnancy, but in general it's recommended to have a well-balanced diet while TTC and during pregnancy. Any diet that excludes important nutrients may have a negative impact on the pregnancy and is not recommended.

MEMBER QUESTION:
I am TTC No. 2. I got pregnant with my son in two cycles without changing anything in my life. This time, I asked my doctor for vitamins and she gave me preconceive vitamins. We have been trying for five months. Could the vitamins be hindering our efforts?

DR. AMOS:
Your doctor did the right thing. It is highly unlikely that vitamins prevent you from getting pregnant.

MEMBER QUESTION:
I am trying to conceive and my temp has remained elevated for 18 days after ovulation. Am I likely to be pregnant? Also, I seem to ovulate on the eighth day of my cycle. Is this normal?

DR. AMOS:
You are likely to be pregnant if you have no period and the temperatures have been up for 16-plus days after ovulation. Do a pregnancy test and find out for sure!

"Not being pregnant without a period usually means that you did not ovulate."

MEMBER QUESTION:
I am just five days past ovulation and I've been experiencing very tender nipples to the touch. Is this common?

DR. AMOS:
It's not unusual to have tender nipples after ovulation, so what you describe seems normal.

MEMBER QUESTION:
I'm waiting for my RE to call with my progesterone level today. This test was done to see if I ovulated on first round of Clomid. Can you tell me what is considered a good progesterone level?

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DR. AMOS:
A progesterone level above 10 usually indicates ovulation.

MEMBER QUESTION:
I started birth control pills in January to get my periods regular. I was having one every month after taking the pill. I stopped taking them the last day of April and my period started May 2 and I haven't had one since. I took a pregnancy test last Monday and it came up negative. Is it possible that I could still be pregnant?

DR. AMOS:
It's unlikely to be pregnant with a negative pregnancy test. Not being pregnant without a period usually means that you did not ovulate. This would be consistent with having had irregular periods and the pill is unlikely to change that.

MEMBER QUESTION:
Last month I was on 100 milligrams of Clomid. My ovaries were overstimulated, which caused bleeding and pain. Now my doctor is sending me to an RE. What are the benefits of injectibles? What is the difference?

DR. AMOS:
The RE is better trained to adjust and watch your medication to prevent complications.

The difference is that injectibles are more controllable and the RE can do some tests to prevent hyperstimulation.

MEMBER QUESTION:
How do I pinpoint ovulation with irregular cycles? Mine are 22-44 days. How do I know when to start?

DR. AMOS:
You can't just calculate with irregular cycles. By doing a BBT chart you may find out better if you ovulate and when it happens. With such irregular cycles chances are that you may not ovulate at all and keeping a BBT chart will give you the answer quickly.

MEMBER QUESTION:
I have been TTC for over a year now, charting BBT and using ovulation predictor kits (OPKs). My cycles are very regular and I ovulate around the same CD each cycle. Last month I went in for a vaginal ultrasound right after my positive OPK and my doctor could not find any mature follicles. She said it was possible that I ovulated very quickly after my positive OPK or that I am in fact not ovulating. Is it possible that I am not ovulating even though I get positive OPKs and temp shifts each cycle?

DR. AMOS:
If your doctor would have done a progesterone level seven-plus days after the first OPK you would have the answer. An elevated progesterone and/or a biphasic BBT chart would tell you for sure that you ovulated.

MEMBER QUESTION:
I have a question about EWCM (egg white cervical mucus). What does it mean when it's clear and really stretchy?

DR. AMOS:
Stretchy CM usually means a lot of estrogen which happens just before ovulation. It's the typical stretchy CM that makes it fertile and allows sperms to enter the uterus.

"Join me at the WebMD Fertility Center and I can answer all your questions directly."

MEMBER QUESTION:
Can you start BBT charting any day of the month? I am on cycle day six right now.

DR. AMOS:
The earlier the better. But even CD six may not be too late; you just may have to interpret it differently.

MEMBER QUESTION:
Can artificial insemination (AI) help if I'm rejecting the sperm?

DR. AMOS:
Yes, AI helps if the problem is sperm rejection. It bypasses the mucus and gets the sperm directly into the uterus.

MODERATOR:
Dr. G, we are almost out of time. Any final comments for our TTCers today?

DR. AMOS:
I wish everybody much luck getting pregnant. Join me at the WebMD Fertility Center and I can answer all your questions directly.

MODERATOR:
We are out of time. I'm sorry we couldn't get to all of your great questions. Dr. Grunebaum will be back with us next month.



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Reviewed on 7/8/2005 2:10:09 PM

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