Fertility and High-Risk Pregnancy: Amos Grunebaum, MD

Last Editorial Review: 3/24/2004

By Amos Grunebaum
WebMD Live Events Transcript

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 to WebMD Live. Ob-gyn Amos Grunebaum, MD, co-author of Dr. Ruth's Pregnancy Guide for Couples, has joined us to answer your questions.

Member: I have PCOS [polycystic ovary syndrome] and have been TTC [trying to conceive] for about two years now. Had surgery in December to remove a dermoid cyst from one of my ovaries and now I am on Glucophage [metformin]. I just found out hubby has genital warts that he most likely got from me. Does genital warts affect fertility?

Dr. Amos: You have a very important question. As you probably know, genital warts are sexually transmitted. So many people have them; it's hard to keep track of it. When a woman has genital warts, HPV, she is at increased risk of developing cervical cancer. Especially types 16, 18, 31, and 33. And there are several others. So the most important exam is to have a regular Pap smear. But when you have HPV, it does not usually affect your fertility.

Member: I have been taking oral Lamisil to treat a toenail infection. I think I may be one week pregnant, and I just learned that pregnant women should not take Lamisil. Of course, I will stop taking the medication, but do you think harm has already been done?

Dr. Amos: There are so many different medications, it's hard to keep track exactly of the thousands, especially when new ones come out every day. Off the top of my head, I don't recall any specific problems with this medication. To be sure, you should let your doctor know about having taken it.

Member: I stopped taking birth control pills in November but haven't had a period on my own since then. I had an US [ultrasound] and everything was OK. Is this normal -- for your body to take this long to get back to rights?

Dr. Amos: Once you stop taking BCP [birth control pills], ovulation usually resumes within two to three months. And once you start ovulating, your regular period will follow. However, if your period (and ovulation) hasn't come back after three to four months, that's called post-pill amenorrhea. Seems like it's now six-plus months after stopping the pill. That's a good reason to see your doctor to find out why your ovulation hasn't returned. Your doctor can examine you, do some tests, and evaluate if there is a specific cause.

Member: I haven't had a period for six months. Are there any health risks in that alone -- not having it for so long?

Dr. Amos: Not ovulating (which is the likely reason for not having a period) can have many reasons. It does change your hormones, so that can be a problem depending on why you don't ovulate. The 'not having a period' is less of an issue. What's more important is why.

Member: Do you recommend any vitamins or herbs to try and get my body out of this post-pill phase and make me ovulate?

Dr. Amos: Your best choice is a visit with your doctor. There are just no herbs or medication to help. And don't you want to know first why you don't ovulate, instead of taking something that's unproven?

Member: I have visited my doctor and I'm currently waiting to see an ob-gyn but my appointment is not until July, so I was just wondering if there is anything I can ask my regular GP to do. And is it normal for women who have been on the pill for 14 years to experience post-pill amenorrhea?

Dr. Amos: I am not sure I understand what you want the regular GP to do. It's normal, to a certain extent, to have post-pill amenorrhea. But if you want to get pregnant soon, the cause should be found and adequately treated.

Member: If you are over 40 and trying to conceive, and have not had any luck, when is a good time to see your physician?

Dr. Amos: You didn't tell us how much over 40. That makes a huge difference. I usually suggest to not wait and to see your doctor right away before you start TTC. At that time you get examined and get your important questions answered. Women 35 and over should see a specialist after six months if they haven't been able to get pregnant. And if you already have problems (e.g. not ovulating) then right away.

Member: I usually ovulate on day 20. This month, according to my BBT [basal body temperature], it was day 22. We conceived this month. Because I ovulated later than usual, does this increase a chance for miscarriage? Does it decrease the quality of the egg?

Dr. Amos: It's normal to ovulate between cycle day 7 and CD 21, so you are close to normal. If your hCG [human chorionic gonadotropin] rises appropriately, and there is a fetal heartbeat when it's supposed to beat, then this is a good sign.

Member: My husband and I have been trying to get pregnant for over a year now. I was recently diagnosed with polycystic ovary syndrome and my husband has gone for semen analysis two times and had a low sperm count each time. We are going to see an endocrinologist in July. Is getting pregnant naturally hopeless for us? We don't want to have in vitro fertilization.

Dr. Amos: You should never give up hope. The whole issue revolves around whether you ovulate or not (you did not say), and how low his sperm count is (you did not say). If you don't ovulate, then a naturally occurring pregnancy is highly unlikely. And if he has no sperm, then it's also unlikely. The reproductive endocrinologist should be able to help you and your husband get pregnant quickly. Good luck!

Member: I am 47 years old, recently married, have had one child previously, and have had Crohn's disease for 20 years. I know my age alone puts me in the high-risk category. With the medication I am presently on, what are my chances of having a healthy baby?

Dr. Amos: At 47, your chances of conceiving naturally are low. You should consult a doctor right away to discuss your desire to have a baby. Probably your age is more of an issue than the Crohn's disease.

Member: I am pregnant with my first child at age 38. I'm just a few weeks along. What possible, if any, complications could I experience because of my age?

Dr. Amos: At 38, you have an increased risk of having a baby with Down syndrome. That risk is maybe around 1 in 150 or so. Other risks include a higher chance of diabetes and hypertension. If you have otherwise no medical issues and you are in good health, then you should expect a healthy pregnancy.

Member: I recently lost my son at 23 weeks, 4 days due to incompetent cervix/chorioamnionitis. Do you recommend any testing prior to conceiving and how long should I wait before TTC?

Dr. Amos: I am so sorry to hear about the loss of your son. You probably should see a high-risk obstetrician before you get pregnant. And you may need a stitch in the cervix in the next pregnancy. There are no strict guidelines concerning how long to wait after a pregnancy. The general rule of thumb is to wait as long as the previous pregnancy has lasted. But even if you happen to get pregnant earlier, no significantly increased complications are to be expected.

Member: I've been treated for a hyperprolactinemia (pituitary tumor) with Dostinex for the last six months. I was not ovulating, due to this tumor. My question is, when would it be safe to have my IUD (I've had it for 10 months) removed and start trying to conceive? I am 37 years old and have one child. I have starting ovulating. I am very eager to start trying.

Dr. Amos: You should discuss the specifics with your doctor. But if you ovulate now, then you should be able to conceive. But not with the IUD in place. As soon as it's removed you can get pregnant.

Member: My husband and I have been trying to conceive for almost a year and a half. I have been on Clomid for seven months together with Glucophage. I have not yet got my [period] this month but it is not due until next week. I did take an early pregnancy test on about day 8 after ovulation and it showed positive. The reason I took the test early was because the ovulation kit that I was using the week before showed three days of a positive LH [luteinizing hormone] surge. So I wondered if those were all positive, would a pregnancy test be positive too? And yes, they were all positive. Are these all showing false positive readings? Is the medicine affecting the results I am getting?

Dr. Amos: A positive pregnancy test means you are pregnant. Congratulations. But one warning! You must read it according to instructions. If it says to read it after three minutes, then that's what you should do. If it's negative after the suggested time, throw it out! Keeping it around for longer than suggested is confusing and a really bad idea. Sometime an evaporation line can appear later on, and that's not a positive test.

Member: In May of 1999 and then again in October of 1999, I had ectopic pregnancies that led to both of my tubes being removed. I recently read an article of a couple that became pregnant after a similar situation, and there was no mention of any kind of fertility treatment that the woman had undergone. Is this possible?

Dr. Amos: If your ectopic pregnancy is not treated by removing the tube, then that tube can open up again and allow the sperm to meet the egg. So the whole issue resolves around how the ectopics were treated. If, as is often done, both tubes have been removed, then it's close to impossible to get pregnant normally.

Member: How can a pregnant woman with periodontitis reduce the risk of a premature labor and low birth weight baby? My sister has periodontitis, although her gums are not red or inflamed. Does that mean she's still at a high risk?

Dr. Amos: I am not a dentist. But I suggest that all of my pregnant patients see a dentist during pregnancy. The dentist can decide how to treat the periodontitis.

Member: I have been diagnosed with stage 3 endometriosis (adhesions are between ovaries, and ovaries are also adhered to my uterus). I would like to know if this condition can be treated and if so, will I be able to conceive (TTC for 26 months now)? What are my options?

Dr. Amos: How and whether it can be treated depends on the individual circumstances. There are no general rules. But if both your tubes are affected and prevent passage of the egg, then many doctors feel your best bet is In Vitro Fertilization. Endometriosis is one of the more frequent indications for IVF. And with endometriosis, your pregnancy success rate is very high.

Member: What does HPV do to your chances of conceiving?

Dr. Amos: HPV, or human papillomavirus, usually does not influence fertility.

Member: Have been TTC for about three years now. I had two ectopic pregnancies within the last year, which both required surgery. The most recent ended with my doctor having to remove part of my tube. At my follow-up visit, my ob-gyn also informed me that the remaining tube was not normal, and we may have problems having a child, but to go ahead and try to see what happens. As much as my husband and I both want to have a child, I am hesitant to follow this advice given my history and things I have read. Do you think it is wise to follow the advice I was given or should I insist that she refer me to a specialist?

Dr. Amos: I agree with you. After two ectopics, specifically when both tubes are not OK, it's not wise to just go ahead. At the least, your chance of having another ectopic is extremely high, maybe 50% or so. The first step is to check and see if the other tube is open. If both are closed, then your best chance is probably IVF. Good luck.

Member: I am trying to conceive. My husband is fertile; he has four children from a previous marriage. I had a miscarriage about three years back. Since then we've been trying. I only have one ovary since my operation for ovarian cysts in 1996. My right ovary was repaired. My left was taken out. I've noticed that since my miscarriage, after sex a lot of the semen comes back out. Could this be the reason for my not getting pregnant?

Dr. Amos: Large amounts of the ejaculate coming out is rarely a reason for problems getting pregnant. One caution though: Just because your husband has four children from a prior marriage doesn't mean he is fertile at all. That was then and this is now. So part of the evaluation is to check his sperms. But more important, with your history of surgery, you should get checked right away to see if your tubes are open.

Member: My husband and I have been trying to conceive for about two years now with no luck. I have also had two abnormal Pap smears within the last six months. Could there be a correlation between the two?

Dr. Amos: It's unlikely that an abnormal Pap smear affects your fertility. After two years it's time to see a specialist to find out why you can't get pregnant.

Member: I have been using a fertility monitor for three cycles. It shows me as "high" for CDs 8-23 every month, but it never peaks. Could this be an indication that I am not ovulating, even though my temperature charts indicate that I do ovulate?

Dr. Amos: I am not sure what it means. You should contact the manufacturer; they usually have a great explanation. You also may want to have your doctor check the temperature curves to make sure they are interpreted correctly.

Moderator: We are out of time. Thanks to Amos Grunebaum, MD, for being our guest, and thank you, members, for joining us today.

The opinions expressed in this transcript are those of the health professional's and have not been medically verified by WebMD. If you have questions about your health, you should consult your personal physician.

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