Trying to Conceive: Starting Out-- Amos Grunebaum, MD-- 1/26/04

By Amos Grunebaum
WebMD Live Events Transcript

Are you trying to conceive? Amos Grunebaum, MD, medical director of the WebMD Fertility Center, joined us on Jan. 26, 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 guest's 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 taking a photography class and using developing and processing chemicals. Are these chemicals harmful while TTC or during the early stages of pregnancy?

Dr. Amos: These photographic chemicals are really nasty. My father was a photographer and I remember spending hours in that darkroom. Everything smelled horrible, and the air was thick with it. Most rooms are nowadays well ventilated (ours was not), so if you do not smell much then you should be relatively safe. However, if it smells, then you may decide not to go there.

In addition, you should not forget that your skin takes up the chemicals too. Wearing gloves is a must to prevent this from happening. The only way to be 100% sure nothing will happen is to switch to digital photography. That way you can be sure you won't be exposed to chemicals.

Member question: Should I wear a mask to be safe?

Dr. Amos: Unfortunately most regular masks won't filter much of it. You would have to wear those "army grade" chemical masks.

Member question: I would like to ask a question regarding LH levels. My doctor has told me that mine are four times higher than normal and has prescribed progesterone to stimulate a period and then Clomid for ovulation. Does this high LH put me at greater risk for miscarriage? 

Dr. Amos: You may want to find out exactly what the LH level was. I am not sure that a "high" LH levels is very significant. Most doctors do the FSH levels on CD 3 and high levels indicate a problem. A high LH level normally happens shortly before ovulation and is normal.

Member question: Also, I experienced an early miscarriage at six weeks, but was told by my doctor that it was most likely a chemical pregnancy. What does this really mean and how long should I really wait before trying to conceive again? 

Dr. Amos: A chemical pregnancy is a miscarriage, except that you can only diagnose it by a urine or blood test. The pregnancy miscarries too early to be seen on ultrasound. The cause of a chemical pregnancy (miscarriage) is the same as any other miscarriage: Over two-thirds of miscarriages happening early on (the first six to eight weeks) happen because of chromosome anomalies of the fetus. That's something nobody really can change. It's random, and it increases with the mother's age. 

After one single miscarriage your risks in the next pregnancy of it happening again are not that much increased. The risk is directly related to the mother's age.

Member question: I've had two early miscarriages. What are my chances of having another one?

Dr. Amos: This also depends on your age. In general, after two consecutive miscarriages the risk of it happening again is about 25%-30%.

Member question: This is my second cycle of IUI W/HCG shot + Clomid 150 milligrams and estradiol. Got positive ovulation on CD 15, IUI on CD 15. Everything is normal in my body including DH SA.I just wanted to know what are my chances of getting pregnant this cycle, as it's my last try for IUI.

Dr. Amos: In general, the chance of getting pregnant with IUI in the first three cycles is about 15% to 20%. That's for each cycle. And overall about 50% get pregnant after three tries.

Member question: So should I keep my hopes up?

Dr. Amos: It's always good to keep hoping. I hope you are seeing a reproductive endocrinologist. They are best trained to help you get pregnant quickly and to find out how.

Member: Yes I am and she said there is nothing wrong in my body. I had early miscarriage after TTC for three months.

Dr. Amos: Good luck!

Member question: How important is a regular cycle to conceiving? Is a 28- to 31-day cycle acceptable?

Dr. Amos: A 28- to 31-day cycle seems normal. But it also depends on when exactly you ovulate. If, for example the time period between ovulation and the next period is lower than 12 days, then you may have difficulties getting pregnant.

In addition, his sperm count is crucial. It's not enough just for you to ovulate and have regular cycles. He must have enough sperms to get you pregnant. Unfortunately, in up to 50% of couples with infertility problems there is a male factor, which means he has a low sperm count. And many of these couples were trying for a long time and lost valuable time before finding out the hard way. Many of the women I see have undergone infertility tests, including surgery and X-rays, and many have taken fertility drugs. Only after he had a sperm count done did they find out the problem was with him all along.

I suggest always starting the infertility work-up with a sperm count. It's a simple enough test (all you need is for him to have an orgasm!) And it saves you a lot of time and efforts. Why try in vain for months or even years when he does not have enough swimmers?

Member question: If there is low sperm count involved, are there ways to remedy this problem?

Dr. Amos: Absolutely. He can get examined to find out whether there is a cause. Sometimes there is a varicocele, which is an enlargement of his veins, blood vessels. This enlargement warms up the testes and decreases sperm production. Surgery can often help remedy this problem.

Then some men take medications that could affect the sperm count. Again, stopping or changing them helps.

In addition, alcohol and tobacco can also make him less fertile. So there is a lot that can be done to improve his sperm count if it's too low.

Member question: Are we talking about the OTC sperm tests or do you have to go to a doctor to get them done?

Dr. Amos: We are talking about a specialty lab doing the test. Let me tell you about the OTC sperm test: First of all, they are unreliable; they don't provide enough information. All they do is tell you whether there are more than 20 million sperms or less, but there is so much more information in a regular count. There are about 10-15 different tests usually done, including mobility (how they move) and morphology (what the sperms look like). The OTC does not really check for this sufficiently enough. I would not completely rely on the OTC test. Have it done by a reputable lab to be completely assured.

Member question: So the more reliable test is at the doctor's office? How long before we know the results?

Dr. Amos: Most will give you the results within a week or so.

Member question: How does endometriosis affect someone who is TTC?

Dr. Amos: Endometriosis is when there is the lining of the uterus, which is usually inside the uterus, outside of it. Endometriosis can sit on the fallopian tubes and prevent them from moving normally. Sometimes it can also obstruct the tubes, block them, and prevent the egg from moving down into the uterus.

Member question: So it is best to get the endometriosis taken care of before TTC?

Dr. Amos: There are several stages of endometriosis. In the very early stages it's less likely to impair fertility. In its most severe stage it blocks both tubes and makes you infertile. Endometriosis is the top cause for infertility because of tubal obstruction. The diagnosis of the stage is usually done on laparoscopy. And if the laparoscopy is done by a specialist then the endometriosis can be treated at the same time.

Member question: My doctor has told me in the past that I have a "tilted" uterus. How does this affect conception, if at all?

Dr. Amos: The medical term for a 'tilted' uterus is a retroverted uterus. That's a uterus that bends backwards. It's a normal thing, and can be found in about one in three women. A retroverted uterus in and by itself is rarely if ever the cause of fertility problems.

Member question: I am 22 I have had surgery twice for ovarian cysts. We have been TTC for 3 1/2 months now. My cycles are 29 to 30 days. Do you think the cyst could have caused a problem?

Dr. Amos: Prior surgery and cysts can cause infertility. This is because they can create scar tissue that blocks the tubes. Doing a test called a hysterosalpingogram can verify if the tubes are open or not.

Member question: Where can I find more information on unexplained infertility? I have been trying to get pregnant for two years now and two IUI cycles have failed. So I wanted to learn more about it, especially because all tests so far are normal. Thanks.

Dr. Amos: WebMD has several articles on unexplained infertility. In addition, seeing an infertility specialist can help you find out more about possible reasons and can help you quickly decide which treatment is best. IUI is not always the best way to help you get pregnant with unexplained infertility. Many doctors feel that IVF provides you with the best chance getting pregnant quickly.

Member question: I stopped taking birth control about four months ago. Some months I do not have a period at all. How do I calculate when I will ovulate?

Dr. Amos: With irregular cycles you likely do not ovulate normally, or not at all. So it's impossible to try calculating something that's not happening or that's happening irregularly. Doing a fertility chart on will help answer your question quickly. The chart will tell you if and when you ovulate, and it helps your doctor find the right treatment.

Moderator: Thanks for joining us. If Dr.

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