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Q. I have been on Clomid for two months now, with this being my second month. I am now three days late for my cycle. I had a pregnancy test done yesterday and it was negative. My HCG level has always been a little lower than normal, so I am wondering how much longer I should wait until I do a HPT? Should I just request a blood test?
A. Since your HCG levels have been low in the past, a blood test may be the best way for you to determine pregnancy. The urine home pregnancy tests sometimes don’t show a positive result if you don't have a high level of HCG present. It will eventually show a positive result if you are pregnant, but it could be weeks before your HCG levels rise enough.
Q. As part of my natural cycle, I usually only have three to four periods a year. It has been that way all of my life. My doctor says I may only be ovulating from one side. How do I know when I should be having intercourse to help conceive a baby? Is it just hit and miss?
A. I think I agree with your doctor's diagnosis. Since you seem to have only one functioning ovary, your window of opportunity for getting pregnant is smaller, but still very possible.
If you haven't done so already, you may want to mark your calendar to track your cycles carefully and possibly be able to predict when you may have another. During and around the week you may be releasing an egg (usually about 12 to 14 days before the onset of menstruation), look for signs of ovulation such as an increase in cervical mucous (a clear, slimy discharge) and a slight drop in your body temperature. You might also want to invest in a home ovulation test kit, which is by far the easiest, fail-safe method. When you do finally pinpoint your days of ovulation, be sure to have plenty of intercourse on and around those few days. (See "the best sperm meet egg formula" for more for more information on getting pregnant.)
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Q. We have been trying to conceive for the last eight months with no success. I think my partner may have had an orgasm during foreplay. We had intercourse after this and again she had an orgasm. What is the impact of the first orgasm on our chances of conceiving? Please guide us.
A. While it's true that a woman can become pregnant without ever orgasming, I think having an orgasm, especially more than one, can increase your chances for pregnancy. An initial orgasm before the ejaculation of sperm can help lubricate the vagina and cervical canal, making the path for sperm to egg much easier. Another orgasm during intercourse can cause muscular contractions in the vagina that can help pull the sperm up into the cervix. If you are feeling really energetic, another orgasm after sex could help the trek for sperm to egg even more.
Q. I am extremely overweight. My periods are normal. I do not have PCOS (Polycystic Ovarian Syndrome) and I can feel when I ovulate. What are the fertility concerns with being obese? Can you explain insulin resistance and how it affects the hormones and how to reverse it? How long does it take to reverse? I have two children now and would like a third, but I don't seem to be getting any smaller over the years and it seems like it took losing weight for me to be able to conceive my second child.
A. If you are having normal periods, you are most likely ovulating regularly, which means you don't need to worry about PCOS or insulin resistance. PCOS can cause your body to be resistant to insulin, leading to the release of more and more insulin to compensate. The ovaries of PCOS women are sensitive to high blood levels of insulin and respond by overproducing androgens such as testosterone. This disrupts the feedback between the ovaries and the pituitary gland. Then the pituitary gland produces too much luteinizing hormone, which leads to more even production of androgens. The immature follicles in the ovaries then fail to convert the excess androgens to estrogen, which inhibits ovulation. Ovulation doesn't take place because the egg couldn't develop properly, and the immature egg, instead of being released from the ovary, becomes a tiny cyst that starts producing its own supply of androgens, which interferes with next month's developing follicle.
There may be no medical term for your fertility problem, but it probably has something to do with your obesity, especially since you mention it took losing weight to get pregnant the last time. Sometimes your body will not allow a pregnancy to develop because conditions are not right to physically carry a baby to term. I think losing weight now will give you the best chance for getting pregnant and delivering a healthy baby. If you are seriously motivated to get pregnant, you can use that same motivation to diet. And remember, the thinner you are before pregnancy, the thinner you will be after. It's much easier to lose those pregnancy pounds when you are not overweight in the first place.
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Q. Is it possible to become pregnant right after an abortion? If so, how fast and how easy is it?
-Carol, New Jersey
A. It is possible to get pregnant immediately following an abortion, but I don't advise trying it. Most OB/GYNs will recommend abstaining from intercourse for two to four weeks after an abortion so that your cervix can close and your uterus has time to heal. If you have intercourse before then, you may be putting yourself at risk for pregnancy or getting an infection that could develop into PID (Pelvic Inflammatory Disease). You can get pregnant as soon as you begin to ovulate, which could be as early as one day or as late as three months after an abortion.
Q. During intercourse, when my husband pulls out his penis after ejaculating into my vagina, all the sperm comes out. This happens even when he keeps his penis in for a while after ejaculation. I am worried that my chances of getting pregnant are affected because to this. Is this right?
A. It's normal for semen to leak out of the vagina after intercourse. The more your partner ejaculates, the more you will have spilling out. Sometimes a man will ejaculate only about a teaspoon of semen while other men seem to ejaculate a pint. In either case, I don't think you need to worry about all of it falling out. I'm fairly sure an ample amount stays in there. All it takes is one drop of semen to get pregnant. And one drop can contain millions of sperm. See "the best sperm meet egg formula" for more information on how to get pregnant.
Q. My spouse and I had anal sex not too long ago and he ejaculated in me. Is there any possibility that I might be pregnant?
A. If any semen got into your vagina and you were ovulating, you may get pregnant. Otherwise, no,- you cannot get pregnant from anal sex alone.
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Q. I have had four children and I know your cervix is always dilated to 1 after having a vaginal birth. I'm TTC (Trying To Conceive) #5 and wondering how I tell what my cervix does during a fertility cycle. Will mine also open when ovulating and then close back up? Is it more closed if I'm pregnant? When does this happen – right before I find out I'm pregnant or into the pregnancy?
A. Normally, your cervix opens and changes position at the time of ovulation. During ovulation, your cervix is slightly higher, softer and open. The cervix closes shortly after ovulation and the discharge of cervical mucous, signaling the end of your fertile time. It then opens again slightly about two weeks later to allow for menstrual blood to pass. If menstruation does not happen, pregnancy is a possibility. During pregnancy, the cervix is closed and quickly becomes quite engorged with blood. I think it most resembles an over-ripe plum.
Q. I have always been told that I have a tilted cervix. A friend just told me that she has a tilted cervix and her doctor recommended a particular position ("doggy style") for her to get pregnant, and it worked. Ever heard of this?
A. Sometimes a tilted cervix makes conception a little more troublesome because the ejaculation doesn't get a direct hit into the cervical opening. If your friend's cervix was tilted forward, doggy-style intercourse could have given her an advantage with the sperm deposit positioning. If your cervix is also tilted in the same fashion, it could be an advantage for you, too. It's worth a try!
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Q. Can an egg implant, un-implant and then implant again? I can't get a clear test result, but I have the symptoms of pregnancy. When I was pregnant with my daughter the result was faint, but plain. Now it's positive then negative, then positive again, then negative. I'm so confused!
A. An egg cannot implant and then un-implant and relocate. If you had one positive HPT (home pregnancy test), then you probably are pregnant. It's possible that during certain times of the day you have less of a hormone level that would create a positive test. If you use a HPT with your first urine of the day, you will get your most accurate reading. If, a week from now, you are still getting varying results, you may want to visit your OB/GYN to check your progesterone levels. If your levels are low, you may be put on a hormone supplement for the first few weeks of pregnancy. (See the other progesterone/Prometrium question for more details.)
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