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khagihara, OB/GYN (Doctor)
Category: OB GYN
Satisfied Customers: 6414
Experience:  Trained in OB & GYN for many years.
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I am 37 years old and trying to get pregnant, but have observed

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I am 37 years old and trying to get pregnant, but have observed absolutely no cervical mucus. What could be causing that and how can I address it?
Submitted: 4 years ago.
Category: OB GYN
Expert:  khagihara replied 4 years ago.
How tall are you? How much do you weigh? Any weight change? If so, over what period of time?
Do you have regular periods? Have you ovulation checked? How long have you been trying to get pregnant? Have you been pregnant? Does your partner have his own children?
Have you had a pelvic exam, and ultrasound lately?
Do you have any other symptoms associated with your problem?
Are you aware of anything which might have brought this on?
Do you have any other medical problems?
Any surgeries?
Are you taking any other medications including over-the-counter pills and herbs?
Any family medical history?
Customer: replied 4 years ago.
5'4" 145 lb, no recent weight change.

Regular periods, almost always 27 days.

Using ClearBlue fertility monitor for about six months, and previously some OPKs. Ovulation is typically indicated on day 12 or 13.

Had surgery in June 2011 to remove a fibroid that was outside the uterus. Had an ultrasound before that (around May) to identify the fibroid, but no ultrasound since. Had HSG in December 2011, normal result.

Been trying to get pregnant from Jan 2010, for about 24 cycles (skipped a few cycles around the surgery). Have never been pregnant, husband has no children but had normal sperm analysis.

We typically use a small amount of Astroglide for lubrication.

No gynecological problems in family medical history.

Also taking prenatal vitamins and fish oil (as recommended by GYN), along with Nexium and Gaviscon regularly for GERD. I take tylenol and ibuprofen for menstrual pain. This is in addition to the medication mentioned earlier. Recently stopped Buproprion, about two weeks ago after consultation.

I recall being "wetter" many years ago (perhaps in college), but my husband and I have not observed any obvious cervical mucus in at least 10 years. I have looked at reference photos, and I don't have anything like the "hostile" or "egg white" cervical mucus. I suspect the antidepressants and / or Ritalin but I can't be sure of a correlation.
Expert:  khagihara replied 4 years ago.
The antidepressants and Ritalin could cause vaginal dryness. You should try intrauterine insemination (IIUI) combined with clomid (which makes eggs mature) & HCG (which stimulates ovulation) because the cervical mucus is problem. Women with "unreceptive cervical mucus" are good candidates for artificial insemination. In these women, the mucus surrounding the cervix is hostile to sperm and prevents sperm from getting into the uterus and fallopian tubes. Artificial insemination allows the sperm to skip the cervical mucus entirely.

Your doctor will use ovulation kits, ultrasound, or blood tests to make sure you are ovulating when you undergo artificial insemination.
When you are ovulating, your partner will be asked to produce a sample of semen. The doctor will suggest that your partner abstain from sex for two to five days in advance to ensure a higher sperm count. If you live close to the clinic, your partner may be able to collect the semen at home by masturbating. Otherwise, the clinic will provide a private room for this purpose. The sperm must be "washed" in a laboratory within one hour of ejaculation.
The process of "washing" the sperm enhances the chance of fertilization and removes chemicals in the semen that may cause discomfort for the woman. It consists of liquefying the sperm at room temperature for 30 minutes. Then a harmless chemical is added to separate out the most active sperm. Then a centrifuge is used to collect the best sperm.
The sperm are then placed in a thin tube called a catheter and introduced through the vagina and cervix into the uterus. Artificial insemination is a short, relatively painless procedure that many women describe as being similar to a Pap smear. Some women have cramping during the procedure and light bleeding afterward. Immediately after the procedure your doctor will probably have you lie down for about 15 to 45 minutes to give the sperm a chance to get to work. After that, you can resume your usual activities.
In some cases, your doctor will have you on fertility drugs, such as Clomid, to induce superovulation (ovulation of multiple eggs) before having artificial insemination.
Customer: replied 4 years ago.
Unfortunately IUI is not an option for us for religious reasons. This also includes things like IVF. Medication is OK, but not anything that interrupts intercourse.

So I am still trying to address the underlying problem. Is there anything that can be done to produce cervical mucus when there normally isn't any? I have heard of estrogen supplements, evening primrose oil, and an over-the-counter product called "FertileCM," but I don't have any medical opinion to back up any of those.
Expert:  khagihara replied 4 years ago.
You should try clomid or HMG(or FSH) plus hCG. Clomid could increase the cervical mucus. Talk to your doctor.
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