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Trying to Conceive Community

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David K Walmer, MD, PhD

Joined: 02/26/2010

Expert Profile:

David Walmer, MD, PhD is a reproductive endocrinologist and infertility specialist at Atlantic Reproductive Medicine Specialists. During his 25 years in academic medicine, he served as an examiner for the American College of Obstetrics and Gynecology as well as on national practice guideline committees, working with fertility experts across the country to evaluate and update the standards for fertility care. Walmer is a member of the American Society for Reproductive Medicine and the Society for Reproductive Endocrinology and Infertility. In 2011, he was rated by Castle-Connelly in the top 1% of experts in his subspecialty. In his current practice, Walmer's clinical interests include age-related issues of fertility, fertility preservation, preimplantation genetics, premature ovarian failure, polycystic ovarian syndrome and uterine fibroids.
Walmer has a passion for improving women's health in low resource countries as serves on the faculty of the Global Health Institute at Duke University. He founded Family Health Ministries in 2000 to promote cervical cancer prevention and maternal-child health in Haiti. In 2011, Walmer helped Dr. Harry Beauvais establish a pioneering IVF program in Port-au-Prince, Haiti.

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Reply: Help

Dear meluvsjim, As long as you are not having regular predictable periods,...

Posted by David K Walmer, MD, PhD

1 Reply | Reply | Watch This DiscussionReport This| Share this:Help Dear meluvsjim, As long as you are not having regular predictable periods,...

Reply: Trying to conceive after IUD (Mirena)

Although the Mirena IUD is a long acting type of contraception, its...

Posted by David K Walmer, MD, PhD

1 Reply | Reply | Watch This DiscussionReport This| Share this:Trying to conceive after IUD (Mirena) Although the Mirena IUD is a long acting type of contraception, its...

Reply: LH Surges how long do they last before you Peak or...

Dear Spoilme, There are many strategies that you can use to help you...

Posted by David K Walmer, MD, PhD

Dear Spoilme, There are many strategies that you can use to help you increase your probability of conceiving and this is one area where technology can help. However, it is important to understand how the technology works so that you can get the most out of it and interpret the information in concert with everything else that you know about your cycle. A few key principles. Sperm can live for days in the female reproductive tract, once the door is opened. A woman's cervix is a reservoir or a time-release capsule for sperm. Sperm can not get into the cervix until the water content increases to the point that the mucous transitions from a thick dense state to an egg white, elastic and abundant consistency. Women who are good at assessing their mucous are quite good a preventing pregnancy (natural family planning) and they should therefore be quite good at optimizing their chances of conceiving. The rise in estrogen that precedes ovulation is one of the key factors that allows this change in the mucous to occur. Now back to the Clear Blue Easy test. The key to most ovulation predictor kits is the ability to detect LH, the hormone that triggers the maturation and release of your eggs at the right time. Many kits only measure LH and the signal occurs for one day or at the most two. The Clear Blue Easy test measures both LH and estradiol, which means that it is designed to anticipate as well as signaling the LH surge. If you are not able to or really don't want to be assessing your own cervical mucous, the Clear Blue Easy test helps you know what days the sperm can probably get into your cervical "reservoir". However, to interpret this information accurately, it is important to see the whole picture. Some women can have a problem with ovulation that is associated with an estrogen / testosterone imbalance and this condition can also be associated with chronically elevated LH levels in their bloodstream. This condition can give a weak positive signal for LH that can also be seen for days and in some cases all of the time. In this situation the woman is actually not ovulating. So what you want do know first is, are you having regular predictable cycles? If yes that is a sign that the signal is accurate. Second, you want to know if the LH surge (the last day that the signal is positive, remember the estradiol goes up first and then the LH surge happens) is occurring abut 14 days before the nest menstrual period. If yes, then this is another sign that the signal is accurate. Another thing that you can do to confirm that the signal is accurate is to get your progesterone level checked about a week after the LH surge. Your peak fertile day is the day of the LH surge; the last day of the Clear Blue Easy signal; and/or about 14 days before your next period if you are not pregnant. Having intercourse a day or two before the surge can also result in pregnancy. Remember, the sperm live a long time and the key is getting them into the cervix after the door is open. Eggs on the other hand have a very short window of receptivity that is estimated to be about 12 hours and your fertility drops rapidly after this interval. Two days after you detect the urine LH surge you are probably back into the recreation window and out of the procreation window. I hope this helps... Good luck!View Thread

Posted byDavid K Walmer, MD, PhD

1 Reply | Reply | Watch This DiscussionReport This| Share this:LH Surges how long do they last before you Peak or ovulate? Dear Spoilme, There are many strategies that you can use to help you...

Reply: Can you get pregnant without a period???

Dear AmPray, It would probably be a good idea for you to see your...

Posted by David K Walmer, MD, PhD

2 Replies | Reply | Watch This DiscussionReport This| Share this:Can you get pregnant without a period??? Dear AmPray, It would probably be a good idea for you to see your...

Reply: Pregnancy wanted:) however have to wait til I have...

Dear Shalom007, Typically the meds that you take for surgery will clear...

Posted by David K Walmer, MD, PhD

2 Replies | Reply | Watch This DiscussionReport This| Share this:Pregnancy wanted:) however have to wait til I have surgery Dear Shalom007, Typically the meds that you take for surgery will clear...

Reply: Trying to conceive at 2 losses

Dear An_250842, Yes you should definitely talk to your obstetrician and...

Posted by David K Walmer, MD, PhD

2 Replies | Reply | Watch This DiscussionReport This| Share this:Trying to conceive at 2 losses Dear An_250842, Yes you should definitely talk to your obstetrician and...

Reply: Help

Dear An_250653, Understanding what is going on with a woman's reproductive...

Posted by David K Walmer, MD, PhD

Dear An_250653, Understanding what is going on with a woman's reproductive cycle can be a lot like figuring out a puzzle. The first thing to do is to accept that you aren't going to get all of the answers all of the time. In fact, you might not have a clue what is going on some of the time. That is one of the beautiful things about women. Sometimes they are a mystery. The process of ovulation is an orchestrated dialogue between your ovaries and your brain. There are probably other members of the orchestra in there that we don't even know about yet. The only true proof of ovulation is a positive pregnancy test. The other pieces of the puzzle are things that we know are associated with normal ovulatory cycles. If I were you, I would keep a calendar and record days of bleeding, days of intercourse, cervical mucous changes, and the day the ovulation predictor kit turns positive. Don't start using the OPK until you can pretty accurately predict your next menstrual perioid. If you are having a normal ovulatory cycle, the OPK should turn positive 14 days before the next menstrual cycle begins. You want to start testing a couple of days before that. If your cycle is 34 days then the OPK should turn positive on cycle day 20. Your fertile period is 3-5 days leading up to the positive OPK. After that intercourse is recreation, not procreation, until the next month. If things don't seem right in any way, don't hesitate to take your data to your ob/gyn and sit down for a little preconception counseling. Try not to stress out too much. Remember in the long term the most important thing is relationships. Love your husband. Guide him in the process but don't forget that every day isn't about making a baby. After your kids are out of college, it will be back to just the two of you. This should be a time of fun and planning together. There are many paths to parenthood and sometimes that path requires a little help. I hope you don't need too much help. Good luck!View Thread

Posted byDavid K Walmer, MD, PhD

1 Reply | Reply | Watch This DiscussionReport This| Share this:Help Dear An_250653, Understanding what is going on with a woman's reproductive...

Reply: Ovulation and LH Surges

Dear brandi2022, Our goal is to figure out if your positive tests represent...

Posted by David K Walmer, MD, PhD

1 Reply | Reply | Watch This DiscussionReport This| Share this:Ovulation and LH Surges Dear brandi2022, Our goal is to figure out if your positive tests represent...

Reply: Trying to conceive... need advise!!!

Dear An_250343, I think that you are on the right track with the monitoring...

Posted by David K Walmer, MD, PhD

Dear An_250343, I think that you are on the right track with the monitoring that you are currently doing. Normal ovulatory cycles are between 27-35 days most of the time. Situations that increase the suspicion of a problem with ovulation include short cycles, long cycles, cycles that are variable by more than /-1 day and short luteal phases. The luteal phase is the length of time from the positive OPK until the first day of your next menstrual period. Exceptions to these rules do occur. No one knows for sure when ovulation occurs but it is probably between 40- 45 hours after the LH surge. The LH surge appears first in the bloodstream and then later in the urine after the LH hormone is filtered through the kidney. One of the key principles for timing intercourse is to understand that the sperm can live for days In the female reproductive tract and eggs are probably receptive to sperm for only about 12 hours. Therefore the sperm need to be in the female reproductive tract waiting for eggs before or close to the time of ovulation. Throughout most of the menstrual cycle, sperm cannot get into the cervix and upper reproductive tract because of the very dense cervical mucus. As the estrogen rises before ovulation, the water content of the mucus increases. Somewhere 3-5 days before ovulation the mucus develops and egg white consistency, becomes very inelastic and for the first time sperm can gain access to the cervix its elaborate labyrinth of glands and the upper reproductive tract. When you have intercourse during your fertile window, your partner is filling the reservoir, i.e. cervix, which releases sperm into the upper reproductive tract continuously for days. Men should ejaculate, i.e. clean their pipes, once a few days before the fertile window and then You should have intercourse at least once during the fertile window. Fertility is highest when intercourse happens close to the time of the positive OPK. the reason for the first ejaculation that I mentioned above is to move the old sperm out of the way and the unhealthy sperm to the front of the next ejaculation. If men have not ejaculate for approximately 2 weeks, there may be no living sperm in the ejaculate. For example, if a woman has a 28 day cycle with a positive OPK on day 14 then her fertile window begins somewhere around cycle day 9-11 and ends shortly after cycle day 14. Men should ejaculate once within a few days of cycle day 11 and then you should have intercourse at least once in the11-14 day window, preferably closer to cycle day 14. It may be helpful to keep a calendar of your dates of bleeding, intercourse, cervical mucous changes and OPK. This can help you and your healthcare provider determine if you are timing things correctly. It is normal for it to take 4 months or so to get a positive pregnancy test. If you are close to 35 years old or older it is not unreasonable to seek help if you're not pregnant within six months. It is also very reasonable to seek counseling for preconception planning anyway and especially if you are suspicious that there may even be a subtle ovulation disorder. Good luck!View Thread

Posted byDavid K Walmer, MD, PhD

1 Reply | Reply | Watch This DiscussionReport This| Share this:Trying to conceive... need advise!!! Dear An_250343, I think that you are on the right track with the monitoring...

Reply: Trying Desperately to Conceive

Mrs. Gonzalez, It is never wrong to see your primary care provider for...

Posted by David K Walmer, MD, PhD

2 Replies | Reply | Watch This DiscussionReport This| Share this:Trying Desperately to Conceive Mrs. Gonzalez, It is never wrong to see your primary care provider for...

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