No luck conceiving
Dear Dr Mitchell,
I’ve been trying to conceive for two years with no luck at all. I’ve had chlamydia in the past but was treated for it and I’ve recently been diagnosed with abnormal uterine bleeding. Could those be the reasons I can’t seem to get pregnant?
Approximately 90 per cent of couples will conceive after trying for one year. This will involve regular sexual activity, at least two to three times weekly without any form of contraceptive protection.
The fact that you have tried for two years without becoming pregnant is significant. Inability to conceive may be due to several factors in both the male and female. Infertility may be due to failure to ovulate regularly, pelvic infection with tubal occlusion, or abnormalities in the uterus.
Failure to ovulate may be due to thyroid problems with overproduction or underproduction of thyroid hormones, excessive production of prolactin by the pituitary gland, polycystic ovarian disease, or excessive weight loss or weight gain that may be associated with extreme dieting. Pelvic infection with tubal occlusion may be a significant factor in your case since you have a history of chlamydia infection. Gonorrhoea and chlamydia infection are significant infections which contribute to the blockage of the Fallopian tubes. Delay in the treatment of these infections or inadequate treatment may result in tubal occlusion.
The abnormal uterine bleeding that you experience may be due to a pelvic infection or a hormonal problem. This may be due to an abnormal ovulation pattern.
You should have a complete hormonal evaluation done to determine if you are having problems with ovulation. A basic screening test should include a progesterone test (done 21 days from the first day of the menstrual period), prolactin level, thyroid stimulating hormone (TSH), leutinizing hormone (LH), and follicular stimulating hormone (FSH). An X-ray of the Fallopian tube and uterus called a hysterosalpingogram (HSG) should be done. This will help to determine if the Fallopian tubes are blocked and rule out abnormalities in the cavity of the uterus such as polyps and adhesions that can interfere with implantation of the embryo even if fertilisation occurs.
A pelvic ultrasound can also help to detect abnormalities in the ovaries and uterus. Polycystic ovaries can be diagnosed on ultrasound and in severe cases dilated Fallopian tubes can be detected.
Your partner should be evaluated since the inability to conceive may be due to a male factor. A detailed physical examination and a semen analysis should be done to determine if there is a male factor that is contributing in your case. Excessive smoking, alcohol consumption, and infection can cause decreased sperm production. Exposure of the testes to high temperatures can cause reduction in sperm production and motility and this should be avoided in males. Problems with undescended testes or a history of operations on the testes may be a factor in contributing to altered sperm production.
Consult your doctor who will do a complete physical examination with you and your partner and then do the appropriate investigations to determine the underlying cause of the infertility and abnormal uterine bleeding.
Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@jamaicaobserver.com; write to All Woman, 40-42 1/2 Beechwood Ave, Kingston 5; or fax to 968-2025. All responses are published. Dr Mitchell cannot provide personal responses.
DISCLAIMER
The contents of this article are for informational purposes only and must not be relied upon as an alternative to medical advice or treatment from your own doctor.
