Trying to have a baby…

Dear Dr Mitchell, 

I am 36 and I am trying to have another child. I did a HSG which says one of my tubes is completely useless, and the other can be fixed. I need your help.

The problem that you have with your Fallopian tubes needs to be properly evaluated so that the appropriate form of treatment can be planned.

Inability to become pregnant because of blocked Fallopian tubes is a common problem. It is usually due to an infection that is sexually transmitted such as chlamydia or gonorrhoea. This infection can damage the lining of the Fallopian tubes or can cause the ends of the Fallopian tubes to become sealed off, thus preventing pregnancy. This is usually confirmed on doing an X-ray of the Fallopian tubes, called a hysterosalpingogram (HSG). This may show a dilated Fallopian tube with no spillage of the applied dye from the ends of the tube, or partial spillage of dye, or total absence of any dye in the Fallopian tubes.

The other problems that can cause damage to the Fallopian tubes include endometriosis, pelvic tuberculosis, infection or scarring from previous operations.

The fact that one Fallopian tube is completely damaged could also suggest that the lining of the other Fallopian tube is also damaged. Surgery can sometimes be done to clear the blocked end of the Fallopian tube, but if the lining is already damaged this can result in an ectopic pregnancy. This happens because the mechanism to move the fertilised egg from the Fallopian tube to the lining of the uterus is damaged and the embryo becomes lodged in the Fallopian tube. This can cause severe internal bleeding if the Fallopian tube ruptures and can cause death if detected late or if treatment is delayed.

You will probably need to get a diagnostic laparoscopy to properly evaluate the other partially damaged Fallopian tube to determine whether it will be beneficial to do surgery to repair it.

If surgery is not feasible or not advised, then removal of both Fallopian tubes should be done and invitro fertilisation should be considered. This is available locally in Jamaica at the Hugh Wynter Fertility Management Unit at the University of the West Indies. The success rate is good and the cost is definitely less than in most other countries.

You should try to have a consultation with your gynaecologist and get a referral to see a fertility specialist. The fact that you are 36 is good since you will still have good quality eggs at this age. It is best to do the procedure now before you’re 40 when your egg quality will decline significantly.

Your spouse should also get a complete physical and a semenanalysis done to ensure that he is also not contributing to the infertility.

Consult your gynaecologist who will advise your further.

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 Avenue, Kingston 5 or fax to 876-968-2025. 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.