Dear Dr Mitchell,
I'm a 24-year-old female who has an ectopic pregnancy in 2005 where I lost a tube. I have been trying to conceive for almost two years now and have been unsuccessful. I saw a gynaecologist in November 2011 who assured me that I had a 60-70 per cent chance of getting pregnant and he gave me some antibiotics to clear an infection I had in my remaining tube. I also got a lab referral to test for amenorrhoea because my periods are quite irregular. My gynaecologist also said he suspects that I have PCOS based on my symptoms, but I would like a second opinion from you. I would like to conceive this year. Please tell me what to do. Should I try to regulate my period by going on contraceptive pills because I'm not sure if I'm ovulating?
An ectopic pregnancy is usually due to pelvic infection that causes significant damage to the pelvic tubes. This infection is sexually transmitted. The damage may involve the lining of both fallopian tubes, the end of the tubes, and can also involve infection in the ovaries. This interferes with the ability of the fallopian tubes to pick up the egg when the ovary releases it (ovulation) and so fertilisation is interfered.
In a lot of women, fertilisation of the egg takes place but the fertilised egg becomes lodged inside the fallopian tube instead of moving down into the cavity of the uterus, thus resulting in an ectopic pregnancy.
The fact that the infection can involve both fallopian tubes means that the other tube that is left back needs to be evaluated. You need to do an x-ray of the fallopian tube to determine if it is blocked since this might be the cause of your inability to conceive. This test is usually done at the end of the menstrual period when there is no possible chance of a pregnancy in place.
Sometimes there is no evidence of a blockage on the x-ray (hyssterosalpingogram-HSG) but the end of the fallopian tube is bound down, making it useless. This can be confirmed by doing a diagnostic laparascopy. This procedure can also confirm the presence of polycystic ovaries.
The cyst can also be drained (cauterised) at the time of the laparoscopy to improve your fertility. Polycystic Ovarian Syndrome (PCOS) is associated with irregular cycles, excessive weight gain and evidence of excessive levels of male hormone (testosterone). There is also an increased risk of developing diabetes mellitus. This can be controlled by achieving your ideal weight for height (regular exercise programme and diet) in addition the use of metformin and clomiphene citrate (clomid) to induce ovulation.
The use of the contraceptive pills to regulate your periods is not a good idea since you are trying to conceive. You should do a baseline progesterone test on day 21 of your cycle to determine if you are ovulating. This is a blood test which is done counting 21 days from the first day of the last menstrual period. If this is low, the clomid and metformin will certainly help, assuming that the remaining fallopian tube is not blocked. It is also important for your partner to be tested to see if he has any fertility issues. Low sperm count and problems with motility of the sperms are a relatively common problem in males. Consult your gynaecologist or family doctor who will advise you 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 Ave, Kingston 5; or fax to 968-2025. Dr Mitchell cannot provide personal responses.
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.