I'm unable to conceive

Dr. Sharmaine Mitchell

Monday, November 12, 2012

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Dear Dr Mitchell,

I recently found out that the inner part of both of my fallopian tubes are blocked and as such I am unable to conceive. I am 26 and my gynaecologist mentioned two options in fixing this, which were surgery or the in-vitro method. My partner and I really do want to start a family but the figures quoted were expensive. Is there an alternative or an inexpensive way to go about this?

I am truly sorry to learn about your inability to conceive as a result of blocked fallopian tubes. The most common cause of this problem is pelvic inflammatory disease. This is usually due to infection such as gonorrhoea and Chlamydia which cause inflammation involving the lining of the tubes, the fimbrae of the fallopian tubes, the lining of the uterus (Endometriosis) and also the cervix.

PID sometimes goes unnoticed at first and is diagnosed late resulting in silent damage to both fallopian tubes and subsequent infertility. Repeated infection despite adequate treatment may also cause damage to the fallopian tubes. This infection is sexually transmitted. Surgery can be done in some cases to clear the blockage in the fallopian tubes. However, if the damage is severe, then repairing the fallopian tubes may result in an ectopic pregnancy. This is a pregnancy that becomes lodged in the fallopian tube. This can become a catastrophic event since the fallopian tube can rupture causing severe blood loss and shock. This may even result in death if diagnosed late or if access to medical care is delayed.

The problem with pelvic inflammatory disease is that the cilia that line the inner part of the fallopian tube become damaged so despite successfully clearing the blockage, the fallopian tube becomes useless in moving the fertilised egg into the uterus. Sometimes the fimbral ends of the fallopian tube are also damaged and the tube becomes ineffective in picking up the egg at the time of ovulation so no fertilisation takes place. Surgery to repair the fallopian tubes is a major undertaking. It may be done using laparoscopy or open surgery (traditional surgery).

In vitro fertilisation provides a real alternative to couples with damaged fallopian tubes. This bypasses the tubes since the egg and sperm is recovered from the female and male, fertilised, and then transferred into the uterus. The fact that you are young is a huge advantage. This improves your outcome since your egg quality is excellent. The cost of in vitro fertilisation (IVF) can sometimes make it prohibitive. However, you can consider doing egg sharing. This involves donating some of your eggs that are removed at the time of the IVF cycle to another couple who might not have good quality eggs because of age (usually women over 40). In this situation a significant part of the cost of the procedure is paid for by the couple who is fortunate to receive the eggs, making your cost significantly lower and more affordable.

The Fertility Management Unit at the University of the West Indies has excellent results with IVF which is comparable to results in first world countries such as the USA and the United Kingdom. The advantage in doing the procedure at this institution is that the basic overall cost is significantly lower, being only a fraction of the cost in other countries. If egg sharing is undertaken the cost will be even less, thus making it a really feasible option.

The fact that you are young is also a big advantage, since the outcome is usually very good with good egg quality in the young women. There are several highly qualified doctors attached to this unit so you should ask your gynaecologist to refer you to one of these doctors for a consultation. A payment plan can also be worked out whereby you pay for the procedure over time and on completion, the procedure is undertaken. You may even be blessed to have twins from one attempt, thus making it worth your while.

Consult your doctor who will advise you further and make the appropriate referral.

Best wishes.

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.




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