Dear Dr Mitchell,

I found out in January of this year that I have secondary infertility. My gynaecologist did a HSG test and said I have one good tube. My partner did a semenanalysis and my gynaecologist said everything was OK, and that we were good to go. But so far nothing is happening. I already have one child and my partner has two. I am 35 and really want another child before I get any older. I have really irregular periods also, ranging from 28-36 days. This changes every month. What can we do?

The problem that you have with the inability to become pregnant may be twofold. The x-ray of the fallopian tubes and uterus (HSG) showed that one fallopian tube is blocked and one is “good”. However, despite the fallopian tube appearing to be good on the x-ray, the tube might not be working properly to pick up the egg at the time of ovulation.

The most common cause of a blocked tube is pelvic infection. The infection could have completely damaged one fallopian tube and caused one to be somewhat bound down so the fimbrial end of the tube becomes useless. This is the part of the tube that picks up and sweeps the egg into the tube so that fertilisation can take place. This egg will become wasted if this does not work. The x-ray of the fallopian tube might not effectively demonstrate this.

The other problem that can cause you not to conceive is endometriosis. This is a condition that can also cause the fallopian tubes to become bound down and become totally useless. Sometimes the often-classic symptoms such as painful periods or chronic pelvic pain might not be present and the endometriosis goes undiagnosed. A diagnostic laparoscopy will definitely help in the evaluation of the fallopian tubes and this will determine if you have adhesions or scarring from pelvic infection or endometriosis. Tubal surgery can also be done at the time of the laparoscopy to remove any adhesions and burn away the endometriosis and improve your outcome at becoming pregnant.

The fact that your menstrual cycle is irregular is significant because this could mean that you are not releasing an egg regularly. so drugs are readily available that can correct this problem once the underlying cause is determined. You need to have your hormone profile done (blood test) and then treatment can be undertaken. You need to be properly evaluated and seen by an infertility specialist. Laparoscopy can be done at the Fertility Management Unit at the University of the West Indies. There are highly skilled doctors at this unit who can effectively treat your problem and help you to become pregnant. 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.

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.