Dear Dr Mitchell,

I am in my late 30s and trying hard to get pregnant, which is not happening. I was diagnosed with endometriosis and underwent surgery, and was told that I would conceive after the surgery and up to this date nothing has happened.

What would you think is my issue? My husband did several semen tests and the only findings of those were that his sperm move very slow. How can we have a child together before it’s too late?

Endometriosis can definitely contribute to your inability to conceive even after you have done surgery to remove the endometriosis. There can be residual scarring or adhesions that cause the Fallopian tubes to become blocked or bound down. This could prevent pregnancy from occurring since the egg would not be able to travel into and along the Fallopian tubes from the ovary. Even if the Fallopian tubes are not blocked, women with endometriosis still have difficulty becoming pregnant because the eggs that are released each month have a higher chance than usual of being destroyed or wasted.

The fact that your partner has a problem with the sluggish movement of his sperm needs to be further investigated and treated. He should see a urologist. There are several causes of slow movement of sperm. These include a genetic problem; smoking; work induced infertility, in particular jobs which involve repeated trauma to the pelvic area; and varicocele (enlarged veins in the scrotum). Poor diet including vitamin C and B12 deficiency can also contribute to sluggish movement of the sperm. Excessive stress can also cause infertility in men.

For men who are otherwise normal except for slow movement of the sperm in the 30-40 per cent range, artificial insemination might be successful in achieving a pregnancy. The success rate is however low and most couples will need invitro fertilisation (IVF) with the direct injection of the sperm into the egg (ICSI) to achieve a pregnancy.

It is important for you to get an X-ray of the Fallopian tubes done to ensure that at least one Fallopian tube is not blocked. Artificial insemination will not work if both of your Fallopian tubes are blocked. A diagnostic laparoscopy might also be necessary to determine if there are adhesions causing the Fallopian tubes to be bound down and non-functional. If there is scarring around the Fallopian tubes this can also be corrected at the time of the laparoscopy to improve your outcome of becoming pregnant naturally or via artificial insemination.

You should consult your gynaecologist and ask for a referral to a fertility specialist trained to do IVF and ICSI. You are young and should have excellent quality eggs so do not be too anxious since you should have a good outcome.

Best regards.

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.