I can’t get pregnant

Dear Dr Mitchell

I’m 24 years old and haven’t had any children as yet but I’m really scared that I won’t. I have lots of facial hair that I get rid of by laser. My dermatologist told me that women like me sometimes cannot have children. My period was irregular from about January and I started working out and by April it was normal. My concern is that I’ve been having unprotected sex with my boyfriend for one year now and I cannot get pregnant. My boyfriend does not have any kids. Do you think he should do a sperm test? What are my odds of getting pregnant?

The problem that you seem to be having is a condition called polycystic ovarian disease syndrome. This is a fairly common cause of infertility. This syndrome is associated with irregular menstrual period, excessive weight gain, excessive hair growth on the face and body in the usual male pattern type and infertility. There may also be associated enlargement of the clitoris (clitoromegaly) and male pattern type baldness due to excessive male hormone (testosterone) production by ovaries.

The polycystic ovarian disease syndrome can be treated, however. The aim of the treatment is to reduce the baseline testosterone levels and establish regular ovulation each month. The first thing to do if you are overweight is to lose weight; the aim is to achieve your ideal weight for height. Weight loss alone is sometimes effective in re-establishing regular menstrual cycles and improving fertility. Weight loss can be achieved by a regular exercise programme and appropriate diet. You need to consume foods which are low in calories, avoid fried and fatty foods, sweet drink, cakes, ice-cream, and consume more vegetables and fruits. A regular exercise programme for at least 30 minutes to one hour daily, three times per week will definitely go a far way in trying to reduce you weight.

If you are not successful in becoming pregnant after appropriate weight loss then the use of metformin and clomiphene citrate will definitely help you to achieve regular ovulation and improve your chances of becoming pregnant. In some women the condition does not respond to these drugs and a procedure called ovarian drilling can be done to reduce the cysts in the ovaries, reduce the baseline testosterone levels, induce regular ovulatory cycles and ultimately conception. This can be done by an outpatient procedure called operative laparoscopy or by laparatomy which is a bit more involved and includes a longer hospital stay.

If these interventions fail to help you to become pregnant, then invitrofertilisation will definitely offer a very good chance of success. The fact that you are 24 years old is an advantage, as you should have very good quality eggs and this will result in a good outcome of invitrofertilisation. It is important for your partner to do a semen analysis to determine if he has any underlying problems that could contribute to your infertility.

You will need a hormone profile and a pelvic ultrasound to confirm the polycystic ovarian disease and then a definitive treatment can be undertaken.

Best wishes.

Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@ jamaicaobserver.com; mail c/o Jamaica Observer, 40-421/2 Beechwood Ave, Kingston 5; or fax to 968-2025. See responses to your questions in All Woman. We regret we cannot provide personal responses.