I desperately want a baby

Dear Dr Mitchell,

I am 25 years old and I desperately want to get pregnant. About five years ago I got pregnant and had an abortion. I later started taking the pill, then I switched to the IUD. I then had that removed because of an infection which I got treatment for. About a year later, I had to do a HSG which showed that my tubes were blocked. At that time I was having bad pains during sex along with discharge which carried a bad scent. The doctor also told me I had PID. What are my chances of getting pregnant?

The problem that your are now experiencing in not being able to conceive is definitely due to the damage to your fallopian tubes as shown on the Hysterosalpingogram (HSG). Inflammation of the tubes is usually due to bacterial infection that is sexually transmitted. The most common cause of this is usually gonorrhoea or chlamydia infection. In some cases, chlamydia is silent and does not present with any symptoms but stays in the cervix, uterus and tubes and quickly causes inflammation and destruction of the fallopian tube. Gonorrhoea usually causes a blood-stained purulent discharge (pus with blood in it). When the infection involves the fallopian tubes, uterus and cervix, it can also cause painful intercourse.

It is most unfortunate that you did the abortion when you were 20. An abortion, if not done properly, can also be a source of infection that can cause the fallopian tubes and uterus to become infected and damaged thus resulting in subsequent infertility. If you do in fact have pelvic inflammatory disease (PID) then it means that your partner is most likely unfaithful and is the source of the infection. He needs to be properly examined and treated and you should abandon the thought of trying to become pregnant for him if he does not change, otherwise the problem will worsen. With the presence of blocked tubes, your chance of becoming pregnant naturally is virtually zero. If you do become pregnant there is a great risk of the pregnancy lodging in the fallopian tubes resulting in an ectopic pregnancy. This then becomes a life-threatening emergency because the tube can rupture causing severe internal bleeding and shock.

You can actually have the tubes repaired by doing an operation. However, the tubes will need to be evaluated before by doing a diagnostic laparoscopy since sometimes the damage is so severe that it is not possible to correct the blockage by doing surgery. The operation to repair the fallopian tubes can be done by doing the operation through a small incision and this is called laparoscopic surgery or by doing it by the usual approach through a bigger incision in the pubic area (laparatomy).

If surgery is not feasible because of severe damage to the tubes, then you can consider doing invitrofertilisation (IVF) where the egg is removed from your ovary fertilised with the sperm collected from your partner, then put back into the uterus to complete the nine months of pregnancy.

The fact that you are only 25 years old is good since you should have lots of good quality eggs and this will improve your chance of having a successful IVF outcome. This procedure is expensive but you can reduce your costs if you are willing to share your eggs with another woman who has no eggs or poor quality eggs. In this case, the person receiving the eggs will pay a significant part of your cost. Discuss this with your partner since he has to be a willing participant in this process.

It is important that you only do this procedure when you are in a stable relationship and ready to undertake caring for a child, since this can be quite demanding. Consult your gynaecologist who will refer you to an infertility specialist. The Infertility Unit at the University Hospital of the West Indies has some of the best doctors in the Caribbean and the outcome with IVF is comparable to that in first-world countries. The cost of IVF is also significantly cheaper than that in the USA and UK, so this would be your best option if you are in this region. You can also get the diagnostic laparoscopy and operative laparoscopy done there if this becomes necessary.

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. We regret we cannot provide personal responses.