Unable to conceive after chlamydia infection
Dear Dr Mitchell
I am 43 years old, and have been unable to conceive. When I was much younger I had chlamydia and I was treated, but I think I have become sterile because of this infection. I would still like to have a child. Do you think there is any possibility?
Chlamydia is a sexually transmitted infection that can cause significant damage to the Fallopian tubes. It can damage the lining and ends of the tubes, thus causing them to become blocked. This results in infertility. Chlamydia may sometimes be silent and a woman can have significant tubal damage by the time the infection is confirmed and treated. In severe cases, the presentation may be that of severe pelvic pain, fever and a blood-stained vaginal discharge. It can also present with painful sexual intercourse or bleeding after sexual activity. Once it is diagnosed and treated early, the outcome can be good, but both partners have to be treated.
The diagnosis of chlamydia usually suggests a third – party involvement and so this requires a change in sexual practices to effectively solve the problem. Anyone diagnosed with chlamydia should also be tested for other sexually transmitted infections such as syphilis and human immunodeficiency virus.
Tubal surgery can sometimes be done to open up the ends of blocked tubes and give the couple a chance at natural conception. However, because the lining of the tubes is also damaged in many cases, tubal surgery does not work well. Even if pregnancy results, this leads to an ectopic pregnancy, which implants in the lining of the Fallopian tube instead of the cavity of the uterus. This can result in rupture of the Fallopian tube and significant blood loss leading to shock, and massive blood transfusion may be necessary to save a life.
At age 43, your egg quality will be significantly compromised. There is still a chance of pregnancy but this is significantly lower. You can actually get a blood test done on the third day of your cycle to determine your ovarian function. Additionally, you can do a progesterone test on day 21 to see if you do ovulate. An x-ray of the uterus and Fallopian tubes (hysterosalpingogram) can determine if the Fallopian tubes have been blocked by the chlamydia infection.
If both Fallopian tubes are blocked and your egg quality is bad, then you can still conceive by doing in vitro fertilisation. This can be done using donor eggs. The donor eggs are usually from a younger person and the outcome in this case is usually very good. This procedure is offered at the Fertility Management Unit at the University of the West Indies and the results from this unit are excellent.
In the event that this is not affordable, then adoption can be an option to consider. This brings just as much joy as having your own biological child.
Consult your general doctor or gynaecologist who will advise you and make the appropriate referral to one of the doctors in the Fertility Management Unit.
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.
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.
