What are my chances of becoming pregnant?
Dear Dr Mitchell,
I am 29 years old and my partner is 25. We have been trying to conceive for one year now with no results. My partner did a semen analysis. His results are: pH-8.6; volume 3.5; count-4.0; motility-20 per cent; progressitivity-eight per cent; liquefaction-one hour; pus cells-18-20 and morphology – 80 per cent normal sperm. My doctor says his sperm are normal but I don’t think so. She prescribed Clostilbegyt for me and Altacef-500 for him. What are my chances of getting pregnant? I also have an eight-year-old daughter.
Approximately 84 per cent of couples will become pregnant after one year of regular unprotected sexual intercourse at least two to three times per week. The fact that you have a child already is good and is definite evidence that you do ovulate. However, because the child is eight years old you should still be evaluated. Tests should be done to determine if your Fallopian tubes are blocked. An X-ray of the tubes called a Hysterosalpingogram (HSG) can be done shortly after your menstrual period is finished and this will give important information about the state of the cavity of the uterus and both Fallopian tubes.
If the Fallopian tubes are blocked there will be no spill of dye seen on the X-ray film. If you had an infection in the past, then adhesions in the cavity of the uterus can be detected. These adhesions can in fact prevent a pregnancy from occurring. If the Fallopian tubes are blocked, then attempts can be made to clear the tubes affected by doing surgery depending on the severity of the blockage. In severe cases, the Fallopian tubes may have to be removed and in vitro fertilisation (IVF) done.
Blocked or damaged Fallopian tubes increase the risk of an ectopic pregnancy, which can be life-threatening. An ectopic pregnancy is one which implants outside of the uterine cavity, most commonly in a damaged Fallopian tube. It is important for you to establish whether you ovulate before taking Chlomiphene Citrate (Clostilbegyt), since it is of no benefit in women who ovulate regularly. This can be estimated by doing a progesterone test 21 days counting from the first day of the last menstrual period. This is a simple blood test that is widely available. If you have put on excessive weight, then weight loss with an appropriate diet and regular exercise will definitely improve your chances of ovulation and pregnancy.
The semen analysis for your partner is definitely abnormal. The count is extremely low at four million and the movement of the sperm is extremely sluggish. There is also evidence of a definite infection on board as evidenced by the large number of pus cells.
It is important for your partner to take the antibiotics prescribed by your doctor. He will also need additional antibiotics to cover Chlamydia infection since this is a possible cause of the low sperm count and slow motility. You should also have an endocervical swab done to screen for Chlamydia and Gonorrhoea. These two infections can cause significant damage to the Fallopian tubes and scarring of the lining of the uterus (Asherman’s Syndrome) which will prevent you from becoming pregnant. You will also need to be treated with medication to cover both Gonorrhoea and Chlamydia. In the presence of significant infection, screening for other sexually transmitted infections should be done. This includes doing a test for Human Immunodeficiency Virus(HIV), Syphillis (VDRL), and Herpes Virus type II (HSV2). This is important since these can have significant consequences for the unborn child. Treatment can make a significant difference in reducing transmission to the foetus. Lifestyle changes with safe sexual practices will definitely decrease the risk for all involved. If your partner consumes excessive alcohol, smokes cigarettes or marijuana, this can reduce sperm production and motility. Working in conditions of extreme high temperature can also decrease sperm production. Truck drivers and chefs who are exposed to high temperatures from truck engines or stoves over prolonged periods can have reduced sperm production. Taking hot showers and wearing tight underpants, using saunas, hot tubs and sitting for long periods of time can cause a reduction in sperm production and motility.
Ninety per cent of male infertility cases are due to low sperm count, poor sperm quality or both. If the number of sperm in your semen is low it decreases the chance of fertilisation. The sperm count is considered low when there are fewer than 15 million per milliliter of semen or fewer than 39 million in each ejaculate.
Your partner needs to be properly evaluated by a urologist who will do a detailled examination and further investigations to determine if there are other factors other than infection which are contributing to your infertility. Consult your gynaecologist who will advise you further and make the appropriate referral. 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.
