I can’t get pregnant

Dear Dr Mitchell,

I am a 42-year-old woman who has been trying to get pregnant for the last three years. I have had three abortions and I’m not sure what is happening. I am wondering what I should do and what are the necessary steps I can take to correct what has happened.

The fact that you have tried unsuccessfully to conceive over the last three years is significant. Approximately 90 per cent of couples will become pregnant after regular sexual activity two to three times per week for one year. Fertility declines significantly with advanced maternal age over 35, and definitely by age 40 your ovulation patterns fall off dramatically.

Your history of having had three abortions is also important, since complications during the procedure can lead to damage to the lining of the uterus and the Fallopian tubes resulting in an inability to become pregnant.

Infection can also be a risk factor, and overzealous scraping of the lining can lead to damage causing adhesions within the cavity of the uterus and subsequent infertility. It is also possible that you could have picked up a sexually transmitted infection which could have resulted in inflammation of the Fallopian tubes and subsequent blockage of the tubes, and hence your inability to conceive.

Occlusion of the Fallopian tubes and adhesions within the endometrial cavity can be suspected on an abdominal or transvaginal ultrasound. However, an X-ray of the Fallopian tubes and the cavity of the uterus (hysterosalpingogram) should be done to confirm this problem. This is usually done at the end of a menstrual period.

If the Fallopian tubes are blocked, then surgery can be done to relieve the blockage if it is not extensive, or in vitro fertilisation (IVF) can be done. Adhesions within the cavity of the uterus can be removed by a surgical procedure, and then an intrauterine contraceptive device (IUCD) can be inserted to keep the walls apart while using hormones to promote regrowth of the lining of the uterus.

At age 42 you need to have a blood test done to check your baseline progesterone production on day 21, counting from the first day of your last menstrual period. If this confirms that you are not ovulating, then ovulation induction medication can be prescribed to improve your outcome.

Of course, the problem might rest entirely with your partner. He needs to have a complete physical examination and a semen analysis to determine whether he is fertile.

Consult your gynaecologist or family physician, who will advise you further and make additional recommendations.

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. 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.