I want to be assured that I can have a baby
Dear Dr Mitchell,
Are there any tests that I can do to know if I am fertile, before I get pregnant? I am getting married in a few months and we want to have children; however, in my last relationship (five years), I never had a pregnancy scare even though we did not use protection at all. I want to be assured that I can have a baby with my husband before marrying him, as I’d not want to disappoint him or force him to marry someone who is infertile.
Most couples (85 to 90 per cent) who are sexually active two to three times per week will conceive within one year. Approximately 15 per cent of couples will need to have investigations done if no pregnancy takes place after trying regularly for a year. The fact that you were in a previous relationship and you were sexually active without contraception for five years without becoming pregnant is significant. The problem could also actually be related to your spouse and so both partners have to be investigated.
The important thing to establish is whether your Fallopian tubes are blocked and whether you are releasing an egg every month. It is also important to determine your ovarian reserve.
Sexually transmitted infections such as chlamydia and gonorrhoea can cause significant damage to the Fallopian tubes and prevent pregnancy from occurring. This tends to be severe if the infection is picked up and treated late or if the infection is recurrent. An X-ray of the Fallopian tubes (hysterosalpingogram) can be done to determine if the tubes are blocked or damaged. A pelvic ultrasound should also be done to look at the ovaries and the uterus. This can help to detect polycystic ovaries, fibroids and adenomyosis.
Women who ovulate have regular predictable cycles. This usually occurs every 28 days or range from 21 to 35 days. However, to confirm ovulation you can do a blood test to check the progesterone level on day 21 of the cycle, counting from the first day of the start of the menstrual period. If the progesterone level is low then you will need to get medication to help you to establish frequent ovulatory cycles. In addition to the day 21 progesterone you should also do your thyroid function test, prolactin level, luteinizing hormone, and follicle stimulating hormone level tests. These will help to rule out polycystic ovarian disease, ovarian failure and thyroid problems that can contribute to your inability to become pregnant. The Anti-Mullerian Hormone test can also be done to determine your ovarian reserves especially if you are 35 years and older. As you get older your pool of eggs tends to decline rapidly and so timing is important.
It is a good practice to get a full physical examination and a Pap smear done as a part of your premarital preparation. Screening for sexually transmitted infections should also be done by both you and your partner. If you have not received the vaccine for prevention of cervical cancer then you should contact your doctor about obtaining the three doses to reduce your risk of cervical cancer.
Your spouse is also a key player in this since he might also have issues that can affect his sperm production and sperm quality, thus preventing pregnancy. If he is serious about having children then you could encourage him to do a semen analysis.
It is important to realise that there are several options available to you both if you want to become pregnant. Invitro-fertilisation can be done if the Fallopian tubes are blocked and cannot be repaired by doing surgery. If you do not ovulate regularly then ovulation can be stimulated by the use of appropriate medications. If your ovaries have failed and you do not have any eggs then you can get donor eggs and do invitro-fertilisation using your partner’s sperm. If he does not have any sperm then donor sperm can be used. If there are problems with your uterus and you cannot carry a pregnancy, then you can employ the services of a surrogate mother to carry the pregnancy for you. Adoption is also always a feasible option if you are both committed to having children.
You should both consult your doctor and have a proper physical examination and appropriate investigations done. If you are both committed to having a lifelong relationship then you have several options available to both of you.
Congratulations on your wedding plans and I pray that you will have a happy marriage filled with many children.
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 Avenue, Kingston 5; or fax to 876-968-2025. 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.
