Yearning to get pregnant
Dear Dr Mitchell, I want to know if you can help me to get pregnant. I used to take contraceptives and I see my period regularly, but it seems I’m not ovulating. I even have sex on fertile days and still no change. I would love to get pregnant. What can I do?
The inability in a couple to conceive after having regular sexual activity two to three times per week for one year should definitely be properly investigated. The fact that you have regular menstrual periods does not mean that you release eggs regularly. It is important for you to get a blood test to check your progesterone level on day 21 to see if you are actually ovulating. It is also important to check your anti-mullerian hormone levels (AMH) to see if you can produce eggs of any significant quantity. This is especially important if you are over 35. Ovarian function significantly starts to decline after 35 years and even more so after 40 years old. If you produce eggs but do not ovulate regularly, then drugs can be prescribed to help you to release eggs regularly and increase your chance of becoming pregnant. If your egg reserve is low, then you can still become pregnant by doing in-vitro fertilisation and using eggs from a donor and the sperm from your partner. Most in-vitro fertilisation units can match you with a suitable donor if you do not have one of your own.
Blocked tubes can also be the problem preventing you from becoming pregnant. Pelvic infection from chlamydia or gonorrhoea is a common contribution to this problem. These infections, especially chlamydia, can be silent and show no significant symptoms but cause extensive damage to the Fallopian tubes. You should get a cervical swab done to rule out infection from chlamydia or gonorrhoea and do an X-ray of the Fallopian tubes to determine if the tubes are blocked. This is called a hysterosalpingogram (HSG). This test is usually done at the end of a menstrual period. A pelvic ultrasound should be done to rule out uterine fibroids and ovarian cysts. This ultrasound will also help to rule out abnormal growths in the cavity of the uterus that can interfere with you becoming pregnant or maintaining a pregnancy.
In up to 20 per cent of couples, the problem with the inability to become pregnant is due to the male partner. This is the case even where he has had children before, especially if the child is over two years old. A complete semen analysis should be done to check on the sperm count, movements and also to determine if the sperm are normal. Smoking, especially marijuana (ganja), wearing tight underpants, exposure to extremely high temperatures, chemotherapy drugs and infections including chlamydia and gonorrhoea can significantly affect the sperm count and motility. Your spouse should get a complete physical examination and a semen analysis done to ensure he is not the problem. If the count and motility is significantly low or if he does not have any sperm, then donor sperm can be used to achieve a pregnancy by artificial insemination or in-vitro fertilisation.
There are a lot of options available these days in having a baby. The option of using a surrogate (another woman) to carry the pregnancy to term or adoptions are also possibilities to consider if the other options do not work out. You should take folic acid supplements and lose weight if you are overweight.
Consult your doctor who will investigate you and your partner thoroughly and advise you further.
Best regards.
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.
