[Celena]

I want to have a baby

News article, "I Want To Have A Baby" Jamacian Observer

By Dr Sharmaine MITCHELL

Monday, February 22, 2010



Dear Dr Mitchell,

My fiancé and I have been trying to have a baby for two solid years now. It gets me so depressed at times and it is putting a lot of strain on our relationship because I am worried about why I can't conceive. This is the first time I have tried to conceive and I just didn't expect to have these problems. I went to my doctor who recommended that I do an HSG test. I did this and the tests showed that my tubes were OK. The doctor said that my progesterone serum level was low. What causes that and would that prevent me from getting pregnant? What is in vitro fertilisation? Is it done here in Jamaica and is it expensive?

The fact that you have been trying to become pregnant for two years now without success is significant. Usually one gets concerned after trying for one year since infertility is defined as the inability in a couple to conceive after one year of unprotected intercourse at least two to three times per week.

In order for one to become pregnant it is important for the fallopian tubes to be healthy (free from infection and any blockage), an egg must be released every month and the male partner should have a normal sperm count with good movement and normal structure. The fact that your serum progesterone level is low is significant and suggests that you do not ovulate regularly or probably not at all. The important thing is to determine the underlying cause of your failure to release an egg monthly. There are several factors that can contribute to failure to ovulate. These include:

*Hormonal imbalance such as thyroid problems or high prolactin level.

*Polycystic ovarian disease (infertility, hirsutism, obesity, insulin resistance with a tendency to developing diabetes mellitus)

*Stress

*Excessive exercise

*Dramatic weight loss or excessive weight gain

*Anorexia nervosa

*Ovarian failure with premature onset of menopause.

Women who do not ovulate tend to have irregular menstrual periods. However, in some instances, the period may be seen every month even though ovulation does not occur and so one cannot rely on the presence of a monthly period as an indication of ovulation. Women who ovulate also tend to have mid-cycle breast discomfort, bloating and sometimes abdominal cramps. There is usually a change in the cervical mucus associated with ovulation. The mucus at mid-cycle (usually 14 days counting from the first day of the last menstrual cycle) tends to be clear and thicker in consistency.

Ovulation can be induced once the underlying cause is determined and the specific problem treated. Clomiphene and Metformin are two commonly used drugs in inducing ovulation in polycystic ovarian disease. This is usually done with the help of weight loss to achieve close to the ideal weight for height. Bromocriptine can be used to decrease high prolactin levels and other hormone imbalance can be treated specifically.

In some cases the use of these drugs fails to induce ovulation and more powerful drugs have to be used, usually with good outcome. In ovarian failure, donor eggs can be used and the outcome is usually good since eggs from a young donor are usually chosen. In vitro fertilisation is a procedure that is usually utilised in couples who fail to conceive in the normal way. The egg is taken from the woman after stimulating the ovaries with medication to cause several eggs to mature and then the sperms are collected from the male partner. Fertilisation is then carried out in a special lab by a trained embryologist and infertility specialist. The embryo is then transferred back into the uterus. Sometimes the egg and the sperms are transferred into the tubes where fertilisation is allowed to take place and pregnancy continues as usual.

In vitro fertilisation is done in Jamaica at the Hugh Wynter Fertility Management Unit at the University Hospital of the West Indies. The facility is similar to that in first world countries with equally good results and the cost is significantly less than that in places like the USA. You should have your gynaecologist do further tests to determine the cause of your low progesterone levels. Your partner will also need a semen analysis. If there is no success with ovulation induction or if your partner has a low sperm count or the motility is low then in vitro fertilisation should be considered. Ask your gynaecologist to refer you to one of the infertility specialists at the University Hospital of the West Indies who will advise you further.

Best wishes.

Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@ jamaicaobserver.com; mail c/o Jamaica Observer, 40-421/2 Beechwood Ave, Kingston 5; or fax to 968-2025. See responses to your questions in All Woman. We regret we cannot provide personal responses.