Monique Rainford - HER HEALTH

Dear Dr. Rainford,

I am interested in knowing what are my chances of having the ability to conceive again. I am 34 years old and I have a 14-year-old son. I have had laparoscopic surgery in the past to confirm findings of endometriosis; following surgery confirming salpingitis. I have been infertile for two years. My physician requests in vitro fertilisation (IVF) but my husband and I are unable to afford the expense of the procedure. What other hopes exist in such a case as this?

Dear Reader,

I am sorry to hear about your predicament. Unfortunately, you have two different problems that can each affect your fertility. Endometriosis is a condition in which the type of tissue that grows in the lining of the uterus grows in other locations in a woman's pelvis such as her ovaries, the ligaments that support her uterus and the membranes that line her pelvis and covers her abdominal and pelvic organs.

The cause is not known but it is believed that it results from backward flow of menstruation through the fallopian tubes during a woman's period. Therefore, women who have their first period at a younger age, have longer periods or have periods more often are more likely to have this condition since they are more often exposed to menstrual flow. Women with endometriosis most often have pain in their pelvis but they may also have back pain, pain with intercourse or pain with urination or defecation. The pain usually begins about one and a half to two days before the period begins and decreases when the period ends. However, about one third of women with this condition have no symptoms.

One study has shown that about 15-20 per cent of women, as in your case, have infertility (the inability to get pregnant). This condition causes infertility partly because it may cause scarring in a woman's pelvis that affects the normal position of her pelvic organs and the ability of the eggs to be released from the ovaries and to be collected by the fallopian tubes. The condition also seems to affect the quality of a woman's eggs.

For women whose anatomy is severely affected by endometriosis, surgery may improve their chances of getting pregnant.

Infected fallopian tubes

This may not be an option for you because you also mentioned that you have salpingitis. This is inflammation of the fallopian tubes that is usually caused by an infection. Salpingitis is also known as pelvic inflammatory disease. I assume that the HSG (hysterosalpingogram - a dye study of the tubes) showed that the tubes were occluded or blocked which may have resulted from an infection in your past. With this combination, I have to agree with your physician that IVF is your best option.

The technique of IVF involves taking a mature egg from a woman's ovary and placing it in a special sterile growth solution. The egg is usually extracted through a woman's vagina using an ultrasound to determine its position. Sperm which are separated from the semen are then added to the solution containing the eggs and they are allowed to fertilise them. If an egg or eggs are fertilised, they are allowed to grow for a few days and are then implanted into the woman's uterus.

About 25 per cent of woman will have a baby after a successful IVF cycle but this number decreases with increasing age of the woman. Women who use this technology are also more likely to have multiple gestations (twins, triplets etc.) Unfortunately, I am unable to recommend any other option for having another biological child. In vitro fertilisation is performed at the University of the West Indies.