Monique Rainford

Frequently women come into my office with a problem achieving pregnancy. I find it very striking and somewhat perturbing that a woman tends to blame herself even when her partner has a known problem. Some of my patients will insist that they must have a problem. Well, what are the facts?

Infertility is the inability of a couple to achieve pregnancy after one year of unprotected sex. The frequency of sex required is approximately two to three times per week.

For a couple to achieve pregnancy, a woman needs to produce an egg (or ovulate) and the man needs to have healthy sperm to fertilise that egg. A woman ovulates in the middle of her menstrual cycle or approximately 14 days before the start of her next period.

A normal couple has a 30 per cent chance of pregnancy in a normal ovulatory cycle (that is, a cycle when a woman produces an egg). About 57 per cent of couples will get pregnant after three months, 72 per cent after six months, 85 per cent at one year and 93 per cent at two years.

Between 10 and 15 per cent of couples have infertility with a range of about seven per cent for couples in the age group 20 - 24 to 28 per cent in couples ages 40 - 44. Thirty-five per cent of cases of infertility are due to a problem with the man and 35 per cent are due to abnormality of the woman's fallopian tubes (for example, 'blocked tubes') or another abnormality of her internal female organs. Fifteen per cent of cases are due to a problem with ovulation.Women with this problem may have irregular menses and may report that they sometimes have several months without periods and their pregnancy test is always negative.

Ten to 15 per cent of the time, a couple has unexplained infertility. This occurs when all the usual tests done to find a cause are normal but a couple cannot achieve pregnancy.

Dear Dr. Rainford:

I would like to answer a reader's question:

"...my name is... I'm from Jamaica, but living in the Virgin Islands. I had my daughter when I was 16 year of age, I'm now 27 years old, married to my daughter's father, and we are trying to conceive again. I was taking birth control for about 10 years straight. I stopped taking them from last year April, but still not pregnant. I visited my gynaecologist sometime this year and did some blood tests. He said that everything is fine with the test, so it seems as if I have a blocked fallopian tube, so I have to do a HSG test. Do you think that I can get my tubes clear without doing a HSG test? I know that some doctors will give you herb or other stuff to take to clear it.

I will be visiting Jamaica next month and hope to find a gynaecologist that will let me not do the HSG test. Can you please let me know? Any information you have will be great for me."

Dear Reader:

I assume that your doctor gave you a blood test to confirm that you are ovulating. Your husband should also have had a semen analysis to check if his sperm appears healthy. A hysterosalpingogram (HSG) is a test to check if your tubes are opened or blocked. You cannot be certain if your tubes are blocked if you do not do this test so, I do recommend it.

There is no scientific proof that herbs or other medicines taken by mouth can unblock tubes. In fact, evidence shows that couples are more likely to achieve pregnancy after an HSG is done. Please reconsider doing this test.

Dr. Monique Rainford is a consultant obstetrician and gynaecologist; email: yourhealth@gleanerjm.com.