Dear doctor;

I have a four-year-old child. It is almost three years since I stopped using the depo provera contraceptive, but I have failed to conceive. What can I do?

Jenny

Dear Jean,

It seems you are having secondary sterility, i.e. failure to conceive after bearing one child. There are multiple reasons for secondary sterility. One of them is advanced maternal age. Eggs present in a woman’s ovary are formed since birth. As a woman ages, quantity and quality of eggs reduces thus increasing chance of miscarriage or infertility. If there has been some intervention during the first delivery, there can be blocking of fallopian tubes or abdominal adhesions which can impair fertility. Adhesions can also form due to any other abdominal or pelvic surgery, thus hampering with conception. Tubes can also be blocked due to any chronic infection, including sexually transmitted ones. Any structural or functional abnormality of ovaries and fallopian tubes reduces chances of conception.

Hormonal disorders like hypothyroidism and high prolactin levels reduce fertility. Hormonal contraceptives can disrupt hormonal equilibrium which takes some time to recover after stopping its use.

If a woman becomes obese after first child birth, her fertility is reduced. This is due to the fact that levels of testosterone increase with obesity and estrogen level declines. Use of alcohol and cigarette smoking affects fertility in both men and women.

As in women, quality and quantity of semen declines in men also with advancing age, thus reducing fertility.

Wrong timing of coitus, i.e. which does not coincide with ovulation fails to result in fertilization. Stress, both physical and mental, tends to cause spasm of tubes transporting sperms and fertilized ovum in both men and women and reduces chance of conceiving.

The best option is to time your intercourse with the period of ovulation, i.e. approximately 14-21 days beginning from the first day of the menstrual period. The day of ovulation can be determined by elevation in basal body temperature, alteration in cervical mucous and serial ultrasound examination. Both partners need to be relaxed.

Eating a nutritious diet with whole grains (source of vitamin E) and regular physical exercise is useful. It is also good to quit alcohol and tobacco. Along with these measures one can also do tests for hormone levels. Any abnormality found is treatable.

Dr Rachna Pande  is a specialist in internal medicine at Ruhengeri Hospital