I don't mean if you're fertile today--that's a topic for a different post. But I'm often asked by patients to check to see if they're able to have children, whether it's more kids or any at all. In order to be fertile, you need three working parts: your ovaries to regularly ovulate, your fallopian tubes to be clear to allow fertilization, and your uterus to be clear to allow implantation. Gynos can evaluate each of the three, based on your medical history, physical exam and sometimes testing.
- Ovaries. The best sign of regular ovulation is regular menstruation. If your periods are coming regularly--21 to 35 days apart--you are most likely ovulating. Longer or shorter periods could signify thyroid or pituitary dysfunction, which can be diagnosed through blood testing. Gynos can also evaluate the general state of your eggs, or "ovarian reserve," through specialized blood testing on day three of your period.
- Fallopian tubes. Scarring of the tubes sometimes occurs with pelvic inflammatory disease, endometriosis, or pelvic surgery. Your doc can order a special X-ray of your tubes called a hysterosalpingogram (HSG) if she suspects tubal blockage. If a blockage is found, there are multiple procedures that can be performed to clear the path.
- Uterus. Uterine anomalies like a septum, polyp or fibroids can impede a pregnancy's implantation. Often these anomalies don't cause any trouble, but if you have a history of super-heavy periods or several miscarriages, your gyno may order an HSG to check out the inner contours of your uterus. If something there is making mischief, it can be surgically removed.
If you have regular periods and you've never had any gyno woes, your
reproductive tract is likely in order. The hardest question I hear is
"Can I put off trying to get pregnant for a year or two?" While I can
determine how your gyno health is today, there's no test that can
predict what will happen in the future. In other words, I can't tell
you when you'll run out of eggs, or if another problem will develop.
The best things you can do? Stay STD-free, in the best health you
can...and when the time is right, go for it.
Do any of you have fertility concerns?
My question is about my daughter (I managed to have triplets while I was on the pill, so my fertility isn't in question)
My daughter had cancer (germ cell tumour) when she was 8, which involved the removal of one ovary, one fallopian tube and 2 lymph nodes as well as a whopping huge tumour in her abdominal cavity. Her oncologist told us that his best guess was that she would still be able to have children (although he said that it was a guess). The chemotherapy regimen that she was on (BEP), apparently has no bearing on future fertility although it's likely that she will face kidney problems in her 20s.
Does the removal of one ovary and one fallopian tube affect fertility? I had assumed that it would, but her oncologist said that since no one really knows why some women get pregnant and some don't, it's pretty much a crapshoot. She's not even close to menstruating yet as far as I can tell- her chemo occurred during 2 of her twin sister's growth spurts, so we've all accepted that she's probably going to be a few years behind.
It's not a pressing issue- she's only 12 now (completely cancer free, with little likelihood of a recurrence), but as she is 12, and totally in love with babies, she is asking more frequently now if she will be able to have children.
I realize that it might be a complicated question, so I apologize if it's out of line. I do trust her oncologist completely, but it would be interesting to hear your take on it. I'd like to be able to reassure her if I could.
Jen
I'm 32 years old in a serious relationship for about a year trying to get pregnant and not having any luck. Have had a few stds in the past but was always treated also had pid once. I have a normal period was told i my uterus is tilted and have a small ovarian cyst. My fiancee and I have a strong desire for children. Dont know what my course of action should be any advice you can offer would be greatly appreciated. I fear my years of risky sexual behavior may be affecting my efforts to concive. I was pregnant once when i was 17 but i had an abortion. I've tried tracking my ovulation for the past 6 months and still no luck. What should i do?
Jen, I'm so glad your daughter is healthy. To the best of my knowledge, the chemo regimen she underwent shouldn't affect her fertility. With only one tube and ovary, it may take her longer to get pregnant, but I think you should tell her that yes, she will be able to have children.
Emma, your tilted uterus, small cyst and previous abortion should not be affecting your pregnancy chances. If the ovulation kits are positive each month, that's a good sign. But I advise my patients to go to their doctor after one solid year of trying to conceive. Your history of PID is the one worrisome thing...your gyno will likely order an HSG to take a look at your tubes and uterus to see if there are any blockages. Best of luck.
Thanks very much Dr. Kate! I appreciate the answer, and we'll all keep our fingers crossed for her.
I too had a germ cell tumour when I was 21, and I only have one ovary as well. I did chemo and survived thankfully. I was blessed to have 2 beautiful children one 6 years old and one 17 months. I was so scared that I couldn't have children but God blessed me with 2, so I would tell your daughter yes too.