Dealing with a Diagnosis
Understanding how some reproductive conditions affect your chances of conceiving
Many women who suffer a miscarriage or ectopic pregnancy want to jump back into action and try to conceive again fast. They are often frustrated by being advised to wait for three months.
One of the ways to document the complete resolution of an ectopic pregnancy, as with a spontaneous abortion or miscarriage, is by the levels of HcG (pregnancy hormone) going down to zero. Furthermore, your body will probably not ovulate well until the HcG is gone.
Most women will begin menstruating again sooner than 12 weeks, but the first period may be weird—early or late, light or heavy. It won’t be until you get your second period that you’ll know you’re back to normal cycling again. Still, becoming pregnant before the HcG goes down to zero from the previous pregnancy leads to much confusion: Is the new rising HCG because of a new pregnancy? Or is it that the ectopic pregnancy still has some viable tissue, indicating a continuing dangerous process? Doctors try to keep things clear by separating the two pregnancies from each other: The previous ectopic pregnancy and the hopefully ensuing intrauterine one. In that way he or she can use HcG levels to monitor the resolution of the first with the fetal well-being of the second.
Only One Fallopian Tube
Sometimes women with ectopic pregnancies have to have one fallopian tube removed. And some women are born with or develop only one functioning tube.
Having one fallopian tube removed will make it less likely for you get pregnant in the short term, but as time goes on and there are more ovulations on the side where your remaining tube is, your chances of conception increase—ultimately to the same pregnancy rates as those with both tubes. Your biggest risk in conceiving after an ectopic pregnancy, says Dr. DiLeo, is that whatever made you prone to the first ectopic pregnancy (old infection, scarring, etc.) may also be present in your remaining tube. Check with your doctor about what shape your remaining tube is in.
If you have only ever had one tube, again the longer you try to conceive, the better your chances. It is just a matter of raising the odds of having had more ovulations take place on the side with the tube over a longer period of time. Unfortunately, ovulation kits cannot determine which side you ovulate from; if you retain both ovaries, they “race” to ovulate first, the other falling in function when one has “won.”
Only One Testicle
Some men have lost one testicle to cancer, testicular torsion, accident, or an undescended testicle.
Removing one testicle does not impair fertility or sexual function. The remaining testicle can produce sperm and hormones adequate for reproduction. But that doesn’t exclude a man from having other unrelated fertility concerns. Or, if the loss of the testicle was from cancer, there are related fertility complications. Sometimes the disease will have curtailed sperm production, but if not, doctors frequently advise banking some sperm before undergoing invasive procedures, including surgery, radiation, or chemotherapy.
What are your chances of getting pregnant if you have a tubal ligation, and later decide that you want it reversed?
Reversing a tubal ligation is not as simple an operation as “untying tubes” sounds. It requires exquisite surgical technique and is also very expensive; insurance rarely pays for it. “Even if you do get the tubes reconnected,” points out Dr. DiLeo, who is not a fan of tubal ligation, “there’s scarring at the junction where they were repaired, enough of a rough spot where a fertilized egg can get hung up on its way to your uterus.” This means an increased risk of an ectopic pregnancy, which may end up being a surgical emergency leading to loss of the tube, blood, and even life.
He also cites “post tubal syndrome,” in which some but not all doctors believe, where the blood supply to the ovaries is damaged, leading to faulty hormonal regulation and therefore faulty ovulation. Fixing the continuity of the tubes later won’t help the ovaries work better; the best tubes in the world don’t benefit from bad cycles.
With the advent of assisted reproductive technologies, such as intrauterine insemination (IUI), GIFT, and ZIFT, you can bypass the uncertainty of the tubes for the more controlled uncertainty of the laboratory. Before reversing the tubal ligation, check with your doctor for a referral to an infertility specialist. If your tubes have been ligated and you really want a baby badly, then it’s a bargain at any price. And the results are getting better and better, says Dr. DiLeo.
Reversing male sterilization (vasectomy) is a bit less problematic. A vasectomy reversal rejoins the vas deferens, which has been snipped and cauterized. It is performed under light sedation with the aid of a microscope. Pregnancy rates following a vasectomy reversal are generally over 50 percent, says Dr. Michael M. Alper, of Boston IVF. A major factor that impacts fertility following the reversal is the time elapsed since the vasectomy was performed (the less time the better).
At the time of the surgery a sperm sample can be aspirated near the testes and then frozen. If the surgery turns out to be unsuccessful, the sperm sample can be used as part of IVF treatment later on.
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