ASK DOC: I’m off the pill, but I can’t conceive

I have been off the pill for nine months now, yet I am still unable to conceive. My gynaecologist put me on fertility drugs but they haven’t worked. PHOTO| FILE| NATION MEDIA GROUP

Dr Flo, I am 33 years old. I have been off the pill for nine months now, yet I am still unable to conceive. My gynaecologist put me on fertility drugs but they haven’t worked. Someone advised me to have my hormones checked for imbalances, which I did, but nothing unusual was found. I was also told to have a HSG scan to check if my tubes are blocked. I am stressed and worn out. Kindly advise me on the way forward. Thanks.

Millicent

Dear Millicent,

It is not automatic that you will conceive when not using contraceptives, even when there is nothing wrong with either of the partners. In fact, medically speaking, concerns about fertility arise after one year of regular unprotected sexual intercourse. You should therefore allow yourselves at least a year before you begin to worry.

For some women, the body may take some time to recover after using contraceptives. This means that it may have taken a few months before your body recovered from using the pill, and so you were not able to conceive during that time. The fact that you are already feeling stressed and worn out also may interfere with your ability to conceive.

About 15 per cent of couples are unable to conceive after one year of trying. Of these, a third of the time the problem is in the woman, a third of the time, the problem is in the man, and in the other third, both partners have a problem, or no problem can be found at all.
In women, infertility can be caused by abnormal ovarian function, hormonal disorders, fallopian tube obstruction and abnormalities of the uterus. Some factors that can increase the risk of infertility are alcoholism, smoking, obesity, severe weight loss, extreme physical or emotional stress, and being over 35 years of age.

In men, infertility can be caused by a disruption of the function of the testicles, ejaculatory dysfunction, hormonal disorders and genetic disorders. Some factors that can increase the risk of infertility include diabetes, alcoholism, smoking, use of steroids, injury to the testicles, being overweight or exposure to some drugs, toxins or radiation.

Wait till you reach the threshold of one year, then see one, not multiple gynaecologists, and preferably see a reproductive endocrinologist/endocrine gynaecologist. He or she will do a pelvic ultrasound to check the pelvic organs, a hysterosalpingogram (HSG) to check the fallopian tubes and a hormone profile to check the hormones.

Your partner may need to have a seminalysis and a hormone profile. Treatment will be prescribed depending on what is found. For example, you may be given medication to facilitate ovulation or to control hormones, you may need surgery if there is scarring, endometriosis or if the fallopian tubes are blocked. Your partner may also be put on medication. You may also benefit from assisted conception through intra-uterine insemination or in vitro fertilisation.

Dr Flo, I am a 30-year-old man. I recently had a urinary tract infection (UTI). I took medication and the infection cleared. Now I produce a white smelly liquid often, though I don’t feel any pain. This has gone on for a month. What am I ailing from?

Kaka

Dear Kaka,

Having a white, foul smelling discharge from the urethra means that you have an infection, even though there is no pain. It may be due to chlamydia, trichomoniasis, or other bacterial infections. It may also be due to gonorrhea. Most likely, you acquired the infection through sex with any of the partners you have had in the past three to six months.

If it is not treated, the symptoms may reduce with time, though the infection will still be present. The danger with this is that the infection can spread to the testicles and the rest of the reproductive tract and in the long run, can lead to infertility. The infection can also spread to the rest of the body, causing serious illness. Moreover, any time you have unprotected intercourse, you can spread the infection to your partner. In women, this can lead to infection of the reproductive tract and pelvic organs, and lead to fertility problems.

You need to see a doctor for examination immediately. A sample of the urine and the discharge will be taken for analysis and culture. You also need a chlamydia test and a HIV test. You will be given antibiotics to treat the infection, depending on the results.

Abstain from sexual intercourse until you have completed treatment, and you have been retested and found to be cured. Any partners you have had in the past three to six months also need to be tested and treated, for their own health’s sake, and to prevent them from re-infecting you.

Dr Flo, my son sweats so much on the hands and feet. Should I be worried?

Catherine

Dear Catherine,

Sweating is one of the ways the body regulates excessive body heat. When the sweating is too much, in excess of what is needed for temperature regulation, it is called hyperhidrosis. Hyperhidrosis can affect the whole body or specific sites e.g. the face and head (craniofacial hyperhidrosis), the palms (palmar hyperhidrosis), the armpits (axillary hyperhidrosis) or the feet (plantar/pedal hyperhidrosis).

Excessive sweating is not considered dangerous. However, the constant wetness of the palms and feet makes it easier to get other skin conditions like fungal infections, eczema and even cracking. Excessive sweating in most cases is due to overactive sweat glands, due to miscommunication from the nerves. In a few people, there may be other health problems like hormonal disorders, blood sugar disorders and anxiety.

Your son should take a lot of water and wear cotton socks and leather shoes. He can change socks and shoes halfway through the day, if possible, and change to open shoes in the evening. He can also apply aluminium chloride/chlorhydrate solution, prescribed by the doctor or from a chemist, to the palms and soles. If the sweating continues to be excessive, he can be seen by a dermatologist, for iontophoresis, which means that a mild electric current is passed to the feet and the hands through water. Some medications or injections may also be prescribed for the condition.

Because the sweating may be triggered by emotional responses e.g. anxiety, fear and excitement, it would also be beneficial to learn relaxation techniques to help reduce the sweating.

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