Wednesday, December 9, 2009

Infertility Workup for Young Woman with Chlamydia and Previous Drug Addiction


I am 20 years old, married, and have been trying to get pregnant. About 2 1/2 years ago I became very dependant on prescription narcotics because of herniated discs in my back. I was able to get off of the pain medicine and was put on suboxone. I am taking 8mg daily of it. As for trying to conceive, I've never been on birth control pills and we have been "careful" up until 6 months ago. We have been trying to get pregnant for the last 6 months. I am starting to worry that I have some infertility issues. My periods have always been normal, but for the last 3 months they have been lasting about 10 days (when they were 5-7 before) and the first 3 or 4 days I am just barely spotting, but it is brown and really thick. Nothing I have ever experienced before. I have an appointment scheduled this month with a gynecologist, but I am embarrassed to talk to her about these issues.

I also contracted chlamydia about 3 years ago. I am scared that I may have had it for a long period of time. I was treated for it and am okay, but I have read that sometimes if you have it for a long time it can cause scar tissue and make it hard for you to get pregnant. Finally, my last question is, do you think because of the pain medication I could have become infertile? I know I will eventually have to talk to the doctor about these issues. Do you know what kind of tests they could do right off the bat knowing my history?

I think it is wonderful that you offer your time to answer these long questions :) Thank you so much!


Thank you for your question. You have several questions and issues within your note. I hope to answer each one, but if I miss any, please let me know.

You are 26 years old and that puts you in the highest fertility years of your life. Statistically, 85% of women in your age group will become pregnant by one year of trying. Anyone exceeding that time frame is considered infertile. Since you have not gotten pregnant in 3 years, it seems that there is some type of problem going on. Part of it could be your addition, but as you know, addicts get pregnant all the time. There are probably some other issues going on. Since you are off the oxycodone, I think the Chlamydia needs to be looked at. The bottom line is that you need to have a complete infertility evaluation. This can be done with a general OB/GYN or a fertility specialist. In order to not waste time, I recommend that you see a fertility specialist (someone that does ALL levels of infertility care and treatments).

Chlamydia is a silent bacteria that can damage the tubes causing blockage. If that happens, you are at risk for a tubal pregnancy (ectopic), or will not get pregnant by natural means. You would need to proceed to IVF (in vitro fertilization) if the tubes are blocked.

The basic infertility workup that I do is as follows:

1. Cycle day #2 or 3 hormone panel to check ovarian, thyroid and pituitary function.

2. Hysterosalpingogram (HSG) to check the tubes.

3. Diagnostic hysteroscopy to check the uterus, ovaries and tubes.

4. Pelvic ultrasound to check the uterus, ovaries and tubes.

5. Endometrial biopsy to check the uterine lining.

6. Semen analysis to check the male.

7. Mid luteal progesterone level to check for ovulation.

8. Laparoscopy (if needed) to check for pelvic abnormalities such as endometriosis and scar tissue.

I know that you were being careful, but the failure rate of being careful is pretty high. Since you were not on birth control pills it is a bit troubling that you have not been able to get pregnant. I think you need to undergo an evaluation. I also think you need to be totally honest and up front with your doctor. He/She needs to be able to see all the circumstances and take them into consideration. At this point, if your doctor tells you to keep trying, I would recommend you see another doctor for a second opinion. Chlamydia blocks tubes by causing scar tissue formation within. It is not surgically repairable. The only way to diagnose this is to do a hysterosalpingogram (HSG).

I hope this helps and good luck!

Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
Monterey, California, U.S.A.

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