Q: Dear Doctor, please can you give me guidance on the issue of (secondary infertility and uterine fibroid impression) as diagnosed. Please, I once had an abortion which was not my intention. After a year, I began to feel something in my lower abdomen but later I discovered it wasn’t pregnancy. I discovered a swelling on the lower part. I’m fed up going from one hospital to another. I need a direction on what to do. Thanks
A: Secondary infertility is very common, but not often talked about. Even when women present themselves to the hospital, they don’t come out straight to let the doctor know what actually brought them to hospital, and rather list a series of symptoms most often, unconnected to their primary (main) concerns. Secondary infertility is the inability to become pregnant, or carry a pregnancy to term following the birth of one or more children. There however has to be frequent (at least three times a week), unprotected intercourse for a period of at least one year (six months for women older than 35), for this definition to be complete.
The causes include impaired sperm production (quantity and/or quality), erectile dysfunction, or new disease conditions in males. In females the causes include tubal damage (that is damage to the tubes from infections or adhesions in which case certain body surfaces stick together following surgery), ovulation problems (menstrual abnormalities), uterine conditions (infections from complications during a prior delivery, retained placenta, or a miscarriage which wasn’t properly cared for), complications from previous pregnancy(excessive bleeding following delivery) and changes in you or your partners’ risk factors; like changes in age (increasing age), weight, smoking and use of certain medications or disease conditions.
Fibroids may or may not cause inability to have a pregnancy. It depends on size and position. Big fibroids in the area of the womb where a baby is meant to implant may cause a miscarriage or indeed, failure of the fertilized embryo to implant. Your doctor will take a decision on what to do with the fibroids based on size, symptoms etc
Fibroids develop from the muscle tissue of the uterus (womb). These growths can range in size from seedlings to big masses. They are differentiated by the sites where they are found: inside the cavity of the womb (sub-mucosal), within the muscle of the uterus (intramural), on the surface of the womb (sub-serosal). Fibroids do not cause infertility per se, but sub-mucosal ones in the cavity of the womb, can take up the place where a baby would have implanted causing infertility. Fibroids can also distort the shape of the ovaries and fallopian tubes causing problems with conception.
Hormones are implicated in the development of fibroids as when women get to menopause with resultant decrease in the level of circulating hormones, estrogen and progesterone, the fibroids shrink. Fibroids are more likely to occur in black women, people who take alcohol, people with a family history, people who eat a lot of red meat and little vegetables.
Symptoms of fibroids include heavy menstrual bleeding, prolonged menstrual bleeding, frequent urination as the mass presses on the bladder, feeling of incomplete emptying of the bladder, pelvic pressure etc. Pain can also result in fibroids when a fibroid has a stalk and gets twisted or when the fibroid grows so fast that it outgrows its blood supply lead to its ‘death’.
Fibroids can co-exist with pregnancy in which case pregnancy may be normal or associated with breech pregnancy, pre-term delivery (delivery of pre-mature babies) etc. However, once a woman registers in a good antenatal center under a good obstetrician, these issues will be anticipated and addressed promptly.
Find a hospital with a good Obstetrics and Gynaecology specialist. The closest teaching hospital to you may be a good place to start your search. He will examine you properly and advice on the best course of treatment for you.
All the best!