Q: Good evening doc, I had a miscarriage last year due to fibroid, I went surgery in March, now we are in July. I am not yet pregnant. What should I do?

A: Sorry to hear about your miscarriage. Take heart.

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.

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.

Please note that fibroids can also 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.

On not getting pregnant, it depends on how long you’ve been trying. There 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 to be seen as a problem.

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.

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. S/he will examine you properly and advice.

All the best!