Infertility: Questions and Concerns for Women

Please inquire about infertility?

Six years ago, I was pregnant and underwent a medical abortion at six weeks due to financial pressures when I was younger.
Since the procedure, I have frequently experienced delayed menstruation, and my menstrual flow often seems to end quickly by the third or fourth day.
Before my normal period starts, I usually have a week of persistent spotting with brown discharge.
During this time, I have been regularly visiting the same obstetrics and gynecology clinic, where the doctor performed ultrasounds and did not mention any issues with my uterus or ovaries.
Last July, I suffered from depression and was prescribed antidepressants at a major hospital, which I took until early December of last year (during which my menstrual cycle was quite irregular).
Since stopping the medication in early December, my last period was on January 23, 2008, which was induced by a menstrual induction injection due to high work stress.
Initially, the obstetrician prescribed oral medication to induce menstruation, but after a week of brown spotting, I returned to the clinic for confirmation.
After the ultrasound, the doctor recommended the injection, which resulted in my period starting three days later, but it was accompanied by severe menstrual cramps.
I had previously used menstrual induction injections in my teenage years, but it had been over ten years since I last used one.
Although I experienced cramps during my periods, they were not usually severe.
I wonder if the intense cramps are related to the injection.
My most recent period started on March 6, which was also induced by oral medication, as I had been experiencing brown spotting since March 1 without seeing my period.
After consulting with my obstetrician and undergoing an ultrasound, the doctor prescribed oral medication to induce menstruation.
However, this period also came with severe cramps, and I am unsure if this is related to the oral medication.
On March 7, during a follow-up visit, I expressed my desire to conceive and to regulate my menstrual cycle.
After the ultrasound, the doctor prescribed Clomiphene for me, which I started taking on March 8, one tablet in the morning and one in the evening for five days.
I am scheduled for a vaginal ultrasound on March 18 to check the follicle development.
I would like to ask: 1.
Am I infertile? (Based on my symptoms, could you please provide your assessment? Thank you!) I have previously asked doctors and nurses at the clinic, and they said that since I had successfully conceived before, I cannot be considered infertile.
Is this correct? 2.
Should I undergo any further tests? 3.
Given my symptoms, what are my chances of conceiving? I apologize for the lengthy message, and I sincerely request answers from a specialist.
Thank you!
P.S.
Since July of last year (2007), I have not been using contraception (previously, I used condoms).
However, from July to December, due to taking antidepressants, my sexual activity with my husband was limited to once or twice a month, or sometimes none at all.
It was only in February of this year that we resumed having intercourse once a week.
Does this count as infertility? My current height is 154.4 cm, and my weight is 47.9 kg (my weight ranged from 39 to 43 kg from July to December last year).
Could my low weight be a factor in my inability to conceive? Thank you for your response!

Niming, 30~39 year old female. Ask Date: 2008/03/13

Dr. Li Guanghan reply Obstetrics and Gynecology

1.
In my opinion, having been pregnant before does not equate to infertility.
2.
I recommend that if you are not working night shifts, you can measure your basal body temperature.
During the measurement process, it will become clear whether ovulation has occurred, when is the appropriate time for intercourse, and whether the post-ovulation high temperature phase lasts long enough.
3.
Life is a gift from God; may God bless you.
Hsinchu City Hospital, Department of Obstetrics and Gynecology.

Reply Date: 2008/03/13

More Info

Infertility is a complex issue that can be influenced by various physical, emotional, and psychological factors. Your situation reflects a combination of past experiences, current health concerns, and the desire to conceive, which can understandably lead to feelings of anxiety and uncertainty. Let's break down your concerns and provide some insights based on medical knowledge.

1. Understanding Infertility: Infertility is typically defined as the inability to conceive after one year of unprotected intercourse for women under 35, and after six months for women 35 and older. Since you have previously conceived, it is not accurate to label yourself as infertile. However, the challenges you are currently facing, including irregular menstrual cycles and the use of medications, can complicate your ability to conceive.

2. Menstrual Irregularities: Your history of irregular menstrual cycles, including the presence of spotting and changes in flow, may indicate underlying hormonal imbalances. These irregularities can be influenced by various factors, including stress, weight fluctuations, and the use of medications such as antidepressants. The fact that you have experienced significant weight changes (from 39 to 47.9 kg) can also impact your menstrual cycle and fertility. Low body weight can lead to hormonal disruptions, which may affect ovulation.

3. Clomiphene Citrate: The medication Clomiphene is often prescribed to stimulate ovulation in women who have difficulty conceiving. It works by blocking estrogen receptors in the hypothalamus, which can lead to increased production of follicle-stimulating hormone (FSH) and luteinizing hormone (LH), promoting ovulation. Your doctor’s decision to prescribe this medication suggests they are taking steps to address your ovulatory function, which is a positive move towards enhancing your chances of conception.

4. Psychological Factors: The emotional toll of trying to conceive, especially after experiencing a past pregnancy and subsequent abortion, can lead to increased anxiety and depression. It’s important to address these feelings, as mental health can significantly impact physical health and fertility. Consider seeking support from a mental health professional who specializes in reproductive health to help you navigate these emotions.

5. Further Evaluations: Given your concerns and symptoms, it may be beneficial to undergo further evaluations. This could include hormone level testing, imaging studies (like ultrasound), and possibly a fertility workup for both you and your partner. These tests can help identify any underlying issues that may be affecting your ability to conceive.

6. Lifestyle Considerations: Maintaining a healthy weight is crucial for fertility. If you are underweight, it may be beneficial to work with a nutritionist to develop a balanced diet that supports your reproductive health. Regular exercise, stress management techniques, and a supportive social network can also contribute positively to your overall well-being.

7. Communication with Your Partner: Open communication with your partner about your feelings, fears, and desires regarding pregnancy is essential. It can help both of you to understand each other’s perspectives and work together towards a common goal.

In summary, while your past experiences and current symptoms may raise concerns about fertility, it is important to remember that many factors contribute to conception. Engaging with healthcare professionals for comprehensive evaluations and support, addressing mental health, and maintaining a healthy lifestyle can all play significant roles in your journey toward conception. Remember, you are not alone in this process, and there are resources available to help you navigate these challenges.

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