Reversal of sterilization

Question: I don’t have any insurance to pay for this .Are there any insurance plans that I can get on or I can pay for some insurance so that maybe I can get surgery to get my tubes unblocked? I’m willing to pay a monthly fee for insurance. I have been searching on the internet and I haven't found no insurance . I do have Medical so do you know any doctors that can help me? I’m 52 years old and I still have a period. Thanks I sure hope that you can help me. C.M. (USA)

Answer: I am assuming you were sterilized in the past hence your quest for ‘unblocking’ your tubes. That would also suggest that you want to conceive. I’m going to give you a completely different advice. It might disappoint you but it is my honest professional opinion.

You might be having periods still at the age of 52 but that does not mean you are able to conceive or do so easily. Spontaneous conception for women over 50 is extremely uncommon; even rare. For those who spontaneously conceive, the risk of pregnancy loss is also quite high because of inherent risk of fetal abnormalities, usually chromosomal or genetic. The simple fact is, at 52 your ovulation, if it is taking place at all, would be quite erratic, probably occurring 2 or 3 times a year. Even when you ovulate, the quality of the eggs is likely to be quite poor meaning possibility of conception is not good and even when you overcome those odds, the baby would likely have a chromosomal or genetic disorder, often lethal and incompatible with life. All this is not meant to discourage you; only to make you look at things dispassionately and rationally. So, what is the practical advice I’m giving you? The easiest first thing you could do at this stage to give yourself clarity is to do the simple progesterone hormone blood test to check for ovulation. This is carried out in the so-called ‘luteal phase’ of the cycle (the beginning of the final week). It is very reliable and it will tell you whether or not you are ovulating. If it shows that you are not, you can then abandon your quest for tube unblocking surgery as that will not serve any purpose. If you are shown to be still ovulating, your best way forward is to pursue IVF if you want to use your own eggs. That has a higher general success rate than reversal of sterilization for the older woman. If you do not have any good quality eggs, then your final recourse is still IVF but using donor eggs. I hope that is of some help.

Prolonged pregnancy

Question: Is it possible for a woman to be pregnant for almost 20months or 2yrs? and why? F. (Canada)

Answer: it is not possible for a human pregnancy to carry on for that length of time. The placenta is simply incapable of sustaining a baby beyond, at most, 44 weeks (just under 10 months). With that finite functional life of the placenta which is wholly responsible for fetal sustenance, if delivery does not take place, the baby will die in the womb. Over 60 years ago, there was a report in the United States of a woman, Mrs Beulah Hunter, from Los Angeles whose pregnancy was said to have lasted an incredible 375 days. That is just over a year. Delivery was in 1945 but those were the days when there was no pregnancy tests as we know them today let alone an ultrasound scan.

An explanation for this is probably quite simple that Mrs Hunter was pregnant, had a miscarriage and conceived again probably within a few weeks and, crucially, before her periods had resumed. In other words, two pregnancies might have merged into each other to the outside world.

Vaginal bleeding in early pregnancy

Question: I’m about 5 weeks pregnant and I’m bleeding. S.

Answer: You are probably trying to find out ‘why’ you are bleeding. It is really not possible for me, or indeed anybody, to answer that question. Bleeding in early pregnancy is unfortunately quite common. In some cases, this heralds impending miscarriage. In most cases, it is a short-lived self-limited scare. The first thing you should do, if you haven’t done so, is to confirm that you are indeed pregnant. A positive pregnancy test will do that. If it is positive, get to see your doctor straight away. He/she will then contact the early pregnancy assessment unit at your local hospital where an urgent review, usually within 24 hours, will be arranged. 5 weeks is rather early and a scan may still give unclear results but that will be the least that will be arranged. If the overall picture gives a rise to a suspicion of other early pregnancy complications such as an ectopic pregnancy, a blood test may be done also. Best wishes.

Vaginal bleeding at 6 weeks pregnant

Question: I'm six weeks pregnant and started bleeding no pain no clots just really bright blood started yesterday still have today but very light bleeding. Have i lost the baby ? A. (Ireland)

Answer: Your problem is similar to the one answered immediately above. Bleeding in early pregnancy, especially if painless, should be treated as a case of ‘threatened’ miscarriage until proven otherwise. The only way you get that clarity is by having an ultrasound scan. This is, regardless of whether the bleeding has stopped or not. Of course if the bleeding gets heavier or you develop pain, that would not be a good sign and should be treated as an emergency.

Two miscarriages and a stillbirth: Is there a connection?

Question: Hello. My wife had a miscarriage in Jan 2008 when she was about 1 month pregnant. Prior to that another Doc had said she had hormonal imbalance and without laparoscopy she would not be able to conceive. So, we proved the first doctor wrong when she got pregnant, only unfortunately, to miscarry in Jan 2008.She again conceived in late 2008 (her first period date was I think 18/Nov/2008 (due date 25/Aug/09). She lost the baby in the womb on 9/Aug/2009 due to IUGR because Doc could not judge or interpret the situation correctly. She conceived again in 2010 - first day of period was 6/6/10. First U/S was okay in it gave a due date of 15/Mar/11. She miscarried after an U/S confirmed that on 28/Aug/10. I want to know what's going on if she will have a successful pregnancy again in future. She is 36 now. Can the 3 failed pregnancies be linked to get to the root of the cause? I understand that different doctors will have different opinions and interpretations. Many Thanks. H. (Kenya)

Answer: A quite heart rending story. There is a real possibility the events in these pregnancies are connected but that is far from certain. I am not sure what your wife’s first doctor meant by saying pregnancy wouldn’t happen without laparoscopy. I can only guess that perhaps your wife had features of polycystic ovarian syndrome (PCOS) and the doctor was offering to perform ovarian drilling. In any case, that is academic as your wife has managed to conceive three times. The two miscarriages could be a sign of an underlying antiphospholipid syndrome (APS) which also, incidentally, can cause intrauterine growth restriction (IUGR) and even stillbirth. I have made a lot of assumptions with the limited information I have but if we were to look for a possible common cause, that will certainly be a prime candidate. I would suggest that, if facilities allow, your wife should have tests done to actively establish or rule out APS before she starts trying again for a baby. If this is not possible, it may be worthwhile just to go ahead and take daily low-dose (75mg) Aspirin as soon as a pregnancy is confirmed. This can’t do any harm but has a potential of doing a lot of good. Aspirin should not be taken in the pre-conception phase. I do really hope things work out for you and your wife soon.