Infertility

Everyone here wants babies.  Lots of them.  And while I don’t have the numbers to prove it, the number one complaint here is infertility. Of course, no one comes to gyn clinic complaining of infertility.  Rather, they complain of lower abdominal pain.  So, even if today’s complaint is not infertility, looking back over just about any woman’s record you will see “LAP.”  As one of the doctors here told me, infertility is a medical complaint and a complaint must have a symptom, so the manifested symptom here is lower abdominal pain.

The office where I do my consultations

When I ask them about this LAP the women describe daily cramping and shooting pains, radiating to the back.  But, they say it doesn’t stop them from doing any of the things they like to do.  And though this population is far more stoic and tolerates far more pain than the population I see in the US, for many of these women I get the sense that this is the pain that they think they should be having, more than what they are actually experiencing.  I offer them analgesics, and they are almost always refused.  They want to be pregnant, not pain relief. 

The women range in age from 18 to late 40s.  They are married and unmarried.  Many have been abandoned by their husbands because of their inability to produce more children.  Though, very few actually present together with their husbands.  Many have children already – 2, even 3.  But they want more – or at least the possibility of more.  

My favorite exam table

Pelvic inflammatory disease – often untreated – is rampant here.  Out test for chlamydia has been out of service for the entire time I have been here, so I treat empirically.  I order thyroid studies and prolactin levels and hope that the thyroid is deranged so that at least I have something that I can treat. 

I order imaging studies to visualize the fallopian tubes and more than half the time the tubes are occluded.  That is the end of it then.  There is no way to fix a scared down fallopian tube.  And if an egg can’t get from the ovary to the uterus, then a normal pregnancy can’t happen.

But, I have consulted on women that have already had this test at other hospitals, been told this answer, come here for repeat of the test.  The diagnosis is so damming that no one will take the answer of “There is nothing you can do,” easily.  As well they shouldn’t.  I imagine that women who get this answer at this hospital are taking themselves to other hospitals for a repeat of the same test, as well. 

It is heart breaking to tell a woman that you don’t believe that she will have children.  This is a society that (largely) bases a woman’s worth on her fecundity.  And while I can tell a woman that I think that she has value outside of her ability to be pregnant, that means very little when her husband leaves her and her society tells her otherwise.   So I treat chronic PID and order ultrasounds and HSGs and hormone levels looking for anything I can do something about.  Most times though, there is very little I can do.   It is out of my hands.