Q-I have been off birth control pills for six months. I want another child, but nothing has happened. I`ve read books concerning pregnancy, and it tells you about getting pregnant during ovulation. I don`t know when I ovulate.
I had a D&C about two weeks after I had a baby in 1983. Do you think something went wrong during the surgery to prevent me from becoming pregnant again? I`m not using any contraception since I stopped taking the pill. Can you tell me what the problem is?
A-Though most women begin to ovulate (release an egg from the ovaries about three to four months after stopping oral contraceptives (the pill), some take longer. About 20 percent of women who have stopped the pill take a full year to regain fertility.
The only time you can become pregnant is when you ovulate. This occurs about halfway between the first day of one menstrual period and the first day of the next menstrual flow. For example, women who menstruate every 28 days usually ovulate about 14 days after their periods start.
You need to find out if you are ovulating or not. One way to do this is to take your temperature, called the basal body temperature, first thing every morning. Ask your physician or a family planning clinic to explain how to do this accurately, how to keep a chart of the results and how to interpret the chart. Once a woman has kept these records for several months she is better able to predict on which day during each cycle she will ovulate and then have intercourse two or three days before ovulation and on the day an egg is released.
It`s important to know that even when both partners are perfectly healthy and fertile, the chances for pregnancy in any single cycle is only 25 percent. But once you and your partner have had unprotected intercourse at your most fertile time for a full year and you still are not pregnant, then it will be time to consult a physician who specializes in treating delayed fertility. It is unlikely that the D&C has affected your fertility, but that specialist can assess all aspects of your reproductive status.
Q-Recently I had an IUD inserted. I had one for three years and the time had come for a new one. After wearing the new one for a few months, I found out I was pregnant. Could you tell me how common this is? What could have caused my IUD to fail? I had no problems with either IUD as far as excessive bleeding and I could feel the string.
Also, would you suggest getting another IUD inserted? I am 30 years old and cannot use birth control pills because of high blood pressure. Or should I seek another means of birth control?
A-The IUD (intrauterine device) is one of the most effective reversible methods of contraception. Its rate of effectiveness is 97-99 percent. (This means that for every 100 women who use an IUD for one year, one to three will become pregnant.) This effectiveness rating is higher than for oral contraceptives, condoms, spermicides, any barrier method and natural family planning.
Clinicians are not always certain what causes an IUD to fail. Some reasons for failure include expulsion of the IUD (about 10 percent of women do this in the first year) and improper insertion. If you have not already done so, see your gynecologist for a prenatal examination. He or she needs to determine whether you expelled the IUD or whether both the IUD and the fetus are inside your uterus. If the IUD is still in place, you are at increased risk of miscarriage, premature delivery and other pregnancy problems.
If the string from the IUD can be seen, the IUD can be removed to reduce these risks. If the string is not visible and you continue your pregnancy with the IUD in place, your physician will tell you how to watch for symptoms of uterine infection, which are an additional problem under these circumstances. You should review other contraceptive options-such as a diaphragm, cervical cap, condoms, foam, spermicide or the ”minipill,” which contains no estrogen and a smaller amount of progestin-with your gynecologist.
Because IUDs have received a good deal of bad publicity in the last few years, some readers may wonder whether women should consider using them at all. New research has shown that the increased risk of pelvic inflammatory disease known to be associated with some IUDs occurs most often in the first four months after an IUD is inserted and when a woman has been exposed to a sexually-transmitted disease. Women who are in a mutually faithful
relationship and are not exposed to a sexually-transmitted disease have no increased risk of pelvic inflammatory disease and later infertility, especially if one of the newer types of copper IUDs is used.
Q-I am 38 years old and can no longer achieve an orgasm. It is virtually impossible to even become aroused. I feel like I`ve lost my sexuality.
In the past six months, I have visited my gynecologist and an endocrinologist for separate check-ups, and nothing was found to be wrong. Four years ago, I had half my thyroid removed because of a benign growth. I now take Synthroid daily.
Could my sexual problems be related to my thyroid or are my problems purely psychological? I am very frustrated and don`t know where to turn.
A-Your problem is one that can cause frustrations and unhappiness for you and your partner, but there are some other steps you can take.
Make an appointment at a sexual dysfunctions clinic. If you don`t know of one in your area, call the nearest university medical school or large hospital for a referral.
At a sexual dysfunctions clinic, you will be given a medical examination to determine if there is a physical cause for your problem (called secondary anorgasmia). You will consult a therapist or counselor. You haven`t mentioned your feelings about your relationship. This is important because many sexual dysfunctions involve relationship issues rather than a problem with only one of the partners.
Researchers have found some relationships between thyroid disease and sexual dysfunctions, although it is not clear what causes these problems.
Although a lack of sexual arousal is not listed as a side effect of taking Synthroid, make sure you tell the clinic you take this drug in case your current dosage needs to be re-evaluated.
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June Reinisch, Ph.D., is director of the Kinsey Institute for Research in Sex, Gender and Reproduction, Indiana University, Bloomington. Send questions to June Reinisch, in care of the Kinsey Report, P.O. Box 48, Bloomington, Ind. 47402.
