Doctor's advice - Can I have a baby with just one tube?

• Q: I am a young woman, and I had an ectopic pregnancy almost nine years ago. My right tube was removed. And my left tube is blocked. I would like to have a baby. Do I have to undergo surgery to unblock my tube?

A: I am sorry to hear about this. It is important to realise that every woman has two Fallopian tubes. They are located low in the belly, some distance behind the pubic hair.

In order that conception can occur, an ovum - that is, an egg - has to pass down one of these tubes and into the womb. Unfortunately, both Fallopian tubes are quite narrow, and so are easily blocked. Most commonly, this occurs as a result of infection.

Oftentimes, that infection is transmitted during sex. That's why it's a good idea for a girl to avoid sleeping around. The more partners you have, the more likely you are to pick up germs like chlamydia, which can easily block the tubes.

I must add that not all cases of blocked tubes are caused from sexual infection. Germs can sometimes be introduced during childbirth or abortion. Occasionally, infections occur when a coil (intrauterine device) is inserted into the womb.

One tube left

Now, I don't know how it happened that one of your Fallopian tubes became blocked. However, this is the only tube you have left, because the other one was removed when you had an ectopic.

Therefore, if your remaining tube really is blocked, you are not going to get pregnant. But are you absolutely sure it is blocked? Have you had the special tests which determine whether a Fallopian tube is obstructed?

Bear in mind that it is possible for a tube to be only partially blocked. I recently encountered a patient who was supposed to be infertile because of blocked tubes. In fact, there was a small passage through one of her damaged tubes. An egg found its way downwards through this tiny aperture and was fertilised by her partner's sperm. As a result, she now has a beautiful baby boy.

There is some hope that you might still be able to conceive. I suggest you see a gynaecologist, who can tell you what the chances are.

However, if your one remaining tube really is totally obstructed, there are really only two ways you can defeat that:

1. 1. The gynaecologist could try to repair the damaged tube, if possible;
   
2. 2. You could have the test-tube baby (in vitro fertilisation) technique, in which an egg is taken from your body and fertilised in the lab with your partner's sperm. But that procedure is very expensive, and difficult to obtain.

I don't think you should give up hope, but clearly it is time that you get yourself examined.

• Q: Doc, it is common knowledge that there were relatively 'safe days' in the menstrual cycle, and that it is OK to have sex during the few days immediately after a woman's menses. This was in line with the Catholic 'rhythm method'. A current radio ad disclaims that idea. Are those comments based on new and accurate data? Or do people criticise the rhythm method as a way of selling condoms?

A: Well, trying to prevent pregnancy by using the rhythm method (also known as the 'safe period method') is pretty risky. But I have to admit that it is certainly better than nothing!

However, it is very easy to make mistakes while using this method. For instance, you yourself suggest that it is OK to make love during 'the few days immediately after a woman's menses'. Personally, I would regard that as a little risky, as some females ovulate only about four or five days after the end of menstruation. That is particularly likely in women who have long periods.

So what dates are safe for a couple to have sex without running too much risk of pregnancy? That depends a lot on the length of the lady's menstrual cycle which, as you probably know, varies quite a lot from woman to woman.

But in a young female who has a dead regular menstrual cycle lasting exactly 28 days, the big danger time for conception is from the eighth to the 17th day of her cycle.

By the way, I cannot overemphasise the fact that such timing must be taken from the first day of the woman's period - not the last. Again and again, folks get confused about this and try to time things from the last day of the period. That just will not work!

So what I am saying is that in a woman with a 28-day cycle, it becomes highly dangerous to make love eight days after the start of her period. And it will remain very dangerous till at least 17 days after the start of a period.

Regrettably, conceptions can occur outside these times. And if a female has a long or irregular cycle, it becomes difficult to calculate her safe time. But there are various ways of improving the effectiveness of the rhythm method. For instance, a doctor or nurse can show a woman how to keep a daily temperature chart. After doing this chart for some months, it is usually possible to see a characteristic change in temperature which occurs on the day of ovulation.

Also, many years ago, a Catholic gynaecologist called Dr Billings worked out a clever way of plotting the nature of a woman's vaginal secretions on a daily chart. When you have been shown how to do this, you can detect ovulation day with reasonable certainty.

Summing up, I would say that the rhythm technique is better than using no contraception at all. But ideally, you need a doc, a nurse or a midwife to show you the best way of employing it.

• Q: I am a young diabetic. Is it inevitable that I will lose my nature one day?

A : No. Most male diabetics do not lose their sexual potency. However, the incidence of erectile dysfunction is higher in diabetics than in other men.

• Q: I took the blood tests for HIV and VDRL 10 months ago after having sex. The results were negative, but I am puzzled because I get moderate to high fever and occasional headaches. Do you think my concern is justified?

A: There are hundreds of different causes for fever and headache, so you should go to a doc for a check-up. It is reassuring that your HIV and VDRL tests were negative. As you probably know, the VDRL is essentially a test for syphilis, though it also picks up any remaining trace of the disease yaws, which was common in rural areas in the 20th century.

Email questions for Doc to saturdaylife@gleanerjm.com. Also read in Outlook magazine in The Sunday Gleaner.