How do I prevent or pre-treat various pregnancy issues?

November 17, 2009 6:51 PM

I'm-going-to-want-a-baby-someday-filter: My mother had a ridiculous number of issues getting pregnant (inside). I'd like to do my best to prevent these issues, but realize most are inevitably genetic. I'm looking for various pieces of advice ...

To preface - I'm not planning to try for children for at least 5-7 years.

Here is my mother's story in her own words (for the tl;dr skip past the quote):

"Tried to get pregnant for a year. Sent to University hospital fertility clinic. Spent 4 years of taking my basal temperature every day. My periods were so painful I used to rock back in forth bed trying to get some relief. Endometriosis was burnt out 3 times via laparoscopy - on bladder, ovaries, uterus, and I can’t remember where else. I had 2-Hysterosalpingographies in 3 years. Took Danazol for 6 months (chemical menopause). Finally got pregnant with you 6 months later. Nursed you for a year with the hopes of keeping the endometriosis at bay. We hoped I could get pregnant easier. Ended up at University Hospital again, this time they decided to put me on a Clomid, a fertility drug. After 2 years of that nasty drug I gave up. Dr decided to burn out the endometriosis again. When he got in with the laparoscope he found a 5 week old ectopic pregnancy, almost ready to burst. I had no indications to that fact. He had to open me up, to clean out my fallopian tube, but saved it. Dr kept monitoring the endometriosis, and in 1997 I developed fibroids. In a little over 6 months one of the fibroids was the size of a 6-month pregnancy. Dr said it needed to come out, so I had a complete hysterectomy and ophrectomy. The fertility drug I had taken had been studied and found to cause ovarian cancer if taken longer than a year. Combined with the fact my Aunt died of ovarian cancer sealed the case for an ophrectomy."

My questions:

YANMD, but from personal experience, which of these issues am I going to have a possibility of having problems with? Looking for either scientific or anecdotal evidence here.

YANMD, but is there anything I can do now to make getting pregnant later easier? I was on Depo Provera for about 6 months almost a year ago and it completely screwed up my menstrual cycle (I was spotting daily for months, even after dropping off of all forms of bc). I'm now on Portia and things seem to be finally back to normal. I'm slightly overweight but in shape and active. I eat well.

posted by kthxbi to health & fitness (12 comments total)

realize most are inevitably genetic

Has this been confirmed for you by a genetic counselor? Or an OB/GYN? Because I am neither, and neither are you, and the lay person's seat-of-the-pants assessment of what is genetic (and/or heritable) and what is not is not something you should be making your life plans around.
posted by Sidhedevil at 6:55 PM on November 17, 2009

From here: "Certain families may have problems with their genes that make a woman more likely to develop endometriosis".
posted by kthxbi at 7:00 PM on November 17, 2009

Also, one of my mother's aunts died of ovarian cancer and another aunt was never able to get pregnant because of endometriosis and fibroids, so I'm also just assuming these are genetic. I'd love for someone to prove me wrong though!
posted by kthxbi at 7:01 PM on November 17, 2009

Anecdotally, I know someone who had fibroids, and who also was able to have two children (one a vaginal birth, the other by C-section).
posted by limeonaire at 7:14 PM on November 17, 2009

Please see an actual OB-GYN and perhaps a genetic counselor. This is what you can do to improve your chances of getting pregnant in light of your family history of fertility issues. If the OB-GYN identifies specific issues, you can get a referral to a fertility specialist.

The rest is a waste of your time and ours.

And I know several women who've borne children after fibroids, endometriosis, or both.
posted by Sidhedevil at 7:17 PM on November 17, 2009 [2 favorites]

The earlier you try to get pregnant, the greater likelihood of success. I don't think endometriosis and fibroids are genetic, but have no citation.
posted by theora55 at 7:29 PM on November 17, 2009

Endometriosis causes infertility and decreased fertility by choking the fallopian tubes closed, or possibly by covering the ovaries. You have an increased chance of getting endo because your mother had it, but even if you do, you will not necessarily become infertile. Most endo-related infertility happens later in the course of the disease, so if you don't have it now, you probably won't suddenly develop endo and infertility at the same time.
Endometriosis Zone and The Endometriosis Association are good places to start if you want to get more information about whether you could develop it and what you should be looking out for, symptoms-wise.

There are, as far as I know, no genetic tests that will tell you about your likelihood of developing endometriosis, although if you suspect there were other factors in your mother's situation, I suppose it might be worth a test. As far as endo is concerned, they don't know the cause, but there is a correlation of first degree maternal relationship and developing it (that is, you are more likely to get it if your mother, grandmother, mother's sister, or mother's sister's daughter also has it). This does not, however, mean that it is "genetic". It only means that there is some factor that increases risk that is probably genetic (although may be environmental since relatives of this degree often spend extended time in the same environment).
posted by carmen at 7:37 PM on November 17, 2009 [1 favorite]

I have PCOS, which impedes fertility both hormonally and by physically preventing ovulation. I was told when I was diagnosed in my teens that I would probably been infertile. I'll tell you what the OBGYN told me when I went in to see her for the "will I be able to do this" conversation when I was in my mid twenties. She reviewed my chart, looked up at me, and said, if you want to do this, you should do it now and not wait. The longer you wait, the worse the odds are. Due to circumstances, I did put it off.

I'm in my mid thirties now and I have gotten pregnant twice since then, both times accidentally. Apparently, I'm not quite as infertile as previously believed. The morals of this story are (a) If you have good reason (confirmed by a doctor) to believe you will have trouble conceiving, do not postpone having children and (b) you may not be as infertile as you think you are.

Many women with fibroids, endo, and a whole host of other issues have children, so it's by no means a death knell to your dreams.
posted by crankylex at 7:50 PM on November 17, 2009 [1 favorite]

My mom had various troubles and it was alarming & distressingly easy for me, so anecdotally, you might consider the possibility that you won't follow in maternal side of the family footsteps. Best wishes!
posted by susanbeeswax at 9:30 PM on November 17, 2009 [1 favorite]

Sounds like your mother's problems were mostly or entirely due to endometriosis. So the question is, do you have it too? How are your periods? Some women have it with few or no symptoms, but many have painful periods and possibly pain in other parts of the body connected to their cycle. You can ask your obgyn if they think you have any signs of it. There's no genetic test for it as far as I'm aware (but IANAD).

A test called an HSG can tell you if your have blockages in your fallopian tubes, they put a dye into your cervix, which travels through your womb and tubes, and then they x-ray you to see where the dye shows up. It's not an especially pleasant test, with some "discomfort" and a small risk of infection, and generally means taking some antibiotics and other prep. It's usually done as part of a "having issues getting pregnant" workup, but maybe you could find a doctor who would set you up with one now.
posted by crabintheocean at 11:26 PM on November 17, 2009

I was told be several doctors that I was infertile/would need medical assistance to fall pregnant and stay pregnant. I sort of believed them - prepared for not getting pregnant but stayed on hormonal birth control until I was ready if I did. After 6 years of no period thanks to Implanon I had that taken out in November 07. I tapered off my anti-depressants March 08. I started having unprotected sex in May 08 and fell pregnant September 08. I still had issues from the endometriosis they had suspected but fell pregnant with (totally and completely) surprising ease.

My ob. recommended staying off hormonal birth control as long as possible, preferably until I was done having kids. Mostly to avoid any issues with artifically screwing up my hormones but also so I can get a decent baseline of my cycle sans hormones (and after pregnancy). It also means I can start getting some half decent treatment if I really do have endometriosis (the doctors who diagnosed me and told me I was infertile? Never did anything about it apart from putting me on hormonal birth control to stop my cycle).
posted by geek anachronism at 3:20 AM on November 18, 2009

Do you have endo? Do you have painful periods? Have you been to a gynecologist? It seems like you're borrowing trouble if you don't have the symptoms. Sure, you're at increased risk of endo if your mom has it, but it's nothing like a one to one correlation.

Fibroids are very common but usually don't harm fertility.

I don't think your questions are really answerable in some ways without that information. I will say however that I have endo and am currently pregnant. I never took any fertility drugs or anything like that.
posted by miss tea at 3:28 AM on November 18, 2009 [1 favorite]