Doctor's Column: Can I get pregnant with one fallopian tube?

Dear doctor, I had an ectopic pregnancy five years ago. I now have one tube because the other was tied during the removal of the pregnancy. An x-ray revealed that the remaining tube was normal. So, why am I not getting pregnant?

Also, is it true that the commonest cause of ectopic pregnancies in Uganda is contraceptives? What are the chances that I may not get pregnant with the other tube?
Salma

Dear Salma, when a pregnancy takes place outside of a normal womb, then it is said to be ectopic. This is usually in the fallopian tubes but may occur in other areas including the ovaries.

Ectopic pregnancies require immediate attention to stem internal bleeding resulting from bursting of the fallopian tubes since they cannot accommodate a growing foetus.

Though any woman may get an ectopic pregnancy, there are many factors that may put a woman at risk of an ectopic pregnancy.

In Uganda, the biggest problem is sexually transmitted infections which narrow the tubes so that the smaller sperms can pass and fertilise the bigger eggs which then grow in the tubes.

Also, infections may damage the hairs (cilia) which propel the eggs leaving only the tailed sperms to move in and fertilise the egg in the fallopian tubes where they will remain and grow.

Multiple sexual partners increase a woman’s risk to STDs and therefore, ectopic pregnancies.

Abdominal infections like appendicitis can create cobweb-like fibres that tether the tubes narrowing them.

The other risk factor is a prior history of an ectopic pregnancy. Previous surgery on the fallopian tubes such as tubal sterilisation or reconstructive procedures can lead to scarring and disruption of the normal anatomy of the tubes. This increases the risk of an ectopic pregnancy.

It is true that Intra Uterine Contraceptive devices and emergency contraceptions may be associated with ectopic pregnancies when they fail.

But generally, the number of women becoming pregnant while using IUDs is extremely low (one per cent) hence the overall number of ectopic pregnancies related to IUDs is very low.

A woman who has had an ectopic pregnancy may have other problems of fertility just like any other woman. Having had an ectopic pregnancy five years before might mean you are now much older and less fertile.

Older women may have developed fibroids, ovulation problems and medical conditions like diabetes and hypertension which themselves or their treatment may interfere with fertility.

It is true that having only one fallopian tube means that theoretically your chances of getting pregnant are now 50 per cent less since the eggs from the same tube will have no where to pass to be available for reproduction. Even when the other tube is normal, it is likely that the hairs (tubal cilia) that propel the egg for fertilisation (which takes place in tubes) or implantation (in the womb) may have been destroyed risking not only another ectopic pregnancy, but also infertility. In Uganda, the infertility riddle may be solved by in vitro fertilisation, (IVF) or adoption.