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.

Dear doctor, some doctors today have gone native and are practicing herbal medicine. Others behave like the so-called medieval doctors. Quite a good number have brought in their trade antics reminiscent of witch doctors.

I am saying this because recently, I took my mother to a physician and was surprised when he gave her a drug called boniva and told her to take it early morning at least 30 minutes before breakfast and remain standing for two hours after taking it! Is this not strange?
Emmanuel Noel Kyasanku

Dear Emmanuel, our bones have calcium containing building blocks which means remodelling is always taking place with some calcium going in and some going out. In young people, more calcium goes in than comes out resulting in bone growth. In adults, the calcium that goes in matches what goes out.

In women, after menopause, and many elderly people, more calcium comes out leading to smaller and weaker bones (osteoporosis). Drugs like boniva help slow down loss of calcium.

The tablets should be taken at least 60 minutes before the first food or drink, or medications of the day to avoid interference with the absorption of the drug because its own absorption from the intestine is poor.

Also, the drug should be swallowed with plain water while one is in an upright position, in order to be certain that the tablets get into the stomach. If the tablets stick in the oesophagus, they can irritate it.

For the same reason, patients should not lie down for 60 minutes after taking the drug because the tablets are more likely to stick in the oesophagus when one is lying down. It not only irritates the oesophagus, but also the mouth and throat. This is why one should remain standing or seated upright after taking the tablets. These are not witch doctor antics like you think.

Dear doctor, I have been sick for over a year now. Over time, I have been diagnosed with different diseases including malaria, typhoid, bruccella and now kidney infection.

I feel a lot of pain and on-and-off heat in my stomach, get constipation and diarrhoea. Sometimes, my faeces are like goat droppings. My temperature is high, I have on-and-off fever, general body weakness, a pale scaly skin, heart burn and of recent, I feel something stuck in my throat. What is the problem?
Anonymous

Dear Anonymous, it is usual for anybody suffering from a multitude of medical conditions to fear for his life and become stressed and anxious.

Stress and anxiety commonly lead to bowel habit changes (constipation resulting in goat-like droppings and diarrhoea) apart from general body weakness, heart burn and a lump in the throat that cannot go (globus pharyngeus).

Brucellosis, malaria and kidney disease can be handled by your doctor to stem the anxiety and its symptoms.

You may also require services of a professional counsellor.

Although heartburn may be associated with a stressful life, it may be a sign of peptic ulcers which also require proper investigation and treatment.

Send questions to features@ug.nationmedia.com