QuestionMy husband and I have been trying to conceive for 14 months. I am 37 years old, and live in South Florida, and we have been to a fertility specialist. We have been diagnosed with unexplained infertility. The next step to try is IUI, and then IVF if that doesn't work. We are also starting to talk about adoption. Here is my question.
Six years ago I had back surgery. I had a discectomy and laminotomy on L4/5 and L5/S1, after rupturing the bottom two discs in my back after falling down a flight of stairs.
I had a long miserable recovery from the surgery, and lots of physical therapy. I had been completely pain free up until about a year ago.
For the past year I have been in a great deal of pain in my lower back, but it comes and goes. I see a chiropractor periodically and go for massages. We do not know why I am in pain, but one cause could possibly be from scar tissue. My chiropractor has told me that due to my back surgery, I may not be able to have an epidural. She also said I may have a higher increase for back labor and needing a c-section. Would I have to be put completely out? Also, what would a pregnancy do to my back? I am trying to get these answers before I decide if we should start with fertility treatments, or just go for adoption. I cannot reach my original surgeon as he no longer practices in my state. Any advice would be greatly appreciated!
Thanks.
AnswerHello Joyce from the U.S.,
First of all,keep in mind that chiropractors know absolutely nothing about obstetrics. Second, if you have recurrent back pain, you may have another bulging disc, so I would recommend that you go and see a back surgeon.
Pregnancy is highly variable in terms of back symptoms. Some patients have more and some less. Certainly if you have had back problems, there is an increased chance that you will have increased back pain with pregnancy and labor. The reason is that pregnancy will change the configuration of the spine in order to accommodate the increasing uterine size. However, many many patients with back problems have been successful in carrying and delivering. For example, my wife ruptures the same disc when she was 27 years old and had back surgery. She continues to have intermittent back pain because of weakness in adjacent discs. Despite this, she was able to carry our daughter and deliver vaginally. She also had an epidural, AND she was 38 years old at that time (having gone through IVF at 37). There is no reason why you could not have an epidural. The catheter might just have to be placed a little higher. There is also no reason why you would automatically have to have a C-section, unless you chose to, although based on your age, you are at increased risk of having one.
From a fertility point of view, you do not have "unexplained infertility." You are 37 years old. You have "advanced reproductive age" or "age factor" which significantly decreases your fertility and chances for successful pregnancy. This is a reason for your infertility. In general, if a woman is 37 years old or older, it is recommend to proceed directly to IVF. That would give you a 50% chance of pregnancy per attempt, whereas IUI would only give you a 5% chance of pregnancy per attempt.
I hope this helps,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on facebook and twitter with me at @montereybayivf
