Saturday, March 08, 2014

The Infertile woman with Pelvic Pain

Pelvic pain and infertility are both common complaints in young women of reproductive age. Since they are both so common, many patients will have both pelvic pain and infertility.  There are various conditions which can cause these symptoms, including  endometriosis and pelvic inflammatory disease ( PID). Each of these needs a different line of treatment.

When a patient comes to me with these complaints, then it becomes imperative to decide what to treat first.  For most patients, getting pregnant takes priority. The beauty is that getting pregnant will automatically take care of the pain as well !

Tackling the fertility issue first does not means I am ignoring the pain factor – it just means I have to deal with the most important problem first, rather than get distracted and waste time on secondary issues. I am just making the decision which preferably the patient should make for herself.

When you visit a gynecologist, you should decide which problem is more important. If you treat the pain first – for example, with medical therapy such as danazol, birth control pills or Lupron, you may end up getting pain relief, but will lose valuable time. This is especially true when an over-enthusiastic surgeon advises laparoscopic surgery to treat a chocolate cyst. This surgery may provide temporary pain relief, but reduces your fertility as normal ovarian tissue is also removed along with the cyst wall, thus reducing your ovarian reserve. This would mean the infertility becomes tougher to tackle.

If you go to your doctor with more than one complaint, he may end up making a treatment decision based on his prejudices and expertise, rather than one tailored to your needs. Thus, if he specializes in endosocopic surgery, he is much more likely to advise laparoscopy , rather than referral to an IVF specialist, because he does not want to lose a patient.  If getting pregnant is your priority, then make sure you tell this to your consultant at the start. The treatment process is easier for both the doctor and you if you know your own mind and are willing to be articulate !

Not sure what to do ? Please send me your medical details by filling in the form at so that I can guide you better !

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