Monique Rainford - HER HEALTH

Good day Dr Rainford,

My query is about retroverted womb and my attempts to become pregnant. I became pregnant last April and lost the baby in May of the same year. This was my first pregnancy. I am not sure of the reason for the miscarriage but I was told that sometimes the body disposes of the foetus. Could the reason be that I have a retroverted womb or that I wore shoes that were too high or that I had an orgasm during pregnancy?

Since July last year my spouse and I have been trying to become pregnant. We did some fertility tests such as testing for ovulation timing and sperm count. They all came back normal and we were told to continue trying. We visited another doctor (a gynaecologist) and we were told that I have a retroverted womb and should try lying on my belly for 20 to 30 minutes after sexual intercourse. We have been trying that for two months now and still I am not pregnant.

Please advise me about the actions to take. Is there something that I am doing wrong? What is your expert opinion?

Dear Reader,

Thank you for your letter. I believe that some of your concerns about miscarriages are held by many women. In my experience, it appears that women often blame themselves for miscarriages. Almost 20 per cent of women who are diagnosed as being pregnant have miscarriages. This percentage is even higher if pre-clinical pregnancies (early pregnancies not yet detectable by standard pregnancy tests) are included. The majority of miscarriages that occur before 10 weeks of pregnancy are caused by an abnormality of the chromosome of the developing baby, a factor which the mother has no control over.

High heels

Fortunately, most women who have miscarriages will not have another one. However, a woman's risk of miscarriage increases with her age, her partner's age and the number of times that she has given birth. A woman can miscarry and pass out the pregnancy on her own (without any medical intervention). She may require a dilation and curettage if the foetus has died in her womb or if she is in the process of losing the pregnancy and is bleeding heavily. This is a procedure to empty the womb.

Some behaviours of women such as drug use can cause miscarriages but I am happy to inform you that none of those which you mentioned would cause a miscarriage. The main reason to avoid high-heeled shoes in pregnancy is that they may worsen the back pain which many pregnant women experience. It did not cause you to miscarry.

A tilted womb

A retroverted uterus refers to a womb that is tilted towards a woman's spine rather than towards her bladder (anteverted). She may be born with it in this direction or it can occur because of other conditions such as scarring from previous surgery or infection. It did not cause you to lose the baby or to be experiencing difficulty in becoming pregnant. However, if your womb is not naturally retroverted, some of the conditions that can affect the position of your womb can also affect your ability to become pregnant.

Unless you have certain high-risk conditions, sexual intercourse and orgasms are safe throughout pregnancy and do not lead to a miscarriage. Therefore, I have not identified any reason from your letter for your difficulty in achieving pregnancy. Unfortunately, for about 20 per cent of couples no cause for infertility is identified. Since you have spent more than one year trying and your tests have been normal, I would suggest that you return to your gynaecologist or visit another doctor who specialises in fertility treatment. The Department of Obstetrics and Gynaecology at the University of the West Indies has a unit devoted to the treatment of fertility problems.

Dr Monique Rainford is a consulting obstetrician and gynaecologist; email: yourhealth@gleanerjm.com.