Dear Dr. Donohue: I've been trying to get pregnant for years. I do have abnormal menstrual cycles, and some months I don't have any. I have been off the pill for four years, and we already have one baby. Can you help me?
- T.L.
Answer: Even your brief note provides grist for a doctor expert in this subject. You have been trying to get pregnant long enough to be considered infertile as a couple. You have uncertain menstrual cycles and sometimes absence of them altogether. And very importantly, you and your husband have one natural child already.
The best advice I can give is twofold: Locate a fertility specialist, and do not expect easy diagnosis or fast results.
The plethora of possible causes within the set of facts you lay out would keep a diagnostician busy for a while. Realize, too, that one of 10 couples has trouble conceiving through the fault of either partner or both.
Just as there are lots of causes, so are there lots of answers. Your abnormal cycles suggest that you are not ovulating, failing to release an ovum from your ovaries as part of your hormone cycles. There are medicines to promote ovulation that have helped many women. Perhaps some other problem, such as damage to your fallopian tubes, is playing a role. Sometimes that can be dealt with surgically.
As many as 40 percent of infertility cases can be traced to the husband. Some men have a too-sparse or too-inactive sperm population.
After four years, you should start trying to pin things down.
Dear Dr. Donohue: I thought I was healthy until I took an insurance exam that included a stress test. It turns out I have angina, although I told the doctor I never had chest pain or other symptoms. Is this like ischemia?
- J.J.O.
Answer: Angina is chest pain. "Ischemia" means an organ does not get sufficient blood supply. Often that organ happens to be the heart, and chest pain results, although sometimes the heart remains silent. When that happens, we call it "silent ischemia," or for simplicity "silent angina," which for purists is a contradiction in terms.
Do you know that people with silent angina can have full-blown heart attacks as the first sign of the ischemia? Unlike the rest of us, they get no pain warnings, so they live in ignorance of the problem. As it turns out, they are at greater risk than people who do get the warnings.
We have no answer as to why some ischemic hearts do not produce pain signals. But it is not such a rarity.
For more information, see the angina report I'm sending you. Others can order a copy by writing: Dr. Donohue - No. 1, Box 5539, Riverton, NJ 08077-5539. Enclose $3 and a self-addressed, stamped (52 cents) No. 10 envelope.
Dear Dr. Donohue: I am a regular blood donor. How would the daily aspirin recommended by my doctor affect my participation?
- S.A.
Answer: It should not affect it at all.
Tell the nurse, who can apply pressure a little longer at the place where blood is to be taken. You might not form a clot quite so easily as when you were not taking aspirin. And you might ask for an extra bandage just in case you have a bit of lingering bleeding.
But you can definitely donate blood, just as you have been doing. It's always in short supply, it seems.