Question:
I have been married almost two years and I have not been able to get pregnant. I have noticed a clear mucus on the tissue when I go to the bathroom. I went to the clinic because of pelvic pain and the nurse told me that she does not see any signs of an infection but gave me doxicyclin and metronodazol for 1 or 2 weeks. She told me that she noticed a lot of cervical mucus. I had also had the same pain issue 5 months prior and was given doxicyclin then by a different doctor whom also said that she did not see an infection but because I recently had an IUD taken out there might be a little bug in there bothering me. I had an IUD removed in Jan/07. I was in for about 3 months. I was not comfortable with the idea of this foreign thing inside me all the time. I feel a sharp pain and discomfort during sex and also I am shocked that I have not been pregnant yet.
I already have one son who was induced a week past due date, and I have been pregnant a few times after but terminated those. I have never seen this heavy clear mucus before. What is it, and why do I keep having this pelvic pain? My weight has also ballooned up 70 pounds in the last 3 years, and I am under a lot of stress. I feel exhausted all of the time and can barely walk up a flight of stairs without taking a break. I am currently at 220pnds and I am 5"8 tall. I hope you can shed some light on my concerns. Thanks.
Answer:
One of the problems seeing a nurse practitioner is that because they have a limited knowledge base, they treat indiscriminately. As in your example, the nurse practitioner did not detect an infection, yet treated you with two antibiotics. She is essentially covering you for two types of infections. That of course, is improper medical treatment.
I am surprised no one has suggested a pelvic ultrasound. If the pelvic examination was not remarkable, then that would be the next step in your evaluation. You may have a cyst or tumor. Some cysts and tumors express increased amounts of estrogen, which could be why you have an abundance of clear mucous. Clear mucous is usually not due to an infection but due to hormones. I would request a pelvic ultrasound. If the ultrasound does not reveal anything, then you should consider a laparoscopy, which is an outpatient surgery to look into your abdomen and examine the pelvis. Considering your fertile history in the past, and now no pregnancy but pelvic pain, there is a high possibility that you may have developed endometriosis or scar tissue. These entities can cause pain and inhibit fertility.
Finally, your weight is the issue for the remainder of your symptoms. Your ideal weight is 140 lbs. Your are carrying an extra 80 pounds which causes you and your muscles to have to work harder. I would bet that the difficulty going up the stairs is partly due to this and partly due to being out of shape. There have been studies showing that increased weight also decreases fertility, so you may want to use this a a reason to exercise and lose weight.
I hope this answers your questions. Start by insisting on seeing a physician and go from there.
Good luck!
Edward J. Ramirez, M.D.
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
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