A consultant obstetrician and gynaecologist, Department of Obstetrics and Gynaecology, University of Ilorin Teaching Hospital, Dr. Gboyega Fawole, talks about infertility
What is Infertility?
It is the inability of a couple (male and female) to conceive after one year of regular, adequate unprotected sexual intercourse. Adequate intercourse is at least thrice a week.
Is infertility a common problem?
It is common all over the world and about 11 to 20 per cent of couples worldwide are experiencing this problem. In our part of the world, West Africa that is, it can be found in 20 to 46 per cent of couples. However, studies from over 22 countries (involving about 5,800 infertile couples show that men contribute eight to 22 per cent, while women contribute 25 to 37 per cent. Both contribute 21 to 38 per cent. Unknown causes of infertility stands at three to five per cent. Continue..
What is your take on the assumption that infertility is mainly a woman’s problem?
Infertility affects both men and women. Yet women, particularly in developing countries, may bear the sole blame for barren marriages and these women are usually subjected to societal rebuke, intimidation and social rejections. In our African society, a lot of misinformation prevails regarding the causes of infertility. Many Africans believe infertility is caused by witchcraft, sorcery from an unfriendly neighbour or punishment for previous infidelity.
What causes infertility in men?
Usually, causes of male infertility are better understood when they are grouped according to the report of sperm analysis (sperm test). Abnormalities along semen analysis parameters are; azoospermia, oligospermia, and asthenospermia. Azoospermia which is the absence of spermatozoon in semen sample, is as a result of obstruction of the spermatic duct and from non-obstructive causes. Obstructive causes can arise from complications of previous surgery such as inguinal hernia repair (hernia operation), from undescended testis (testicle that does not appear in the scrotum of a child), hydrocele (presence of water in the scrotum housing the testis), epididymitis (infection of the testis) and congenital absence of the spermatic cord bilaterally from birth. Non-obstructive causes can be triggered by germinal aplasia, maturation arrest, bilateral anorchia, presence of sertoli cells only, orchitis and immunological endocrine and genetic conditions. Oligospermia (which means sperm count less than 15 million/ml) may be idiopathic or caused by cryptorchidism (the absence of one or both testes from the scrotum), genitourinary infection, varicocele, drugs, toxins, chemotherapy, radiotherapy, partial ejaculatory duct obstruction, unilateral vassal obstruction and reduced spermatogenesis.
Lastly, asthenospermia (which means abnormal motility of spermatozoon, leading to less than 50 per cent of forward progression), may be idiopathic or caused by prolonged abstinence, anti-sperm antibodies, genital tract infection, spermatozoa structural defect and testicular hyperthermia (varicocele).
What increases a man’s risk of infertility?
Risk of infertility in men is increased by family history of male factor problems, carefree lifestyle that predisposes one to contracting genital infections which damage the genital organs – sexually transmitted infections, prolonged illnesses that were not treated on time, excessive consumption of alcohol, tobacco, – sedentary lifestyle leading to obesity, and exposure to heat, pesticides and other chemicals.
What causes infertility in women?
Causes of infertility in women can be broken down into the following – anovulation, fallopian tube blockage, problems with the womb, problems with the cervix and problems with the vagina.
Anovulation (the inability of a woman to produce eggs) can be triggered by hyperprolactinaemia, excessive production of prolactin (a chemical that helps in milk production from the breast), prolonged or excessive drug usage without the supervision of a doctor, abnormal swellings in the ovary, congenital absence of ovaries in the child from birth, infections in the ovaries, surgical removal of the ovaries. Blockage of fallopian tube and peritoneal problems, are triggered by the congenital absence of the fallopian tubes, endometriosis (a condition where endometrial tissue is found outside the uterus), infections from tuberculosis, pelvic inflammatory disease, abortion (septic abortion), infections following child birth (puerperal sepsis), chronic inflammatory bowel disease. Also, surgical removal of the fallopian tubes following ruptured ectopic pregnancy or abnormal twisting of the ovarian pedicle.
Abnormalities of the womb includes incomplete formation of the womb, small womb, abnormal growth on the womb (fibroids, endometrial polyps) and Ashermans Syndrome(adhering together of the walls of the uterus). Problems of the Cervix usually arise from cervical mucus being hostile to the sperm.
Lastly, vaginal problems includes absence of the vagina, narrowing of the vagina (gynaetresia) from birth (congenital) or acquired from insertion of corrosive materials into the vaginal or through surgery.
What increases a woman’s risk of infertility?
The risk of infertility in the woman is increased by genetic disposition, pelvic inflammatory diseases, abortion, childbirth in unhygienic environment and other accidents of fallopian tubes and ovaries. Generally for both male and female, medical conditions such as diabetes, hypertension and cancer also trigger infertility.
How does age affect a woman’s ability to have children?
A woman is capable of reproduction when she is between the age of 15 and 44 years. During this period, menstruation is well established and ovulation is fairly regular until age of 35 years when there is a general decline in the ability to conceive. Male fertility on the other hand tends to fall after age 40, although the production of spermatozoon usually continues to some extent after old age.
How long should a woman try to get pregnant before contacting her doctor?
A couple should seek medical help from their doctor after they have tried without success to get pregnant for a period of 12 months. For women over 35 years of age, evaluation of infertility should commence after six months of trying to conceive.
How will doctors find out if a woman or her partner has infertility issues?
The first step in the management of infertility is to take a thorough history of events since childhood from both the woman and her partner. The couple also undergoes a clinical examination. These may identify symptoms or signs suggesting specific cause for infertility and then help focus subsequent diagnostic evaluation on the factor(s) most likely to be responsible. Thereafter, the doctor will request relevant laboratory investigations that may reveal where the problem lies. These investigations include, blood tests for hormone profile (male and female)- follicle stimulating hormone, luteinizing hormone, prolactin, progesterone; seminal(sperm) fluid analysis- volume, density, morphology, activity, infections; abdominopelvic scan; X-ray- hysterosalpingography, vasogram ; endoscopy studies – laparoscopy, hysteroscopy; cervical mucus tests; and endocervical swab and HVS swab for infections.
How do doctors treat infertility?
In the treatment of infertility, there are many treatment options depending on the cause. However, a logical approach to the management of the couple is to achieve conception with the simplest, most cost-effective treatment possible. The goal of treatment is conception. Infertility is a common and stressful condition for couples. Evaluation will provide a diagnosis in most cases and effective treatment exists. Early diagnosis and treatment may make the difference between success and failure of the medical options available.
What drugs are used to treat infertility in women?
Some of the medicines used to treat infertility include clomiphene (clomid), metformin, bromocryptine, GnRh analogues, antibiotics, etc.
What is intrauterine insemination?
Intrauterine insemination means to deposit laboratory- prepared sperm into the womb of the woman with the aid of some specially made instruments. It could be the sperm of the husband or sperm from a donor.
What is Assisted Reproductive Technology?
Assisted Reproductive Technology can be classified into the following: Intrauterine insemination with husband or donor semen, gamete and zygote intra-fallopian tube transfer, In-vitro fertilisation and Embryo Transfer(IV-F) into wife or surrogate mother. Gamete intrafallopian transfer uses multiple eggs collected from the ovaries, which are placed into a thin flexible tube (catheter) along with the sperm to be used. The gametes (both eggs and sperm) are then injected into the fallopian tubes using a surgical procedure called laparoscopy under general anesthesia. Zygote intrafallopian transfer, on the other hand, combines in vitro fertilisation and gamete intrafallopian transfer. Eggs are stimulated and collected using IVF methods, then mixed with sperm in the laboratory. Fertilised eggs (zygotes) are then laparoscopically returned to the fallopian tubes where they will be carried into the uterus. The goal is for the zygote to implant in the uterus and develop into a fetus.
During In-vitro fertilisation, eggs and sperm are brought together in a laboratory glass dish to allow the sperm to fertilise an egg, after which one or more fertilised eggs are placed in the uterus.
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