Infertility: The way out

INFERTILITY has become a topical issue as many gynaecology clinics get flooded with out-patients on a daily basis.

Infertility, as a scourge, has taken away some couples’ matrimonial joy with women, most times, at the receiving end, being thrown out after few years of childlessness. How can infertility be gotten rid of and couples have their joy intact?

FamilyDr. Kola Owonikoko, a Senior Registrar, Obstetrics and Gynaecology, University College Hospital, Ibadan, defines infertility as the inability of a couple to achieve pregnancy after one year of adequate, unprotected sexual intercourse. Adequate, in his words mean having 2-3 times per week of sexual exposure, at least 48 hours apart.

According to Dr. Owonikoko, about 10 to 15 per cent of couples worldwide are affected by this condition, and that infertility is the commonest gynaeological complaints in out-gynaecological patients.

As against the general belief of people, mostly men, that females are responsible for infertility, the gynaecologist said it affects both men and women.

Speaking further on the types of infertility, Dr. Owonikoko said infertility can be primary, as well as secondary. When it is primary infertility, he said, it means the woman in question has never been able to achieve pregnancy before, while if it is secondary infertility, the woman has achieved pregnancy, irrespective of the final outcome, which could be miscarriage, abortion or life baby, and now has problem achieving another one.

On the causes of infertility, the medical practitioner said, 40 per cent is due to the male factor and another 40 per cent due to the female factor. He added that about 10-15 per cent is due to both male and female factors, with about 5 per cent, unknown cause.

When infertility is caused by the male factor, it can start from the act of intercourse itself, that is, inability of the man to achieve erection, experience premature ejaculation, or have mumps that affect his testes at childhood or at puberty. He also said infertility may occur in a man that does not have vas deferens (the passage for the semen) or have it blocked. Also, in a man whose prostate gland has been removed, or may not be able to produce enough or no sperm at all (oligospermia or aspermia, respectively).

Infertility, as added by the expert, can be as a result of a man having inadequate mobility of his sperm, that is, azoospermia or abnormal sperm called Teratospermia. It may also be as a result of absence of testes, ectopic testes (congenital cause), gonorrhea infection, chlamydia infection, orchitis (infection of the testes), or indulgence in social drugs like cocaine and heavy cigarette smoking, among other causes.

Under the female factor, Owonikoko said, “it could be vagina caused” that is, that which is caused by vaginal gynaetresia (shortness of the vagina), which, according to him, can be congenital (inborn) or acquired, due to the use of vagina pessaries, which are mostly corrosive and are used by tradomedical people to treat fibroid.

There are also those that can be cervical or the neck of the womb caused i.e. hostile cervical environment, in which the cervix produce antibodies against her husband’s sperm, or develop tightness or closed cervix, following D & C.

The womb or uterine causes can be as a result of tuberculosis, infection of the womb (endometritis) through chlamydia or gonorrhea that is not well treated, or the absence/ irregular menstruation, which can also follow overzealous D & C.

He added that there can also be tubal causes of infertility resulting from chlamydia or gonorrhea infection, absence of fallopian tube (very rare) or tubal blockage and the removal of the tube, following ectopic pregnancy or tubal surgery for family planning i.e. Bilateral Tubal Ligation (BTL).

Infertility can also be caused by absence of ovaries or its infections, premature ovarian failure, meaning failure of the ovary to produce female hormones or monthly release of eggs before the age of forty, and failure of ovary to respond to ovarian stimulations for the release of egg.

The medical personnel did not leave out infertility that could be caused by the brain (higher centre), in which the thalamus and pituitary glands, which are the major organs producing hormones that stimulate the ovary to release eggs, are not functioning well. And as a result, there may be excessive production of prolactin hormone, that is the hormone causing breastmilk production and lactation in a non-breastfeeding woman. Other rare causes include thyroid gland dysfunction.

Speaking on the effect of infertility on parties concerned, Dr. Owonikoko said it could be psychological, that is, such a woman may not be comfortable attending weddings or naming. She could also be labelled as a witch, with some women, in this situation being driven away from their matrimonial homes due to in-laws’ pressure. But for every problem, there is a solution. The gynaeocologist said there are ways out of infertility, which involves subjecting the couple to series of examination and investigations to determine the obvious cause(s) of their infertility and give direct treatment to those causes.

He said for instance, there is the seminal fluid analysis for the husband, ultrasound, hysterosalpingogram (HSG) or laparoscopy for the women, as the case may be. Aside these, if the infertility is due to the male factor e.g. variecosele, patient would be advised to see an Urologist. He also said that tubal surgery can be done for the blocked tubes, while the vagina and cervix that are tight or closed can be dilated. Also, according to him, intrauterine insemination can be done for women with cervical factor.

For huge uterine fibroids, Owonikoko said it can be removed, especially in anticipation of invitrofertilization. Invitrofertilization as described by him, involves the taking of the woman’s egg and fertilizing it with sperm outside the womb, in the laboratory, followed by the transfer of the fertilized egg to the womb. “We also have assisted reproductive technology (ART) like intracytoplasmic sperm injection (ICSI), zygote intrafallopian transfer (ZIFT), testicular sperm aspiration (TESA) as solutions to infertility. However, its financial implications are enormous, with the cost of any of the ART ranging between N750,000 and N1.5m, though the facility is not readily available in most teaching hospitals in Nigeria".

On the prevention of infertility, the doctor stressed, is that most of the time, secondary infertility, which is commonest in this country is preventable by giving adequate treatment to those having sexually transmitted infections (STIs), by qualified health personnel. He also advised a change in some people’s sexual habit like having extra marital affairs and if that is not possible, they should make use of condoms (male and female).

Adequate treatment of pelvic inflamatory infections (PID) like chlamydia and gonorrhea should be strictly adhered to. He added that women should maintain safe obstetric practices e.g. delivery in clean and safe environment by qualified health personnel. Pointing out to the male folks, Dr. Owonikoko said, men should desist from wearing tight underwears, but free underwears (boxers), preferably cotton, should be worn, as nylon generates heat, which is not good for the testes/scrotum.

Women, on the other hand, are encouraged to maintain or improve on personal hygiene, especially in the use of toilets and the cleaning of their private parts. It is to be cleaned from front to back and not the other way round. They should also avoid the use of hard drugs and excessive intake of alcohol (if they cannot be totally done away with). In cases where solution could not be proffered, surrogacy or adoption could be a way out.

And on a final note, Dr. Owonikoko called on government to equip teaching hospitals, and training of personnel, so that ART, being the treatment for most of the causes of interfility will be reachable and affordable to the common man.