Let’s talk about infertility
By Dr Brighton Chireka
THIS week we are talking about infertility, which is when a couple cannot get pregnant despite having regular unprotected sex. It is estimated that one in seven couples in the UK may have difficulty conceiving. This is approximately 3.5 million people in the UK. A couple will be diagnosed as being infertile if they have not managed to have a baby after one year of trying. There are two types of infertility: primary and secondary infertility. Primary infertility is where someone who has never conceived a child in the past is having difficulty conceiving. Secondary infertility is whereby a person has had one or more pregnancies in the past, but is having difficulty conceiving again
If couples have regular unprotected sex, about 84% of them will conceive within one year and 92% in two years whilst 93% will conceive within three years. By regular sex we mean unprotected sex every other day or three times a week. For couples who have been trying to conceive for more than three years without success, the likelihood of pregnancy occurring within the next year is 25% or less.
According to a 2003 research project completed by Health Care Women International on the fertility patterns of women in Zimbabwe, at least one in every four women of childbearing age suffers from some degree of infertility. In fact, a 2010 World Population Prospect survey demonstrated that Zimbabwe has one of the world’s highest infertility rates. The major cause of infertility in both men and women in Zimbabwe is due to inadequately treated sexually transmitted infections (STIs).
This issue of infertility is a hot topic as sadly our society value a child more than its mother and the worthiness of a woman is measured by her ability to reproduce. Women are always the scapegoat when a couple fails to conceive but research shows that both parties are equally responsible for infertility. It should not be about apportioning blame to each other but about putting heads together and seeking medical help as a couple. It is a challenge for an African marriage to survive if the couple fail to get a child. After a few years together without a child both parties can start to try to prove that it’s not their fault. Men are the culprits here, as they often go out and have extramarital affairs. Sadly for many, infertility is a justifiable reason for divorce.
We have all heard of sad stories of women faking pregnancy and ending up stealing babies. Some women have been made to feel inadequate because they are perceived as unable to conceive. The sad thing is that male infertility is not discussed openly in African culture, it’s always the woman at fault and women try desperately to prove that they are “real women” by trying to conceive by any means necessary.
I know that some women do get desperate and become gullible to dubious “Men of God” who claim to help the couple have miracle babies. Some have even slept with these “Men of God “in the quest to get a child. I used to live in Highfield at a house opposite Mastones Bar and we had fake “Men of God” renting at the same house as me. I would see lots of women coming for help and when I asked these “prophets” why they were so popular with women, they told me that they were helping them to become pregnant.
On asking how, I was shocked when they told me that they were having sexual relationships with their clients and most of them were getting pregnant. Having said that, I do not want to paint all pastors with the same brush. I do believe that one needs a prayer to be able to conceive but there are wolves out there in sheep’s clothes. They are ease to identify, because a sheep does not eat another sheep but a wolf does so if you see a sheep eating another sheep then it must be a wolf.
What is the real cause of infertility? Are man always fertile and women always at fault? A study by Ms Stancia Moyo of the University of Zimbabwe’s Centre for Population Studies says over 50 percent of infertility issues among the 10 percent of couples that experience such are a result of male infertility.
Before I go into the details about this issue, I just want to highlight a simple fact that many people forget. We all know that life at times does not allow couples to live together. The husband may be in town and the wife in rural areas and it can be worse that the other party is as far away as the United Kingdom whilst their partner is in Zimbabwe. For a child to be born the couple has to have sex and to increase the chances of conceiving the couple must have sex every other day or three times a week and they must have tried for a least a year for them to seek medical help unless they have other problems that warrant them to see a doctor sooner such as STIs or Irregular periods.
Let us look at the causes of infertility:
Infertility can be caused by a lot of different things and sadly in 25% of couples a cause is not found. I need to correct the misinformation that many people have; no, infertility is not always a woman’s problem. Both women and men can have problems that cause infertility. About one-third of infertility cases are caused by women’s problems. Another third of fertility problems are due to the man.
To help us understand the causes of infertility we need to look at pregnancy. Pregnancy is the result of a process that has many steps and to get pregnant the following must happen: A women must release an egg from one of her ovaries and the process is called ovulation. The egg must go through a tube toward the womb and the tube is called the Fallopian tube. A man’s sperm must join with the egg along the Fallopian tube and the process is called fertilisation. The fertilised egg must attach to the inside of the womb and this process is called implantation. This fertilised egg will grow into a foetus leading to a fully developed baby that can be born. Infertility can happen if there are problems with any of these steps.
Let us look at infertility in women:
Infertility in women is mostly commonly caused by ovulation problems. These ovulation problems can be due to: polycystic ovary syndrome (PCOS) – a condition that makes it more difficult for your ovaries to produce an egg. Secondly thyroid problems – both an overactive thyroid gland (hyperthyroidism) and an under-active thyroid gland (hypothyroidism) can prevent ovulation. And, thirdly, premature ovarian failure – where a woman’s ovaries stop working before she is 40.
Damage to the Fallopian tubes or womb is a cause of infertility and this can happen in the following cases: surgery to the pelvis can result in damage to the Fallopian tube. Fibroids which are benign (non-cancerous) tumours that grow in, or around, the womb can cause infertility possible by preventing an embryo from implanting itself into the womb.
Endometriosis is a condition where small pieces of the womb lining, known as the endometrium, start growing in other places, such as the ovaries. This can cause infertility because the new growths form sticky areas of tissue or cysts that can block or distort the pelvis. These make it difficult for an egg to be released and become implanted into the womb. It can also disturb the way that a follicle (fluid-filled space in which an egg develops) matures and releases an egg.
Pelvic inflammatory disease (PID) is an infection of the upper female genital tract, which includes the womb, fallopian tubes and ovaries. It is often the result of a sexually transmitted infection (STI). PID can damage and scar the fallopian tubes, making it virtually impossible for an egg to travel down into the womb. This seems to be the major cause of infertility in Zimbabwe.
The side effects of some types of medication and drugs can affect one’s fertility. Long-term use or a high dosage of Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin, can make it more difficult for one to conceive. Medicines used for chemotherapy (a treatment for cancer) can sometimes cause ovarian failure, which means ovaries will no longer be able to function properly. This ovarian failure can be permanent.
Neuroleptic medicines are antipsychotic medicines often used to treat psychosis and can sometimes cause missed periods or infertility. Spironolactone – this is a type of medicine used to treat fluid retention (oedema) can affect fertility. Fertility should recover around two months after stopping taking spironolactone.
Illegal drugs such as marijuana and cocaine can seriously affect fertility, making ovulation (the monthly cycle where an egg is released from the ovaries) more difficult.
Infertility in women is also linked to age. The biggest decrease in fertility begins during the mid-thirties. Among women who are 35, 95% will get pregnant after three years of having regular unprotected sex. For women who are 38, only 75% will get pregnant after three years of having regular unprotected sex.
Infertility in men
Male infertility is caused by abnormal semen (the fluid containing sperm that is ejaculated during sex). Possible reasons for abnormal semen include:
Decreased number of sperm; decreased sperm mobility and abnormal sperm, especially the shape. The testicles are responsible for producing and storing sperm. If they are damaged, this can seriously affect the quality of the semen. This may occur if one has, or has had in the past, any of the following: an infection of the testicles, testicular cancer, testicular surgery, a congenital defect (a problem with the testicles that one is born with) or undescended testicles (when one or both of the testicles has not descended into the scrotum) and injury to the testicles.
Some men do have ejaculation problems hence the sperms do not reach the egg. Two examples are retrograde ejaculation – where semen is ejaculated into the bladder and premature ejaculation – where ejaculation occurs too quickly.
Hypogonadism is an abnormally low level of testosterone – the male sex hormone that is involved in making sperm. This could be due to a tumour, taking illegal drugs or Klinefelter’s syndrome (a rare genetic condition where a man is born with an extra female chromosome).
Anabolic steroids – often used illegally to build muscle and improve athletic performance. Long-term use or abuse of anabolic steroids can reduce sperm count and sperm mobility. Chemotherapy – medicines used in chemotherapy can sometimes severely reduce sperm production.
Drinking too much alcohol can damage the quality of the sperm.
Infertility in both men and women
There are many factors that can affect fertility in both men and women. These are being overweight or obese which reduces both male and female fertility. In women, being overweight can affect ovulation. Being underweight can also have an impact on fertility, particularly for women, who will not ovulate if they are severely underweight.
There are several STIs that can cause infertility. For example, chlamydia can damage the fallopian tubes in women, and cause swelling and tenderness of the scrotum (the pouch containing the testes) in men. The major cause of infertility in both men and women in Zimbabwe is due to inadequately treated STIs.
As well as affecting one’s general and long-term health, smoking can also adversely affect fertility. Exposure to certain pesticides, metals and solvents can affect fertility in both men and women.
If one or partner is stressed, it may affect the relationship. Stress can contribute to a loss of libido (sex drive), which in turn can reduce the frequency of sexual intercourse. Severe stress may also affect female ovulation and limit sperm production.
For some, adopting a healthier lifestyle through simple lifestyle changes, or staying up to date with regular health checks and tests, may help to prevent infertility.
I urge everyone to seek treatment for sexual transmitted infections (STIs). I also urge people to change behaviour that also Increase their chances of getting STIs and HIV which can lead to infertility.
Make sure you are up to date with your cervical screening tests (smear tests). You need to have one every three to five years, depending on your age. You should also visit your local sexual health clinic (GUM clinic) to make sure you do not have any sexually transmitted infections (STIs). Infections such as chlamydia may not have symptoms, but can cause infertility if left untreated.
Avoid recreational drugs and other drugs that cause infertility and please do not ignore stress, it can be easily treated. Make sure that you eat a nutritious, balanced diet. Ensuring you maintain a healthy weight will make it easier to conceive.
When confronted with infertility, it is always best for both partners to visit their doctor because fertility problems can affect a man or a woman, and sometimes both partners. We need to understand that the process of trying to conceive can be an emotional one, so it is important to support each other as much as possible.
I hope reading this article will make us view infertility in a different way and reduce the stigma associated with it. I then urge all concerned to see their doctor for further advice on this important topic. Time and space has not allowed me to write about detailed treatment of infertility. I leave that to your doctors to discuss with you different treatment options.
This article was compiled by Dr Brighton Chireka who is a GP and a Patient Engagement Advocate (PEA) in Folkestone Kent in UK. You can contact him on firstname.lastname@example.org or read more of his work on DR CHIREKA’S BLOG
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions.