Vusumuzi Dube
Phillipa Mukome-Chinhoi, Correspondent
Be Stronger Together as a couple and everything will work out for good.
Infertility is a condition that affects both men and women equally. Contrary to common belief, infertility is not solely a woman’s issue. In fact, about half of the causes of infertility are due to, or include, male factors. This condition is one of the most common issues affecting individuals in the reproductive age group of 20 to 45 years.
For couples hoping to become parents, the journey can be frustrating and unexpected when faced with difficulty conceiving. However, many couples who struggle with infertility do end up having children, sometimes with the help of medical interventions. Understanding the possible causes of infertility is an important early step in this journey.
On April 4, 2023, WHO reported that approximately one in six people globally experience infertility at some point in their lives.
Understanding Infertility
WHO defines infertility as the inability to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse.
Infertility is defined as the inability to get pregnant (conceive) after one year (or longer) of unprotected sex. For women aged 35 years or older, this period is reduced to six months. It’s important to note that these definitions are used for public health data collection and are not intended to guide recommendations about fertility care services.
Infertility can result from issues at any stage of the reproductive process. Impaired fecundity, a related condition, refers to women who have difficulty getting pregnant or carrying a pregnancy to term. Reproductive endocrinologists can also assist women with recurrent pregnancy loss, defined as having two or more spontaneous miscarriages.
Factors Affecting Female Fertility
A woman’s menstrual cycle, typically 28 days long, can provide clues about her fertility. Regular, predictable periods that occur every 21 to 35 days likely indicate ovulation. Irregular periods may suggest a lack of ovulation, which can be confirmed through ovulation tests or blood tests.
Several factors can disrupt ovarian function, necessitating evaluation by a healthcare provider. Common markers of ovarian function include follicle-stimulating hormone (FSH), anti-müllerian hormone (AMH) and antral follicle count (AFC) tests. Key factors affecting female fertility include:
· Age: Fertility declines with age due to a decrease in egg quality and quantity. Older women are also more likely to have health conditions that can cause fertility problems, and the risk of miscarriage and genetic abnormalities increases with age.
· Lifestyle Factors: Smoking, excessive alcohol use, and extreme weight changes can impact fertility. Excessive physical or emotional stress can also lead to amenorrhea (absent periods).
Factors Affecting Male Fertility
Infertility in men can be caused by disruptions in testicular or ejaculatory function, as well as hormonal and genetic disorders. A semen analysis, along with a complete medical history and physical examination, helps determine if and how male factors are contributing to infertility. This analysis assesses the number, motility and morphology of sperm.
Conditions that can disrupt testicular or ejaculatory function include:
Varicocele: Enlarged veins in the testicles that may affect sperm number or shape.
Trauma: Injury to the testes can lower sperm production.
Unhealthy Habits: Heavy alcohol use, smoking, anabolic steroid use, and illicit drug use can decrease sperm production.
Cancer Treatments: Chemotherapy, radiation, or surgery to remove one or both testicles can impact sperm production or function.
Medical Conditions: Conditions such as diabetes and cystic fibrosis can also affect male fertility.
Infertility is a shared responsibility, affecting both men and women. Understanding the causes and seeking appropriate medical help can significantly improve the chances of conception. By being stronger together, couples can navigate the challenges of infertility and work towards achieving their dream of parenthood.
Esther Mupungi a shop owner in Hauna, Manicaland faced multiple miscarriages and an undiagnosed autoimmune condition, celiac disease. She was referred to Dr Gupta in Harare and after several failed attempts at IVF and a strict gluten-free diet, Esther and her husband finally welcomed a baby girl, Atipa Sharlom who is now three years old. Her story highlights the importance of personalised medical care and emotional support.
Kudakwashe Wilfred and Melody, a couple from Mbare endured years of miscarriages. Their perseverance paid off when they finally had their first son through IVF. Miraculously, they conceived their second son naturally a year later. “We thank God for technology and giving wisdom to those who do researches, IVF is a very expensive procedure, we hope it is going to be affordable to many who are facing this challenge. We got assistance from my sister who is a healthcare nurse in Nottingham”said Kudakwashe.
On May 22, 2024, WHO emphasised the significant social and psychological impacts of infertility, including stigma, emotional stress and financial hardship. They called for better policies and public financing to improve access to fertility treatments, which are often prohibitively expensive.
WHO’s reports highlight that infertility affects people in both high-income and low- and middle-income countries almost equally, indicating that it is a major global health challenge.
Patience Humba (not real surname) battled uterine fibroids and endometriosis. Despite multiple surgeries and failed IVF attempts, she eventually became pregnant and gave birth to a healthy boy. Her story is a testament to the emotional and physical challenges of infertility and the joy of eventual success.
Patience said she faced a lot of emotional abuse by the pressure she was being given be friends and family members. As a couple they became silent and stopped sharing their issues with anyone even close people.
“By being stronger together, will help to stop stigma and discrimination caused by attitudes and beliefs by society that manifest in many ways.
Women are often unfairly blamed and shamed for infertility, leading to feelings of shame and isolation. This stigma can prevent couples from seeking medical help or discussing their struggles openly leading to silence especially in men because they feel pressured to prove their virility, while women may feel inadequate if they cannot conceive.
Couples who do not support each other end up encompassing a range of abuses, including physical, sexual, and psychological violence. Family dynamics and cultural norms that perpetuate violence.
Both stigma and GBV can have severe mental health impacts, including depression, anxiety, and post-traumatic stress disorder (PTSD).
Raising awareness about the realities of infertility and the unacceptability of GBV can help reduce stigma. Education programs can challenge harmful gender norms and promote equality. Providing robust support systems, including counseling and support groups, can help victims of GBV and couples dealing with infertility.
Strengthening legal protections against GBV and ensuring access to justice for victims is crucial. By addressing stigma and GBV, we can create a more supportive and understanding environment for couples and families, helping them navigate these challenges together.
Infertility is a shared responsibility, affecting both men and women. Understanding the causes and seeking appropriate medical help can significantly improve the chances of conception. By being stronger together, couples can navigate the challenges of infertility and work towards achieving their dream of parenthood.
Bongani Ndlovu