malvernmugadzikwa
Catherine Murombedzi
Health Correspondent
- Part Two.
The possible causes of infertility. The complex nature of infertility and medical interventions.
It is important to note that infertility is a shared responsibility between partners. Both husband and wife should undergo medical evaluation and treatment.
Sadly, in the African context, infertility carries the face of a woman. It is viewed as a cultural shame and is blamed on the woman with calls to have the infertile woman return to her parents.
Such crude language destroys the woman’s confidence.
However, when the new wife fails to conceive again, alarm bells sound.
A thorough understanding of the causes of infertility is needed. The media, through capacity enhancement in fellowships, come in.
Infertility differs from place to place. In Europe, it is around 5%, in the USA, 6%, and in Africa 20% to 30%.
Africa has limited access to quality healthcare, leading to undiagnosed and untreated medical conditions that contribute to infertility.
Cultural practices like female genital mutilation in some West and East African countries may cause infertility.
With the use of pesticides in farming and control of mosquitoes and tsetse fly, exposure to pesticides and other toxins is high. This too, can affect fertility.
Some genetic conditions, like sickle cell disease, are more prevalent in Africa and can also contribute.
With Southern Africa bearing the brunt of HIV/AIDS, the risk of infertility also rises.
Pelvic inflammatory disease (PID) and tubal damage are more common in Africa due to untreated STIs, leading to tubal factor infertility.
Limited access to fertility care
Africa has a shortage of fertility specialists, clinics, and assisted reproductive technologies like IVF, making it harder for people to seek fertility treatment.
These factors contribute to the higher infertility rates in Africa.
Medical interventions can help individuals and couples make informed decisions on their reproductive health and rights.
Primary infertility and secondary infertility
Primary infertility refers to couples who have never conceived or carried a pregnancy. It could be due to various factors such as genetic, hormonal, or anatomical issues.
Secondary infertility refers to couples who have had at least one previous successful conception or a live birth but struggle to conceive again.
This may be due to age-related decline in fertility. There can be changes in reproductive health since the previous pregnancy. There could be lifestyle changes, environmental factors, or stress emanating from the loss of the pregnancy or baby.
It’s important to note that both primary and secondary infertility can be caused by a combination of male and female factors, and in some cases, the cause may be unknown.
Infertility is a complex issue with various causes and medical interventions.
Unsafe abortions may damage the fallopian tube, sexually transmitted infections, and misuse of substances are risk factors.
Speaking in a Merck Foundation webinar on infertility awareness, Dr Edem Hiadzi, immediate past president of the Fertility Society of Ghana (FERSOG) for couples to visit health facilities for proper diagnosis.
“STIs like chlamydia, gonorrhea, pelvic inflammatory disease (PID), syphilis, and even tuberculosis can also lead to infertility if left untreated or poorly managed. STIs can cause tubal damage or blockage, uterine or cervical scarring, epididymitis (inflammation of the epididymis in men) or orchitis.
“In females, unsafe abortion can result in uterine perforation or damage, cervical lacerations or scarring, infection or sepsis. These complications can increase the risk of infertility or make it more challenging to conceive,” said Dr Hiadzi.
He emphasised the need to seek treatment early.
“Early detection, treatment, and prevention of STIs, as well as safe abortion practices, can significantly reduce the risk of infertility and other complications,” added Dr Hiadzi
It is essential to manage stress through relaxation techniques, exercise, and social support to optimise fertility. He pointed out that hormonal imbalances, ovulation disorders, tubal damage or blockage, and low sperm count can cause infertility.
“Stress can have a significant impact on fertility in both men and women. Chronic stress can disrupt hormonal balance. It can affect the production of hormones that regulate fertility, such as cortisol, adrenaline, and thyroid hormones.
“Stress can delay or prevent ovulation in women, making it harder to conceive. Stress can lower sperm count, motility, and morphology in men. It can negatively impact libido, thereby killing sexual desire and arousal.
“It can also reduce the success of fertility treatments like IVF and IUI. Stress can increase the risk of miscarriage, cause irregular periods, amenorrhea (no periods, or oligomenorrhea (infrequent periods). In males, it can lower testosterone levels, thereby affecting sperm production.
“Chronic stress may cause polycystic ovary syndrome (PCOS). Stress can cause anxiety, depression, and emotional distress. These all negatively impact fertility.
“There are several interventions like intrauterine insemination (IUI), in vitro fertilisation (IVF), intracytoplasmic sperm injection (ICSI), egg or sperm donation, surrogacy, laparoscopic or robotic surgery for endometriosis or tubal repair,” Dr Hiadzi said.
Although the above-mentioned interventions are now being scaled up, the cost remains too high for many people.
Women undergoing cancer treatment can have their eggs frozen. The intervention is known as cryopreservation. This technique has become increasingly popular among women undergoing cancer treatment, as well as those who want to preserve their fertility for further use for various reasons.
“For women undergoing cancer treatment, egg freezing offers a chance to preserve their fertility before undergoing chemotherapy, radiation, or other treatments that may damage their ovaries or affect their ability to conceive,” said Dr Hiadzi.
“The woman undergoes a cycle of ovulation induction to stimulate her ovaries to produce multiple eggs. The eggs are retrieved through a minor surgical procedure. The eggs are then frozen using a process called vitrification, which involves rapid cooling to prevent ice crystal formation. The frozen eggs are stored in a cryobank for future use.”
When the woman is ready to conceive, the frozen eggs are thawed and fertilized using IVF. This way, she can use her eggs, even if her ovaries have been damaged by cancer treatment.
Egg freezing can also be used by women who want to delay child-bearing for various reasons such as career goals, lack of a suitable partner or personal reasons.
“The success rates vary depending on factors like age, egg quality and the number of eggs frozen. However, it can offer a sense of security and peace of mind for women who want to preserve their fertility,” he noted.
In Zimbabwe, with less than 10 percent of the 15,2 million people on health insurance cover and fertility drugs costing anything from US$10 to US$100 a cycle, the treatment is beyond the reach of many.
While IUI is mostly carried out in some private clinics and hospitals in cities, the training of embryologists by the Merck Foundation in Zimbabwe has spread the program to the public sector.
The foundation has also trained more than 80 oncologists and 156 graduates in diabetes management and preventive cardiovascular medicine.
The Merck Foundation has also trained more than 180 fertility specialists and embryologists from 35 countries in Africa and Asia. Many more are being trained.
Treatment in the private sector requires $500 to $2,000 per cycle.
On the other hand, IVF costs $3 000 to $6 000 per cycle.
But with the Merck Foundation striving to improve access to infertility care in Africa and Asia, the steps are making notable progress. Rome was not built in a day.
The Merck Foundation, through a program known as “More Than a Mother,” aims to empower infertile couples through access to information, education, and a change of mindset.
Merck supports African and some Asian Governments in training embryologists. The Foundation works with African First Ladies in 22 countries and welcomes more to join.
It has partnered the International Federation of Fertility Societies (IFFS) and the Africa Reproductive Care Society (ARCS), among others, in conducting summits and trainings.
Meanwhile, a visual in-depth on infertility awareness shared by The Sunday Mail in 2022 is attached here.
https://www.facebook.com/share/v/NRNFKt3bLCKMfvb1/?mibextid=5Mube3
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