By Dr. Edem K. Hiadzi,
Consultant Obstetrician/Gynecologist/Fertility Specialist,
CEO – Lister Hospital Fertility Centre, Accra – Ghana
Immediate Past President – Fertility Society of Ghana (FERSOG).
INFERTILITY
Definition:
The failure of a couple to achieve a pregnancy after 1 year of unprotected intercourse (WHO, 1987)
Primary – If pregnancy has never occurred
Secondary – If there has been a preceding pregnancy irrespective of the outcome Prevalence:
United Kingdom – 6%
USA – 10%
Sub-Saharan Africa: 20 – 30%
South East Asia, East Asia and Oceania: 19 – 27%
CAUSES OF INFERTILITY:
In the developed countries, female infertility is caused by factors such as
Endometriosis
An ovulation from polycystic ovarian disease
Hyperprolactinemia
Premature ovarian failure
Cervical and endometrial factors
CAUSES OF INFERTILITY – ctd.
In developing countries, the high level of infertility is due largely to consequences of reproductive tract infections. These are commonly from
sexually transmitted infections
post abortal infections and
puerperal infection which lead to tubal occlusion and peritubal adhesions.
All the above lead to blocked tubes and/or peri tubal adhesions
PROOF – Several studies have shown higher levels of infectious organism in infertile women compared to fertile controls
Infections associated with unsafe abortion leads to tubal blockage.
Also, Asher man’s syndrome produced by excessive curettage of the uterine endometrium during D&C may lead to infertility.
Only few women in developing countries obtain care from trained personnel at delivery. The majority still rely on traditional birth attendants where non-sterile delivery procedures are practiced. The result is a high rate of pelvic infection after delivery.
In addition, prolonged obstructed labor is a frequent complication of pregnancy in many African countries. This is often complicated by pelvic infection which can result in maternal death or severe tubal damage or obstetric fistula (urinary or fecal) and its sequelae.
Other infections like tuberculosis and schistosomiasis may damage both the endometrium and tubes leading to infertility
The practice of female genital mutilation is usually associated with complications of infertility. Infertility affects Men and Women equally, therefore, SHARE THE TREATMENT JOURNEY TOGETHER:
Infertility does not just affect women1
About half of the causes of infertility are due to, or include male factors1
Infertility is one of the commonest conditions affecting reproductive age group between 20 and
45 years2
MALE INFERTILITY
Definition:
The inability of a male to make a fertile female pregnant after a minimum of at least one year of regular unprotected intercourse
Common Causes:
In the developed world – the most prominent causes of male infertility include;
Hypogonadotropic hypogonadism as produced by tumors or functional failures at the pituitary or hypothalamic levels
Hyperprolactinemia
Testicular failure
By contrast in sub-Saharan Africa, sexually transmitted disease especially by Gonorrhea and Chlamydia account for a significant proportion of cases. These infections cause chronic epididymitis and occlusion of the vas deferens leading to oligospermia (low sperm count) and azoospermia (No sperms in semen).
Other causes in the male
Previous hernia repair may accidentally damage the vas deferens
Varicocoele may lead to low sperm count
Sexual dysfunction – Premature ejaculation
– Anejaculation
– Infrequent Sexual Intercourse
– Erectile Dysfunction
SHARE THE TREATMENT JOURNEY TOGETHER
The following healthy tips may help:
1. Limit your alcohol intake
2. Avoid drugs
3. Stop smoking
4. Avoid high temperatures as this can affect sperm production and motility
5. Although this effect is usually temporary, avoid riding motorbikes, hot tubs and steam baths – instead use showers and wear loose pants.
INFERTILITY – SOCIETAL IMPACT
Infertility is a major cause of marital disharmony in Africa and it exposes women especially to ostracization, social discrimination and physical violence
In India and South Asia for that matter, Infertility has significant negative social impact on the lives of the infertile couple particularly women, who frequently experience violence, divorce, social stigma, emotional stress, anxiety, depression and low self-esteem.
INFERTILITY PREVENTIVE MEASURES
PREVENTION:
Since the major cause of infertility in Sub-Saharan Africa is from pelvic infections in both male and female, it is clear that a better approach in its management is to direct programs towards prevention at various levels
1. Primary prevention – Consists of the prevention of
Sexually transmitted infections
Post abortal infections
Post-delivery infections
INFERTILITY PREVENTIVE MEASURES – ctd
1. Primary prevention – ctd
These should consist of community education on behavioral change modification on sexual practices, effective contraception including barrier methods of contraceptive – male + female condoms reduce transmission of infectious organisms
Contraception will reduce the number of unwanted pregnancies thereby reducing the number of posts abortal infections and abortion related infertility
Similarly, the provision of effective maternal care services will help reduce puerperal infection
INFERTILITY PREVENTIVE MEASURES – ctd
2. Secondary prevention
Involves early recognition and aggressive treatment of sexually transmitted infections and prompt treatment of post-abortal and puerperal sepsis to prevent future infertility. Go to a health facility when you suspect any pelvic infection. Do not self medicate
3. Tertiary Prevention
Use of methods to mitigate the effects of infertility in a couple. Includes systematic
counselling with conventional methods. Where cost is not a problem – use of one of
new reproductive techniques
Where infertility is irreversible counsel couple to accept their fate and consider
options of adoption or fostering
KEY MESSAGES FOR YOU
1. INFERTILITY IS NOT A STIGMA
2. INFERTILITY AFFECTS MEN AND WOMEN EQUALLY
3. GET INFORMED
4. SUPPORT YOUR WIFE
5. FERTILITY IS A SHARED RESPOSBILITY.
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By Dr. Edem K. Hiadzi,
Consultant Obstetrician/Gynecologist/Fertility Specialist,
CEO – Lister Hospital & Fertility Centre, Accra – Ghana
Immediate Past President – Fertility Society of Ghana (FERSOG