WHAT YOU NEED TO KNOW ABOUT: INFERTILITY PREVENTION: THE LINK BETWEEN INFERTILITY AND INFECTIOUS DISEASES.

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.

Powered by Merck Foundation in collaboration by the Uganda Journalists Association (UJA).

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

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