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INFERTILITY

WHAT IS DELAYED CHILD-BEARING?

Most couples experiencing difficulty with child-bearing will, with appropriate medical treatment, eventually achieve pregnancy and have their own children, so the term is considered more positive than infertility. 

WHAT IS INFERTILITY?

Infertility is generally defined as the inability to conceive after twelve months of regular unprotected sexual intercourse.

IS INFERTILITY A WOMAN'S PROBLEM?

The central role played by the woman in the child-bearing process means that it is normal to question the woman when a couple is not achieving pregnancy However, the process of .conception requires the infraction of the man and the worn .id. Among couples who seek help, infertility is exclusively a problem in the female in about 40% of cases and exclusively with the male in about 30% of cases.

HOW COMMON IS INFERTILITY?

It is estimated that one in every ten couples seeks help in achieving pregnancy worldwide. Although concrete data is lacking; it is thought that the problem is more common in developing countries like Nigeria.

WHAT ARE THE CAUSES OF INFERTILITY?

•  Problems with the, sperm of the male.
•  Problems of the fallopian tubes.
•  Problems of egg release (ovulation).
•  Other causes include: endocervical. uterine, immunological, endometriosis and sexual    problems.
•  Unexplained infertility.

WHAT ARE THE INVESTIGATIONS TO BE DONE_?

The essence of investigations is to exclude the possible causes as listed above. These investigations include:

•  Semen analysis/hormonal assay of the male.
•   HSG/Laparoscopy.
•   Hormonal assay of the female/scan.
•  Other tests are to check for uterine, endocervical and immunological problems.

WHAT ARE THE TREATMENT OPTIONS?

The treatment options available include:

• Ovulation inductions with oral or injectable drugs in ovulation problems.
• Tubal surgery in tubal problems.
• Artificial insemination.
• Assisted conception techniques, GIFT, ZIFT, IVF, ICSI, assisted hatching, oocyte,  cryopreservation, etc.

WHAT ARE THE PSYCHOLOGICAL EFFECTS OF INFERTILITY ON A COUPLE?

It is the natural desire of most couples to have their own children. This is particularly so in Nigeria where children are usually necessary to secure the marriage union. Having to deal with infertility can lead to painful and difficult emotions. It is normal to assume fertility but can be very confusing and painful to learn that one is infertile after trying for a long period. Many experience frustrations and powerlessness in dealing with the situation. Others experience isolation amongst others couples with children. Other emotions commonly expressed include fear of the future, anger at having to deal with such situations, guilt that they caused this to themselves, shame, sadness and hopelessness.

HOW CAN A COUPLE COPE WITH INFERTILITY?

The best thing a couple can do for each other is to try and express the sincere feelings they have about the situation to one another. Men and women usually have different feelings and it is important for the couple to talk through things. Men are not very good at expressing themselves as they tend to focus on things they have more control over such as their work. This does not mean they do not care. Rather, they have merely devised their own coping strategy, but it is important for the couple to try and work things out together.

HOW CAN A COUPLE COPE WITH PRESSURE FROM RELATIVES AND FRIENDS?

Infertility is one of the biggest problems a couple will have to deal with. Though well intended, family and friends can exert tremendous pressure on such a couple. The most important thing any couple can do is to support and protect each other from their own relatives and make it clear that their concern is understood but that you are rather better off being left alone.

WHAT ARE THE EFFECTS OF INFERTILITY ON OUR RELATIONSHIP?

Infertility can have a significant impact on any relationship. It is sometimes said that infertility is the major test of any couple's relationship and can make or break the relationship. By providing mutual support and working together, infertility can strengthen a relationship as the couples learn to give assurance and encouragement to one another.

HOW CAN I HELP MY PARTNER COPE WITH INFERTILITY?

Infertility is a couple's problem and is best approached from that perspective. Be there for your partner; always provide a listening ear; be sensitive, patient and stay informed and always carry your partner along with whatever you are doing

WHAT ARE THE EFFECTS OF INFERTILITY ON SEXUALITY?

Sex is commonly boring to couples who are experiencing infertility due to the repeated process of timed intercourse, temperature charts and medical procedures which takes the spontaneity and pleasure out of the sexual experience. It is important for each couple to realise that they can help each other through this difficult experience. Try and keep life in perspective and share your feelings with each other, and above a]l, remember that your life as a couple is not defined solely by your ability to conceive.

WHEN CAN I SEEK HELP?

It may take up to a year for a couple without any infertility problem to" achieve conception. In some cases, it may take as long as eighteen months. It is better to wait for this time before, starting investigations. However, there are exceptions on this. If a couple know, that they have problems, for instance, if the woman has a history of ectopic pregnancies or she is between 35 and 45 years old, because there is age related decline in female fertility.

WHERE SHOULD I SEEK HELP?

The most important issue is building trust and relationship with your doctor, but then, it is also important that the doctor has the required skill to help and assist the couple. Each couple must choose a doctor they feel confident in. It is important that couples seeking solutions to infertility problems realise that they are dealing with an issue that can affect their lives forever. They must make all efforts to empower themselves on all issues relating to their problems so that they can work with their doctor to achieve their aim.

HOW CAN INFERTILITY BE PREVENTED?

Tubal infertility is usually acquired and can be prevented by keeping one sexual partner. Using contraception, particularly barrier method to prevent sexually transmitted infections and unwanted pregnancy is also helpful. Unplanned pregnancy increases the risk of unsafe abortions, which can latter lead to difficulty in achieving conception. Prompt and appropriate attention to any episode of pelvic infection is also important.

Sometimes, the process of seeking help for the management of infertility can be the cause of the problem. For example, removal of fibroid or operating on the ovaries and fallopian tubes in young women may lead to adhesion formation and tubal infertility. There must be a very good reason before consenting to these operations. The inappropriate use of fertility drugs such as clomid may lead to an increase in the size of fibroids, which when removed, can cause problems.

There are, however, some cases of infertility that people are born with, such as  abnormal  sperm samples,  which cannot be prevented, but can, in some' cases be treated.

WHEN TREATMENT FAILS?

It is very difficult for a doctor to guarantee that a couple will achieve pregnancy. Despite access to sophisticated treatment methods, there are still some couples who will not achieve pregnancy. It is then the role of the clinic or the doctor to help these couples to either adjust to accept that treatment has not worked and to settle to a life without a child or to open up discussions about other methods of achieving parenthood such as adoption.

The decision to stop treatment, whether taken by the doctor or the patient, signifies failure of treatment. This may represent a major life crisis. Counseling is available to help the couple. The grieving phase is important if the patients are able to reinvest in their relationship as a couple. The ability to focus on other projects for the future; the rediscovery of abandoned activities such as sport, music etc or the renewal of neglected relationships is crucial for such a couple.

Once the reinvestment in the couple's relationship and their social life is made, other parenting approaches may be explored such as adoption, working as foster parents or on other projects that cater for the needs of children. There is no evidence that childless couples are less happy or less stable than those who have founded a family. In any case, it is a question of adjusting to any situation and once a couple can live with it, they can indeed live a much fulfilled life.

NOTE: The material contained herein is by no means exhaustive. For details and further enquiries, please contact a consultant Gynaecologist.

DR. Y. O. SANUSI, MBBS, FWACS, MBA (IFE) Consultant Obstetrician & Gynaecologist. Isalu Hospitals Limited, 10 Wempco Road, Ogba-lkeja, Lagos, Nigeria. . Tal: 234-1-0803-308-9592, 234-1-792-8206, 234-1-818-3134.