05:03 11th January 2013 | Common Infertility Pain
For the last 14 years we have seen couples come through our doors from different parts of the world, some known to us personally and others absolute strangers, sharing a common pain and an equally common need. One of our earliest couples, who had been married for 7 years without having a child, referred to the “deafening silence” in their home brought on by the absence of the noise of children. They went on to have 4 beautiful children with us. This common pain is indescribable and unique to each couple as they have to deal with the pressure within their marriage and the pressures that their families and the greater society weighs on them from unanswered questions. The story of creation is one that we all grew up on with the charge to procreate and multiply our progeny. Some civilisations have consciously decided to reduce the number of children being born while some couples have decided not to have children of their own. However the overwhelming majority of couples plan on having children and subconsciously feel that their marriages can only be validated by their capacity to indeed multiply. It is to those couples that infertility is most harrowing and IVF becomes most important.
Natural conception and pregnancy is a complex but well-coordinated system. The reproductive organs implement this system which is controlled by the hormones such as oestrogen, progesterone and testosterone that are secreted by the reproductive organs under the control of some other substances produced by a small gland in the brain called the pituitary gland. The substances secreted by the pituitary gland are follicle stimulating hormone (FSH) and luteinising hormone (LH). The events of this complex system are described as menstrual cycle in women which involves the simultaneous production of a matured egg, which can be fertilized and preparation of the inner lining of the womb to receive a fertilised egg (an embryo).
Before a couple can achieve pregnancy naturally they must have intercourse and the man releases his sperm into the woman’s vagina. The sperms swim through the neck of the womb (called the cervix) into the uterus and own the fallopian tubes where, ideally, the sperms will meet an egg that has been released from the woman’s ovaries if intercourse coincides with ovulation. Fertilisation may occur with a single sperm and the embryo will continue down the tubes into the uterus where it should implant and form a foetus. Infertility occurs when any or all of these processes become defective.
Infertility: who, where & how?
Infertility is the inability of a couple to achieve pregnancy after a year of regular unprotected sexual intercourse. It is further defined as failure of the couple to achieve pregnancy within six months of regular unprotected sexual intercourse if the woman is 35 years old or more OR any period of time in a woman with menstrual irregularities or in a man with reliably proven abnormal sperm parameters. Typically about 84% of couples will conceive within the first year of trying, by the second year 92% would have conceived and 93% by the third year.
Globally it is has been proven that 1 in every 6 couples of childbearing age experience difficulties with having children. These figures are worse in Nigeria where studies have shown that on the average 1 in every 4 couples will experience these difficulties and infertility still remains the most frequent complaint gynecologists manage. With our population in excess of 150 million people the rates of primary (when a couple has never achieved pregnancy) and secondary (a couple who have been pregnant previously but are no longer able to conceive) infertility estimated together affect about 30 percent of our married couples.
Causes of infertility may be categorized as male factors, female factors, combined (male and female) factors and unexplained infertility. The proportion of infertility contributed by each of these factors varies from country to country but in Nigeria it has been suggested that the male factors and the female factors contribute equally to causes of infertility. It is clear therefore that infertility is not just a problem of the woman as is often wrongly assumed.
Factors contributing to infertility in men include: abnormal sperm production due to conditions like undescended testes, genetic or chromosomal disorders like cystic fibrosis, repeated infections, mumps infection in childhood and tuberculosis. Defective hormonal production from the brain, pituitary or thyroid gland my also impair sperm production. Others include enlargement of the veins that surround the testicles, a condition known as varicocoele, which may lead to poor sperm production. Conditions such as premature ejaculation painful intercourse or blockage of the passage for sperms may also lead to infertility while drugs like anticancer medication and environmental toxins like pesticides, lead or turpentine found in commercial paint, nicotine, frequent exposure to heat as in hot baths and wearing of tight pants may impair the ability of the testes to produce sperms. Twisting of the testes on its cord (torsion) may result in obstruction of the blood supply to the testis and damage to testicular tissue leading to poor sperm production. Sperm transport disorders can be caused by Infection especially gonorrhoea and chlamydia infection, congenital disorders such absent or underdeveloped duct and past sterilization though not common in this part of the world.
Factors contributing to infertility in women include: damage to the fallopian tubes brought on by infections following either termination of pregnancy under unhygienic conditions, delivery in unsanitary circumstances, pelvic infection which sometimes might have occurred in the past and previous surgery on the uterus. Some women would also have had ectopic leading to the damage of the tube. With tubal damage the sperm is unable to get to the egg or the fertilized egg is unable to get into the womb. All these contribute to the tubal causes of infertility. In a number of women infertility may be caused by the lack of or irregular ovulation which may manifest in the woman as either irregular or absent monthly bleeds and is often seen in women that regularly engage in extreme physical exertion such as professional athletes or in women undergoing emotional stress or in women with the extremes of weight, either too thin or too fat. Other causes of female infertility include polycystic ovary syndrome, drugs which impair ovulation and premature ovarian failure where the woman’s ovaries stop functioning even though she is still below the age of 40 years. Uterine causes of infertility include the presence of fibroids, endometrial polyps and scar formation in the cavity due to infection or surgery can cause infertility by interfering with implantation. Some congenital abnormalities affecting the uterus are also associated with infertility.
Other factors include advancing age in the woman as a woman’s fertility potential begins to decline with age but after 35 years it declines at an even faster rate; social habits such as smoking, excessive alcohol intake, consumption of excessive amounts of caffeine and abnormal dietary habits which could predispose the woman to being overweight or underweight can impair ovulation.
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