Infertility is the inability of a person to reproduce by natural means. According to Word health organization infertility affects up to 15% of reproductive-aged couples worldwide.
Although male infertility as been found to be the cause of a couple’s failure to conceive in about 20-30% of cases, the social burden ‘falls disproportionately on women’; hence it is important to realize that infertility is a complaint relating to a couple and not just a single person.
Infertility can be primary; that is infertility in a man or woman who have never had a child, or Secondary; the failure to conceive after at least one previous conception by both a men and a woman. WHO demographic studies from 2004 have shown that in the sub-Saharan Africa, more than 30% of women aged 25-49 years old suffer from secondary infertility. In many cultures childless women suffer discrimination, stigma and ostracism.
Women infertility in women can be caused by:
- Anatomical defects
- This ranges from from birth and infections of the female genital tract, the vagina and the womb, including benign growths on the womb called fibroids.
- Ovary problems (This is the gland that produce eggs)
- Medical conditions affecting the thyroid gland, the pituitary gland, liver, kidneys and autoimmune conditions.
- Medications such as antidepressants
- Previous abdominal surgery
- Social factors such as smoking
After the age of 35, a reduction of female fertility is usually experienced, the reason for age-associated infertility is unclear, but may be related to the decreasing numbers of eggs in the ovaries. Of the above the most common cause is an infection of the fallopian tubes, parts of the womb where the female egg meets with the male sperm to form a baby.
The infection of these tubes by sexually transmitted diseases such as gonorrhea results in occlusive tubal damage. This infection usually presents as a vaginal discharge, but the symptoms may be subtle and it is not surprising that up 50% of patients with post-infective tubal occlusion do not recall the infective episode, only to present with infertility later in life.
Lately there have been high rates of TB affecting the female genital tract leading to infertility. A blocked tube is a risk factor for the pregnancy to grow outside the womb, a condition known as an ectopic pregnancy. Work-up to diagnose the cause includes blood tests, a sonar and evaluation of the fallopian tubes and the womb by means of a combination of laparoscopy (a camera looking into the abdomen) and hysterosalpingogram or hysteroscopy (looking into the womb).
Male infertility is usually caused by problems that affect either sperm production or sperm transport. Sperm production may be affected by medical conditions such as obesity, pituitary gland problems, medications cimetidine, spironolactone, steroids (commonly used by body builders), and social factors like smoking and recreation drugs. Testicular factors refer to conditions where the testes produce semen of low quality, can be congenital, infections, trauma and effects of radiation. A low quality semen contain abnormally functioning sperms, very few to complete absence of sperm cells or a reduced sperm motility.
Sperm transport factors decrease male fertility due to conditions that affect the male genital tract after sperm production and include defects of the genital, which can be congenital or acquired, mainly due to infections as well as problems with ejaculation. Medical conditions especially diabetes mellitus is known to cause erectile dysfunction. Work up includes blood tests, sonar and a semen sample to assess the quality of the sperms.
Treatment vary according to the underlying disease, and may include surgical tubal repair for the blocked fallopian tubes. Specialist treatment includes artificial insemination, in vitro fertilization, which enables eggs to be fertilized directly by sperm outside the woman’s body. The fertilized embryo is then transferred back into the woman’s uterus.
Dr David N. Emvula is a qualified medical doctor who holds a MBChB degree from the University of Pretoria. He is currently a fellow in Obstetrics and Gynecology at the University of Pretoria and co-runs Westcare Medical Center in Windhoek.