Infertility
causes great worry and sorrow for many couples in Africa, especially for the
women. Medical evidence shows that men and women usually have the same rates of
infertility
Infertility
- Unwanted Childlessness
Infertility
is typically defined as the inability to achieve pregnancy after one year of
unprotected sexual contact. Worldwide more than 70 million couples suffer from
infertility, affecting up to 15% of the couples in their reproductive age.
Infertility
can be caused by various factors; Male, female, or a combination of the two. In
approximately 30% of cases no reason will be found. For couples who have not
conceived after one year of trying it may be worth seeing a specialist. The
doctor can check for some common causes, evaluate and discuss possible
treatment options.
WHAT
CAN CAUSE INFERTILITY?
In
order to understand the tests and treatments you may be offered, it is
important to understand how conception naturally occurs. First, your ovary must
release (ovulate) an egg. This usually occurs once a month, approximately
mid-way through the menstrual cycle. The egg must be picked up by the fallopian
tube. Sperm must travel through the vagina, into the uterus, and up into the
fallopian tube in order to fertilize the egg. The fertilized egg, or embryo,
then travels down the fallopian tube to the uterus, where it implants in the
uterine lining and develops (Figure 1). A problem in any part of this process
can lead to infertility.
DEALING WITH INFERTILITY
If
you and your partner have been unable to have a baby, you’re not alone. At
least one out of seven couples has trouble conceiving. During this time, it is
normal to experience feelings of frustration, jealousy, anger and stress.
However, once you begin to explore your medical options, you’ll find that
fertility treatments offer hope for a successful pregnancy.
Causes
of Infertility
Most
important reasons for infertility in Africa are infections which may be
sexually transmitted, that affect both men and women, and pregnancy related
infections. Approximately 20% is caused by ovulatory dysfunction, for example
in poly cystoid ovary syndrome, diabetes and or in severe obesity. In a
significant number of cases no cause for infertility can be found. Assisted
reproductive techniques such as IUI, intra uterine insemination may be
successful here.
Since
infertility is a shared experience and is best dealt with as a couple, both you
and your partner should try to attend the first meeting with your doctor. Your doctor will review your history and ask
you and your partner questions to help identify potential causes for your
difficulty in conceiving. Since at least 25% of infertile couples have more
than one factor causing infertility, it is very important to evaluate all
factors that may affect both you and your partner.
You
and your partner might undergo a series of tests including a sperm test (semen
analysis) of the male partner, an ultrasound scan and or x ray of the womb for
the female partner, blood test for both partners to screen of sexually
transmitted diseases and HIV and possibly other tests, depending on any other
symptoms that you may have. For example, Hormone tests: Testosterone in the
male and Estragon, Progesterone and FSH in the female partner.
Fertility
Treatment
Sometimes
the factors affecting your fertility are easy to detect and treat, but in many
cases a specific reason for infertility may be difficult to identify. After a
full evaluation, your physician can give you a reasonable idea of your chances
of achieving pregnancy with various treatment options.
Even
when no cause for infertility is found there are ways to help you increase your
chances of getting pregnant. Examples of these Assisted Reproduction Techniques
are ovarian stimulation, intrauterine insemination (IUI) and IVF (in vitro
fertilization).
Ovarian
stimulation is a hormonal treatment with which the menstrual cycle is
regulated. Follicle growth will be monitored and ovulation detected with
ovulation test (LH tests) or induced by an injection of Phenyl. This way we
will know exactly when ovulation will take place.
Intra
Uterine Insemination (IUI) is a procedure in which after ovarian stimulation
sperm that is processed in the laboratory is placed directly high in the
uterus.
In
Vitro fertilization (IVF) involves the culture of eggs with sperm in a
laboratory to create fertilized eggs, which develop into embryos. The embryos
are allowed to grow up to 4 days and then one or two embryos are transferred
into the woman’s uterus.
The
choice of which treatment to pursue, if any, is strictly a personal one. Side
effects, costs and expected success rates are important factors to consider
when choosing a treatment plan.
OTHER
FACTORS OF INFLUENCE ON FERTILITY
Lifestyle
For
both men and women a healthy lifestyle will contribute to your chances of
conceiving. Tobacco and alcohol are
known to have a negative effect on the fertility of both men and women, as well
as on the development of a foetus in pregnancy. You have a reduced chance of
conceiving if you are very overweight or underweight. Stress has been known to
negatively influence libido in men, and the menstrual cycle in women. In
general it is advised to keep a healthy diet and have some regular physical
exercise.
Fertility
and Age
Fertility
declines with age because fewer eggs remain in the ovaries, and the quality of
the eggs remaining decreases. Blood tests are available to determine your
ovarian reserve, a term which reflects your age-related fertility potential and
indicate your chances for pregnancy, especially if you are age 35 or older. Abnormally
high FSH levels do not mean that you have no chance of successful conception.
However, they may indicate that success rates may be lower, that more
aggressive treatment may be warranted, and/or that higher medication doses may
be needed.
Vaginal
douching
vaginal
douching is a commonly used method to wash out the vagina with water or a
mixture of water and soap, Dettol or other solutions. Douches that are sold in
drugstores and supermarkets may contain antiseptics and fragrances.
Besides
making them feel fresher, women say they douche to get rid of unpleasant
odours, wash away menstrual blood after their period, avoid getting sexually
transmitted diseases and prevent a pregnancy after intercourse. However, health
experts say douching is not effective for any of these purposes. On the
contrary, it can actually increase the risk of infections, pregnancy
complications and other health problems.
Regular
vaginal douching changes the delicate balance of vaginal flora (organisms that
live in the vagina) and acidity in a healthy vagina. These changes can cause
overgrowth of bad bacteria which can lead to infection. Douching itself can
push existing infections further up into the uterus, fallopian tubes and
ovaries.
It
is strongly advised you should avoid vaginal douching. Having some vaginal
discharge is normal however, if you notice a very strong odor, it could be a
sign of infection. The acidity of the vagina naturally controls bacteria, and
simply washing the outside of the vagina with warm water and mild soap is
enough to keep clean.
PSYCHOLOGICAL
IMPLICATIONS
Infertility
is a medical condition that has many emotional aspects. Feelings such as anger,
sadness, guilt, and anxiety are common and may affect your self-esteem and
self-image. You may find it difficult to share your feelings with family and
friends, which can lead to isolation. It is important to know that these
feelings are normal responses to infertility and are experienced by many
couples. Although a doctor will describe various treatments and realistic odds
of success with treatments, you must decide how far you will go in your
attempts to conceive. Coming to a joint decision with your partner about goals
and acceptable therapies is important.
Infertility
in Africa
Even
with the population booming over Africa, infertility is still a big problem.
Infertility
is typically defined as the inability to achieve pregnancy after one year of
unprotected sexual contact. Worldwide more than 70 million couples suffer from
infertility, affecting up to 15% of the couples in their reproductive age. In
Africa, the situation is worse. WHO demographic studies from 2004 have shown
that in sub-Saharan Africa, more than 30% of women aged 25–49 suffer from
secondary infertility, the failure to conceive after an initial first
pregnancy.
The
Impact of Infertility
In
Africa, the inability to conceive is frequently considered a personal tragedy
as well as a curse for the couple, impacting on the entire family and even the
local community. In addition to the
personal grief and suffering it causes, infertility can create broader
problems, particularly for the woman, in terms of stigma, economic hardship,
social isolation, and even violence.
Unlike
the Western world, where infertility is openly discussed and help and information
is widely available, in most African societies the topic is taboo, and help is
scarce, contributing even more to the agony and isolation these women suffer.
Seeking fertility care often means a lonely path for women wishing to conceive.
Main
cause of infertility in Africa is the result of genital infection, which may
have been sexually transmitted, or caused by traditional practices, such as
female genital mutilation or unsafe abortions and home deliveries in unhygienic
circumstances. These infections, if left untreated often result in bilateral
tubal occlusion.
Other
causes of infertility include ovulatory dysfunction (approximately 20%), for
example in poly cystoid ovary syndrome (PCOS), diabetes and or in severe
obesity. In a significant number of cases no cause for infertility can be
diagnosed.
Fertility
Treatment
Fertility
care, if available is very basic in the Gambia. Conventional methods of
infertility treatment involve the surgical repair of blocked fallopian tubes
and hormonal stimulation with Clomid.
Highly
controversial is the procedure of D&C (dilation and curettage). D&C as
an infertility treatment has long been eliminated from the reproductive
medicine textbooks, and government hospitals and most private clinics no longer
offer this procedure as infertility treatment. Still, many Gambian women feel
that the process of ‘cleaning out the womb’ or ‘stomach washing’ will remove
any blockage that might prevent a pregnancy or affect its viability and some
are willing and able to offer large sums for the procedure. Sadly as of to date
some doctors still perform D&C for these reasons.
In
the West infertility care is highly standardized and a number of treatments are
available. These ‘Assisted Reproduction Techniques’ such as intrauterine
insemination (IUI) and in vitro fertilization (IVF) can be very expensive. It
is not uncommon for these treatments to cost up to thousand dollars per cycle
in London and New York. Those who can’t afford this go to Algeria, Tunisia and
India. Still, out of reach for most Africans.
Low
Cost IVF
The
Walking Egg Foundation, a charity sprang from the Genk Institute for Fertility
Technology in Belgium has developed a Simplified Culture System (SCS), which is
an enclosed culture system in a shoe-box size environment. This technology
allows IVF to be carried out without the need for a full laboratory, therefore
massively reducing the cost and making it a real possibility in African
settings. Results so far indicate that SCS works at least as well as conventional
IVF systems. As of to date 16 healthy babies have been born from this
initiative. Presented to the European Society of Human Reproduction and
Embryology conference, the Walking egg low cost IVF method showed a pregnancy
rate of 30% – approximately the same as conventional IVF
Dimbayaa,
a collective of fertility professionals based in Holland and the Gambia strives
to raise awareness for the problem of infertility and help make fertility care
available and affordable for people in the Gambia. Aiming to provide for high
quality fertility care including low cost IVF in cooperation with the walking
Egg Foundation on the one hand, but also to develop outreach programs on
infertility awareness and prevention. Prevention should cover both primary prevention;
sexual education of young people on how to avoid STD’s, as well as secondary
prevention; early and appropriate diagnosis and treatment of STD’s.
Author Dr Cynthia Witsenburg, MD Fertility
physician, Medical Director Sunnu Medical services
www.dimbayaafertilityafrica.com
Sunnu Medical Services, East Fajara telephone 2196809
Africmed
Medical Services, Brusubi telephone 7332101
