by ADEKUNLE YUSUF
Not having anything to blame for inability to get pregnant is a huge source of frustration for many couples. With significant advances made in the diagnosis and treatment of reproductive disorders, experts say there is hope for those battling with how to get pregnant, reports Associate Editor ADEKUNLE YUSUF
It was a miracle, or so it seemed to Adebo Hezekiel, 48, and his wife, Asunle, 42, who had to wait for 16 agonising years before having a child. As they navigated the pregnancy journey from one hospital to another, including visiting homes of spiritual healers, emotional toll on both partners almost dismantled their matrimony.
Undaunted, Adebo and Asunle were determined to surmount any health issues that might be creating an obstacle. They tried every possible natural way, every remedy to conceive, but nothing seemed to work. However, after 16 years of fruitless search for a baby, emotional and physical exhaustion set in, forcing them to stop thinking about pregnancy. Their focus shifted from starting a family to considering adoption. Then a baby boy came when he was least expected. “It is a miracle. Initially, I did not believe I was pregnant, but time soon proved me wrong. Because of what I had gone through, I also expected problems during pregnancy, but God did it without a hitch,” Asunle said in a joyful tone of voice.
Globally, millions of married people are caught in the infertility web, with many unable to find happiness or fulfillment in their marriage as a result of inability to reap the fruits of the womb. Now a global public health issue affecting 10-15 per cent of couples of reproductive age, infertility (or inability to get pregnant after one year of unprotected sexual intercourse) is often associated with devastating social, emotional and psychological consequences that have condemned many homes to perpetual misery, especially in societies and cultures that place a high premium on child-bearing. It is estimated that about 50 million couples experience fertility problems globally, with 15-30 per cent of this population suffering from unexplained infertility.
According to Dr. Kemi Ailoje, a reproductive endocrinologist and CEO of Lifelink Fertility Clinics, unexplained infertility is “when a perfectly healthy couple with no reproductive or lifestyle challenges is unable to conceive.” In other words, it means all the basic infertility tests (such as egg supply testing, imaging to check fallopian tubes and ovary, and sperm analysis) are normal, leaving the doctor unable to pinpoint why a patient is not getting pregnant. However, unexplained infertility does not necessarily mean nothing is wrong; that nothing is showing up in the tests to explain what may be the cause means there may be a few subtle things beyond the realm of testing.
It means infertility issues that have a root cause that cannot be diagnosed. Sometimes, it may be sexual issues or timing issues. Female age is another influence, as natural fertility rates beyond 35 do decline. Approximately one in five couples will be diagnosed with unexplained infertility even after going through a complete fertility work-up. About 30 to 42.9 per cent of couples suffering infertility crisis in Nigeria share this maddening diagnosis.
Whenever couples are handed a diagnosis of unexplained infertility after countless rounds of tests, it often leaves them disillusioned that getting pregnant will be more difficult, perhaps impossible. But fertility doctors say couples diagnosed with unexplained infertility need not panic at all. Because current tests used to evaluate infertility are still somehow limited in scope, normal test results do not mean the possibility of subtle issues affecting fertility is completely ruled out. For instance, a woman with an appropriate amount of eggs may have issues with the quality, perhaps impacted by her age. Fallopian tubes may look normal on testing, but there may be microscopic issues within the tubes affecting their function. Also, semen analysis can not pick up subtle sperm defects affecting fertilisation. Other general health issues, which are usually not part of infertility screening process, may affect fertility in both sexes.
Explaining why more Nigerians are becoming infertile, Prof Oladapo Ashiru, CEO of Medical Art Centre (MART) Clinics, blamed excessive reliance on technology, especially the use of laptop by men, toxins in food and from the environment, bleaching creams, artificial sweeteners, and obesity. According the foremost fertility expert, these decrease sperm count in men and fuel the growth of fibroids in women. He said this during a chat with journalists, stressing that medically monitored detoxification, weight loss, treatment of infections and other life style modifications can turn the tide.
Another culprit fueling infertility crisis in many homes is endometriosis, a medical disorder experienced by women where patches of the womb’s inner linings are found growing in other parts of the body. According to Dr. Abayomi Ajayi, consultant obstetrician and gynaecologist who is the founder and chief executive officer, Nordica Fertility Centre, the disease occurs when tissues similar to the lining of the womb are found where they are not supposed to be, especially in the bladder, ovaries, among others. The tissue bleeds monthly and can cause chronic pains for sufferers during and between menstrual periods, resulting in heavy and long menstrual cycles, gastrointestinal upsets, fatigue, anxiety and depression. While its cause remains unknown, experts said endometriosis, which affects about 176 million women worldwide, may lead to infertility if not treated.
Fertility experts recommend that couples have a semen analysis, testing for detection of ovulation (mid luteal progesterone, LH kit), assessment of ovarian reserve, transvaginal ultrasound, and hysterosalpingography (a radiologic procedure to investigate the shape of the uterine cavity and the shape and patency of the fallopian tubes). With this expanded testing, it is projected that fewer than 15 to 30 per cent of couples will have unexplained infertility. To win the race against unexplained infertility, couples are advised to improve their lifestyle habits: quit smoking, stop use of recreational drugs, cut back on caffeine and alcohol consumption, as there are studies suggesting that excess consumption of these may adversely impact fertility.
After observing all this, Dr. Ailoje recommended that fertility-challenged couples should ensure they enjoy regular unprotected sex timed especially around ovulation. This should be capped with eating right for fertility, use of prenatal multivitamins, minerals at least three to six months before attempting conception, she also suggested. “Expectant management with guidance to identify the fertile window, having timed regular unprotected intercourse especially around ovulation is recommended. Men and women who join fertility support groups are better able to cope than those who do not and are emotionally more stable.
“Assisted conception methods (IUI) and assisted reproductive technology (IVF) provide the opportunity for couples to become parents irrespective of age and type of diagnosed infertility. On a lighter note, couples experiencing unexplained infertility need to know that life is a rhythm; the wise will chose to dance to the melody. Do not let infertility overwhelm you. Learn to enjoy this special gift called today while you bask in the expectation of successful parenthood,” Dr. Ailoje said.
Also speaking on the emotional but common issue of unexplained infertility, Dr. Adeleke Daramola and Dr. Charles Oluwabukunmi Kolade, medical director and gynaecologist/chief operating officer, respectively, Androcare Fertility Centre, Akowonjo, a Lagos suburb, said anyone with such diagnosis should not see it as a death sentence. There is always hope, they assured, stressing that more patience and efforts may do the magic. According to Dr. Daramola, with the advent of Sperm Chromatin Assay Structure (SCSA), it is possible to find out the DNA make-up of sperm cells, which is a procedure that allows experts to dig deeper into the roots of the problem. “This procedure helps many couples to know the next step to take, whether to go straight for IVF treatment or for Intra-cytoplasmic Sperm Injection, ICSI, which is an advanced treatment for low sperm count and other problems with sperms produced by the man himself or donor sperm. This procedure has opened doors and made couples smile,” he said.
The two fertility experts said it makes a lot of sense for all couples who have struggled to get pregnant for upward of one year to subject themselves to clinical investigations without any further delay, preferably both wife and husband. And for couples who are 35 or older, it is advisable they consult a fertility doctor after trying to get pregnant for six months without success. The same advice goes for wives who experience irregular menstrual cycles, who have a high history of pelvic infections, who have a history of tubal pregnancy, or those who have experienced two or more miscarriages.
Stressing that prevention is always better and cheaper than cure, Dr. Kolade said most causes of infertility could be prevented if people are armed with the right and adequate information on what can cause or lead to infertility in both men and women. Apart from low sperm count in men which is said to be caused by varicoceles (an enlargement of the veins within the loose bag of skin that holds testicles or scrotum), the gynaecologist also listed blocked fallopian tubes in women as the most common causes of inability to get pregnant for many Nigerian couples. Unfortunately for men, low sperm count is a problem that increasingly gets worse every year, with actual cause still largely unknown. “Men have enlarged veins in their scrotum which starts from childhood, and if not early detected and corrected, could lead to zero sperm count in the future,” he warned.
Also for men, he explained further that testicular mumps can affect a man’s fertility from his childhood, stressing that this is why mothers should be observant and always check their male child’s testicles in case there is any abnormality. Reason: if the testes are not in their normal position by the time a boy is four years old, he may be on his way to permanent or irreversible infertility, he advised. “The problem must be fixed before he attains four, not even at five or six. This and other abnormalities happen over a period of time, but can be corrected when detected early.”
For young ladies experiencing blocked fallopian tubes arising from pelvic infections that are not properly treated, Dr. Daramola advised them to take care of such things before the problem snowballs into bigger issues that may complicate child-bearing attempts in the future. To this end, he urges vaginal swab or microscopic culture for any woman experiencing vaginal discharge that is white or yellow, with or without odour, which may be accompanied with pelvic pain in the left lower side of the abdomen. These are signs of infections and it is important for ladies to properly get treated when they see such signs, he said.