Fertility is one topic that's usually swept under the rug until it becomes a big problem.
Many people never do fertility checks before marriage. They assume that they will sire children or get pregnant.
If a woman gets her monthly periods with no fail, she assumes that she is fertile. While men generally assume because they get erections, they will also sire children.
Infertility is, however, a very traumatic journey. It causes anxiety in couples. It may attract stigma as people talk, speculating on causes that may be making it difficult for them to conceive. The blame is usually heaped on women.
“Infertility is not only a women’s issue. It is found in both men and women. Surprisingly, 40 to 45 percent of men compared to 35 percent of women are affected. At the same time, about 20 percent of infertility cases remain “unexplained”, even after a full diagnostic process,” says Dr Kireki Omanwa, a consultant obstetrician and gynaecologist, and fertility specialist.
This, he attributes to factors such as culture which has, for instance, made men shy away from seeking medical health. He urges those in the reproductive age to start thinking about it on a serious note.
“You don’t want to wait until you are married and then you start to struggle. This can be inculcated in premarital counselling, as it can also lead to blame games.”
“Proactive fertility testing can help one learn more about their reproductive health, including any obstacles to future conception,” says Dr Omanwa.
He warns that one should never wait until they want to conceive to think about their fertility.
Doctors generally define infertility as not conceiving after 12 months of regular sexual intercourse without using any form of birth control.
Though less discussed, fertility checks are as important as general health checks, as they prevent a serious health issue that could impact overall well-being from escalating.
How long should one try to conceive before seeing a doctor?
If the woman is under the age of 35 and has been trying to conceive for more than one year, Dr Omanwa recommends that the couple consult a fertility specialist.
“For couples who have intercourse twice to three times a week, and a year has passed without conception, then we call that primary infertility and should start looking for a diagnosis. Secondary infertility is when a couple has a child or children, but now they are finding it hard to have another pregnancy. The same parameters apply; Intercourse up to three times a week, no contraceptive, and the woman is not breastfeeding as well,” he says.
Dr Charles Muteshi, a consultant obstetrician-gynecologist, and fertility specialist at the Aga Khan University Hospital, Nairobi advises a doctor visit if you’ve been diagnosed with cancer previously or undergone treatment around the reproductive system or women who have irregular periods. For those older than 35, they will need to come sooner, which is usually six months.
Causes of infertility
While people believe that infertility is only linked to age, there’s so much more that comes into the picture. Age has been a Western issue when it comes to fertility issues. However, it is now creeping into our society. This is according to Dr Omanwa.
At age 30, a woman’s chance of conceiving each month is about 20 percent. At 40 years, it’s about five percent.
“Age is the most important factor influencing a woman’s fertility. A woman is born with all the eggs she will ever have. As she ages, her eggs also age, and they diminish in quantity and quality,” he says.
Problems with ovulation, Dr Muteshi says are the most common reasons for infertility followed by hormonal imbalances and weight.
“Other reasons include cervical mucus issues, endometriosis, blocked tubes, where the tubes are filled with fluids, polycystic ovary syndrome, and uterine fibroids,” says Dr Muteshi.
Between 30 to 60 percent of African women will have fibroids, small or big in their reproductive period. Endometriosis affects about 15 percent of women trying to conceive. Hormonal imbalance and chronic diseases like diabetes are also big concerns.
Male infertility can be caused by low sperm production, abnormal sperm function, or blockages that prevent the delivery of sperm.
Other causes include erectile dysfunction, undescended testicles, and drugs.
Services offered at clinics
A fertility evaluation should begin with a medical history of both the female and male partners where they will undergo a physical exam, including a gynecological exam and pelvic ultrasound for the woman.
A semen analysis will be performed on the man, and a hormone screening done on the woman.
A woman may also undergo an evaluation of tubal patency to examine whether the fallopian tubes are open or blocked and determine the condition of the uterine cavity.
“We would assess a couple or an individual to determine any underlying reason behind why they have not been able to conceive. Where we find the issue is related to ovulation, we offer ovulation induction. Some couples may need what is called intrauterine insemination (IU),” says Dr Muteshi.
IU is where sperm is placed directly into the uterus using a small catheter. The goal of this treatment is to improve the chances of fertilisation by increasing the number of healthy sperm that reach the fallopian tubes when the woman is most fertile.
“Those who are not able to conceive for other reasons such as blocked fallopian tubes will receive more advanced treatment such as In-Vitro-Fertilization (IVF).”
IVF is the joining of a woman's egg and a man's sperm in a laboratory dish. The embryo(s) is then transferred to the uterus.
Main treatment methods
The inability to conceive a child can be stressful and frustrating, but several treatments are available for male infertility.
Dr Muteshi says the most common treatments for infertility are intrauterine insemination (IU) and in vitro fertilisation (IVF).
“The fertility specialist will evaluate each couple individually and discuss a personalised treatment plan with each couple based on their specific circumstances. In some cases, reassurance may be all that’s needed,” he says.
Dr Omanwa, however, stresses that one should see a fertility specialist, to help and guide them.
“It is always important to see a doctor to determine the cause of infertility rather than asking a friend or relative who may refer you to unconventional medications which end up taking up your treatment time that further affects your conceiving time.”
The cost of treatment he says depends on the reason for infertility such as fibroids where surgery is done, age issues that will require IVF with donor eggs, and lack of sperm where donor sperm is necessary.
