Dealing with infertility: Key steps to follow
Infertility means not being able to get pregnant after one year of trying (or six months if a woman is 35 or older). Women who can get pregnant but are unable to stay pregnant may also be infertile.
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To get pregnant, a woman's body must release an egg from one of her ovaries (ovulation). The egg must go through a fallopian tube towards the uterus (womb).
A man's sperm must join with (fertilise) the egg along the way, then the fertilised egg must attach to the inside of the uterus (implantation).
Infertility can happen if there are problems with any of these steps.
Infertility is not always a woman's problem. Both women and men can have problems that cause infertility.
Causes of infertility in men
Infertility in men is most often caused by a problem called varicocele (VAIR-ih-koh-seel). This happens when the veins on a man's testicle (s) are too large. This heats the testicles. The heat can affect the number or shape of the sperm.
There are other factors that cause a man to make too few sperm or none at all.
Mention could be made of the movement of the sperm, which may be caused by the shape of the sperm. Sometimes injuries or other damage to the reproductive system block the sperm.
Sometimes a man is born with the problems that affect his sperm. Other times problems start later in life due to illness or injury. For example, cystic fibrosis often causes infertility in men.
Radiation treatment and chemotherapy for cancer may also contribute to the problem.
Infertility in women
Most cases of female infertility are caused by problems with ovulation. Without ovulation, there are no eggs to be fertilised. Some signs that a woman is not ovulating normally include irregular or absent menstrual periods.
Ovulation problems are often caused by polycystic ovarian syndrome (PCOS). PCOS is a hormone imbalance problem which can interfere with normal ovulation. PCOS is the most common cause of female infertility.
Less common causes of fertility problems in women include blocked fallopian tubes due to pelvic inflammatory disease, endometriosis, or surgery for an ectopic pregnancy, physical problems with the uterus, as well as uterine fibroids, which are non-cancerous clumps of tissue and muscle on the walls of the uterus.
Many things can change a woman's ability to have a baby. These include age, smoking, excess alcohol use, stress, poor diet, athletic training, being overweight or underweight, as well as sexually transmitted infections (STIs), health problems that cause hormonal changes, such as polycystic ovarian syndrome and primary ovarian insufficiency.
Ageing and infertility
At a certain age the woman’s ovaries become less able to release eggs, she has a smaller number of eggs left, her eggs are not as healthy as before, she is more likely to have health conditions that can cause fertility problems and she is more likely to have a miscarriage.
Experts suggest that women 35 or older should see their doctors after six months of trying. A woman's chances of having a baby decrease rapidly every year after the age of 30.
Health problems
Some health problems also increase the risk of infertility, so women should talk to their doctors if they have irregular periods or no menstrual periods, very painful periods, endometriosis, pelvic inflammatory disease and more than one miscarriage.
It is a good idea for any woman to talk to a doctor before trying to get pregnant. Doctors can help you get your body ready for a healthy baby. They can also answer questions on fertility and give tips on conceiving.
Doctors will do an infertility check-up. This involves a physical exam. The doctor will also ask for both partners' health and sexual histories. Sometimes this can make him or her find the problem. However, most of the time, the doctor will need to do more tests.
In men, doctors usually begin by testing the semen. They look at the number, shape and movement of the sperm. Sometimes doctors also suggest testing the level of a man's hormones.
In women, the first step is to find out if she is ovulating each month. There are a few ways to do this. A woman can track her ovulation at home by writing down changes in her morning body temperature for several months, writing down how her cervical mucus looks for several months and using a home ovulation test kit (available at drug or grocery stores)
Doctors can also check ovulation with blood tests, or do an ultrasound of the ovaries. If ovulation is normal, there are other fertility tests available.
Treatment
Infertility can be treated with medicine, surgery, artificial insemination, or assisted reproductive technology. Most often these treatments are combined. In most cases infertility is treated with drugs or surgery.
Doctors can help men deal with impotence or premature ejaculation. Behavioural therapy and/or medicines can be used in these cases.
Sometimes surgery can correct the cause of the problem of men producing too few sperm. In other cases, doctors surgically remove sperm directly from the male reproductive tract. Antibiotics can also be used to clear up infections affecting sperm count.
In women, some physical problems can also be corrected with surgery.
A number of fertility medicines are used to treat women with ovulation problems. It is important to talk with your doctor about the pros and cons of these medicines. You should understand the possible side effects.
Assisted reproductive technology (ART) is a group of different methods used to help infertile couples. ART works by removing eggs from a woman's body. The eggs are then mixed with sperm to make embryos. The embryos are then put back in the woman's womb.
In vitro fertilisation
In vitro fertilisation (IVF) means fertilisation outside of the body. IVF is the most effective ART. It is often used when a woman's fallopian tubes are blocked or when a man produces too few sperm. Doctors treat the woman with a drug that causes the ovaries to produce multiple eggs.
Once mature, the eggs are removed from the woman. They are put in a dish in the lab along with the man's sperm for fertilisation. After three to five days, healthy embryos are implanted in the woman's uterus.
Surrogacy
Women with no eggs or unhealthy eggs might also want to consider surrogacy. A surrogate is a woman who agrees to become pregnant using the man's sperm and her own egg. The child will be genetically related to the surrogate and the male partner. After birth, the surrogate will give up the baby for adoption by the parents.
Women with ovaries but no uterus may be able to use a gestational carrier. This may also be an option for women who shouldn't become pregnant because of a serious health problem. In this case, a woman uses her own egg. It is fertilised by the man's sperm and the embryo is placed inside the carrier's uterus. The carrier will not be related to the baby and gives him or her to the parents at birth.
Nigeria’s initiative
Nigeria’s First Lady, Mrs Aisha Buhari, is championing a project called “Merck More than a Mother” to empower more infertile women; this time in Nigeria.
Merck More than a Mother was first implemented in Kenya in 2015, followed by Uganda, Cote d’Ivoire, Central African Republic and Nigeria.
Credit: For Africa Forever
