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Weeping for Different Reasons

Infertility can be an immense source of emotional distress and so is the occurrence of unwanted pregnancy

Micheal Ihemaguba, a specialist in Obstetric and Gynaecology, is not a novice when it comes to treating couples who have infertility problems. Having worked as a gynecologist for 15 years after graduating as a medical doctor in 1985, Ihemaguba, who is based in NewYork, USA, has come to the conclusion that the problem of infertility “is very, very difficult and frustrating.” His musings resonate from the fact that while some people are battling to overcome infertility, others who are fertile, fight to avoid getting pregnant. His experience in the business has taught him getting pregnant is something that people want and they don’t get. On the other hand, some people get it and they don’t want it.

One day, in his clinic, he had to attend to two female patients, one of whom wanted to get pregnant and thought she was, but the other did not want to get pregnant and said she would kill herself if she discovered she was. When the pregnancy tests came, it was negative for the woman who thought she was pregnant and positive for the one who did not want pregnancy. If Ihemaguba were God, he could have swapped the fate of the women who were kept in separate rooms. But since he could not, he ended up handing out serviette to them to dry their tears as they broke down and wept. “It is very bizarre and sobering at the same time because you have to be sensitive to people’s feeling.”

This is just one of the drama gynaecologists experience daily in pregnancy related issues. Another one is a case of a Ghanaian woman who had terminated nine pregnancies and now wants to have a baby but she is having difficulty. According to Ihemaguba, “infertility problem could plunge people into depression. Regardless of these extreme cases, infertility is a very challenging situation and it could be very expensive to treat”.

Infertility, which primarily refers to the biological inability of a person to contribute to conception has crashed many marriages. Most of the time women carry the can in the homes where there is an infertility problem. But many men are also infertile although infertility may also refer to the state of a woman who is unable to carry a pregnancy to full term. 

There are many biological causes of infertility, some which may be bypassed with medical intervention. Women who are fertile experience a natural period of fertility before and during ovulation, and they are naturally infertile during the rest of the menstrual cycle. Fertility awareness methods are used to discern when these changes occur by tracking changes in cervical mucus or basal body temperature. 

 Reproductive endocrinologists, that is doctors who specialise in infertility, consider a couple to be infertile if: the couple has not conceived after 12 months of contraceptive-free intercourse if the female is under the age of 34.  Alternatively, the NICE guidelines define infertility as failure to conceive after regular unprotected sexual intercourse for two years in the absence of known reproductive pathology. A couple that has tried unsuccessfully to have a child for a year or more is said to be subfertile, meaning less fertile than a typical couple. The couple’s fecund ability rate is approximately 3-5 percent. Many of its causes are the same as those of infertility. Such causes could be endometriosis or polycystic ovarian syndrome.

Couples with primary infertility have never been able to conceive while, on the other hand, secondary infertility is difficulty in conceiving after already having conceived (and either carried the pregnancy to term or had a miscarriage). Technically, secondary infertility is not present if there has been a change of partners. Generally, worldwide, it is estimated that one in seven couples have problems conceiving, with the incidence similar in most countries independent of the level of the country’s development.

The proportion of childless women declined from 12 percent  to 6 percent in Cameroon and from 6 percent to 4 percent in Nigeria. Still, a substantial proportion of women suffer from infertility in both countries—39 percent of women aged 20–44 in Cameroon and 33 percent in Nigeria. 

 Sexually transmitted diseases such as gonorrhoea and syphilis (also known as STDs — or STIs for “sexually transmitted infections”) are more than just an embarrassment. They’re a serious health problem. If untreated, some STDs can cause permanent damage, such as infertility and even death (in the case of HIV/AIDS).

Other factors that can cause male as well as female infertility are: genetic factors - a Robertsonian translocation in either partner may cause recurrent spontaneous abortions or complete infertility. General factors include diabetes mellitus, thyroid disorders, adrenal disease while hypothalamic-pituitary factors are Kallmann syndrome, hyperprolactinemia, hypopituitarism. Environmental factors include toxins such as glues, volatile organic solvents or silicones, physical agents, chemical dusts, and pesticides also causes infertility. Tobacco smokers are 60 percent more likely to be infertile than non-smokers. Smoking reduces the chances of IVF producing a live birth by 34 percent and increases the risk of an IVF pregnancy miscarrying by 30 percent.

 Also, problems affecting women include endometriosis or damage to the fallopian tubes, which may have been caused by infections such as chlamydia. Other factors that can affect a woman’s chances of conceiving include being over- or underweight for her age. Female fertility declines sharply after the age of 35. Sometimes, it can be a combination of factors, and sometimes a clear cause is never established. Common causes of infertility of females include: ovulation problems, tubal blockage, age-related factors, uterine problems, previous tubal ligation.

On the other hand, the main cause of male infertility is low semen quality. In some cases, both the man and woman may be infertile or sub-fertile, and the couple’s infertility arises from the combination of these conditions. In other cases, the cause is suspected to be immunological or genetic; it may be that each partner is independently fertile but the couple cannot conceive together without assistance.

However, there are infertility that cannot be explained. For instance, Wikipedia says in the US, up to 20 percent of infertile couples have unexplained infertility. In these cases, abnormalities are likely to be present but not detected by current methods. Possible problems could be that the egg is not released at the optimum time for fertilisation, that it may not enter the fallopian tube, sperm may not be able to reach the egg, fertilisation may fail to occur, transport of the zygote may be disturbed, or implantation fails. It is increasingly recognised that egg quality is of critical importance and women of advanced maternal age have eggs of reduced capacity for normal and successful fertilisation. Also, polymorphisms in folate pathway genes could be one reason for fertility complications in some women with unexplained infertility.

If both partners are young and healthy and have been trying to conceive for 12 months to one year without success, a visit to the family doctor could help to highlight potential medical problems earlier rather than later. The doctor may also be able to suggest lifestyle changes to increase the chances of conceiving. 

Treatment methods for infertility may be grouped as medical or complementary and alternative treatments. Some methods may be used in concert with other methods.  A take-home baby assessment can provide a best guess estimate compared with women who have succeeded with invitro fertilisation, based on variables such as maternal age duration of infertility and number of prior pregnancies. Medical treatment of infertility generally involves the use of fertility medication, medical device, surgery, or a combination of them.

If the sperm are of good quality and the mechanics of the woman’s reproductive structures are good (patent fallopian tubes, no adhesions or scarring), physicians may start by prescribing a course of ovarian stimulating medication. The physician may also suggest using a conception cap, which the patient uses at home by placing the sperm inside the cap and putting the conception device on the cervix, or intrauterine insemination, IUI, in which the doctor introduces sperm into the uterus during ovulation, via a catheter. In these methods, fertilisation occurs inside the body. If conservative medical treatments fail to achieve a full term pregnancy, the physician may suggest the patient undergo in vitro fertilisation, IVF, which is very expensive. To get an IVF treatment could cost between 8,000 to 10,000 dollars and this will be cheap and it could be quite trying.

 The medicalisation of infertility has unwittingly led to a disregard for the emotional responses that couples experience, which include distress, loss of control, stigmatisation, and a disruption in the developmental trajectory of adulthood. Infertility may have profound psychological effects. Partners may become more anxious to conceive, ironically increasing sexual dysfunction. Marital discord often develops in infertile couples, especially when they are under pressure to make medical decisions. Women trying to conceive often have clinical depression rates similar to women who have heart disease or cancer. Even couples undertaking IVF face considerable stress. Emotional stress and marital difficulties are greater in couples where the infertility lies with the man. In many cultures, inability to conceive bears a stigma. In closed social groups, a degree of rejection (or a sense of being rejected by the couple) may cause considerable anxiety and disappointment. 



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