Infertility is the failure of a couple to achieve pregnancy after a period of one year despite regular unprotected sexual intercourse. This period permits the natural probability of getting pregnant per month even if all factors are normal. Statistically, about 60% of couple will conceive within the first 6 months of attempt. This will increase to 85% and 92% in one and two years respectively. Therefore, patience and being less anxious maybe the only solution when there is no pregnancy per menstrual cycle.
The causes of infertility include:tubal factor,ovulatory disorder,male factor, and can be unexplained infertility. It is worthy of note that the cause is almost equally shared between both the female and male. It is therefore a shared challenge between the couple. In about 10%, there seems to be no identifiable reason for its occurrence. Infertility can be primary when the woman has not had any previous pregnancy irrespective of its outcome,while it is secondary in a woman with previous pregnancy.
Management of infertility is based on detailed history from both party to unravel the possible causative factor, and this will also help as regards the approach to the couple’s management. Couple may also be investigated for infertility if they present to a specialist before a year of attempt when there are identified risks factors for infertility. These include menstrual irregularity, previous sexual transmitted disease, previous pelvic inflammatory disease or pelvic surgery. In the man, there may be previous history of STD, previous history of scrotal trauma, or inguino-scrotal surgery or Mumps infection.
The basic infertility tests include female hormonal assay to ascertain ovarian reserve, or ovulatory disorder. Tubal patency evaluation and Seminal fluid analysis will identify possible Fallopian tube damage/blockage, and sperm count (among other semen parameters) respectively. There are other routine or further investigations that may be possibly requested for. A Medical practitioner or better still a Gynecologist should be consulted.
The solution is dependent on identifiable causative factor. It may be attainment of ideal weight, adequate diet, ovulation induction, correction of excessive prolactin in the blood, optimising chronic medical or endocrine disorders. Above, emotional support is offered to the couple and this is an integral part of the treatment irrespective of the modality. In few cases, timed intercourse, and ‘watchful waiting’ and continued encouragement may suffice when no obvious cause is identified. Other solution options include: Assisted reproductive technique, surrogacy, adoption and coming to terms with childlessness.
Prevention of infertility include avoidance of sexually transmitted diseases by the use male or female condom, and prompt recognition and treatment of same. Following induced or spontaneous termination of pregnancy, there must be effective post-abortal care. Also, avoid excessive consumption of alcohol, and smoking cigarettes and marijuana .Avoid indiscrimate use of drugs, and body weight should be optimised.
DR ODOFIN, JAMES TAIYE
Medical Practitioner
