06 May 2015

Infertility has always been associated with bad omen, witchcraft, curse from some supernatural being somewhere and all other things considered evil.

Sadly for the womenfolk, the burden of stigma was always directed at them, unfairly so in all the cases.

When a couple fails to conceive, in African traditional society, it is the woman who bears the brunt of ridicule, gossip and being tagged derogatory names such that eventually society expects her husband to marry a second wife. 

Even in Setswana for instance, there is no vernacular name that refers to an impotent man, it is rather the woman who is called moopa, mmamosadiseopana and several other disempowering titles.

Enter the advent of technology, modern medicine backed by technology can now decipher which partner has a fertility challenge, a move that hopefully will put paid the stigmatisation of womenfolk when a couple fails to conceive.

Strictly speaking, the term infertility means inability to conceive despite regular unprotected intercourse over a period of more than 12 months.

Head of Obstetrics and Gynaecology at Princess Marina Referral Hospital, Dr Ponatshego Gaolebale says infertility in a couple is measured by the spontaneous pregnancy rate in a two year period which is approximately 57 per cent after three months, 72 per cent after six months and 85 per cent after one year.

Dr Gaolebale said in an interview that it is estimated that infertility affects between nine and 15 per cent of couples, stating that for pregnancy to occur there must be fertile sperm and egg, a means of bringing them together fallopian tubes and a receptive endometrium (uterus/womb) to allow embryo implantation.

“Any defect at any of these stages can lead to infertility,” he said.

He said there are factors which lead to infertility between couples and it differs between a man and a woman, stating that 35 per cent of cases of infertility are as a result of male factor while the women stand at 50 per cent of cases, whereas 15-30 per cent of cases are not identified.

Dr Gaolebale said there is also a gradual decline in fertility after the age of 35 in females, with a marked rapid decline after the age of 40.

He said the female factor infertility in women is found in four areas such as anovulation, fallopian tube infertility, endometriosis and uterine factor.

He said the ovulation factor is when there is frequent cause of infertility with the cause either at the brain or ovarian level and endocrine disorders such as thyroid dysfunction can cause anovulation.

Dr Gaolebale said the fallopian tube infertility is when there is any damage to the tube that can prevent the sperm from reaching the egg or the embryo from reaching the uterine cavity and the main cause of tubal damage occur as a result of the pelvic inflammatory disease, commonly arising from sexually transmitted infections and septic abortion and the pelvic infections from bowel disorders such as appendicitis.

The endometriosis is when there is a scar tissue formation causing mechanical tubal damage whereas the uterine factor is when any structural anomaly that distorts the uterine function may impact on fertility.

The male factor infertility also has four components and is primary testicular disease, obstructive male infertility, hormonal causes and lastly drugs.

The primary testicular disease, Dr Gaolebale said, is the commonest cause of male factor fertility and the cause of no or severe reduction in sperm production is poorly understood and known causes include testicular torsion, undescended testes and infection and trauma.

He said obstructive male infertility can occur at any level of male genital tract and can be as a result of birth defects or inflammatory conditions and said the hormonal causes are very rare but once diagnosed are usually easy to treat.

He said the drug factor occurs when drugs taken for medicinal or recreational purposes can affect both sperm production and function and these include alcohol, tobacco, marijuana, steroids and opiates.

Dr Gaolebale said antidepressants, sedatives and some anti-hypertensives can cause erectile dysfunction.

Regarding assessment Dr Gaolebale said ideally the couple should be consulted together where a full history and physical examination are carried out and the basic investigations include a hormonal assessment, a pelvic ultrasound, and tests of fallopian tube patency and a semen analysis for the male. ENDS