Infertility

This past week I saw a gentleman in my consultation rooms who was having difficult having children. As you would imagine this man was quite distraught. It is our desire as humans to procreate and multiply. Infertility is a common condition with important social, psychological and financial implications.

Infertility is defined as the inability to not fall pregnant after at least 1 year of unprotected. Contrary to cultural believes there are several factors that cause infertility, and these include both male and females. In Setswana culture there is a misconception that if a couple cannot have children its usually due to factors related to the woman only.

For a woman to get pregnant they need functioning ovaries, uterine tubes and uterus. Conditions that affect any of the three will lead to female infertility. They are several conditions that can affect a woman’s ovarian function. These include a decrease in the production of hormones that regulate ovarian production, decreased ovarian production, medical conditions that lead to production of immature ovaries and conditions that lead to absent menstruation such as excessive exercise, weight loss, stress and anorexia.

If the uterine tubes are blocked, then the ovary is unable to meet the sperms and fertilization will not occur. Conditions that can predispose one to blocked tubes include previous pelvic infections, infections such as gonorrhea and chlamydia affecting the ovarian tubes and conditions such as endometriosis.

Conditions that affect the uterus would also lead to female infertility. These include formation of fibroids, an abnormal uterus which would interfere with implantation and in certain cases adhesions inside the uterus would also result in infertility.

The causes of male infertility are also numerous and need to be properly explored. They include hormonal deficiencies or excess that leads to a decrease in production of sperms.

Some individuals have genetic conditions that lead to defects in sperm production. They are however some acquired conditions that affect the testes and invariably result in sperm production. These include; infections, undescended testes, varicocele, drugs, radiation and environmental factors such as smoking and excessive heat. In certain cases, male infertility is related to severe systemic infection. There is a small percentage of men who have infertility but with no apparent cause. These individuals have normal semen analysis, and no systemic illness.

Infertility is a very complex and sensitive problem. A detailed work up is often required to figure out what is the reason behind it. It often needs involvement from multiple disciplines and the management should be at specialized centers. Seeking help early is advisable.