Mother or Nothing: The Agony of Infertility

By Esther Akinmade

For many men it is very difficult to accept and understand Infertility. They think only women can be infertile. They do not understand or want to understand that there may be a deficiency in men.  

  Ravi Ranjan Goswami

Many infertile women in developing countries consider that, without children, their lives are without hope. These women carry a lot of burden and the lack of affordable care is extremely alarming.

Our culture demands that, for a woman to be socially accepted, she should have at least one biological child, Almost all cultures across Africa put emphasis on women having children … Marriage without children is considered a failure of the two individuals.

In general, infertility is defined as not being able to get pregnant (con-ceive) after one year (or longer) of unprotected sex. Because fertility in women is known to decline steadily with age, some health providers evaluate and treat women aged 35 years or older after 6 months of unprotected sex. 

Infertility is not always a woman’s problem. Both men and women can contribute to infertility.  

Many couples struggle with infertility and seek help to become pregnant, but it is often thought of as only a woman’s condition. However, in about 35% of couples with infertility, a male factor is identified along with a female factor. In about 8% of couples with infertility, a male factor is the only identifiable cause.

Almost 9% of men aged 25 to 44 years in the United States reported that they or their partner saw a doctor for advice, testing, or treatment for infertility during their lifetime.

Women need functioning ovaries, fallopian tubes and a uterus to get pregnant. Conditions affecting any one of these organs can contribute to female infertility.  Infertility affects up to 15% of reproductive-aged couples worldwide. 

In many cultures, childless women suffer discrimination, stigma and ostracism. For example, some women will be banned from attending her father-in-law’s funeral. “The relatives, when getting together, talk a lot about their children or being pregnant and having children. Those are the moments when an infertile woman feels extremely isolated. So often, people do not regard them as human. There is no respect,”   most women often have to bear the extra-marital relationships that husbands tend to have. 

The stigmatization can be extreme in some countries, where infertile people are viewed as a burden on the socio-economic well-being of a community. Stigma extends to the wider family, including siblings, parents and in-laws, who are deeply disappointed for the loss of continuity of their family and contribution to their community. This amplifies the guilt and shame felt by the infertile individual.

Infertility causes can affect one or both partners. In general:

• In about one-third of cases, there is an issue with the man
• In about one-third of cases, there is an issue with the woman
• In the remaining cases, there are issues with both the man and the woman, or no cause can be found

Causes of male infertility

These may include:

• Abnormal sperm production or function due to undescended testicles, genetic defects, health problems such as diabetes, or infections such as chlamydia, gonorrhea, mumps or HIV. Enlarged veins in the testes (varicocele) also can affect the quality of sperm.
• Problems with the delivery of sperm due to sexual problems, such as premature ejaculation; certain genetic diseases, such as cystic fibrosis; structural problems, such as a blockage in the testicle; or damage or injury to the reproductive organs.
• Overexposure to certain environmental factors, such as pesticides and other chemicals, and radiation. Cigarette smoking, alcohol, marijuana, anabolic steroids, and taking medications to treat bacterial infections, high blood pressure and depression also can affect fertility. Frequent exposure to heat, such as in saunas or hot tubs, can raise body temperature and may affect sperm production.
• Damage related to cancer and its treatment, including radiation or chemotherapy. Treatment for cancer can impair sperm production, sometimes severely.

Causes of female infertility

Causes of female infertility may include:

• • Ovulation disorders, which affect the release of eggs from the ovaries. These include hormonal disorders such as polycystic ovary syndrome. Hyperprolactinemia, a condition in which you have too much prolactin — the hormone that stimulates breast milk production — also may interfere with ovulation. Either too much thyroid hormone (hyperthyroidism) or too little (hypothyroidism) can affect the menstrual cycle or cause infertility. Other underlying causes may include too much exercise, eating disorders or tumors.
  • Uterine or cervical abnormalities, including abnormalities with the cervix, polyps in the uterus or the shape of the uterus. Noncancerous (benign) tumors in the uterine wall (uterine fibroids) may cause infertility by blocking the fallopian tubes or stopping a fertilized egg from implanting in the uterus.
  • Fallopian tube damage or blockage, often caused by inflammation of the fallopian tube (salpingitis). This can result from pelvic inflammatory disease, which is usually caused by a sexually transmitted infection, endometriosis or adhesions.
  • Endometriosis, which occurs when endometrial tissue grows outside of the uterus, may affect the function of the ovaries, uterus and fallopian tubes.
  • Primary ovarian insufficiency (early menopause), when the ovaries stop working and menstruation ends before age 40. Although the cause is often unknown, certain factors are associated with early menopause, including immune system diseases, certain genetic conditions such as Turner syndrome or carriers of Fragile X syndrome, and radiation or chemotherapy treatment.
  • Pelvic adhesions, bands of scar tissue that bind organs that can form after pelvic infection, appendicitis, endometriosis or abdominal or pelvic surgery.

• Cancer and its treatment. Certain cancers — particularly reproductive cancers — often impair female fertility. Both radiation and chemotherapy may affect fertility.

Prevention

Some types of infertility aren’t preventable. But several strategies may increase your chances of pregnancy.

Couples

Have regular intercourse several times around the time of ovulation for the highest pregnancy rate. Intercourse beginning at least five days before and until a day after ovulation improves your chances of getting pregnant. Ovulation usually occurs in the middle of the cycle — halfway between menstrual periods — for most women with menstrual cycles about 28 days apart.

Men

Although most types of infertility aren’t preventable in men, these strategies may help:

• Avoid drug and tobacco use and drinking too much alcohol, which may contribute to male infertility.
• Avoid high temperatures found in hot tubs and hot baths, as they can temporarily affect sperm production and motility.
• Avoid exposure to industrial or environmental toxins, which can affect sperm production.
• Limit medications that may impact fertility, both prescription and nonprescription drugs. Talk with your doctor about any medications you take regularly, but don’t stop taking prescription medications without medical advice.
• Exercise moderately. Regular exercise may improve sperm quality and increase the chances for achieving a pregnancy.

Read Also: How Men And Women’s Body-Weight Cause Infertility – Expert

Women

For women, a number of strategies may increase the chances of becoming pregnant:

• Quit smoking. Avoid alcohol and street drugs. 
• Limit caffeine.
• Exercise moderately. .
• Avoid weight extremes.

In a world that needs vigorous control of population growth, concerns about infertility may seem odd, but despite their importance, infertility prevention and care often remain neglected public health issues, or at least they rank low on the priority list, especially for low-income countries that are already under population pressure. Low fertility is becoming more common worldwide, particularly in ageing populations and many urban settings where women are having their first babies at older ages.

Health policy-makers are increasingly being urged to begin to integrate infertility prevention, care and treatment into the work being done to strengthen maternal, newborn and reproductive health-care systems.