Infertility is not a death threat to married couples, says medical expert

A medical expert, Dr Robinson Ugwuanyi, says the challenge of infertility in married couples is not a death sentence, but could be treated with the presence of modern medicine tools.

In in an interview with The News Agency of Nigeria (NAN) in Awka on Friday, Ugwuanyi gave the assurance that infertility is curable once it is followed up medically.

He stressed that infertility occurs in a couple, if they are unable to achieve pregnancy after one year of regular and unprotected sexual exposure of at least 3 times in a week.

He rolled out some medical terms like Fecundability, the probability of conception in a month or in a menstrual cycle, which varies across and within age groups for both women and men.

The monthly probability of conception is at most 0.15–0.25 among newlyweds and this declines with increasing age and duration of marriage. It is this low because fertilization can occur only during about two days around the time of ovulation in the middle of the menstrual cycle.

He further said Pregnancy rate per age is as follows: Women under 30 years have 70-75 per cent chance, Women 35-35 60 per cent while Women aged 36 years and above have 50 per cent chance.

He further said that motivated couples that comply with therapeutic guidelines can expect 50 to 60 per cent chance of conception.

Ugwuanyi said that infertility can be primary or secondary and described Primary infertility as a subunit of infertility in which the woman has never been pregnant while Secondary infertility is a subset in which the woman has previously been pregnant irrespective of the outcome.

He also said that either of the two subsets can be further classified as unexplained infertility which describes a situation where the couple have no discernable cause of the infertility after a comprehensive investigation of tubal assessment, Ovulation assessment, Seminal fluid analysis, amongst others after two years of regular and unprotected sexual intercourse.

He said the medical term, Epidemiology, is the prevalence of infertility and Etiology which cause infertility among couples. This shows that about 10-20 percent of couples of reproductive age will present with infertility.

According to him, “In Nigeria, 0.2 per cent of every couple has difficulty with conception. 30-40 per cent due to male factor 30-40 per cent due to female factor, 10-20 per cent due to both male and female factors 5-10 per cent is unexplained.”

He said that infertility in Nigeria is largely secondary and mainly due to infections such as Sexually transmitted infections (STIs), Post abortal sepsis, Puerperal sepsis, indicating that Tubal damage accounts for more than half of all female causes of secondary infertility.

Ugwuanyi said that age is another important etiological factor of infertility as 10 per cent of women under 30 years will present with infertility, ditto for 15 per cent of women between 30 and 35years will present with infertility.

He further stated that 30 per cent of women between 35-40 years will present with infertility, 60 per cent of women above 40 years will also present with infertility.

Ugwuanyi said that reduction in age-related fertility is predominantly the result of the decline in oocyte quality, enhanced follicular atresia, and an increased rate of chromosomal abnormalities in fertilised oocytes and resulting embryos.

He explained that socio-economic factors that have been implicated in the propagation of infertility are poverty, smoking, alcohol intake and substance abuse.

He disclosed that female infertility etiology are Tubal damages which may be due to infections or adhesions, another is Uterine fibroid (bilateral cornual or cervical); Asherman`s syndrome.

According to him, Ovarian which is problems with ovulation, Cervical factors, Endometriosis unexplained are issues with the females while cause of male infertility were described as Endocrine which is Thyroid disorder among others.

He said that Coital disorder erectile dysfunction, ejaculatory dysfunction, abnormal spermatogenesis, mumps orchitis, genetic, chemical, radiation, drugs, heat Vascular varicocele, testicular torsion, immunologic Idiopathic are all male issues.

Ugwuanyi said that there is hope in the management of infertility through evaluation and diagnosis of infertility in female by checks on female menstrual history, gynaecological and contraceptive history, past obstetrics history, past medical and surgical history.

He also stated that in the male management, their history of genital tract infection, previous genital tract operation, past or present medical condition such as Diabetes mellitus or renal disease, drug use, anti hypertensive, immuno suppressives, nitrofurantoin, anabolic steroids, nicotine, alcohol, must be ascertained.

The medical expert said that behavioral and occupational hazards such as soldiers on special duties, long distance drivers, men who have multiple sexual partners are all parts of the need to be checked.

He said that there is the need for initial clinical assessment that is history and examination of couple, the general examination such as their nutritional status, general wellbeing, height, weight, male type baldness, finger clubbing.

Ugwuanyi said that Breast check for abnormal nipple discharge, Abdominal exam, Pelvic exam Investigations are geared towards tubal assessment, ovulation assessment and male fertility status by seminal fluid analysis.

He said that after all the basics are done, there is hope for treatment though that is dependent on the causes detected which can be medical or surgical.

However, he said the hope of presence of quality medical technique would bridge the infertility challenges.

He said that cases that are not amenable to medical or surgical treatment options would have assisted conception technique which includes intrauterine insemination and surrogacy.

He said also that the choice of adoption and acceptance of childlessness are also hope available to such couples instead of living in pains.

Ugwuanyi said that quality Counselling and psychological support play vital roles in the management of infertile couple.