The prevalence of infertility in Nigeria is becoming alarming. According to statistics, 45 to 50 per cent of all consultations in gynecological clinics are infertility-related and over 80 per cent of laparoscopic investigations are for management of infertility. As the growing incidence of infertility in the country continues to stare victims in the face, exploring other options aside from natural fertilization has become an object of discussion but how open is the average Nigerian to scientific techniques that could aid reproduction? This monthly special for waiting mothers is aimed at debunking the myths surrounding assisted fertility while exposing its benefits and viability.
Mr and Mrs TK are a middle aged couple who were referred to me from a nearby teaching hospital. They had been married for eighteen years and apart from a miscarriage in the first year of marriage. There had been no other conception. They had been “everywhere” in the last ten years in a bid to achieve conception. After my discussion with them, it became obvious that assisted fertility treatment could give them the best chance of achieving conception.
“Why has no one recommended it till now if it can help us?” was the question an expressionless Mr TK kept asking. Apparently he was tired of moving from pillar to post, needless spending and wife a constantly sobbing wife.
Infertility is generally defined as the inability of a couple to achieve conception despite regular unprotected intercourse of at least 2-3 times per week for twelve months.
If a couple has been having regular unprotected intercourse for more than a year and there is no conception, there may be a problem. The only way to find out is to visit a doctor who will request for certain basic tests. If these tests are in any way abnormal, time should not be wasted further and the couple should be promptly referred to a fertility specialist. If all the tests are normal, the couple should be reassured but if there is no conception after 24 months of regular unprotected intercourse, they should be referred to a fertility specialist.
It must be borne in mind that certain people do not have to wait for a year before they see a doctor about challenges with conception these include women older than 37 years of age, women with infrequent periods, women who have been diagnosd with gynecological conditions which impact negatively on fertility such as endometriosis, tubal blockade or PCOS.
Men with conditions which impact negatively on fertility should not wait for a year before they see a doctor for fertility concerns, these include men with low sperm parameters, previous testicular surgery, particularly small testis, or wide variation in testicular size.
A referral to a fertility specialist is usually better than no referral; this is because a gynecologist will most likely know a reputable fertility clinic. However, if you were not referred, the next best thing to do is to window shop and make up your mind about your choice of a fertility clinic. It is also important to educate yourself from this and other resources to be able to have an intelligent discussion with whoever attends to you during your discussion.
Preparing couples for assisted reproduction
There are basic tests that your fertility doctor will request for but an infectious screening test is usually performed on the couple. These tests screen for infections such as Hepatitis B and C, HIV and syphilis. Chlamydia and Cytomegalovirus are also screened for in some centers but the first four are primary. These infections are potentially transmissible to offspring and if it is detected that any of the parents is positive, proper precautions can be taken in preventing transmission to the baby.
Men will have to undergo seminal fluid analysis. During this test, a sperm sample, which is produced by masturbation or using withdrawal method is analysed within half an hour of production and examined. From this, factors such as low sperm counts or absent sperms can be determined. Sperm parameters for an individual are optimal after about two to a maximum of five days of sexual abstinence.
Women will be subjected to a test to detect the quality and quantity of eggs in the ovary. A simple blood test can be done between the second and fifth day of the cycle. This test detects the levels of the Follicle stimulating hormone, leutinising hormone and prolactin. Different laboratories have different values as normal but when the level of these hormones are higher than the normal values, it suggests that the quality and quantity of eggs in the ovary is reduced. This has implications for preparation for the treatment and the best treatment option. If the sperm and hormone tests are normal, your doctor may or may not request for a test to check if the fallopian tubes are open.
Your doctor will discuss all these results and interpret them to you. Only about 10 per cent of patients will not have an identifiable factor responsible for the delay in conception, these are labeled as having unexplained infertility. After evaluation, your doctor will counsel you on what is best to do. Any means of assisting conception in which the eggs and sperms are handled outside the body is referred to as assisted reproductive technique.
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