Infertility: The facts and the myths

Infertility is the inability of a couple to achieve conception after 12 months of regular unprotected intercourse. In this part of the world it quite commonly affects up to one in five couples. As with most other issues in developing countries, there are many misconceptions associated with infertility especially with its causes and treatment options.

I had the pleasure of attending to a couple from the south western part of Nigeria a few years ago. Mr and Mrs O.E had been married for about 3 years when I met them. Mr O.E was a well to do building contractor who had an eight-year-old son from a previous relationship before getting married to a 33-year-old fashion designer. They had a glamorous talk of the town wedding on Valentine’s Day of that year. However, three Valentine celebrations, many quarrels, several doctors and tests later, Mrs O.E was still unable to conceive. Her husband had a confirmation of his “fertility” after all, he had fathered a son before. He was convinced that his wife was unable to conceive because she had terminated an unwanted pregnancy while she was an undergraduate. So, he kept on harping on that mistake to the gentle woman’s dismay.  The first day I met them, Mr O. E asked me this: “How do you know if a woman has had an abortion before?” and his wife simply burst into tears. I had to carefully explain that infertility is not a wife or a husband issue; it is a couple’s challenge. In some situations, nothing may be wrong with either of them but there may be a challenge with conception.

I requested for baseline fertility test for the couple and it turned out that Mr E.O had very low sperm counts. With tears in his eyes, he asked me “does that mean the previous child is not mine?” My response was aimed at reassuring him. So I said, “it doesn’t mean that at all. It may be that when you had him 8 years ago, your sperm cells were fine but now that is not the case”.

On second thoughts, I probed him further about the age of the woman with whom he had the son. “How old was your son’s mother when she got pregnant?” His response was “she was barely 22 years old.”

At that age, a woman is most fertile and even with low sperm counts, there still may be pregnancy because at that age, a woman’s egg quality is at its peak. I advised him on the need to have in-vitro fertilisation to achieve conception in his marriage. As you read this, infertility is a thing of the past in that family. Mr and Mrs O.E are proud parents today. Based on my interaction with them, I realised that so many people have little or no real information about infertility and have swallowed hook, line, sinker, misconceptions from a misguided society. Consequently, I have chosen to write about infertility, what is true and what is only a figment of the imagination.
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Myth 1: If a couple has infertility, it is most commonly due to the woman

Fact: While it is easy to point the accusing finger at the women maybe because they carry the pregnancy, the truth is that in out of a 100 couples with infertility, 30 cases are due to a male cause, another 30 are due a female cause and 30 others are due to both male and female causes. The last 10 cases of infertility often have no identifiable cause. This shows that infertility is a man’s problem as much as it is a woman’s problem.

 

Myth 2: Semen spilling from the vagina after intercourse is a cause of infertility.

Fact: While most African cultures believe this, post coital semen spillage is not a cause of infertility. After ejaculation, the semen is stuck to the posterior vaginal wall and during that time the sperm cells swim into the woman’s womb. Within 30 minutes, the semen liquefies and drains out of the vagina. Before it does this, the sperm cells are on their way to the fallopian tubes to meet with the egg.

 

Myth 3: Stress causes infertility

Fact: I tell my clients humorously that if this is so, nobody living in Lagos should get pregnant as everybody in Lagos is under stress! One of the most stressful events a woman can ever go through is rape and still we have quite a number of these women getting pregnant from rape. While stress may delay ovulation by suppressing hormones in the woman and can affect sexual desire and erection in men, strictly speaking, it is not a cause of infertility.

 

Myth 4: A man with a high sexual drive is definitely fertile and can impregnate a woman.

Fact: There is no relationship between sexual drive and fertility for men and some men with high sexual drive have no sperms at all. The only way to tell is to do a sperm test.

 

Myth 5: Having sex daily increases the chances of conception

Fact: Having sex every other day at the time of ovulation usually between days 12 and 16 of a woman’s cycle is sufficient.

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Myth 6: Having infrequent sex will make the sperms concentrate and improve the count thereby improving chances of conception.

Fact: Infrequent sex will lead to accumulation of “aged” sperms. The genetic materials of these “aged” sperms are damaged. Therefore, they are unable to fertilize eggs as they should thereby reducing chances of conception.

 

Myth 7: A woman is not able to conceive because she has been promiscuous and has had sexually transmitted infections or abortions in the past.

Fact: There are many women who have had several sexual partners and are still quite fertile and there are women who have had just their husbands as sexual partners but yet are having conception challenges. Some reasons for infertility are inborn, such as endometriosis, polycyctic ovarian syndrome, ovarian aging, etc. Who says it is not the male partner that is responsible.

 

Myth 8: There is no hurry to get pregnant. Look at all the women in the news having babies in their 40s and even 50s.

Fact: Fertility in women starts to decline from 30 years of age till menopause and the vast majority of women who achieve pregnancy in the older age group (40-50) used another woman’s egg or even adopted embryos to achieve conception. There are also significant health risks to the mother and baby when the mother is of advanced reproductive age.

 

Myth 9: In vitro fertilization has a low success rate and rarely succeeds

Fact 9: While there are no guarantees in IVF treatment, your specialist should be able to advise you on what your chances are whether good or bad.  If the chances are bad, he probably can advise on steps to improve the chances.  Pregnancy rates with IVF averages about 35 per cent and when compared to the chances of natural conception of 20 per cent, it is still better.

 

Myth 10: Services for infertility care like IVF is too expensive for most couples to consider

Fact: In-vitro fertilization is expensive all over the world; this is because the drugs, equipment, training, maintenance and support services are expensive especially in developing countries. However, any couple that can afford a decent second hand car can afford IVF.