Infertility – A Heavy Burden to Bear

Infertility in Nigerian Couples

It is generally expected in Nigeria that children be born to a couple not too long after marriage. However, this doesn’t come easily to some couples. There are no readily available statistics on this challenge. However, you would not have to look too far to find a couple facing this situation.
The Royal College of Obstetricians and Gynecologists defines infertility as “failure to conceive after regular sexual intercourse for 12 months in the absence of known reproductive pathology”. Contrary to perceptions in many traditional contexts, this is not simply a woman’s problem. This condition affects men just as much as women. Fertility rates in Nigeria are between 5.7 and 6.5 children per woman.

Infertility in Men

Several issues could lead to infertility in men including low sperm count, abnormal sperm shape and abnormal sperm movement. There are also lifestyle factors which could reduce male fertility. Examples are smoking, heavy alcohol use, poor diet (leading to obesity) and frequent exposure to chemicals such as herbicides, heavy metals, pesticides, and other toxins.

Several medical conditions can also increase the risk of male infertility. These include retrograde ejaculation, undescended testicles, swelling of veins surrounding the testicles, hormonal imbalance and destruction of sperms by antibodies.

Finally, there are some drugs, medications and treatments which can have adverse effects on fertility in men. These include radiotherapy, chemotherapy, calcium channel blockers, sulfasalazine, tricyclic antidepressants, recreational drugs (e.g., cocaine, marijuana, and other recreational drugs) and anabolic steroids.

Infertility in Women

Factors which affect fertilization, ovulation, or egg implantation can cause infertility in women. These include smoking, old age, alcoholism, obesity, being underweight and sexually transmitted infections that can damage the reproductive system.

Some health conditions may also put women at risk of infertility. Such conditions (which also have a relatively high prevalence among Nigerian women) include endometriosis, pelvic inflammatory disease, ovulation disorders, uterine fibroids and premature ovarian failure.

As is the case with men, some drugs, medications, and treatments may also affect fertility in women. Prominent among these include recreational drugs (e.g., cocaine and marijuana), antipsychotic medications, radiotherapy, chemotherapy, and prolonged usage of non-steroidal anti-inflammatory drugs (e.g., ibuprofen and aspirin)
It is important to note that fertility begins to decrease in women after the age of 30. Women under the age of 35 who have been unable to conceive after a year of a trial should see their gynecologist. Women above 35 years of age should consult their gynecologist after trying unsuccessfully for 6 months.

When Should You Be Concerned?

As a man, you should see your doctor if you have tried conceiving for a year and have been unsuccessful. You should also see a doctor if you experience conditions which adversely affect fertility such as erectile dysfunction, low libido, retrograde ejaculation or swelling/ pain in the genitals.

The doctor’s assessment will typically include a review of your medical and sexual history. The doctor will also carry out a physical examination as well as an assessment of the individual’s semen. Further tests may also be required depending on the results of the initial assessment. One of such tests could be a genital ultrasound.

For a woman, it is important to note that fertility begins to decrease after the age of 30. Women under the age of 35 who have been unable to conceive after a year of a trial should see their gynecologist. As with men, the doctor’s assessment will include a review of medical and sexual history. The doctor will also conduct a physical assessment for any of the risk factors mentioned earlier which may lead to infertility. The doctor may also carry out tests such as ultrasound scans of the uterus and ovaries, laparoscopy, ovarian reserve testing and hysterosalpingography.

Treatments

Treatment options for female infertility include reproductive assistance, medication, and surgery. Some cases may require the combination of several treatments to address the condition. The need for surgery as a treatment option for female infertility is reducing due to advancements in medical science. However, surgery is still required in cases such as removal of fibroids, unblocking of the fallopian tubes or correcting a poorly-shaped uterus.

Assisted Reproductive Technology (ART) measures help to address weaknesses in reproductive systems of one or both parties. Such measures include Invitro Fertilisation (IVF) and Intrauterine Insemination. IVF involves fertilizing eggs with sperm under laboratory conditions. The resulting embryo is placed into the uterus. This is increasingly being adopted in Nigeria but remains out of reach of many due to the cost implications. In Intrauterine Insemination involves injecting sperms into the uterus just around the time the woman is about the ovulate.

Medications that treat infertility in women typically work like hormones. They are mainly used to enhance or control hormones which affect ovulation in a woman.

As is the case with women, treatment for infertility in men may require one or more of medication, surgery or ART.

Do Treatments Always Work?

The short answer is no. Medical science is yet to fully understand the complexities of the human body. However, advances are being made daily. These advances continue to provide a source of hope to couples struggling with infertility. The important thing in exploring medical treatments is that both parties in the relationship need to be open. This is instead of casting the blame for the situation on one party.

Surrogacy

This is a well-established option for couples in the western world. In this situation, doctors use sperm from the father to fertilise eggs either from the mother or a surrogate. The surrogate then carries the baby to term for the couple. While proven, this option also comes with a fairly significant financial cost as well as a psychological barrier (for some couples) to overcome.

We’ve Tried Everything We Can – Still Nothing

Not every couple can afford the resources required to explore the different medical options available. These options are resource intensive and will prove a bridge too far for many especially considering the precarious state of the economy. Couples who either find themselves with limited medical options or have exhausted all available options, should be open to explore the option of adoption. Statistics are limited but there has been a lot of public commentary about child abandonment in Nigeria. Victims of this phenomenon suffer this from as early as a few days after birth. There is a framework in place in Nigeria to support adoption and it is no longer met with as many inquisitive stares as it may have in the past. Couples have started to take this up . It is a viable option for couples to achieve their dreams of becoming parents.

In Short – There are Options

Couples are not as restricted as they may have been in the past when it comes to becoming parents. Medical science is advancing and is making options more widely available. However, where medical science and/ or your resources have reached their limits, adoption is a viable option.

References

  1. Cheap IVF Needed. Nature. 2006;442(31):958.
  2. O’Flynn, Norma. “Assessment and treatment for people with fertility problems: NICE guideline.” The British journal of general practice: the journal of the Royal College of General Practitioners vol. 64,618 (2014): 50-1. doi:10.3399/bjgp14X676609
  3. Larsen Ulla. “Trends in Infertility in Cameroon and Nigeria”. International Family Planning Perspectives. 1995;21(4):138–142.
  4. World Health Organization (WHO) World Health Report 2006: Working Together for Health. Geneva: WHO; 2006.
  5. Moshood, Yusuff. The Problem of Child Abandonment. The Punch Newspaper. July 20, 2020
  6. Tajudeen, Ojo Ibraheem. “Adoption Practice in Nigeria – an Overview”. Journal of Law, Policy and Globalization Vol.19, 2013