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Issues of Infertility in Couples (I): Definition and Social Impact in Africa

Issues of Infertility in Couples (I): Definition and Social Impact in AfricaInfertility is a disease of reproduction that impairs on the body’s physical and hormonal systems in performing the basic ability of humans to procreate. It is fraught with tremendous amount of psycho-social disturbance that eats deep in all cultures of the world especially amongst the Africans. It is a taboo that transforms into isolation and depression where the individual especially the female partner is down-graded to the lowest cadre in the social strata.
A woman of reproductive age less than 36 years old is normally expected to conceive after 12 months of unprotected sexual intercourse. If conception has not occurred, infertility is diagnosed and justifiably the couple investigated.
Infertility in Nigerian couples is about 1:5 and couples must understand that there are various interventions that can be used for its management. About 1:6 South African couples suffer from negative financial and psycho-social impact of infertility. In the orthodox religions across cultures the world over, terrestrial powers have been invoked to intercede on the infertile couples. They are for example, Osun goddess in the South West Nigeria (Yoruba cultures), the Ala god amongst the Ibos in the South East of Nigeria, the Hausa god of fertility called Foroforondu, Lono amongst the Haitians, Min amongst the Egyptians, and Venus during the Roman civilisation. These traditional forces have been the major interventions in the past, with legion of sacrifices (spiritual, financial and material) and faith submission to the whims and caprices of the custodian of the forces of the goddesses (the priest). Many of the male priests in the past ended up marrying their clients! This therefore, buttresses once again the significance of infertility in the life of couples especially among the female partners – a pathetic emotional trauma that still exists up to date.
The role of pastors, Imams or the traditional healers in infertility cannot be discarded. Apart from the belief that they intercede on behalf of their clients or faith followers to the Supreme Being, they reassure the infertile couples and allay their anxieties. This may positively affect conception as the cerebral cortex which controls all other organs in the body including the ovary, which may start performing at its best. Depending on the couples’ belief, majority of these interventions cannot and will not be subjected to scientific evaluation.

Infertility in men
Male infertility is not uncommon. It represents 30-40% of all infertility and 8% of all men are infertile. A fertility clinic should always encourage both partners to consult during the first few times of seeing the fertility doctor. In a nut shell, the reasons given below are some of the causes of male infertility:
Infectious diseases: Infections of the male genital tracts in form of sexually transmitted diseases can have a deleterious effect on fertility and should be treated with the appropriate antimicrobials after a microscopy culture and sensitivity tests have been performed on the semen. Infection of the epididymus, prostate and gonococcus urethritis may be such examples.
Viral systemic infection: Mumps can affect the testes causing mumps viral orchitis, a well-known cause of male infertility.
Blocked vasa deferens tubes that transport the sperm: The blockage can be congenital or acquired. The latter is often from infection, adhesions from sport injury, or from a previous surgery like herniotomy or herniorrhaphy.
Varicoceles: Congestion in the venous blood drainage of the testis, termed varicocele causes infertility in male by up to 30-40% of cases of male infertility. This impairs sperm production.
Alcohol and drugs: Alcohol, Social drugs, cigarette smoking, anxiety, stress do impair sperm production both in quantity and quality.
Chemical Toxins/ aflatoxins: a man can be exposed to toxins which can negatively affect the quality and quantity of sperm production. Several studies in South West Nigeria where farmers are exposed to the use of herbicides have been shown to be responsible for poor sperm quality. Aflatoxins are fungi that grow on plants and crops in the tropical climate. They impair sperm production. Others are insecticides or certain anti-cancer drugs.
Retrograde ejaculation: In this condition, the sperm enters the bladder instead of it coming out via the penis. It occurs in diabetes, spinal injuries, those on social drugs, and medications and surgery to the neck of the bladder.
Immune system disorders, e.g. anti-sperm antibodies: the body recognises the sperm as a foreign body.
Medications: Testosterone therapy is a noted example. Anabolic muscle building drugs and anti-cancer medications.
Celiac disease: It is a disorder of the intestine whereby gluten sensitivity is the aetiological agent. Treatment is simply by avoiding gluten in the diet.
Undescended testis. The testis is found in the abdomen or along its tract without descending into the scrotum. When recognised and corrected early, the outcome is very good.
Hormonal imbalance: Conditions of low testosterone production and hypogonadism is an example.
Abnormalities of the chromosomes: Klinifelter’s syndrome of 2X and 1Y (XXY) instead of XY or XX chromosomes can cause infertility. We can also have conditions such as kartargener’s syndrome, cystic fibrosis and Kallman’s syndrome. These conditions are rare but your gynaecologist will mention them when indicated.
Sexual dysfunction – such as erectile dysfunction, painful intercourse and hypospadias, where the opening of the penis is abnormally situated.
Testicular overheating: Long distance vehicle drivers and the use of tight fitting underwear are notable culprits.
Obesity: It affects sperm production by interfering with various body mechanisms.
It is important to investigate the male in cases of infertility “lest you concentrate on treating fungal dermatitis and forgetting leprosy”. The male semen is analysed using the standard approach that consists of microscopy and macroscopy. Sperm motility, concentration, structure and infectious cells are assessed. Specialised semen analysis is not routinely carried out but in suspicious cases of abnormal routine tests above or male factor infertility of unknown cause.
These tests may include sperm auto-antibodies, biochemistry, cervical mucus interaction test, culture, sperm function test, computer aided sperm analysis. Endocrine tests of serum testosterone, LH/FSH (to differentiate between primary or secondary hypogonadism), prolactin and inhibin. For obstructive causes, the serum testosterone, inhibin, FSH/LH could be normal. Ultrasound of the testicles could be carried out. In all cases the infection screening detailing hepatitis, HIV, syphilis, should be done.

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