PRIMARY INFERTILITY

“Infertility has never been the fault of the man”; I don’t know what to call this, a myth or a lie. This has been planted into the psyche of most women that they do unthinkable things to prove how true this generational lie is. You should know that both male and female may contribute to their inability to conceive equally. The cause of the infertility could be due to a male factor, female factor or both. At times, it may be difficult to convince a woman in an African setting that she is not responsible for their childlessness. This belief has permeated our society that even our home movies clearly depict that. 

Also, the attendance of the male partners of couples with infertility to the gynaecology clinic speaks volume. In my facility, patient with complaint of inability to conceive are first seen at the gynaecology clinic. They may be referred to our fertility centre on need basis. It is rare to see a man accompany his wife to the clinic. We have to insist many times we want the spouse to take a seminal fluid analysis test. Sometimes, the woman will finish her evaluation and the man is yet to do his sperm analysis.

At one consultation, after reviewing the woman’s test results, she was told she was fine based on her results. She was not convinced and went ahead to tell me how strong the husband is and that he ‘last long’ in bed. She also brought up another complaint attributing her vaginal discharge to infection and therefore the probable cause of her inability to get pregnant. After another examination, she was found to have a normal vaginal discharge. For this patient, the husband had been invited twice to the clinic which he never showed up. He was also yet to do his sperm analysis.

INFERTILITY; WHEN IS A COUPLE SAID TO BE UNABLE TO CONCEIVE?

The word barren is often erroneously associated with a woman who is unable to bear children, whether it is her fault or not. The real meaning of this word should apply to either the male, female or the couple in a sexual relationship. A couple is declared infertile if they are unable to conceive after one year of regular, unprotected, sexual intercourse. For women who are advanced in age, ≥35years, 6months is used instead of one year. One year is used because about 90% of couples will conceive within one year. It should be noted that the ability to conceive in one menstrual cycle is less than 50% for a fertile couple.

WHEN SHOULD A COUPLE SEEK HELP FOR INFERTILITY?

Generally, after one year of actively trying to conceive, a couple should seek help if they are unable to conceive. For older women, their evaluation should start after 6months of actively trying to conceive. This consideration has to do with the average age of menopause, which is about 45years and the fact that the quality of the woman’s eggs begins to depreciate. While for younger women, their evaluation starts after one year.

However, if the couple feel they have a problem, they can seek help earlier. it is not in all cases that the couple have to wait for 6months or one year. If there is an obvious cause for the couple’s inability to conceive, they will be evaluated and treated. Your gynaecologist will not ask you to mandatorily wait when the cause of the infertility is already known.

WHO SHOULD BE EVALUATED FIRST FOR INFERTILITY?

Contrary to what I have seen in my practice, the male should be tested first. Ideally, the couple should be seen together and their evaluation can go on concurrently. If for any reason one of the couple must be tested first, the male should be the first. This is because it is easier and cheaper to test the male than the female. The evaluation of the female is more expensive, discomforting and takes a longer time. Some of the tests must be carried out at specific periods in her menstrual cycle. For the male, the test can be done at any time except for the sperm analysis that will require a brief period of abstinence.

TYPES OF INFERTILITY

Basically, infertility is classified into two; primary infertility and secondary infertility. A couple is said to have primary infertility if the man had not impregnated his partner in his previous or current relationship, and the woman had not been pregnant ever in her life. Infertility is secondary if either the man had impregnated a woman in the past or his current partner had been pregnant in the past. The outcome of the pregnancy does not matter; whether it resulted in child birth or ended as a miscarriage.

Infertility can also be classified based on which partner is the cause; male factor infertility, female factor infertility, both male and female factors infertility and unexplained infertility.

WHAT ARE THE CAUSES OF INFERTILITY?

For conception to take place; it requires a healthy sperm, healthy egg, normal fallopian tube for the egg to pass and unite with the sperm, and a normal womb for the developing baby to implant and grow. Abnormality that interferes with any of these will result in infertility. One minor but often neglected cause is inadequate sexual exposure.

I once asked a patient how many times in a week she has sexual intercourse since she started trying to conceive. The response was quite funny, she said may be once. If I may ask, for a couple trying to conceive, how many times per week is sex deemed adequate? If your answer is three, you are right, yes you need that much. It is worthy to note that too much of everything is bad including sex. Non-stop daily sex is not recommended, the sperm need some break to accumulate again, a day or two break is fine.

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