Monday, October 29, 2012

Infertility: Causes, costs of a rising problem

dr. abayomi aiyesimoju

Many homes are going through the frustration and agonies of childlessness, with observers saying the problem of infertility is fast-becoming a plague in the country.

In Nigeria today and the world at large, the desire of every couple is to become parents within the first or second year of married life. Some couples have this dream fulfilled, while there are quite a number of others who do not. There are also couples who already have one or two children and want more.

Infertility, according to medical experts is the inability of a couple to get pregnant after a year or more of trying. The prevalence of infertility in Nigeria is between 20 and 25 per cent among married couples. It has been found that female factors are responsible in 40 per cent of cases; male factors account for 40 per cent; the remaining 20 per cent are the combination of both.

Experts list the causes of male factor infertility to include: poor sperm count, poor motility, total absence of sperms and testicular cancer, while some reasons adduced for female infertility include: tubal blockage, endometriosis, elevated hormones and lack of ovulation (that is, when a woman does not produce any eggs).

According to them, many of these factors often lead to the high incidence of sexually transmitted diseases, which is a preventable condition. Unfortunately, by the time the couple seeks help for their infertility, the damage has already been done and will require some form of infertility treatment.

In many cases, especially in the country, women are blamed for childlessness in marriages. It is in fact common that men are absolved of any blame in such circumstances, as a lot of people believe, albeit ignorantly, that the problem of infertility is exclusive to women. However, medical research had proven that men and women do share equal blame for infertility.

Although experts agreed that the problem of infertility in men could be genetic (inborn) or could be as a result of illness or injury, they are also of the opinion that many other factors including the lifestyle of the individual play major roles.

According to Dr. Abayomi Aiyesimoju, a Lagos-based Consultant Physician, a lot of factors could be responsible for infertility in men. Some of these factors, according to him, are preventable. Simple things like placing laptop on the lap, wearing of tight underpants and constant riding of bicycle could make a man infertile.” These activities can lead to increase in the temperature around the testes (the organ responsible for sperm production in men). One thing that the testes do not like is heat and any activity that heat up the testes could lead to infertility in men,” he explained.

Speaking further, Dr. Aiyesimoju said the eating of food from plastics placed in a microwave oven could affect a man’s fertility. “When you put a plastic in a microwave, the plastics are known to contain substances that have hormone-like effects and if you keep consuming that every day, somehow it is going to affect your hormonal system and the essence of the reproductive function has to do with the right state and function of the hormones”, he stated. Rather than use plastics, the expert advised men to use plates made of ceramics, noting that ceramic plates were completely safe.

The main factors that could affect a man’s fertility, according to the physician, include exposure to pollutants in the environment, use of herbicides and pesticides, as well as certain drugs used in the treatment of other ailments. “Unknown to many, ulcer drugs like cimentidine can affect fertility. Also, aspirin and anti-malarials can reduce sperm count. Furthermore, radiation treatment and chemotheraphy for cancer patients can reduce sperm count,” he added.

According to experts, lifestyle problems such as excessive alcohol consumption, cigarette smoking and drugs like marijuana could also affect a man’s fertility.

Aiyesimoju disclosed further that marijuana could lower sperm count. Apart from this, he said poor diet and age could reduce a man’s fertility. He said, “If a man is malnourished, his fertility can be affected and of course, the older one gets, the less fertile he becomes.”

Another problem he identified that could lead to infertility in a man was the presence of varicose veins (veins that have become permanently swollen or enlarged.

He noted that varicose veins in the scrotum can cause congestion, which may prevent free flow of blood and eventually affect the supply of nutrients to the male organ.

It is common to find many homes, where couples have been running from pillar to post in their desperate search for the blessing of the womb. They move from one worship centre to another or from one herbalist to another who professes to have a panacea for infertility. Some claim to seek unorthodox means towards overcoming the challenge. A lot of them doubt the efficacy of western medicine on the issue of infertility. But a Consultant Obstetrics and Gyneacology and Managing Director of Bridge Clinic, Lagos, Dr. Richard Ajayi, said with advancement in medicine, it was now possible for infertile couples to have their own children through various assisted reproductive techniques. Such techniques, according to him, include: Ovulation induction and cycle monitoring, Intrauterine insemination with partner’s sperm (IUI), Donor Insemination(DI), In Vitro Fertilization and Intracytoplasmic Sperm Injection(ICSI).

He explained that ovulation induction and cycle monitoring could be used for women with irregular menstrual cycle such that if ovulation was absent drugs may be administered to stimulate egg production. “IUI is performed on women with healthy fallopian tubes and it involves the injection of treated sperm from the husband, partner or donor into the uterus through the cervix. DI is used for men who have no sperm in their ejaculate”, he said, adding that: “The most effective treatment for women with absent, blocked or damaged fallopian tubes is the IVF in which we create a condition to allow the sperm and the egg to meet as if it is happening inside the woman’s body.”

Also speaking on the issue, another assisted conception expert who is also the Medical Director of St. Ives Hospital, Lagos, Dr. Tunde Okewale, however, lamented on the cost of IVF in Nigeria which according to him was beyond the reach of many infertile couples in the country. He disclosed that an IVF cycle cost between N800,000 and N1million. While calling on the government to urgently pay attention to infertility problems, Okewale said: “Infertility has to be recognised for what it is. If individuals have heart problem, government sees it as a disease condition; orthopedic hospitals for people who have broken bones, but government generally tends to see infertility problem as a personal problem and not as a medical problem.”

Okewale spoke on the negative implication of infertility, especially on general society, hence the issue should not be handled with levity. “When a couple is infertile, it goes beyond a personal problem but a social problem. When couples are infertile, it affects their families and so many people around them because they go through all sorts of emotions. Even the marriage is at stake. Other vices such as adultery, polygamy, illegitimate children and sexually transmitted diseases can result from there. So, it is a social problem on its own and the responsibility of government is to tackle social issues. That is why in the UK, the government lists out some criteria on infertile couples that need IVF and the government not only pays for it but they pay for three cycles for those people.”

by muda


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