Infertility: Who is to be blamed?

Infertility is a global problem, a public health concern in many parts of sub-Saharan Africa and remains a common gynaecological and social problem.
It is a disease of the reproductive system defined as the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.
8-12% of couples worldwide, 6% in UK, 10% in USA, 30-40% in sub-Saharan Africa and 20-30% in Nigeria, are affected by infertility.

Fertility on the other hand is the actual performance of persons (male or female) in terms of reproduction. This is measured by counting live births.
Time required for conception in couples who will attain pregnancy is as follows: 57% of couples in 3 months, 72% in 6 months, 85% in 1 year and 93% in 2 years.
The probability that a single cycle will result in a pregnancy (fecundability) is 20-25%.

The male, the female and both partners combined account for 30% causes of infertility respectively. In the remaining 10% no cause can be identified and it is termed unexplained.
The male factor may be as a result of abnormal, low or absent sperm production from the testes, blockage in the duct carrying the sperm or ejaculatory dysfunction.
The female factor may be as a result of anovulation, tubal disease, endometriosis, uterine or cervical factors.
Polycystic ovarian syndrome (PCOS) accounts for 80% of anovulation (class II anovulation).
Tubal factor can be congenital or acquired from infections such as gonococcal, chlamydial or tuberclosis.
Uterine factor may be as a result of congenital absence of the uterus, uterine anomalies, uterine fibroids, TB endometritis or adenomyosis.

It is essential that a gynecologist is consulted whenever a couple has infertility. A review which entails discussion that may be a pointer to the cause of infertility followed by clinical examination of the couple, is conducted.
Seminal fluid analysis is carried out on the male partner to assess the quality of his semen. The female partner is asked to have a transvaginal scan to assess the womb, a day 3 hormonal (FSH, LH, prolactin, estradiol) assay or a test for ovarian reserve (antimullerian hormone) and the fallopian tubes are assessed using sonohysterogram, hysterosalpingogram or laparoscopy + dye test.

Treatment option will include ovulation induction, intrauterine insemination and in vitro fertilization depending on the findings of the investigation. Myomectomy (removal of fibroid) may be necessary especially for fibroids encroaching and distorting the endometrial cavity (submucous fibroids).

Indications for IVF are blocked fallopian tubes, abnormal semen parameters, unexplained infertility, endometriosis, failure of artificial insemination and immunological factors.



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