Children are blessings from God, right? Why doesn’t God want to bless me?

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UTG Medical Students’ Association

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By Aghogho Olukemi Obuotor
6th year medical student (UTG)

“Alieu, holal! I want to carry my grandchildren before I die! Jeh! 2 years! Fatou amut dorm beyy legi! Luhew? Hana morm doma la?”, Fatou cries silently as she remembers the piercing words her mother-in-law said to her husband, Alieu. She cries even more when she realizes that this is the last night she will spend with Alieu, as she will be welcoming her ‘wuja’ tomorrow. Alieu is set to marry a beautiful 21-year-old lady, Isa, who will fill the house with laughing children. Within the first year of marriage, Alieu and Isa are planning the ‘ngenteh’ for their bouncing baby boy. Fatou slips into depression because her womb is cursed; it just has to be, right?

What is infertility?

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Infertility is generally defined as the inability to achieve pregnancy despite regular unprotected sex

o          after at least 1 year in women less than 35 years old, and

o          after 6 months in women 35 years and older.

Despite the definition resonating around women, infertility may be caused by a number of different factors, in either the male or female reproductive systems. Although, on few occasions, infertility may be unexplained; where fertility testing cannot determine a cause.

Infertility can further be classified as:

o          Primary infertility: infertility in a couple who has never achieved pregnancy.

o          Secondary infertility: infertility in a couple who has previously achieved at least one pregnancy.

Causes of infertility

In the female reproductive system, infertility may be caused by disorders of the fallopian tubes, uterus, ovaries and the endocrine system.

o          Tubal disorders such as blockage of the fallopian tubes, which are caused by untreated or improperly treated sexually transmitted infections (STIs) or complications of unsafe abortion, postpartum sepsis or abdominal/ pelvic surgery.

o          Uterine disorders like structural abnormalities gotten from birth (congenital), inflammatory disorders (like endometriosis), or benign conditions (like fibroids and Asherman syndrome- that typically results after severe postpartum hemorrhage; abnormal bleeding after childbirth).

o          Ovarian disorders include polycystic ovarian syndrome, among others.

o          The endocrine system is a system that produces and releases hormones that help the body function. Hence, disorders of the endocrine system can cause imbalances of reproductive hormones.

In the male reproductive system, infertility is most commonly caused by problems in the ejection of semen, absence or low levels of sperm, or abnormal shape and movement of the sperm.

Lifestyle factors, like smoking, excessive alcohol intake and obesity, can affect infertility. Also, exposure to environmental pollutants can be directly toxic to eggs and sperm, causing decreased numbers and poor quality, leading to infertility.

Some people also have underlying conditions that may affect their fertility, e.g., diabetes. Some of these underlying chronic conditions require use of long-term medications (Spironolactone; an antihypertensive, Cimetidine; used for treatment of peptic ulcer and gastroesophageal reflux disease, etc) which can be a cause of infertility too. Some very athletic men, ‘Gym heads’, tend to incorporate anabolic steroids into their fitness routine to increase muscle mass, and this can be a cause of infertility too.

What would happen at the hospital?

Infertility is not a curse, it is not a death sentence, it is a medical condition, and just like many other medical conditions, it can be treated.

o          Modification of lifestyle factors such as alcohol, nicotine, and recreational drug use

o          Treatment of underlying causes e.g., PCOS

o          Use of medication to stimulate ovulation

o          Use of assisted reproductive technology (ART); medical procedures used to treat infertility, or

o          Surgical treatment of testicular defects.

But of course, before any treatment is given, there has to be a diagnosis. So how is a diagnosis reached? At the hospital/ clinic, after a series of questions, your doctor would order a hormone profile test for the lady (to check for any hormonal imbalances) and a semen analysis for the man (to evaluate sperm count, motility, morphology, etc).

Alieu and Isa have now been married for 5 years and baby Hassan is 5 years old. Alieu is at his most favourite place in the world, the gym, doing what he loves best when he overhears some guy complaining to his gym partner about how his girlfriend, Isa is pissing him off, not letting him see his 5-year-old son since he was born. “Boy bayil ndo bi, hamga dafa am jekarr.”

Alieu quickly wraps up his exercise for the day and rushes out of the gym, into his car, and tries to catch his breath. There is no way this is just a coincidence. He offers to take Hassan to school the next day and instead drives straight to a DNA testing centre. It has been 2 days, Alieu is not eating, he is not going to work, he isn’t even going to the gym. The results just came in… Probability of paternity: 0%.

Now let’s debunk some infertility myths, shall we?

1.         Infertility is the woman’s fault. Actually, ?of infertility cases are caused by male reproductive issues, ? by female reproductive issues, and ? by both parties or by unknown factors.

2.         Contraceptive pills can cause infertility. The pill has no effect on fertility. And a woman’s menstrual cycle will typically return to normal within a month or two after she has stopped taking the pill.

3.         If a man can ejaculate, he is not infertile. Male infertility is not 1+1=2. Male infertility rarely ever presents with noticeable signs.

4.         Irregular menstrual cycle = infertility. Irregular menstruation cycle doesn’t quorate equal infertility. Infact, it is actually quite common since the female menstrual cycle is regulated by a delicate balance of hormones that can be affected by increase in stress levels, caffeine, etc. However, if you are ever worried about it, you should visit a gynaecologist and air out your concerns.

5.         Infertility can’t happen in young men and women. Sure, increased age is often to blame- women over 35 and men over 50 have lower fertility rates- but young men and women still deal with it too.

6.         Men are fertile at any age. People often believe that male fertility is eternal. After all, the world’s oldest dad was able to father a baby at 96 years old so it just has to be eternal, right? Wrong. It is true that men continue to produce sperm until death, however, paternal age can both affect a couple’s chance of getting pregnant and their pregnancy outcomes. Men over the age of 35-40 typically experience a decrease in sperm health, affecting pregnancy rates, time to conception, miscarriage risk, adverse pregnancy outcomes, and offspring health risks.

7.         Certain sex positions improve the odds of pregnancy. There is no evidence to support this claim. Ejaculated sperm can be found at the cervix within seconds, and within the fallopian tubes within minutes, regardless of the coital position.

8.         A man’s lifestyle doesn’t affect his fertility. A man’s lifestyle may have a significant impact on his sperm health- especially cigarette smoking. Infact, it is found that smokers are 2 times more likely to experience infertility than non-smokers.

9.         Conception is easy after baby #1. Millions of people experience difficulty getting pregnant after baby #1; secondary infertility. The same factors responsible for primary fertility problems are often to blame: blocked fallopian tubes, endometriosis, poor sperm quantity or quality, among others. Whatever the cause, it either developed or worsened since the first birth.

Translation:

o          Fatou amut dorm beyy legi! Luhew? Hana morm doma la? Fatou still doesn’t gave a child! What’s wrong? Is she a witch?

o          Wuja: Competitor/ second wife

o          Ngenteh: Naming ceremony

o          Boy bayil ndo bi, hamga dafa am jekarr.: Leave this girl alone, you know she has a husband.