Monday, February 5, 2018

Infertility: When neither he nor she is the cause

The path to pregnancy can be difficult for some

The path to pregnancy can be difficult for some couples and that is why it is important that they educate themselves on the latest interventions and ask the right questions. PHOTO| FILE 

By Peter Muthamia @TheCitizenTz pmuthamia@tz.nationmedia.com

        Causes of infertility and their respective treatments are so diverse. Infertility could arise from either male or female factors leading dysfunction. Hormonal tests, tests for physical damage to the ovaries and fallopian tubes caused by diseases such as fibroids, endometriosis and others are standard procedures to test for female infertility factors.

Experts say it’s time to check with the gynecologist if one has been intimate without birth control for 12 months if they are under the age of 35 and for 6 months if you are over 35 and no conception occurs. The male factors look into the physical health, the number, concentration and mobility of the sperm. In some cases, your gynecological may not be able to point a finger to the cause of infertility and therefore determine the most effective treatment.

When both female and her partner suffer from what doctors refer to as idiopathic infertility. In this particular infertility, doctors don’t seem to find any reason for the said infertility in either man or woman analysis. The situation is referred to by the doctors as idiopathic infertility - where doctors don’t seem to find any reason for the said infertility in either man or woman analysis.

According to Dr Msemo Musa, a gynecologist based at TMJ Hospital in Dar es Salaam, for any infertility case to be termed as idiopathic, a myriad of tests have to be carried out and the gynecologist has to be 100 per cent sure. However, in Tanzania, real cases of idiopathic infertility are difficult to prove owing to unavailability of laboratory equipment and very prohibitive cost of undertaking such tests.

“For any case to be conclusively to be termed as idiopathic, a battery of tests has to be carried out some requiring very special laboratory equipment. The cost of ordinary laboratory tests can be so high for an ordinary Tanzanian. For instance hormone profiling can cost between Tsh 200,000 to 300,000. That is just one of the tests,” he says.

Some reasons for infertility are also complex – they could be genetic in nature requiring complex equipment. Infertility resulting from the presence of antibodies whereby in layman’s language the sperms or the eggs fight each other also exists.

Weak, slow and poor quality sperm is a male factor that sometimes necessitates the use of In vitro fertilisation (IVF) is a process of fertilisation where an egg is combined with sperm outside the body.

“High quality sperm in the case of IVF are separated and fertilized outside the body. The embryo is then implanted into the body,” he adds.

Intrauterine insemination (IUI) is a fertility treatment that involves placing sperm inside a woman’s uterus to facilitate fertilization. The goal of IUI is to increase the number of sperm that reach the fallopian tubes and subsequently increase the chance of fertilization.

Most traumatising to the woman

Wearing a bold face and as Caroline* handles children (she is a teacher), the thoughts coursing through her brain can only be summed up in only three words, “why not me?”

She has no child of her own and although she derives some consolation from the children all around her in school, she longs for the time when she will cuddle her own.

Behind the bold façade of a composed mien, goodness and love for pupils she attends to is a very troubled soul. She cringes almost visibly whenever her women colleagues talk about their own children and their exploits at school.

Caroline dreads her menstrual periods. Inwardly she reckons that she cannot survive another lengthy month of dreary but hopefully waiting. The cycle is endless.

Any sight of a pregnant woman out there invokes a sense of envy – why can’t she get pregnant despite both she and her husband of five years trying for a child?

According to a research paper published in Oxford Academic, women with idiopathic infertility are more anxious and dissatisfied with self and their lifestyles than women in the other groups, but also reported greater marital satisfaction and greater satisfaction in other areas of life than controls (O’Moore et al., 1983; Callan, 1987; Callan and Hennessy, 1988)

Noverty Deograthias, an assistant lecturer in psychology at St. Augustine University, Songea Campus, infertility breeds inferiority complex and self-loath in the affected people especially the woman and finally, depression.

“African traditions lay so much emphasis on childbearing that after two years of childless marriage/relationships, the society, especially the friends, colleagues, family and neighbours look down on the woman. While the cause of infertility could be the man, woman, both or none of them, the society sees only the woman as the cause,” he said.

Both she and her husband know by first name gynecologists in and out of Tanzania having undertaken all conceivable gynecological examinations in the book – physical, hormonal and even surgical (laparoscopy) without results for their infertility. They have resulted to desperate measures.

Caroline and her husband, in search for their solutions have also tried the desperate option of seeking divine intervention in hope that someday soon, God will answer their problem - they have traversed the entire city of Dar es Salaam to be prayed for by bible-thumbing, fire-spitting pastors purporting to miraculously to “heal” infertility. From the TV “testimonies of women purporting to have given birth after prayers, they surmised that such pastors held the key to their “miracles”. This too has borne no fruits.

She has done this and more with no avail – laparoscopy for establishing the well-being of the fallopian tubes, ovarian reserve tests, hormonal tests and all. Nothing has been found to be wrong with her.

What with the husband having had sperm counts, sperm morphology, sperm concentration and other tests to rule out the male factor of infertility and finding no problem with him?

A diagnosis of male infertility can be one of the hardest challenges a man can face. For some, it can be devastating. After all, the necessity of reproduction is one of the few things on which the society looks at with interest. It is even more devastating when both partners are in the dark about the cause – after all diagnostic tests have been done.

Not being able to father a child can make a man feel like he’s failing at one of his most primal responsibilities. Indeed, the whole infertility issue boils down to wrong interpretation by other men as being impotence and sexual ineptitude.

Worse still, our communities that glorify parenthood such that she is uncomfortable being around relatives who talk about nothing but their children. Traditional and herbal medicine was according to the couple a really bad joke – it never worked for them.     

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