INFERTILITY: Highly Treatable if Presented Early in Hospital

Infertility is the inability of a couple to achieve pregnancy after at least one year of regular (adequate), unprotected sexual intercourse. Adequate sexual exposure refers to sex of about 3-4 times in a week.

TYPES OF INFERTILITY
Primary infertility: – This is when couple has never achieved any pregnancy despite regular unprotected sexual intercourse for more than 12months OR more than 6 months in a woman more than 35years.


Secondary infertility: – This is when an individual irrespective of outcome has conceived before but finding it difficult to conceive again despite adequate unprotected sex.

WHO IS RESPONSIBLE FOR INFERTILITY?
Though, two major factors determine the outcome of management-
1. Duration of infertility
2. Age of woman if more than 35years.
Generally speaking, men account for 35-40%, women 40-50% while both- 15% of reason for infertility. In 10-15% of the cases, no cause is found.

CAUSES OF INFERTILITY IN MEN

  1. Primary testicular disease eg mump orchitis, post gonococcal infection, testicular torsion, chromosomal abnormalities and undescended testis.
  2. Obstructive problem eg post vasectomy
  3. Endocrine cause eg hypogonadotropic hypogonadism, thyroid disease.
  4. Environmental factor eg excessive heat, excessive exposure to chemicals like pesticides, paints, lead etc.
  5. Ejaculation problem.

CAUSES OF INFERTILITY IN WOMEN
Pelvic inflammatory disease
Pelvic surgery
Pelvic mass eg fibroid
Polycystic ovarian syndrome
Premature ovarian failure: This makes a woman to stop menstruating before the age of 40 years.
Hypogonadotrophic hypogonadism
Excessive exercise
Psychological stress
Hyperprolactinemia: This makes a womanโ€™s breast discharge in the absence of pregnancy.
Repeated excessive uterine curettage following abortion

TREATMENT AND INVESTIGATION
Infertility is highly preventable. Early presentation in the hospital improves outcome. Seeking appropriate treatment create better chances of pregnancy or successful assistance.
It is important that couples understand that the cause of infertility could be from the man or woman even both. Hence, the two parties should seek medical attention together.
For male/man, your doctor will request for Seminal Fluid Analysis and hormone profile. Some times, he might request for antisperm antibody test.
For the woman, your doctor will request for pelvic ultrasound scan, hormone profile, hysterosalpingography, post coital test, skull x-ray to detect pituitary tumour etc.


TREATMENT OPTIONS FOR MALE
Dietary and lifestyle modification
Hormone replacement therapy
Varicocelectomy
Assisted Reproductive Technique


TREATMENT OPTIONS FOR FEMALES
Hormone replacement therapy
Assisted reproductive technique
Adhesiolysis
Myomectomy if fibroid is present.


When all the attempts at achieving pregnancy by a couple fails, the couples can be counselled on:
Surrogacy: This is employed in women who has no uterus or has non-functional uterus. The fertilized oocytes (eggs) are transferred into the uterus of another woman (surrogate mother) who carries the pregnancy to term for the couples. The surrogate mother will adopt the child for just 6 months before handing the child over to the actual mother from oocytes (eggs) were collected.


Adoption: This is a legal way of taking over the parentage of a child that is not the biological product of the couples.

SOURCE:
Lecture note by Dr. Jagun Olusoji Edward (Obstetrician and Gynaecologist)

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