Tag: Causes

As I mentioned in last week’s article, in a third of infertility cases, the man is the cause of the infertility and in another third, the woman is responsible while in the remaining third, causes of infertility can be pin-pointed in both couple.

It’s, therefore, crucial that we throw some lights as to what causes infertility in men. In our culture in Nigeria and in Africa in general, women are often blamed for the failure to conceive in a marriage. As can be seen from what has been written so far, this is erroneous and the punishment that such women often endure is unnecessary.

In discussing the causes of male infertility, I am very aware of the complicated process and pathways and the language to explain the causes may be difficult. I am, therefore, going to make the case for simplified explanations. Conscious of the complex nature of infertility and a need for graphic illustration, we are organising a free public education seminar for May 29 in this regard to help address this complex and widespread problem.

Male Reproductive Tract: Courtesy MSD Manual The causes of male infertility can be a factor that is not related to the male reproductive organs: that is, something outside the system. Such factors include anything that may

indirectly impact on the production, maturation and release of sperm. Amongst others, they

include obesity which may lead to under-functioning of the brain-testicular axis. Obesity may decrease the hormones that are necessary for the production of sperm. Diseases of the gut, such as allergic reactions and celiac disease may cause impotence and low sexual energy.

Drugs, some medications and such substances as alcohol may act to decrease the hormones that help produce sperms or impair their maturing process.

Nicotine found in tobacco has been found to be able to kill sperms and also impair the functions of the testicles.

Also, a damaged DNA that is passed from one generation to the other may be responsible for the low quality or even absence of sperms.

Now, let me state some of the direct causes of low sperm quality. Commonly, poor sperm quality may be due to congestion of the vessels that drain the testes. This is called varicocele.

Varicocele, is present in 15% of normal men and in about 40% of infertile men. It probably causes up to 35% of primary infertility and 69-81% of secondary infertility (CDC).

As age of the man advances, the sperm are also affected and their DNA may be impaired.

This should not be confused with the fact that men may continue to produce sperm well into

d age, but it’s important to note that the genetic quality of such sperm decreases with age which may lead to either infertility or impaired offspring notwithstanding that men’s sexual stamina may decrease with age.

The direct causes also include: Abnormal set of chromosomes called Klinefelter syndrome, abnormal growth or cancer called seminoma and . Other causes relate to disease where the testes remain hidden in the abdomen and undescended (Cryptorchidism). Yet, a blunt trauma or forceful damage to the testes can cause poor sperm production. In men, infection with mumps may likely lead to poor testicular function and low quality of sperm.

There is a speculation that malaria can also lead to infertility. In men that is undergoing radiation therapy to a testis, such treatment decreases its function, but infertility can efficiently be avoided by avoiding radiation to both testes. In rare cases, the cause may be unknown.

The factors that I have mentioned relate directly to testes and sperm production. What of the factors relating to maturation and transport of admittedly of say a good quality sperm? If such transport system should fail, then infertility could result.

Such transport and ejaculation issues may arise as a result of: Vas deferens obstruction or lack of vas deferens, often relates to genetic markers for Cystic Fibrosis.

Infection, e.g. prostatitis, retrograde ejaculation, ejaculatory duct obstruction, hypospadias and impotence may all cause infertility. These are the main reasons why men become infertile. Conscious of the complex nature of infertility and a need for graphic illustration, we are organising a free public education seminar for May 29 in this regard to help address this complex and widespread problem.

The next article will deal with solutions to main infertility.

Solutions to female sterility will simply be a call to understand and address the root causes.

As I mentioned before, fertility impairment may be as a result of problems in the couple.

Where the issue is solely with the woman, the solution to the problem will be directed accordingly.

Generally, a female, who approaches a doctor for fertility treatment will undergo at initial stage, extensive history telling to the doctor and the doctor will examine the patient thoroughly.

Investigations will certainly follow. Such investigations may include hormone profile which may pin-point where the error lay. Other investigations may include detailed ultrasound scan of the pelvis and abdomen. This will help analyse the reproductive system of the woman.

Depending on the history, the woman may undergo HSG (Hysterosalpingogram). HSG will outline the different layers and structure of the vagina, womb (uterus) and fallopian tubes. An alternative to HSG is laparoscopy and dye test. The objective is the same: to clearly see how the uterus and fallopian tubes look like.

In some cases, genetic testing may be called for especially if the woman shows the appearance of such illnesses as Turners.

Starting with the indirect causes, the woman can do a lot to help her fertility. If obese, lose weight. Stop smoking. Stop alcohol, marijuana and other dangerous substances that impair health as well as fertility. Avoid radiation except if necessary to heal some other ailment.

A woman, who is about undergoing chemotherapy or radiotherapy, can have some of her eggs frozen by her fertility doctor so she can use such eggs to conceive in future when her chemotherapy or radiotherapy treatment is over and done with. This same advice is applicable to the man to freeze his sperms.

What about those conditions that relates directly to female reproductive systems? Surely, polycystic ovarian syndrome (PCOS) is very disabling as it may be associated with diabetes and obesity as well as abnormal body hair growths. The doctor may advise a regime of weight loss but will certainly address the risk of diabetes and abnormal hair growth with medications. The doctor is more likely to suppress the PCOS with powerful medications.

Rarely in modern times is surgery required that cut into the ovary to repair PCOS.

Pelvic Inflammatory Disease (PID) will require appropriate antibiotics. Similarly, STI will be dealt with by use of suitable antibiotics after the result of an investigation that is called high vaginal swab had been taken.

Where an anti-sperm antibody (where the woman’s cervix is hostile to the presence of sperms) is suspected as the cause, artificial insemination (IUI) may be advised or be undertaken. IUI may also be used for circumstances where sex is impossible as a result of fear gripping the woman during sex (Vaginismus). IUI may also be suitable where a case of impotence in the man is the cause. Of course the fertility doctor would have assessed the suitability of the couple for IUI and the couple be advised accordingly.

If everything else fails so much that natural conception is not possible, then the couple can approach fertility doctor for other forms of assisted conception. This will include in-vitro fertilization (popularly called IVF). Assisted conception comes in various forms depending on the reason for choosing the IVF method.

In summary, infertility is a serious disorder. It comes with severe social stigma and has harsh implications for the sufferer. Marriages may end; relationship and friendships may be dissolved because of sterility. In particular, women suffer a lot. They often erroneously get blamed for a fault which may not be their own. Pushed out of wedlock, women may suffer insecurity as a result of being denied the security provided by money, land and matrimony.

This is especially true in African and Nigerian context.

That said, because women has a “window of opportunity” to reproduce in their younger age group between ages 20-say 40, they should take advantage of and be conscious of this phase in their lives. Delay in having children may not only be disadvantageous but risky as old age is often not compatible with labour.

I am not under any illusion as to the complex nature of human infertility. It’s on this basis that we are organising a free public health seminar on infertility for 29 May to help the public better understand this very emotive topic.

Just as we have dealt with the male infertility, it’s only fair that we should do the same with the female sterility. By this, I mean that we need to discuss the causes of barrenness in the female before we should round up with the available solutions. Notwithstanding, in contrast to the causes of male infertility, the factors responsible for female sterility are significantly manifold and considerably plenty, much more than the male though there are similarities in a number of areas. Again, the causes of female infertility should also follow the pattern of indirect causes on the female reproductive system as well as those factors that act directly on the fertility system.

Female reproductive tract.

Courtesy of Kullab.com

Let us look at the indirect causes first: Being overweight or obesity has a significant impact on the female fertility. Obesity structurally impairs the female system as well as affecting the female hormones that are responsible for the fertility in the first place. On the other hand, being underweight can equally affect fertility Cigarette and marijuana consumption do affect the female hormones. Diseases such as diabetes as well as illnesses affecting the liver, kidney and thrombophilia may all have negative impact on the female fertility.

It’s a common knowledge and generally well recognised fact all over the world that age and aging significantly limit the female fertility. Under normal circumstances, a female reaches its peak of fertility at about 26 years of age and the most fertile time of her life is between the ages of 22-32years. After the age of 32, the number of eggs available to the woman to use for childbearing starts to decrease at a great rate. By the age of 45, the eggs have reached a low end. By the age of 50, at about when the woman ceases to have her menstrual period, her available eggs are nearly zero. Her fertility has diminished greatly. Getting pregnant gradually becomes difficult as the woman’s age advances.

Other indirect factors that affect female fertility include if she is exposed to radiation and chemotherapy for treatment of illness elsewhere in her body or for healing of diseases that relates to her reproductive system.

In some cases, some genetic disorders may cause the female fertility to be negatively affected. Such genetic disorders include Mayer-Rokitansky-Küstner-Hauser Syndrome and Turners. Yet in some individuals, a genetic defect may make the female reproductive system appear as containing both male and female organs. They are called intersex (neither entirely female nor male).

Direct causes of female reproductive disorder may be related to each organ within the reproductive system (the ovary, fallopian tubes, uterus, cervix, and vagina). On the other hands, the fault may lie at the brain (Hypothalamus-pituitary) that controls the female reproductive hormones.

Here is a list of where the fault may be: In some cases, when breasts produces milk when it should not do so as in a condition that is called hyperprolactinaemia, the woman may not be able to ovulate. As such, child-bearing may be impossible to achieve.

Ovarian factors: When ovary makes attempt to develop eggs and does so by developing too many without even shedding or ovulating at the end, a disease called Polycystic Ovary develops and conception may not happen with ease because there is no ovulation. In some very unfortunate individuals, their ovary may fail before its time to do so at later age.

This is called premature ovarian syndrome. If there is cancer of the ovary, it may also be difficult to achieve pregnancy. Needless to mention that regardless of her best efforts, a woman will ultimately reach the end of her fertility period at about the age of 50 on the average.

The Fallopian tubes is used for transporting of eggs and sperms. The tube is also where the female egg and the male sperm meet to achieve fertilization. If there is a blockade of the tube on one side or both sides, natural conception is clearly impossible. This blockade may be due to sexually transmitted infections (STI) such as Chlamydia and gonorrhoea or may be due to some other bacteria. It does means that, at all times STI must be vigorously pursued and treated if one is to preserve ones fertility. STI may also lead to pelvic inflammatory disease (PID) which in turn leads to tubal occlusion with or without pelvic abscess.

Notwithstanding, tubal occlusion may not be as a result of infection as a regular backward flow of menstrual period blood (endometriosis) may also lead to fallopian tubal blockade.

The uterus or the organ popularly called the womb may itself be the cause of infertility.

From its origin, it may be absent from forming or it may come as double wombs in the same individual. In normal individuals, as an adult, fibroid which we have dealt with in previous articles, may distort the womb. In so doing, the fibroid may prevent implantation of a newly fertilised egg.

Yet, in some persons, Asherman’s syndrome which often results from tuberculosis infection or following a badly done “D &C” may deny access to the sperms from reaching the eggs as Asherman’s syndrome causes sticking together of the womb linings.

Also, the neck of the womb called Cervix may become so damaged during “D&C” or by any other surgery as to cause cervical incompetence or stenosis (narrowing) of the cervix. Yet the natural secretions of mucus may not be pleasant or take kindly to the presence of sperms in some individuals (Anti-Sperm Antibodies).

Finally, the female vagina may be too narrow to permit entry of the male penis or fear may grip the woman during sexual intercourse so much that natural sex is impossible.

These are some of the causes of female infertility. If the reader has found this article too complicated to understand, we will be organising a free public education seminar on infertility on May 29 to shed more light and illustrate this complex topic where members of the public is free to attend.

Our next and final article on infertility will address the solutions to female sterility.

Last week, we dealt with causes of male infertility. In this week, let us take a look at the available solutions to the complex issues of male sterility. Once again, I want to emphasise that men are directly responsible for about 35 percent of infertility in a couple and in 35 percent of the cases; the couple jointly share the burden. Women have for long, in different cultures and in particular in African cultures, been blamed for failures to conceive. This is irrational as women are only responsible for a third of infertility difficulties.

Now that we have discussed and outlined the various events that often gave rise to sterility in men, you might ask, what can we do about it?

First step is to help yourself—DIY—Do it yourself. There are several things that the sufferer can do to relieve the challenges of men sterility. Stop smoking. Stop unreasonable alcohol consumption. Don’t “cook” your testes via the tight pants that you wear. Avoid frequent long distance journey that provides heated environment on driving seat for “cooking” the testes.

Heat is bad for sperm production. Cool down. Fever is bad for your fertility.

Lose weight and try to be within the normal range of Body-Mass-Index ratio. Obesity works in both men and women, against fertility. By all means possible, avoid trauma and injuries to your testes.

All infections, without exception are threats to your health and life. Mumps and tuberculosis can severely damage your health and fertility. You can get vaccinated as soon as possible against these deadly diseases. Use the same opportunity to vaccinate your family. If you are taking medications that may impair your health and fertility, have a discussion with your doctor as a matter of top priority. In our environment, many of our folks often use traditional herbs or other preparations. While I do not disprove their usage or doubt their efficacy as they have been in use for generations, clinicians like myself cannot scientifically prove their dosage, expiry date, side effects and what to use as an antedote in case of accidental use. We often do not know their impact on other organs such as on the delicate process of sperm production.

In disease states that directly affect the testes, it’s crucial that a trained doctor that specialise in the field be allowed to intervene to correct the clinical error. I will urge the readers to exercise caution in their dealing with infertility issues. When in doubt about certain treatment, I will advise that patients should seek a second opinion of a qualified expert in the field so as to avoid clinical injuries and mistakes.

What can one do about diseases that impair transport and ejaculation? The starting point is to see a doctor that specialises in reproductive medicine for assessment. Alternatively, is to keep an appointment with an urologist who will provide detailed assessment and offer necessary investigations as well as treatment.

In a lot of ways, the ultimate decision may be with the doctor who will follow what the infertile couple wants.

Technology has advanced to the point in which sperms can be taken directly from the testes and to be used for in-vitro fertilization (IVF). Where cost is a major reason for avoiding IVF, a lesser but effective means such as intra-uterine insemination (IUI) can be used. IUI is useful if there are no physical barriers to fertilization in the woman. The man’s sperm can be collected, processed in the laboratory before transporting the sperms into the woman.

In some situations where sperm quality is very poor, a single sperm can be processed and injected into an egg during an IVF procedure. This injection of sperm into an egg is called intra-cytoplasmic sperm injection (ICSI for short). This process often yields a higher rate of pregnancies in couples who could otherwise found it difficult to conceive.

I have been asked if there are foods and nutrients available that can boost sperm quality. The short and long answer is “no” and “yes”. “No” in the sense that, the cause of the poor sperm quality must first be determined. Food and nutrients are of no use if there is a blockade to sperm transport, for example. That said, the reasonable approach is to eat balanced diet and supplement the food with multivitamins (especially folic acid) that contain zinc which is an anti-oxidant. And that is the basis for the “yes”. If the detailed explanations and terms that had been used here is a challenge to the reader, we are organising a free public education seminar for May 29 in this regard to help address this intricate and widespread problem.

In summary, once again, men are often partly responsible for infertility that afflicts their family. At the same time, there are preventable actions that could be applied as outlined.

Where such actions are not suitable, specialist doctors should be consulted for help.

As I mentioned in last week’s article, in a third of infertility cases, the man is the cause of the infertility and in another third, the woman is responsible while in the remaining third, causes of infertility can be pin-pointed in both couple.

It’s therefore crucial that we throw some light as to what causes infertility in men. In our culture in Nigeria and  Africa in general, women are often blamed for the failure to conceive in a marriage. As can be seen from what has been written so far, this is erroneous and the punishment that such women often endure is unnecessary.

In discussing the causes of male infertility, I am very aware of the complicated process and pathways and the language to explain the causes may be difficult. I am therefore, going to make the case for simplified explanations. Conscious of the complex nature of infertility and a need for graphic illustration, we are organising a free public education seminar for May 29 in this regard to help address this complex and widespread problem.

 

Male Reproductive Tract: Courtesy MSD Manual

The causes of male infertility can be a factor that is not related to the male reproductive organs: that is, something outside the system. Such factors include anything that may indirectly impact on the production, maturation and release of sperm. Amongst others, they include obesity which may lead to under-functioning of the brain-testicular axis. Obesity may decrease the hormones that are necessary for the production of sperm. Diseases of the gut, such as allergic reactions and celiac disease may cause impotence and low sexual energy.

Drugs, some medications and such substances as alcohol may act to decrease the hormones that help produce sperms or impair their maturing process.

Nicotine found in tobacco has been found to be able to kill sperms and also impair the functions of the testicles.

Also, a damaged DNA that is passed from one generation to the other may be responsible for the low quality or even absence of sperms.

Now, let me state some of the direct causes of low sperm quality. Commonly, poor sperm quality may be due to congestion of the vessels that drain the testes. This is called varicocele.

Varicocele, is present in 15 percent of normal men and in about 40 percent of infertile men. It probably causes up to 35 percent of primary infertility and 69-81 percent of secondary infertility (CDC).

As age of the man advances, the sperm are also affected and their DNA may be impaired.

This should not be confused with the fact that men may continue to produce sperm well into old age, but it’s important to note that the genetic quality of such sperm decreases with age which may lead to either infertility or impaired offspring notwithstanding that men’s sexual stamina may decrease with age.

The direct causes also include: Abnormal set of chromosomes called Klinefelter syndrome, abnormal growth or cancer called seminoma and . Other causes relate to disease a disease where the testes remain hidden in the abdomen and undescended (Cryptorchidism). Yet, a blunt trauma or forceful damage to the testes can cause poor sperm production. In men, infection with mumps may likely lead to poor testicular function and low quality of sperm.

There is a speculation that malaria can also lead to infertility. In men that is undergoing radiation therapy to a testis, such treatment decreases its function, but infertility can efficiently be avoided by avoiding radiation to both testes. In rare cases, the cause may be unknown.

The factors that I have mentioned relate directly to testes and sperm production. What of the factors relating to maturation and transport of admittedly of say a good quality sperm? If such transport system should fail, then infertility could result.

Such transport and ejaculation issues may arise as a result of: Vas deferens obstruction or lack of vas deferens, often relates to genetic markers for Cystic Fibrosis.

Infection, e.g. prostatitis, retrograde ejaculation, ejaculatory duct obstruction, hypospadias and impotence may all cause infertility. These are the main reasons why men become infertile. Conscious of the complex nature of infertility and a need for graphic illustration, we are organising a free public education seminar for 29 May in this regard to help address this complex and widespread problem.

The next article will deal with solutions to main infertility.

In the next couple of weeks or so, we shall be dealing with one of the most distressing disorders in a human being. Infertility per se, is not a disease that is life threatening, but asocial and biological disorder.

If we take a broader look at the subject, one can say that, not everyone desires to have a child or establish a family.

Thus, infertility should be seen and defined in the context of those whose intention and desire is to have at least a child. One can be childless by choice.

Therefore, childlessness in such individuals is not an illness.

So, the first step is to define infertility. Infertility is the inability to conceive and have a child in a couple who are desiring to have a child but failing to do so though having a regular sexual intercourse (and I put, having sex through the normal and generally accepted entryports), not using contraception, in a 12-month calendar period. Infertility is a failed desire which may be underpinned by physical, social and psychological illnesses or ironically nothing at all that can be discovered scientifically.

In spite of what I have said above, let us take a quick look at the opinion of World Health Organisation. Infertility is “a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.” (WHO-ICMART glossary1). Put in another way: “Infertility is the inability of a sexually active, non-contraception couple to achieve pregnancy in one year. The male partner can be evaluated for infertility or sub-fertility using a variety of clinical interventions, and also from a laboratory evaluation of semen.” (Semen manual, 5th Edition 3).

In the opinion of Centre for Disease Control (CDC), a woman is said to suffer from infertility “who do not have regular menstrual cycles, or are older than 35 years and have not conceived during a 6-month period of trying, should consider making an appointment with a reproductive endocrinologist—an infertility specialist. These doctors may also be able to help women with recurrent pregnancy loss—2 or more spontaneous miscarriages”.

In terms of how common infertility is or prevalence, the disorder affects 10-15% of couples.

In approximate third of infertile couples, the fault is that of the woman. In another third, the fault is that of the man. In the remaining one third, the infertile couple share the fault jointly.

According to World Health Organization (WHO) evaluation of Demographic and Health Surveys (DHS) data (2004), estimated that more than 186 million ever-married women of reproductive age in developing countries were maintaining a “child wish”, translating into one in every four couples.

Infertility can be classed as primary or secondary. Let us again return to WHO to guide us:

“When a woman is unable to ever bear a child, either due to the inability to become pregnant or the inability to carry a pregnancy to a live birth she would be classified as having primary infertility.

Thus women whose pregnancy spontaneously miscarries, or whose pregnancy results in a still born child, without ever having had a live birth would present with primarily infertility.

When a woman is unable to bear a child, either due to the inability to become pregnant or the inability to carry a pregnancy to a live birth following either a previous pregnancy or a previous ability to carry a pregnancy to a live birth, she would be classified as having secondary infertility.

Thus those who repeatedly spontaneously miscarry or whose pregnancy results in a stillbirth, or following a previous pregnancy or a previous ability to do so, are then not unable to carry a pregnancy to a live birth would present with secondarily infertile.”

Infertility cuts across all cultures. The disorder is no respecter of human colour, religion or geographical location.

Female Reproductive Tract. Courtesy Kullab.com

From what I have explained above, it can be seen that infertility is a complex and delicate subject. If it’s a delicate subject, the actual process of fertilization is in the least, is extremely complicated.

In a simplified form, the human fertilization and resultant pregnancy takes the following steps: A woman’s body must develop follicles and release an egg from one of her ovaries (ovulation). The egg so released must go through a tube called Fallopian tube toward the uterus (womb).

A man’s sperm which be released either through sex or injected by artificial means must join with the egg along the way leading to fertilization. The now fertilized egg must itself find its way and attach to the inside of the uterus in a process called implantation. As can be seen, problems can develop along the way in this complexprocesses.

Further problems can still develop during pregnancy.

In the coming weeks, I will be dealing with male infertility, causes and remedies and the two weeks that will follow thereafter; I will be dealing with the female infertility.