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Tag: Solutions

  • Institute proffers solutions to unemployment

    To tackle growing unemployment in the country particularly among the youths, there is need to address issues of policy inconsistency, poor political governance and setting of policy direction that elicits a harsh business environment.

    Other issues such as lack of stakeholders’ ownership of employment policy, misalignment of the educational system output and the skill-sets required by current employers of labour, which, among others, are factors responsible for the increasing rate of unemployment, must be addressed.

    These are key findings of a study conducted by the Chartered Institute of Personnel Management of Nigeria (CIPM). The study tagged ‘Management of National Unemployment Challenge (MNUC)’ was conceived by CIPM’s leadership to proffer actionable and sustainable solutions to the socio-economic and political challenges of unemployment in Nigeria.

    Speaking in Lagos yesterday at a media and stakeholders engagement on MNUC held at the CIPM Council Chambers, CIPM President/Chairman of Governing Council Mr. Anthony Eromosele Arabome said, for instance, that latest data from the National Bureau of Statistics (NBS) have shown that youth unemployment has grown from an average of 16.43 per cent in 2014 to 21.50 per cent in the first quarter of 2016.

    He also regretted the recent exit of 20 foreign shipping companies from Nigeria, saying that the development compounded the unemployment situation in the country, as it left over 3,000 teeming, able and willing individuals unemployed. He said this is in addition to the rising trend of unemployment recently observed in the financial and oil & gas sectors of the economy.

    The CIPM president, therefore, said “As human resource management experts, our objective is to proffer and recommend actionable and sustainable solutions, which align with the current administration’s focus on job creation initiatives geared at combating this national menace.”

    He said the project, which was championed by a seven man Committee headed by a Fellow and one-time Registrar & CEO of the Institute, Dr.  Musa Rabiu (FCIPM) was done in collaboration with the Federal Government, expressing hope that its recommendations would be adopted by different stakeholders especially the Presidency charged with the responsibility of policy formulation and implementation.

    Arabome pointed out that policymakers have a key role to play in introducing the reforms and measures needed to improve the labour market and also tackle the unemployment scourge. He assured of the Institute’s readiness to work with the Federal Government to implement policies aimed at increasing the nation’s growth potential and create an economic environ

  • The root causes of infertility and the solutions to them (2)

    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.

  • Menopause in women/men: Solutions to the disquiet of middle age (4)

    This article will deal with treatment of menopause in women and tough upon male “menopause”.

    The main symptom of menopause in women is hot flushes (see earlier articles). This symptom of hot flushes can be corrected with the hormone that is so deficient in women at their mid-ages. Doctors, based upon clinical assessment, may prescribe hormone replacement therapy (HRT), which comes indifferent formulations. Some can be taken by mouth as a daily pill similar to contraceptive pill. A note of warning is warranted here.

    HRT is not a contraception or an anti-pregnancy pill. Women should still take precaution so as not to get pregnant. Please note that this statement does not mean that a woman’s fertility has returned with us of HRT. It’s not so. HRT can also be taken as a patch or vagina cream.

    While on HRT, women that have not had hysterectomy (removal of the womb), may resume having regular menstrual periods. Again, this is not an indication that fertility has been restored. The menstrual period is just the consequence of the way the HRT works. HRT may be continued for up to five years.

    HRT is not without risk. Anyone with the history of breast cancer, blood clotting, severe liver disease, undiagnosed vaginal bleeding and pregnancy should not take HRT. The HRT here is a combined hormones of estrogen and progesterone.

    For women who have had their womb removed, they may use a different form of HRT: estrogen. In all, because of the risks, women intending on using HRT should consult their doctor for guidance before commencing usage.

    Vaginal dryness leading to difficult sex may be relieved with either a lubricating cream, such as KY jelly or estrogen cream. Urinary symptoms may also be relieved by HRT. Low sexual drive that is not helped by HRT may respond to male hormone testosterone.

    Risk of bone fractures, which occurs in one in 20 women undergoing menopause, can also benefit from HRT or a non-hormone treatment. However, good nutrition rich in vitamins, vitamin D and calcium, cautiously taken, may reduce fractures.

    For those that HRT is not suitable for, there are alternatives. If mental health deteriorates during perimenopuase and menopause,  doctors will take appropriate measures to solve the problem. The woman should receive counselling and education of the changes in her body. This is cheaper.

    The key issue is not to deny one’s suffering nor refuse to see a doctor. Distress and disquiet brought about by perimenopause or menopause is not just a “woman’s thing” and neither should women suffer in silence!

     

    ‘Menopause’ in men

    True, men do not have menstrual periods. Therefore, the term ‘male menopause’ is controversial. The claim of male menopause is still been researched on.

    Yet, there are some features in men who are in their mid-ages, which lead to the suspicion that they may also be experiencing what women do. These include: tiredness, weakness, depression and sexual problems, such as loss of libido, erectile dysfunction; impotence or ejaculatory problems – called mid-life crises which may come with career changes.

    Essentially, it has been observed that in their mid-ages, men do have low testosterone and, like women, a boost in their hormone levels may actually improve these symptoms.

    Notably, unlike in women, who may experience failure in their ovaries to produce follicles and estrogen, men’s testes do not stop producing sperms and testosterone. Rather, men may continue to produce sperms well into their late 80s, though subtle changes do occur in the testes in some men who are 50.

    Men experiencing fatigue, depression, erectile dysfunction, low sex drive should, therefore, seek medical help. Investigations in the laboratory may not yield much as the changes in men are not as dramatic as in women. The doctor may, nonetheless, undertake an examination to exclude any faults.

     

    Treatment

    While controversial is not without its benefits, what I call male HRT may also help. This may  consist of giving a measure of testosterone. It should be noted that giving artificial testosterone carries its risk; therefore caution should be exercised.

    In summary, women experience menopause and I will urge those suffering from fluctuations in their hormone levels from 40 in some and 45 – 52 years in others should seek help and not be subdued by cultural considerations. Discomfort and disquiet should not be accepted. Similar advice is applicable to men.

  • Menopause in women/men: Solutions to the disquiet of middle age (3)

    Today’s is a continuation of Part 2’s article which was published last week.

    As part of the symptoms or feelings that comes with perimenopause and menopause even up to postmenopause, the mouth may become dry and hot as well as painful.

    There may be colour changesin the mouth as it become pale. In some women, there could be changes in the manner of eating eithertoo high or too low or general dislike for food.

    Of major concern to a lot of women is loss of their skin smoothness which becomes slack. Wrinkles appear. This is as a result of loss of the underlying fat underneath the skin. This loss may give the appearance of aging and loss of beauty. This is probably the reason that makes women to put in more efforts at this age to appear and maintain being beautiful and acceptable.

    Among other reasons, divorce and separation are common in menopausal and post-menopausal times. Still, menopause gives rise to a much more concerning symptoms.

    In the reproductive tract itself, vagina loses its elasticity and lubrication. As a result, difficulty with sex may emerge. These challenges with sex may drive a wedge between couples if not properly managed. Further, the womb itself will shrink. At this time, any fibroid within the womb (uterus) may also correspondingly be reduced in size. The womb lining may also dry up or be reduced in size.

    A note of warning and caution: Any woman, who had stopped having her period or be in post menopause but now having irregular vaginal bleeding, should as a matter of priority see her medical doctor for advice. The reason is that cancer of the womb lining (endometrium) may be the reason for the irregular vagina bleeding.

    That said, the ovaries also become smaller during menopause. Again, I must caution here for two reasons here. The first is, in spite of what I have written so far, break-through or occasional pregnancy may still occur. Women will need to take caution and not make a mistake believing that she is no longer menstruating and so not being fertile. Unwanted pregnancy can be heart-breaking. The second point is, though the ovaries had shrunken in size, and as the years go by, there remains a risk that the ovary may develop cysts and cancers. Post menopausal women should therefore be vigilant to irregular vaginal bleeding, abdominal swelling and unusual body appearances.

    Still on the symptoms of menopause and perimenopause and even post menopause, the bladder and urine passages may lose their strengths. Urging to go to toilet and loss of ability to control passing urine during stress such as coughing may now be a problem. The women simply wet her self. This may create considerable social problem for the woman and her family. She may become an object of ridicule if the people around her fail to understand her difficulties.

    In some other circumstances, the womb may fall out (prolapsed) into outside world through the vagina as a result of the weakening of the supporting structures that hold the womb in place.

    In general, perimenopause due to variation of the hormone levels in the woman poses considerable changes.

    These difficulties may continue into menopause and climacteric times. Of crucial concern lies the fact that the larger African society and in particular Nigerian cultures may not fully understand the many problems that menopausal and peri-menopausal women go through. In ruraln cultures or even in cities, such women may be stigmatised or be called abusive names for lack of understanding of the events that is taking place in the woman.

    Investigations: Very often, the diagnosis of peri-menopause or menopause can be made by the doctor purely on history. Therefore, the woman should tell her story in full to her doctor. Her husband, if married or partner can and should ideally accompany her to see the doctor.

    The man is probably going to be the target of the woman’s irritability that menopause had brought upon her and as such he is at vantage point to give an eye witness account and state his experience of the development.

    The reader should not be surprised that the tests to diagnose menopause is few and sometimes may nor even require a test. The doctor is well advised that the only test is follicle stimulating hormone (FSH) levels. With exception to where the clinical necessity so indicates, there is no need for ultrasound scan or unnecessary prodding or extensive and expensive investigations to make a diagnosis of menopause.

    Crucially, I wish to seriously encourage women that may be undergoing the symptoms and feelingsthat I have described here to consider seeing a doctor. There is really no sense in suffering in silence.

    Part 4 article will deal with treatment.

  • Menopause in women/men: Solutions to the disquiet of middle age (2)

    In this article, we shall look at the cause of menopause in women and the feelings that it generates as well as its impact on the family.

    Remember that we had earlier defined natural menopause simply as the term that is used to indicate that a woman has ceased to have her menstrual periods and her ovaries are no longer functioning to produce hormones to support her so as to be able to reproduce and bear children naturally.

    To qualify as having reached menopause, a woman’s menstrual period must have stopped for at least for the last 12 consecutive calendar months. We also saw earlier menopause may not be natural or it may be induced.

    Whatever the cause, to qualify as being in menopause: a woman’s period “must have stopped for at least for the last 12 consecutive calendar months” backed up relevant laboratory investigations. I will encourage the reader to go back to Part 1 of this series so as to get familiarise with the necessary and guiding definitions.

    Causes of Menopause: The first thing to realise in all these discussions is that, aging process is inevitable. However, natural menopause occurs on the average, in a woman in the age range of 45-52 but most commonly around 48-52 years. At this age range, the ovaries may stop to respond to the instructions or stimulations from the brain. By not responding, there will be no ovulation.

    As a matter of fact, after ovulation which occurs at about the mid cycle in a woman who has a 28-day cycle, pregnancy is suppose to result. It’s the failure of pregnancy to result that leads to menstrual period.

    This event is repeated every month. Therefore, when the ovary fails to respond to the said instructions as I said above, there will be no menstrual period. This lack of response is essentially due to aging process and the woman’s timed biological clock.

    Anything outside the above natural menopause could either be a pre-mature ovarian (POF) resulting in early premature menopause or menopause that is induced. POF may be due to no specific cause which scientists are yet to discover. POF may result from a genetic defect in the individual which the woman may have inherited from her parents. POF may also be due to tuberculosis of her reproductive tract.

    In some cases, POF may be due to treatments that the woman may have received from the doctors. Such treatments are often directed at cancers and may be chemotherapy or radiotherapy. Cigarette smoking is another cause.

    In some individuals, autoimmune diseases may the cause whereby the body works against its own interest and body defences start to attack the body organs. Individuals who have undergone a long time ovarian stimulation for in-vitro fertilisation (IVF) to resolve infertility may also suffer premature ovarian failure and hence early menopause. Yet, there are other causes such as endometriosis whereby the menstrual flow instead of flowing outside the woman’s body through the vagina, flows inward back into the body.

    Outside these listed factors, surgical intervention to remove the womb or uterus may lead to early menopause. Obviously, outright removal of the ovaries without question results in menopause.

    How does perimenopausal and menopausal women present? What do they feel?

    Unfortunately in our African and indeed Nigerian cultures, some women especially if she suffers from infertility or she is under pressure not to appear as “old” may hide her symptoms and suffer in silence.

    Such women may want to prove to her husband (and in polygamous homes prove to her contemporaries), that she is still in her fertile age and that she can bear still children. Some women are in self-denial and may want to continue to have her menstrual periods as a false sign of continuing fertility.

    That said, about 80 per cent of women undergoing perimeno-pause or menopause or climacteric suffer considerably. Sadly only about 10-20 per cent of them world-wide including Nigeria may come forward.

    Some women make the assumption that, menopause is “part of a woman’s life” even if she is suffering greatly. The main symptom of fluctuating hormone in a woman is called hot flush which the main feeling of perimen-opause and menopause.

    The hot flush, or flash, is well known as the classic menopausal symptom and affects 60–85per cent of menopausal women. Hot flushes and sweats constitute vasomotor symptoms and vary immensely in both their severity and duration; for many women, they occur occasionally and do not cause much distress, but for about 20 per cent they can be severe and can cause significant interference with work, sleep and quality of life. Women are affected by vasomotor symptoms on average for about two years but, for about 10 per cent, symptoms can continue for more than 15 years.

    Hot flushes usually last three to five minutes and are thought to be caused changes in the brain’s thermoregulator , according to Menopause Matters.

    In some women, with or without hot flushes, sleep could be impaired.  She may become irritable—a “short fuse”, anxious and even depressed and lacking in concentration. In those with tendency but hidden vulnerability toward frank madness, serious mental illness may manifest as this age of menopause.

    The bones become weak and as a result, fractures of the hip and hands and back may occur in menopausal and post-menopausal women. We shall continue with the symptoms and treatment in next week’s article.

  • MAN rates economy low, proffers solutions

    Manufacturers Association of Nigeria (MAN) has expressed mixed feelings on the current administration’s economic policies.

    MAN President Mr. Franks Udemba Jacobs, in an interview with The Nation, said it has been a mixed bag of sorts for the manufacturing sector, with some policies favouring his members and others hurting the sector.

    Lauding President Muhammadu Buhari on containing the insurgency in the Northeast, he, however, regretted that on the economy, businesses have been forced to slow down or, in some cases, shut down because of insurgents.

    “Traditional trade routes to neighbouring countries have been cut off as was witnessed in the Northeastern part of the country, while companies have been forced out of business because they were unable to continue with their operations in the face of obvious risks of death or incapacitation,” he said.

    Udemba underscored the association’s belief that the economy did not perform up to expectation during the period under review. He said macroeconomic indicators showed that the economy declined from what it was before the inauguration of the administration.

    According to him, this may not be blamed completely on the administration but on the downturn in the prices of crude oil by nearly 70 per cent.

    The MAN boss praised the government on the planned diversification of the economy into agriculture, solid minerals and the manufacturing sector.

    He criticised the non-release of fiscal policy measures by the government within the period under review, noting that it has created a vacuum. Fiscal policies are supposed to be released yearly to harness incentives and other measures and adjustments approved by the government.

    Jacobs cited pharmaceuticals where raw materials and inputs attract higher duty than finished products, and has been accepted for adjustment by the Tariff Technical Committee (TTC).

    He stressed that the absence of the adjustment was affecting local pharmaceutical companies, which are unable to compete. Some, Udemba noted have  had to close shop or downsize.

    Jacobs regretted that the Gross Domestic Domestic Product (GDP) declined to 0.36 per cent in the first quarter of the year, down from 3.96 per cent of the same quarter the previous year. “This negative growth, if not urgently and seriously addressed, could drag the economy into recession,” he warned.

    On the exchange rate, he said during the period under review, it depreciated from N191.10/US$ in the first quarter of 2015 to N200/US$ in the same period of 2016 at the Interbank Forex market, while it hovered around N320/US$ at the Bureau de Change (BDC) segment of the market.

    “The deregulation of the forex market may be seen as a partial solution to the forex challenge the country is facing, but in reality, the scarcity of forex is unabated.

    “Consequently, manufacturing companies found it extremely difficult to source foreign exchange for the importation of essential raw-materials and this has led to a number of closures of affected companies,” he said.

    Jacobs, therefore, called for urgent measures by government to lift the manufacturing sector out of the woods by coming up with policies that will make the manufacturing sector robust.

  • Causes of infertility, solutions (5)

    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.

  • Causes of infertility, solutions (4)

    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.

  • Causes of infertility, solutions (3)

    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.

  • The causes of infertility, solutions Part (2)

    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.