Breaking the silence around infertility in women and men

By Arnold Ageta

In medical terms, “infertility” is defined as not being able to get pregnant after one year or more of regular, unprotected sexual intercourse.

Men and women are affected equally by infertility, with 30% due to male factors and 30% to female factors.
Forty per cent of infertility is caused by both male and female or unexplained factors.

In many sub-Saharan African societies, there is a negative perception of infertility, and this stigma can cause those affected not to seek early medical attention. Women with infertility problems are particularly stigmatized, which adds psychological suffering to physical suffering.

Data from the World Health Organization shows that more than 180 million couples in developing countries suffer from primary or secondary infertility. In sub-Saharan Africa, infertility is caused by infections in more than 85% of
women. This compares to only 33% worldwide, and underscores the importance of prevention programs in Africa.
Infertility can be addressed with surgery or assisted reproductive technologies such as artificial insemination.

‘For those 11 years, it has been difficult. Dealing with relatives who do not understand the struggle and friends who think I am not trying hard enough to get a baby,’ says Alice.

Alice has been trying for a child for more than 11 years now. It has been a tough journey, which she remembers with tears in her eyes. This is the story of many couples struggling to get a baby. Alice is not her real name. She requested that we do not use her real name for privacy purposes.

Causes of Infertility
According to Pauline Kibui, a clinical embryologist, based in Nairobi, infertility is medically defined as an inability to conceive following more than 12 months of unprotected regular sexual intercourse.

Ms Kibui says that in women, ‘it may be caused by blocked Fallopian tubes or non-receptive endometrium as a result of infections such as sexually transmitted infections.’

The infections can also affect the ovaries and result in poor quality eggs. Pelvic inflammatory disease and endometriosis that affects the pelvic region can also cause infertility in women because of the effects on the ovaries, uterus, and fallopian tubes.

Other causes include hormonal imbalance which can disrupt production of eggs, being overweight or underweight, and late bearing of children.

Professor Koigi Kamau who is an obstetrician, gynecologist, and director of the Nairobi Fertility Clinic says male infertility is as common as female infertility.

‘‘It is only that men are silent and hardly seek medical assistance. One-third of infertility cases are caused by women’s reproductive problems, another one-third are due to the man,’’ he said.

Professor Koigi cites that other causes of infertility are a mixture of male and female problems or by unknown problems and at least 50 per cent of the people presenting with infertility are men.

‘‘A man requires at least 40 million sperm for fertilization to occur. There are many factors that may cause a reduction in sperm quality,’’ he emphasized.

Other causes include environmental factors, dietary factors, and infections. He says that that infections can affect any part of the genital tract, which is a tube-like structure from the sperm factory which is the testes.

‘Testes may be affected as well as the storage and delivery system. Men can also be born without some aspects being functional, like the process of making sperm.

These are the main causes of infertility in men, he concluded.

According to Professor Koigi, two out of 10 couples suffer from infertility in Kenya, and almost five million Kenyan couples require interventions to conceive.

Alice who has been trying to conceive for the past 11 years says that without children, a married woman is not considered complete in African cultures.

‘‘I have been ridiculed by family and friends because after more than 10 years, I cannot conceive, says Alice with tears in her yes.

How did Alice know that she could not conceive?

‘‘We got married and gave ourselves a year before we started trying for a baby. At first, we thought it was normal to try for one year—and even the doctor encouraged us to give ourselves a year of actively trying. But each month after the one year elapsed was a disappointment,’’ she painfully recounted the experience.

Alice sought help on her own first because her husband was not ready to seek medical help. After trying medical treatment for six months, Alice got tired.

‘‘I was tired and almost depressed and asked my husband to go with me to a fertility doctor. We went through so many tests and eventually, I was told that an infection had caused my fallopian tubes to become blocked. That was so
devastating for me. I went into depression, she painfully said.

Treatment
Professor Koigi says that there are treatments but prevention is always better than cure.

‘‘Protect yourself from infections by having safe sex, which may also mean abstaining. That way, you increase your chances of remaining fertile,’’ he advised.

He also recommends to people to maintain a healthy diet, avoid too much alcohol and smoking.

For men, he says: ‘‘Activities like driving hot cars or motorbikes, or taking very hot baths create a very hot atmosphere in the scrotum area which may affect sperm production.’’

Age reduces functionality for both men and women: a woman does not produce as many eggs to aid in fertilization and a man’s sperm quality reduces with age.

Stigma
Alice sought medical attention for her condition, and she says the journey was very long and sometimes very disappointing. Some of the people who were close to her did not understand and would say hurtful things about her status.

‘‘My husband was very supportive and I always went to the fertility doctor with him. However, the stigma from family and friends was too much. I stopped attending baby showers because it was too discouraging for me—sometimes I would end up being the subject of sympathy and discussion, she says.

In Kenya, a mother is referred to as mother to their child’s name. It always feels bad not to be known as a mother to someone.

Culture is one sided because it is common for the woman to be blamed for not being able to conceive, even though there are men who are infertile.

In her case, Alice did not realize that she had recurring bacterial infections which led to pelvic inflammatory disease and hence the infertility.

Child Adoption
After 11 years of trying unsuccessfully to conceive, Alice settled for child adoption. ‘‘We started the process of adoption, although I still get ridiculed by some friends because the child is not biologically mine,” she says smiling.

They now have a five-year-old daughter and they are happy and satisfied with her. Even this adoption, Alice says they have not stopped trying. They say if she gets pregnant it will be great but she is still happy with her adopted daughter.