Windhoek Infertility is one of the most common issues that rob married couples of their joy in sub Saharan African.
In some cases of ignorance the society associates infertility with witchcraft and curses or generational curses; while for others, infertility has been marked as a fault for women only and yet both women and men have equal chances of being infertile.
Societies with strong religious background in some parts of the Southern African region view infertility as an attack by evil spirits or a woman being tormented by a ‘spiritual husband’ while others think it is caused by an unclean womb. These are some of the many other myths and beliefs that are associated with infertility in the region.
Sadly, due to such notions, the issue of infertility remains unresolved in some parts of the region due to lack of knowledge.
It is against this background that, The Southern Times last week interviewed health experts to demystify the nature of infertility, risk factors and possible solutions.
Infertility is defined as the inability to conceive after 12 months of unprotected intercourse. The World Health Organization (WHO) defines it as the inability of a sexually active, non-contracepting couple to achieve pregnancy in one year.
In an interview, Dr Bostone Manyika, a Specialist Obstetrician and Gynaecologist with a special interest in Fertility and Reproductive Medicine said both male and females have risk factors to infertility.
Dr Manyika who is based in Zimbabwe said the risk factors of infertility in women include previous pelvic infections such as Sexually Transmitted Infections (STIs), pelvic tuberculosis, previous cancer treatment and obesity among others.
According to Hindawi medical journal, pelvic tuberculosis is a rare and often difficult disease to diagnose which can present with features such as abdominal pain, ascites and pelvic mass.
“Risk factors for infertility in women include age greater than 35 years, endometriosis, previous gynaecological operations, polycystic ovarian syndrome and uncontrolled medical conditions that affect hormonal regulation of fertility,” said Dr Manyika.
Polycystic ovarian syndrome is defined by NHS as a common that affects how a woman’s ovaries work and may cause irregular periods, excess androgen (high levels of male hormones) and enlarged ovaries.
He said congenital abnormalities or birth defects of the womb, ovaries or vaginal tract may also contribute as a risk factor of infertility.
Similarly in men, congenital abnormalities can be a risk factor of infertility.
Dr Manyika added, “In men, risk factors include congenital abnormalities such as undescended testes, blockage of tubes that transport sperm from the testes where they are produced, towards the opening of the penis on both sides.”
Undescended testes is a condition defined by Mayo clinic as where a testicle has not moved into its proper position in the bag of skin hanging below the male sexual organ (scrotum) before birth.
He said there are also birth defects on the male reproductive organ that may affect fertility.
“Among these include-a penile or urethral opening that is abnormally situated on the under surface of the penis. Such a condition is called hypospadias,” said Dr Manyika.
“Some risk factors in male infertility develop after birth and these may include STIs, history of having had mumps, wearing tight fitting underwear and hot baths. The abuse of drugs, alcohol, cannabis, steroids and some illicit body building drugs can also expose males at risk of being infertile.”
Mumps is a viral infection that primarily affects saliva-producing glands that are located near the ears, they can cause swelling in glands, as suggested by the Mayo Clinic.
While other medical conditions may be inherited or passed through bloodlines, Dr Manyika suggests that infertility cannot be passed through bloodlines.
However, he said there are certain risk factors of infertility that are more common in particular families, communities, ethnic groups of countries for instance, obesity, medical disorders contributing to infertility such as diabetes mellitus and hypothyroidism.
Hypothyroidism is defined by the Oxford online dictionary as an abnormally low activity of the thyroid gland, resulting in retardation of growth and mental development in children and adults.
He added, “Moreover, certain causes of infertility may be a result of birth defects which however may be due to side effects of certain substances or medicines taken by the woman's mother during a sensitive developmental stage in the latter's pregnancy, among other causes.”
He said many of the birth defects in both men and women may be rectified by doing special surgical operations by relevant medical specialists, adding that such couples may require further assistance to conceive, and follow ups in pregnancy.
According to Dr Manyika, most couples with infertility have an identifiable cause for it, and of those couples with an identifiable cause, a third will be due to a male factor only, another third it is due to a female factor only. He said the last third, both have a factor requiring medical correction.
He added, “Hence, there is an equal chance for either the man or woman to be affected by infertility. For this reason, when seeking medical assistance for infertility, patients are encouraged to go for the consultation as a couple, rather than as individuals.”
Couples that are trying to conceive are discouraged from taking unprescribed drugs and encouraged to do light exercises during this period.
Dr Manyika said, “They should also take folic acid supplements for about 3 months prior to conceiving. We also encourage them to have frequent and regular unprotected intercourse-at least once every 2 to 3 days. Those with a medical condition should seek medical attention to ensure that it is well controlled before conception. Couples on any medications should seek medical assistance for optimization of these medications to avoid those medicines that suppress fertility and or increase likelihood of adverse effects on the pregnancy.
“The women should also be screened for cervical cancer and be vaccinated against rubella before pregnancy if not already done. We also advise couples to seek medical assistance early after 1-2 years of unsuccessfully trying to conceive naturally. This may allow for simpler and cheaper treatments to be offered.”
In the same notion, Dr Lughano Ndovie-a Namibian Special Obstetrician and Gynecologist who specialises in fertility said couples can increase their chances of conceiving by doing regular check-ups and seeking treatment for infections and optimizing their medical condition.
“Couples should also avoid risky behaviours that leads to STIs by always practicing safe sex, eating balanced diet and maintaining a healthy weight, exercising, avoiding drug abuse, alcohol, smoking and should avoid exposure to industrial toxins,” said Dr Ndovie who operates at Rundu Private Hospital.
He said speculations and myths on infertility can be rectified by awareness campaigns such as, ‘’Merck More Than a Mother’’ which has been launched in several African countries by Merck Foundation.
Dr Ndovie said media training sessions are also key to ensure that the public is given correct information on infertility through all media platforms.
Dr Ndovie and Manyika were both part of the Merck Foundation training program dubbed ‘Merck Fertility and Embryology Training Program which was launched in 2016.