What could be the cause of infertility among Nigerians which is said to have become so rife that many couples have resorted to adopting children? SADE OGUNTOLA writes about some of these couples and what could be done to control their health problem.
WHEN Haruna Balogun and his wife, Julianah, were ready to have a baby, they figured that pregnancy was as easy as deciding to try. But it wasn’t so simple. Instead, for two years the couple wrestled with infertility. Even when they weren’t talking about it, it hovered in the air like heavy humidity. It festers at family gatherings and naming ceremonies, which should have been moments of joy.
Like Julianah, Veronica Agbor, a 40-year-old secondary school teacher, is in a second marriage because she had been unable to have a child. She first became aware of her possible infertility while she was still with her first husband.
They both went to a hospital for treatment. The doctors said her first husband’s sperms were infertile.
Abosede Aluko’s marriage also ended on account of her infertility. There was no quarrel. It was a simple parting. Over time, she had simply sensed that he was no longer pleased with her. She left him. Abosede believed an early premarital ectopic pregnancy was the cause of her infertility, which required a major surgery.
Infertility is actually a very common disorder. It affects about 15 per cent of couples during their reproductive years, so it is one of the more common medical conditions for that age group,” said Osato Giwa-Osagie, a distinguished professor, Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital (LUTH), Idi–Araba.
Infertility is the failure to conceive. In strict technical terms, how medical doctors use it, infertility means a failure for pregnancy to take place after more two years of having sex without family planning. Of course, sex must be regular and should take place at least twice a week.
There are millions of infertile people in Nigeria
Professor Giwa-Osagie, President, Association for Fertility and Reproductive Health (AFRH), said, “Among women in the reproductive age group, between 10 and 20 per cent of them have difficult having a pregnancy within 12 months. Nigeria’s population is put at about 157 million. Even when those below the age of 16 are taken out, the number of people with infertility still runs into millions.
“Saying that 12 million Nigerians are infertile is slightly on the low side. Infertility is very common. Individuals can test this by taking time out to consider the number of people, class mates and their acquaintances that have been married for more than two years and no pregnancy.”
Nevertheless, Professor Giwa-Osagie said infertility was distinct from being childless, which means the person does not have any living child or viable child. Childlessness includes those who get pregnant but keep losing it, what is termed in medical parlance, miscarriage.
“In some social context, a woman that gets pregnant but keeps losing it is said to be infertile, whereas in the medical sense of it she is not infertile,” he added.
Ironically, hardly can a person be said to be sterile, unless the woman does not have a womb again or the man has no testicles and as such cannot produce any sperm at all.
According to Professor Giwa-Osagie, “It is possible that a man has zero sperm count. He, however, cannot be said to be sterile because he may be producing sperm in the testis even though they are not coming out. Of course, there are means of extracting the sperm from the testicles and using it to impregnate his wife for him. That is why we do not use the word sterility anymore.”
Until recently, the problem of African infertility did not receive much attention despite that many people see childlessness as a curse on couples.
But infertility is more apparent now than say three decades ago. “People are more educated and therefore more likely to complain if they are having problem with conception unlike in the 1950s and 1960s.
“Also, more women marry later because of education and as such more likely to have been exposed to multiple sexual partners and sexually transmitted infections as well as unplanned pregnancy and abortion, which could have caused damages to their fallopian tube, thus making infertility more apparent than before,” he said.
Why does infertility occur?
The reasons for infertility are varied and gender-dependent. In men, Professor Giwa-Osagie mentioned causes of infertility to include, congenital problem, sexually transmitted infections (STIs), exposure to chemicals and radiations in the environment, drugs, consumption of foods contaminated with female hormones, as well as diseases such mumps and tuberculosis.
According to him, “These infections in men can actually destroy their testes or epidemidysis; so it is like the factory is destroyed. Even when the factory is intact, but the pipe that leads the sperm out is blocked, sperms will not come out. That is why infection is so important.
Wearing tight pants, smoking can cause infertility
Professor Giwa-Osagie also said that, “Wearing tight pants may keep the testicles worm; chronic exposure to heat by drivers that travel long distances; cigarette smoking; and too much intake of coffee and coffee containing products such as carbonated drinks have all be associated with infertility. In addition, common drugs such as chloroquine can damage sperm.
In women, causes of infertility also include infections, including sexually transmitted infections (STIs), abortion after unsafe sex, and poor diet.
However, there is no geographical difference in level of male infertility unlike women infertility where more women in the rural areas are affected than in urban areas.
Infertility in women common in rural than urban areas
According to the don, “In women, some of the causes of infertility occur more in the rural than the urban areas. They labour for too long a time and are not supervised by skilled birth attendants, thus making them susceptible to infections which can affect their chances of getting pregnant in the future.
“We know statistically that for instance in what was known as the former Western Nigeria, there are more women being delivered in places with midwives and nurses than say in Northern Nigeria. Therefore, impart of that unsupervised delivery will be more in Northern Nigeria than in Western Nigeria.”
Meanwhile, Professor Giwa-Osagie said maintaining good lifestyle could reduce the chances of infertility among Nigerians.
Can a woman maintain her fertility level for life?
“A woman is born with all the eggs she is going to use in her lifetime; it is not like in men where sperms are being produced all the time.”
Imagine that a woman had 1,000 eggs, which is in her store for the whole of her life. When the store is finished, then fertility is finished, but for some women that store can be finished by the time they are 35. This is defined premature menopause.
Unfortunately, some women’s store of eggs gets exhausted early, when her body is producing antibodies against her eggs and so on.
“A man who is healthy even at age 75 can still have sexual intercourse with a lady of 20 years and impregnate her regularly. There is a very small risk that there may be increase in abnormal sperms in much older people, who are like 75 and above, but the risk is so small that it often does not result in abnormal baby by those people.
“This is different with women, because by the time, she is above 50 years, that is the end of her fertility. However, this could be extended using IVF to about 54 years.”
Can couple with infertility be helped to have children of their own?
There are more than 39 IVF centres in Nigeria, with some also in government hospitals. But IVF has its own challenges such as cost and efficacy.
Professor Giwa-Osagie said, on the average, the cost of a cycle of IVF ranged between N1.2 and N1.5 million in Nigeria. Also, the possibility of a pregnancy with each IVF cycle is about 30 per cent. About one in three gets pregnant each time they give IVF a try.
Nonetheless, he said that IVF is the last resort in couples with infertility, adding “the cause of infertility will determine the type of treatment to give.”
“From the history taking, where the problem is due to infrequent sex, lack of ovulation; use of contraceptive, menstrual regulating drugs or a blockage of fallopian tubes from fibroid or ovarian cysts, once these are taken care of, conception will take place,” he noted.
Where there is an indication of excess male hormone as evidenced by excess hair on the face and legs, milk coming out from the breast when pressed because of her high level of an hormone known to cause infertility called prolactin, or abnormality of womb; except these are corrected, pregnancy may not occur.
In the man, where there is no sperm that is produced; the percentage of abnormal sperm is high; or the movement of the sperm is sluggish, treatments are given to correct these as well as improve chances of conception.
The question now is can permanent cure be found to infertility among Nigerian couples thereby putting smiles on faces of many who have lost hope of carrying their own babies?
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