One of the issues affecting most marriages today is the issue of childlessness. In most African countries this is a very big challenge and can result to unhealthy relationships even up to the extended families. Infertility simply means the inability of a woman to conceive or a man to impregnate a woman. Medically a couple is said to be infertile after one year or more of regular and unprotected sexual intercourse. Infertility can be primary (never been pregnant or impregnated someone before) or secondary (been pregnant or impregnated someone before) There are a lot of factors that can predispose a couple to infertility which include unhealthy life style, genetics, untreated infections, hormonal imbalance, exposure to environmental hazards. In women ovulatory dysfunction is the leading cause of approximately 15% of all infertility cases and accounts for up to 40% of infertility thus the evaluation of ovulatory function is usually the first diagnostic step in evaluating an infertile woman, while in men infertility is often defined by abnormal semen parameters; however infertility may be present even when the semen analysis is normal. A careful history, physical examination and diagnostic investigation of the couple can identify the cause of the infertility and thus direct the appropriate intervention(s). The evaluation for infertility be conducted in both the man and the women and should begin at the same period.
Evaluation for the woman: the first assessment for a woman is to take her menstrual history (age at first period, cycle length and characteristics), other evaluations include: assessment of tubal or uterine or peritoneal disease, known or suspected male sub fertility, previous method of contraception, breast secretions ,surgical history, exposure to sexually transmitted diseases, vaginal or cervical abnormalities, previous hospitalization, illnesses and injuries, thyroid diseases, occupation and exposure to environmental hazards, use of illicit drugs, tobacco and alcohol consumption, body mass index (BMI), blood pressure, pulse, thyroid enlargement, presence of nodules and masses or any tenderness, family history of reproductive compromise, abnormalities of cervical mucus production or sperm/mucus interaction ,previous pregnancy history in cases of secondary infertility. ultrasonography for tubal blockage, hormone production (follicle stimulating hormone, progesterone, prolactin, luteinizing hormone, thyroid-stimulating hormone, estradiol, Testosterone, Hysterosalpingography (HSG) for assessment of uterine abnormalities.
Evaluation for the Man: Semen analysis is the basis of the laboratory evaluation of the infertile male and this helps to define the severity of the male factor. The assessment of the male include Careful physical examination which can identify scrotal pathology and this involves examination of the penis noting the location of the urethral meatus, palpation and measurement of the testes, the presence and consistency of the vasa and epididymides, the presence or absence of a varicocele. The assessment also include the assessment of presence of secondary sex characteristics including hair distribution and breast development; sexual and reproductive history of the man including frequency and duration of intercourse, previous surgeries, childhood illness, systemic medical illness like diabetes mellitus, use of tobacco, alcohol, anabolic steroids and recreational drugs, assessment of hormonal abnormalities including: testosterone, Luteinizing Hormone, thyroid stimulating hormone, Follicle Stimulating Hormone, prolactin amongst other evaluations. However, a condition exists (idiopathic) when the cause of abnormal semen parameters cannot be identified.
Despite the incidence of infertility, couples can get help from professionals and experts; a gynecologist / urologist in infertility management at an infertility clinic where they will be properly examined and treated adequately.
Visit Abel Guobadia Specialist Hospital for any infertility challenge
Women’s Health and Action Research Centre
Km 11 Benin-Lagos Expressway Igue Iheya Benin City, Edo State. Nigeria.