Speaking during Reproductive Health Month in February, gynaecologist, obstetrician and fertility specialist, Dr Herman Netshidzivhani, said the perception that infertility mainly affects women is incorrect. It has been shown that fertility complications are found equally in men and women.
Hopeful couples who are struggling to conceive should visit a fertility clinic together, as there is an equal chance that either of them could be infertile. He has run the Netcare Park Lane Fertility Centre in Johannesburg for the past 18 years.
Infertility is the inability of a couple to conceive and is grouped into two categories:
- Primary infertility refers to couples who are unable to conceive a child after at least a year of frequent and unprotected sex - or for at least six months if the woman is 35 or older.
- Secondary infertility refers to couples who cannot conceive a second child after about 12 months of unprotected sex.
Infertility occurs when there are problems at any of the stages of conception. These include the release of an egg from either of a woman's ovaries, the egg moving through a fallopian tube toward the uterus, a man's sperm joining with the egg along the way and the fertilised egg attaching itself to the inside of the uterus. Four main causes
There are four main reasons for infertility.
The first of these, which is the main cause in men, is no or low sperm count. Sperm-related problems result from either too much or too little of some of the hormones required in sperm making being produced. Low sperm count can also be triggered by heat exposure caused by, for example, hot baths and excessive or tight clothing. This is why the testicles are placed outside the body in the scrotum rather than in the abdomen like the ovaries. Obese men can become sterile because sagging fat layers can overheat the testicles.
Men whose jobs involve long hours of sitting, such as long distance truck drivers, may develop infertility due to the increased heat to the genital area. Smoking more than 20 cigarettes a day has been shown to reduce both the sperm count and sperm motility, which is the ability of sperm to move successfully towards an egg. Excessive alcohol intake is another factor that can lead to infertility as alcohol can lower the production of sperm and of the male hormone, testosterone. Treatments include IVF ICSI (Intracytoplasmic Sperm Injection) and testis biopsy for those males with no sperm in the semen.
The three main causes of infertility in women are:
- A blockage of the fallopian tubes resulting from earlier pelvic infections and sometimes also from surgical damage. Nowadays in-vitro fertilisation (IVF) is used to overcome tubal infertility.
- Endometriosis or the presence of endometrium (the inside lining of the uterus) in and sometimes outside the pelvic area. This may involve the ovaries, fallopian tubes, uterus and the rest of the peritoneal cavity, which is a fluid-filled gap between the walls of the abdomen and the organs in the abdomen. The most common symptom to the patient is severe, painful menstruation and painful intercourse. Diagnosis is mainly via further examination and laparoscopy. The best form of treatment is surgery followed by IVF. In mild cases, only surgery may be needed.
- Hormone abnormalities or imbalances. The most common of these is polycystic ovary syndrome, a condition resulting in an imbalance of female sex hormones causing menstrual cycle changes, ovarian cysts and ultimately difficulties in conceiving. In some cases, surgery may be necessary but the main treatment is hormone manipulation and IVF.
Among women, fallopian tube damage (60%) and endometriosis (20%) are the main causes of infertility, says Dr Netshidzivhani. He adds that other hormonal abnormalities and congenital malformations, such as an abnormal uterus that occur early in life could also cause infertility but are rare. Treatment for these conditions depends on the cause for the infertility identified by a family doctor. However, he asserts that for the best advice on infertility, hopeful parents should consult a fertility clinic. As many as one in four couples in South Africa diagnosed with infertility are eventually able to conceive with treatment, he concludes.