A MEDICAL practitioner based in Ndola, on the Copperbelt, says addressing infertility through shared responsibility by partners provides an extremely large benefit for couples with problems of fertility.
Sebastian Chinkoyo, a consultant obstetrician-cum-gynecologist at Ndola Teaching Hospital, refers to secondary infertility as the inability to conceive a child or carry a pregnancy to full term after previously giving birth
According to the World Health Organisation, (WHO) data more than 180 million couples in developing countries suffer from primary or secondary infertility.
Dr Chinkoyo, said weather a pregnancy resulted in a live birth, miscarriage or still birth, it is still a pregnancy that has existed before and if after that pregnancy there is failure to conceive, it is considered as secondary infertility
He observes that in classifying secondary infertility, there must be a couple involved that may not necessarily be married or may be married but regular sexual intercourse is involved between the two.
“What also determines the fertility is how regular they have sex and that is where it starts from. Couples need to have regular intercourse at least three times in a week and if it is less than that, it may affect the fertility,” he said
He said 20 per cent of the cause of infertility in a couple that is failing to conceive is attributed to part of the fault of the male factor..
According to studies, women of 35 years and younger who have unprotected sex frequently and can’t conceive are considered infertile if they’ve not been using contraceptive for a year.
Similarly, those from 35 to forty should seek fertility assistance after six months and those over forty must also seek assistance after only three months of failing to conceive.
The study recommends that women with fertility challenges must consider seeking medical attention together with their partners to determine what could be the cause.
Furthermore, Dr Chikonyo emphasised the importance of couples to seeking medical treatment together as in our African society, women take the lead on fertility problems alone.
“Depending on the circumstances, both partners might need medical investigations as this will determine whether the affected party will need special treatment,” he said
Dr Chikonyo said, secondary infertility shares many of the same causes of primary infertility.
He said one of the most common causes in men is the low sperm count, or when the sperms do not move actively despite the semen being
present, a situation that can affect fertility as fertilisation of the egg may fail to take place.
Additionally, he said another factor that may cause infertility in some men is when one has completely no sperm in the semen.
He said blockage of the tubes that carry the sperm from the testicles could be a contributing factor for sperms not reaching the egg and this usually comes as a result of infections such as Sexually Transmitted Diseases (STIs).
Other causes include a man that may suffer from Mumps in their adulthood and affects the testicles rendering them non functional for them to produce sperms.
Male fertility depends on the man’s ability to make normal sperms and deliver them.
“In addition, aspects of the quality of sperms come in as life styles such as, obesity, excessive alcohol and smoking contribute.
Some men with obese problems tend to have challenges with the quality of sperms, resulting in their sexual performance being affected and may later lead to secondary infertility,” he explained.
The commonest causes in women are tubal factors which include blockage or infection of the fallopian tubes that may also lead to failure of the sperm to meet the egg and also ovulation problems.
He said in some
couples there may be no identifiable problem even when all investigation has been conducted on both of them yet the infertility cannot be explained.
He said such cases are termed as unexplained secondary infertility and in such situations what is needed is to encourage couples and give them the assurance as after some years a good number of them may conceive though it takes some time.
Treatments for secondary infertility are also the same as treating primary infertility.
“For women with problems of ovulation, we look at what could be causing the problem.
The commonest cause of ovulation problems is found in women who are overweight and the first intervention is to ask them to reduce their weight as that in itself can bring about ovulation.
Women who are under weight can also be affected with ovulation problems and this may require putting them on a special diet to gain some weight for them to achieve positive results,” Dr Chinkoyo explained
He said where a woman does not present with all these problems but are not ovulating, hormonal problems could be at play and ovulation inducing drugs such as Clomiphene are administered to bring about ovulation for one to conceive.
However, he said the drug carries a risk of having multiple pregnancies with some women ending up conceiving twins, triplets or quadruplets.
Further studies show that Clomiphene Citrate (Clomid) is a medication that is used to treat infertility problems in women. The drug works by stimulating an increase in the amount of hormones that support the growth and release of mature eggs.
“Results can only be attained when people with fertility problems present themselves for medical treatment as couples.
This is so because the process of explaining the causes and treatment may require one party to undergo an operation and it would be pointless to prescribe something which another partner may not be aware of,” he said
And for tubal factors of the fallopian tube, he said the current set up at local health facilities cannot help much as they don’t have the required technology to use.
He said developed countries offer a number of services such as the use of assisted reproductive technologies that are used to address fertility treatments that handle both a woman’s egg and also treat a man’s sperm.
However, he said, some private clinics in Zambia are currently offering medical services for fertility problems.
The cost of establishing infertility medical centers in developing countries comes with cost and a challenge of trained personnel.
Merck Foundation, a global humanitarian Organisation, has partnered with countries in Africa to help address infertility problems and also help to train fertility experts.
To reduce the stigma and the focus of blame put on women in societies ,there is need for continued education and more sensitisation that will help couples be counseled and learn how to come to terms should they experience such a problem.
And as the need and availability for medical technology for fertility treatment is being enhanced, it is only important that couples make informed decision and seek medical treatment together.
