In Summary

This she mainly did to save her marriage since the husband had threatened to divorce her and marry someone who would have children

Dr Robert Businge, a consultant gynecologist at Mulago National Referral Hospital, explains that there are several causes of infertility, some natural and others secondary

In a modernised society, the problem of infertility has widened its reach in both men and women. Increasing infertility rates are based on the lifestyle changes resulting in stress and obesity caused by lack of physical exercise, changes in eating habits and pollution accompanied by health disorders such as diabetes.

About 45 per cent of couples face infertility problems as it is not only limited to women. The most common problems men face are low sperm count, morphology abnormalities and low motility of sperm.

The “Nandalas” had their first child in 2012. Prior to the wife conceiving, they had not used any contraception heeding the many warnings that contraceptives are a major contributing factor to couples’ failure to conceive. However, it is now five years since the couple had their first child and the wife has failed to conceive again. During this period, the wife has been experiencing irregular periods.

“Sometimes, it takes up to five months before my period comes,” she says.

Case of the man
Jane Nakimuli says her first marriage ended in divorce after spending close to six years without conceiving a child.
“When I left my first marriage, I found another man and was able to conceive in less than a year. I felt a sigh of relief when I discovered that it was my husband who had all along had the problem,” she says, adding that her marriage ended because in our society, it is taboo to tell a man that it might be him with the infertility problem. Therefore, seeking treatment in this case becomes hard.

Failed IVF
Anna Babirye had been childless for eight years and in a desperate bid to conceive, she was forced to withdraw all her savings to undergo an In Vitro Fertilization commonly referred to as IVF. This she mainly did to save her marriage since the husband had threatened to divorce her and marry someone who would have children.
IVF is the process of fertilization that involves extracting eggs, retrieving a sperm sample, and then manually combining an egg and sperm in a laboratory dish. The embryo(s) is then transferred to the uterus.
“Thank God through IVF I was able to conceive but my happiness was short-lived because at six months I suffered a miscarriage. I then had to painfully allow my husband to marry a second wife who could give him children. To me, his happiness was paramount,” Anna narrates.

Several surgeries
For Ritah Kirabo, in her search for a baby, she has had a number of uncomfortable procedures performed and three main surgeries.
“I have had cysts (small, non-cancerous, fluid-filled sacs) and fibroids removed. Issues of infertility are so stressing and can emotionally and financially drain you. I wasted time taking all kinds of herbs with hope that one day, I would be able to conceive in vain,” she says.
Kirabo says she has endured abuse from her husband, in-laws, but her doctors have kept her hope alive saying she will one day be able to conceive.
Dr Robert Businge, a consultant gynecologist at Mulago National Referral Hospital, explains that there are several causes of infertility, some natural and others secondary.

Hormonal imbalance
Dr Businge says hormonal imbalance causes irregular ovulation because there is absence or infrequent release of a unfertilised egg or eggs by the ovaries. “Other factors that can contribute to this condition include premature menopause, polycystic ovarian syndrome (a condition caused by excess luteinizing hormone), chemotherapy, tumours, infections, fibroids as well as heavy exercise or dieting,” he says.
Issues with fallopian tubes
Dr Businge says the major forms of infertility stem from the fallopian tubes which are vital in a woman’s reproductive system.
“These tubes may be affected by sexually transmitted diseases such as gonorrhea and HIV/Aids. Infertility cases that are due to an obstruction of the fallopian tubes may be due to a blockage, scarring, or damage in one or both fallopian tubes which makes becoming pregnant difficult,” Dr Businge explains.
He adds: “An obstruction in the fallopian tubes prevents the egg from moving toward the uterus, making conception impossible. The obstruction can be caused by a range of conditions, including scarring from infection such as pelvic inflammatory disease (PID), adhesions or scar tissue from previous abdominal/pelvic surgeries, ectopic pregnancy, tubal ligation and endometriosis (tissue build-up outside of a woman’s uterus).”
Dr Businge says although the termination of a pregnancy is upsetting to couples who wish to have a baby, worse yet is the prospect of female infertility after miscarriage.
Regrettably, such fate is possible. This form of female factor infertility can be caused by hormonal, environmental, immunological, and even physiological problems. Besides miscarriage the doctor attributes abortions, post-delivery infections and prolonged labour as causes of infertility in women.

Secondary infertility
Dr Businge says secondary infertility is when a couple that have children fail to get more children. “If a couple has already successfully conceived and delivered before, but is having difficulty becoming pregnant again, they may be experiencing secondary infertility,” he says.

Polycystic ovarian syndrome
Dr Businge says there are women whose ovulation is not balanced. This is a disorder called polycystic ovarian syndrome (PCOS) that causes female factor infertility.
“…PCOS affects women of childbearing age. This is where the ovaries are covered with multiple swellings (small, non-cancerous, fluid-filled sacs). These swellings stop the ovaries from producing enough hormones necessary for the maturation of ova and the result is absent or irregular ovulation,” he explains.

Couples with no complication but fail to conceive
Dr Businge confirms that often standard investigations carried out on a couple may not find an immediate cause of infertility.
“The tests used worldwide are sometimes not sophisticated to find some smaller infertility problems. But with time, this will advance and all infertility issues will be diagnosed,” he says.

He advises couples to go for medical examination to confirm that they are in good health before conceiving. For example, women who conceive while having undiagnosed diabetes, hypertension, HIV and hepatitis B among other infections may get complications during pregnancy or give birth to babies with defects.

Things you should know
1. Female infertility is easier to understand as in majority of cases, the problem is known. But, infertility in men is tough to recognise at the early stage.
2. One should keep a check on the nutritional deficiencies and maintain a healthy routine with balanced diet. Know the best fertility diets and best food. Take all nutrients in moderation to boost your fertility after consulting your doctor.
3. Age has direct and distinct correlation with infertility. The vitality and sustainability of our body gets declined as we grow old. Therefore, it is always better to start infertility treatment at the early age.
4. Male infertility is extremely complex to diagnose and cure. Often, doctors try to find out the fundamental reason through various tests and research. Semen samples are tested in the laboratory to know the sperm count, strength and other factors. Hormonal levels are checked to determine the testosterone levels. Physiological problems such as defects in genital organs, STD or VD, retrograde ejaculation are also checked.
5. Dealing with infertility becomes further complicated with the time to provide complete physical, mental and emotional support to each other.