Resources

FEMALE INFERTILITY

Causes of female infertility

• Ovarian causes

• Polycystic ovarian syndrome is the common cause of inability to menstruate
• Luteinized unruptured follicle; the dominant follicle is luteinized but remains unruptured causing inability to menstruate

• Thyroid problems may cause menstrual disorders and inability to menstruate due to

• Low or high thyroid hormone
• Ovarian failure: A woman within the reproductive age ceases to menstruate

• Disorders of ovulation resulting from

• Abnormal release of gonadotrophic releasing hormone (GnRH) causing the woman not to ovulate
• Pituitary disorders: the pituitary gland may produce too much prolactin causing the woman to stop menstruating

• Tubal dysfunction due to

• Poor egg (oocyte) pick up
• Tubal scars and adhesions resulting from sexually transmitted infections

• Uterine fibroids

Other Possible Causes

• Sexually transmitted infections
• Smoking
• Excessive alcohol
• Certain drugs eg diabetic drugs
• Psychological factors such as stress and anxiety
• Exposure to environmental hazards such as radiation and  radioactive substances

Available treatment options

• Ovulation induction: drugs such as clomiphene citrate is used to stimulate ovulation
• Assisted Reproductive Technologies (ART)

• Intrauterine insemination
• In vitro fertilisation and embryo transfer

• Treatment of sexually transmitted infections

Intrauterine Insemination (IUI)

• Is indicated when sperm motility is the cause of infertility
• Involves sperm preparation outside the body
• IUI is intended to;

• Decrease the distance the sperm has to travel by injecting it into the fundus of the uterus
• Time the insemination at ovulation

In vitro fertilisation (IVF) and embryo transfer (ET)

• IVF is indicated when the tubes are completely blocked
• IVF involves retrieval of the oocyte (egg) and sperm and fertilisation of the oocyte in a laboratory
• The embryo is cultured for 3 to 5 days with subsequent transfer via the cervix under abdominal ultrasound guidance into the uterine cavity

Psychosocial health of women with infertility

• In Ghana where childbearing is highly valued infertility is associated with negative psychosocial health problems such as stress and depression (Naab, 2012)
• Infertility-related stress is reported to be high among less educated  Ghanaian women and is associated with more years spent in infertility treatment and being in polygamous marriages ( Donkor and Sandall, 2007)

Infertility affects the mental health of women

• 53% of 203 Ghanaian women with fertility problems studied were clinically depressed (Naab, 2012)
• Negative beliefs about the consequences of not having a child can cause you to be depressed (Naab,2012)

Infertility and Stigma

In Ghana, 64% of 615 women with fertility problems studied were stigmatized (Donkor and Sandall, 2007). The harmful effects of stigma include (Mayoclinic.com, 2007);

• Pretending that nothing is wrong
• Refusal to seek treatment
• Rejection of family and friends

Coping Behaviors for Infertility

Coping with infertility can be very difficult. Many women struggle with issues of stigma, which is usually the main reason for not seeking help. Using any of the bad coping behaviors below can cause women to be more anxious and depressed.

Bad coping behaviors

• Not seeking medical help
• Blaming yourself
• Isolating yourself
• Not seeking counseling

Healthy coping behaviors

• Seek medical help
• Stay in touch with loved ones to get emotional and social support
• Find a support group or counseling service where you can talk about your feelings without worries. Counseling will help maintain your mental health. Remember that counseling is confidential
• DO NOT blame yourself because self-blame only causes you to be more depressed
• Practice relaxation. Relaxation training and stress management, has been associated with higher pregnancy rates (Mayo Foundation for Medical Education and Research, 2011)
• Consider child adoption as an option

MALE INFERTILITY

Causes of male infertility

• Disorders of spermatogenesis resulting from hypothalamus and pituitary dysfunction
• Spermatogenesis can also be disrupted by the following;

• Heat: the normal scrotal temperature is 1 degree lower than the rest of the body. The following factors increases the scrotal temperature;
  • Hot baths
  • Tight and silky underwear
• Excessive alcohol intake
• Smoking
• Drugs such as
  • anti-epileptic,
  • anti-hypertensive agents,
  • antibiotics

• Hormonal problems: The following can go wrong with the hypothalamus-pituitary endocrine system

• The hypothalamus can fail to release gonadotrophic-releasing hormone (GnRH) leading to a lack of testosterone and a cessation in sperm production
• The pituitary can fail to produce enough lutenizing hormone (LH) and follicle stimulating (FSH) hormone leading to cessation in sperm production

• Disruption in sperm transport due to infection and epididymal malformation
• Ejaculatory dysfunction resulting from chronic conditions such as

• Diabetes
• Hypertension
• Multiple sclerosis

• Other Possible Causes

• Congenital e.g undescended testes
• Overly intense exercise causes
  testosterone deficiency
• Inadequate vitamin C and Zinc in the diet
• Exposure to environmental hazards and toxins such as pesticides, lead, paint, radiation, radioactive substances
• Malnutrition and anemia
• Excessive stress

Available Treatment

• Semen processing: The sperms are washed to improve their motility
• Dietary supplements and vitamins
• Lifestyle changes

Infertility affects the mental health of Ghanaian men because of the following (Naab, 2010)

• Insomnia
• Feelings of inadequacy
• Loss of social identity

Male Infertility and Stigma

Infertility affects men and they also suffer the stigma of being infertile. Just as in women the harmful effects of stigma include (Mayoclinic.com, 2007):

• Pretending that nothing is wrong
• Refusal to seek treatment
• Rejection of family and friends

Coping Behaviors for Infertility

Coping with infertility can be very difficult. Many men struggle with issues of stigma, which is usually the main reason for not seeking help. Using bad coping behaviors can also cause men to be more anxious and depressed.

Bad coping behaviors (Naab, 2010)

• Not seeking medical help
• Refusing to accept the diagnosis
• Refusal to share information with the wife
• Blaming the wife
• Isolating himself
• Trying to conceive with other women
• Marrying another woman

Healthy coping behaviors for men

• Seek medical help
• Stay in touch with loved ones to get emotional and social support
• Find a support group or counseling service where you can talk about your feelings without worries. Counseling will help maintain your mental health. Remember that counseling is confidential
• Wife blaming does not help
• Infertility is a problem for the couple rather than for the individual. Discuss the problem with your wife and seek help together
• Practice relaxation. Relaxation training and stress management, has been associated with higher pregnancy rates (Mayo Foundation for Medical Education and Research, 2011)
• Consider child adoption as an option