Infertility: The new silent torment

From April 21 to 27, nations celebrated National Infertility Awareness Week, with a bigger day coming up on November 2 to celebrate fertility globally. We remember couples and individuals who have lived a life of wanting to have children, but have biologically failed to. For many, adoption is not an option! 

The condition affects 15 percent of couples worldwide, with a hefty emotional cost, physical breakdown and the unbearable financial implications incurred by the desire for one to reproduce. We need to raise awareness of this silent tormenting condition that has left marriages broken, with many failing to find spouses. 

Infertility, in both males and females, according to the World Health Organisation, is the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse. It can be primary for a couple/individual who has never produced or secondary if conception has ever taken place - regardless of the outcome of the pregnancy. The causes are where we majorly rush to blame “the other gender”. 
It is estimated that 40 percent of the problem is attributed to females, 40 percent to males, 10 percent to both sexes and 10 percent to unknown factors.

Investigating infertility can be summed up in five main pathological corners, including fallopian tubes, uterus, sperms, hormones in both male and female, and genetics. Specific investigations are carried out in all these areas to confirm a diagnosis of infertility.
Culturally in Africa, it is believed that when adults get married, they start having children unless both decide not to, perhaps when there are other children before marriage for those who marry later in life. It, therefore, carries a burden if couples fail to produce after some time. That is when what was a couple’s private problem spreads to relatives, friends and eventually the entire community.
We should not even assume that the growing population endorses voluntarism of individuals not to reproduce. The top five heavily populated countries in the world are India, China, USA, Indonesia and Pakistan. 

In the early 1990s, India started operating a handful of fertility centres. Today, more than 4,000 facilities are helping couples and individuals realize their dreams of childbearing. This includes those who are infertile, the ones without spouses and surrogates who wish to carry pregnancies on behalf of others. Family planning can be very acceptable if it is not imposed or as an alternative to failed conception. 
The population of Uganda reached 48 million as of 2023, according to the Uganda Bureau of Statistics. We are getting services from about 20 facilities in the country that offer fertility care, both government and private. I believe we can do more if the condition is prioritised by our health system to make services accessible, more available and above all, affordable. 

Recently, the president of Fertility Society of Ghana (FERSOG), Dr Rudolph Akegeba, announced that Ghana was going to introduce a course for nurses that will enable them to treat patients of infertility using low-cost Intrauterine insemination as Assisted Reproductive Technology (ART). These will not only be affordable but will help patients countrywide who cannot travel to urban centres for such a service. If the cases require other specialised attention, then referral is part of management in health care. 
For the start, procedures like In Vitro Fertilisation (IVF) and Intracytoplasmic Sperm Injection (ICSI), will remain in the hands of specialised embryologists and gynecologists. 

We ought to empower this part of the population in Uganda affected by infertility. Men, don’t wait for DNA testing to prove you are the father of the child yet you are infertile. Women, go do fertility tests with your spouse, the causes come from either or both parties. Save that relationship.
 

The author, Dr Paul Kibenge is a trainee of Clinical Embryology at Manipal Academy of Higher Education (MAHE), India