Exploring the unexplained infertility mystery

Some couples may fail to get children because they are incompatible with each other, even though both of them may be fertile. (L), an illustration of an artificial insemination process that some couples may use to have children. Internet Photo.

What you need to know:

When couples cannot have children, the blame is usually put on either the woman or the man. But what happens if they are both fertile, yet they still cannot have children? This is the condition known as unexplained infertility. Here, we explore why it happens, and what couples who find themselves in the same situation can do to address it.

Weddings can be a source of all sorts of rumours and backbiting. Topics range from the quality of clothes that the bridal entourage is wearing, to the social status of guests in attendance.

However, at this particular wedding, a friend and I were engaged in a different kind of backbiting.

As we lined up for food, she pointed at a couple that was in front us.

The couple, she said had been married for seven years now, but had failed to have a child.

“They both went for fertility checks, and the doctor confirmed that they were fine but incompatible,” she explained.

This means that there was another factor that was preventing the couple from having children, apart from infertility.

So what was wrong with this couple?

According to Dr Gilbert Ahimbisibwe, a medical officer at the Women’s Hospital International and Fertility Centre in Bukoto, a Kampala suburb, the couple has a condition that is known as unexplained fertility.

He says medically referring to the condition as incompatible means no matter what they do, the woman can never get pregnant, which is not necessarily the case.

Dr Ahimbisibwe says unexplained infertility is a condition where all tests have failed to signal out any cause for a couple’s failure to get a child.

While Dr Mark Muyingo, a fertility specialist at Mulago National Referral Hospital says there are no definite statistics of how big the problem of unexplained infertility is at Mulago, Dr Ahimbisibwe states that a “sizable number of cases they handle at the Women’s fertility hospital is a result of the condition.”

“Unexplained infertility accounts for about 30 per cent of the cases we get at the hospital,” he says.

Causes
Dr Vincent Karuhanga, a general medical practitioner at Friends Polyclinic in Kampala says one of the common causes of unexplained infertility is the antibodies produced by a woman.

“Some women have been found to produce antibodies against the sperms of a given man, so that when the sperm is in the woman’s body the antibodies fight and kill them.

In such a case, there is no way the woman can become pregnant even when she is fertile.”

Dr Karuhanga adds that in other cases, the level of acidity in the woman’s vagina can also result in such as condition.

High acidity in women
Dr Ahimbisibwe further adds that when the level of acidity is high, the vagina becomes too hostile.

“The sperms are supposed to swim past the vagina, to the cervix and all the way to the tubes to find the egg. But if the level of acidity is too high, it makes the sperms immobile,” explains Dr Ahimbisibwe.

According to him, in cases where the sperm has managed to enter the egg, the first few moments into this process is crucial for fertilisation to happen.

“However, in some cases, there is a defect in the DNA of the egg or the sperm. When this happens, the resulting baby will be miscarried at an early stage (between one or two weeks). However, the miscarriage will appear like a normal period because the egg failed to implant into the uterus,” he notes.

Defective enzymes
Additionally, unexplained infertility can be as a result of a defect in the enzymes on the sperm, and in the shell of the egg. Dr Ahimbisibwe says sperms have an enzyme which is supposed to digest off the shell that covers the egg.

“At these two levels, there can be a defect in the shell of the egg, or a defect in the enzymes that digest it. So, even when the sperm is able to reach the egg, it cannot penetrate it for fertilisation to take place.”

In some women, unexplained infertility can occur when the uterus is not properly positioned. It might be pointing sideways and at times the opening of the uterus is attached to the wall of the vagina, so sperms have no way of entering.

In other cases, a defect in the cervix, where by it has a mass that closes it makes it hard for sperms to enter and allow fertilisation to take place.

But in cases where the sperms have been able to go past the vagina, Dr Ahimbisibwe says they have to go through the cervix, in order to enter the uterus.

“The sperms have to go through the cervical mucous, which is located in the cervical canal. This requires that the sperms must be strong enough to swim through the cervical mucus.”

He adds: “During ovulation, this mucous has to be very thin or watery, so that the sperms can swim easily. However in some women, it remains thick, and when this happens, and the sperms are not strong enough, they remain in the cervix and die.”

But Dr Karuhanga further explains that unexplained infertility can happen when a woman has trouble releasing eggs.

“The egg might grow but in some cases may not be released because of high levels of a hormone in a woman called prolactin.”

Dr Karuhanga says while some couples go for a fertility test before they get married, such tests usually cannot explain this condition.

“A couple can know that they are suffering from unexplained infertility, only after they have tried for conceive for a period of time, and then realise they cannot do so even after tests prove that they are fertile.

Success stories
However, Dr Ahimbisibwe says they have had success in making some couples with unexplained infertility have children.

He offers that the first thing they do when a couple presents with an infertility problem is conduct tests.

“The baseline tests conducted include a scan of the uterus and cervix. We also carry out fallopian tube tests to see if the tubes are open, we do a sperm test to see if the sperms are normal, then we also carry out hormonal and ovulation tests to establish if the woman releases eggs,” he says.

He states that if the entire tests turn out to be negative, then a more comprehensive one is carried out to try and understand the problem.

“These tests can be done to the very smallest detail of the egg and the sperm. However, most of the fertility centres in the country mostly do baseline tests alone,”he says.

Timed conception
According to Dr Ahimbisibwe, when any of the mentioned defect is noted, the first thing they do is advise the couple to have timed sexual intercourse.

“Some couples might not be having sex at the right time. So we prepare the woman and inform her when she is most fertile, give her medication to help her release the egg, and tell them to go and sleep together and within a few weeks, they conceive.”

He adds that if this is done and the couple is still unable to have a baby, the other treatment given is intrauterine insemination.

“We put the sperm inside the uterus of the woman. With this treatment, the man gives us sperm; we then put it in a syringe which has a long tube and push the sperm through this tube into the egg for fertilisation.”

Test tube option
However, if these two options fail, the other alternative is the test tube baby treatment.

In this case, they remove the egg from the woman, put it in a bottle in the lab, pick sperms from the man and mix them in the same bottle so that they meet. Once fertilisation occurs, we transfer the egg to the woman’s womb.”

He adds, “Alternatively we pick the sperm with a needle, push the needle into the egg, to force fertilisation to occur. This is also done in a test tube in the lab.”

These treatments can be found at the women’s hospital and Mulago among other health facilities.

At Women’s Hospital International and Fertility Centre, this kind of treatment costs between Shs500,000 and Shs10m, depending on the type of treatment you are getting.

Dr Karuhanga therefore, discourages couples from separating on grounds that one is infertile.

“People should always seek the help of experts before they come to conclusions especially when it comes to fertility issues,” he notes.