My wife has failed to conceive again

Dear doctor,
My wife has failed to conceive again. We have a four year old boy but have been trying for a baby for the last two years. We make love four times a week unless she is in her periods. We are even tired of making love now because we just do it for the sake of a child but in vain. She once used Norplant family planning method. What can we do to increase our chances of having a baby?
Katende, Kampala

Dear Katende,
Although infertility is feared if a couple takes a year or more of unprotected sex of at least three times a week, any couple that start showing distress about not having a baby should visit a doctor especially a gynaecologist for help. In Uganda where the fear for pregnancy is usually more than the fear of STIs, many couples taking contraception do not protect themselves against STIs ending up with blocked fallopian tubes in the woman and resultant infertility and the blame is wholly placed on the contraceptive. I suspect you blame Norplant for the fertility debacle.
Norplant is known to delay (up to 18 months in some cases) but not to stop fertility completely and as such, couples who want short-term contraception are advised against using it. I suppose your wife has not grown younger and may have developed a problem such as fibroids (or menopause) which requires checking.
It is true that a man himself may have low sperm count and impregnant a younger fertile woman but when a woman grows older (and takes norplant) and her fertility reduces, such a man may find it difficult to impregnate her. Also, a man himself may get blocked sperm tubes after getting a woman pregnant. So you need to visit the doctor with your wife.