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Art of infertility treatment (3) by Prof. Oladapo Ashiru

This article, from inception, has focused on In vitro fertilisation, an extraordinary technique that has saved many lives and has been used to birth almost seven million babies.

Some factors were listed in the previous article to contribute to low sperm count in men. Other factors are;

Sexually Transmitted Diseases: Research shows that about 10 per cent of human infertility is caused by tubule obstruction, and this is usually, although not always, caused by infectious diseases transmitted sexually. One-third of African men are sterile because of epididymal obstruction caused by sexually transmitted diseases. For example, gonorrhea causes irreversible tubule blockage. This type of infertility caused by sexually transmitted diseases requires the most complex medical treatment, which includes new methods of assisted conception or reproductive technology.

Obesity and Infertility

WHO now recommends that persons that are overweight or obese should lose at least five per cent of their body weight using lifestyle changes such as dietary or health spa/detox clinics before attempting conception.

Human destiny and fertility: 25 per cent of infertility are partly due to some of the reasons given above. The remaining couples suffering from infertility that cannot be explained need not be pessimistic. The new infertility technologies of IVF, GIFT, ICSI, microsurgery with TESA, and most recently pre-implantation genetic diagnosis can help most if not all infertile couples conceive.

What is the state of art in infertility treatment?

This refers to the process of solving seemingly impossible or difficult infertility problems with new technology. Such technology usually involves the complex handling of human gametes consisting of the sperm and egg in order to achieve conception and subsequent pregnancy, leading to the delivery of a healthy baby. In the United States of America, after the initial errors in California (by a Dr. Ricardo Ash) in which gametes were improperly handled, resulting in a black couple giving birth to a white baby while a white couple giving birth to a black baby, mandatory training and examination was stipulated and required before someone could be appointed the director of an IVF programme or laboratory. They must be licensed by examination as High Complexity Clinical Laboratory Director by the American Board of Bio-analysis. These individuals have helped in maintaining the practice of Assisted Reproductive Technology in the USA. The Copenhagen meeting under WHO watch now wants all practitioners of ART to start a registry of ART procedures through their national and regional fertility societies and then turn in to a multinational registry with WHO. This is to have a global picture of activities of ART worldwide for the purpose of funding, research, guidelines and regulations.

What type of infertility problem can be helped with the new technology?

There are several problems that can be helped with the new technology. They can be considered as those with male, female or even unexplained infertility.

Male infertility problems

Low sperm count and also a congenital absence of the sperm duct can be helped by the new technology. In this situation, men who were born with missing sperm ducts, today, are now able to have children of their own by ART procedure.

Female infertility problems

Anovulation

This occurs in 10 per cent of most cases of infertility. This female may go through a menstrual cycle but she is not ovulating, that is, not producing eggs. The process of ovulation is complex and involves secretions of several hormones in the brain, hypothalamus, pituitary and the ovary as well as other related endocrine glands like the thyroid gland, adrenal, pancreas and parathyroid. These endocrine glands secrete hormones, which work like the orchestra in a symposium to cause ovulation. If any of these hormones should play out of tune, ovulation will not occur. It is now possible to control this process externally by administering various hormones to the patient. This is done after a very careful analysis of the patients’ hormonal status and deficiencies.

 Tubal blockage

The tubes that carry the egg to the site of fertilisation may be blocked or restricted in their movement. This may result in failure to conceive, even though the patient may be ovulating normally. Blocked tubes occur in about 20 per cent of infertility cases. The cause is usually from previous infections. Sometimes, the woman may not know she had these infections. Even simple appendicitis when young can lead to scarring around the area of the tube which can interfere with the pickup mechanism of the eggs from the ovary. An X-ray called “hysterosalphinogram”  (HSG) which is a slightly painful but non-surgical procedure, which does not require hospitalisation can determine if the tubes are structurally sound. Most recently, there is a virtually painless procedure that is able to determine whether the tube is structurally intact. It is the use of ultrasonography with saline infusion. It is called Hysterosonography.

Immunology

This includes cervical hostility. In this situation, the woman’s cervix recognises the sperm as a hostile foreign body(antigen) and immediately produces antibodies to kill the sperm. Invariably, most of the sperm cells are destroyed just at the cervical entrance and do not pass beyond the cervix.

This condition can be detected by examining a swab of the sperm removed from the cervix after intercourse. It is called Post Coital Cervical Sperm Analysis. There are a number of other immunological factors that can affect pregnancy, conception to the implantation of embryo phase.

 The new technologies

Assisted Reproductive Technology as useful as it has been proven, is not necessary for every couple. A proper evaluation should be conducted by the specialist to ensure that the most efficient and cost-effective procedure is used to help the couple become pregnant. Each individual is different.

Assisted reproduction

Assisted Reproductive Technologies has now gone beyond in vitro fertilisation and intracytoplasmic sperm injection. A number of clinics render these support services in Nigeria.

Patient preparation and counseling

Good fertility clinics recognise that dealing with infertility or high-risk pregnancy can be very stressful. Patient preparation and counseling services were established to provide a range of mental health services to patients needing emotional support and guidance during difficult times. It includes a thorough evaluation of a detailed questionnaire, which has been prepared to bring all the possible factors that could cause infertility in couples. Patients are made to realise that they are not alone in their journey to parenthood.