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Systemic disorders and assisted reproductive technology by Prof. Oladapo Ashiru

Assisted reproductive technology has been in existence for decades; more importantly, it has its significance in helping couples experiencing infertility.

The fertility rate in Nigeria is approximately six children per woman, even though it has a higher percentage of pregnancy wastage. A study done by The World Health Organisation in 1994 and 2004 revealed the value of 6.5 and 5.7 children per woman respectively.

In particular, the most reliable and current form of assisted reproductive technology is the in-vitro fertilisation, which has put smiles on couples battling with infertility and constant use of herbal medications to manage and achieve conception.

Furthermore, there are also systemic disorders termed comorbidities (which is the presence of one or more additional conditions often co-occurring with a primary disease. That can be associated with assisted reproductive technology; these are not far-fetched, as discussed on this platform. We have been able to effectively manage such cases that presented to our canter with infertility.

The Comorbidities associated with assisted reproductive technology are; hypertension, diabetes, obesity, cardiac diseases and renal diseases.

Hypertension

The use of ART has increased globally, it is responsible for over a million births annually. However, its association with hypertension remains one of the maternal risk factors. Some studies have shown that the risk of hypertensive disorders in pregnancy is increased in women undergoing in-vitro fertilisation conceived through frozen embryo transfers and fresh donor oocyte transfer, but not seen with fresh own embryo transfers.

We know that hypertension and diabetes are some of the leading comorbidities in West Africa. Thus, a hypertensive woman with infertility should have optimally controlled blood pressure and a clinical review from a cardiologist before commencing ART treatment to avoid elevated blood pressure, leading to stroke and cardiac complications even before treatment begins. Failure to do this, while proceeding with the commencement of treatment, may result in the patient developing the hypertensive disorder in pregnancy, which is the leading cause of morbidity and mortality.

It’s not an innocuous idea to engage in some lifestyle modification if there’s a family history or

Diabetes

This one of the leading non-communicable diseases in West Africa; couples with diabetes mellitus are increasingly inquiring about assisted reproductive technology because of their inability to achieve spontaneous conception. With a careful patient selection, counseling, and monitoring, assisted reproductive technology can be applied with ease.

The adverse effect of uncontrolled diabetes mellitus in females, such as infertility and miscarriages, results from disturbed ovarian function. The insulin metabolism appears to be fully involved with the ovarian function via the mechanism surrounding the actions of insulin-like growth factors.

With reasonable glycemic control, this may improve ovulation’s resumption and allow ovarian stimulation for assisted reproductive technology.

Males with uncontrolled diabetes mellitus show minimal effects on spermatogenesis; nevertheless, it can also cause erectile and ejaculatory function. When this happens, and treatment is difficult or complicated, sperm aspiration techniques, also known as testicular sperm retrieval and in-vitro fertilisation and intracytoplasmic sperm injection, are employed.

Couples with diabetes mellitus should endeavor to adequately control their blood glucose by adhering to medications and see their endocrinologist more often before they can commence ART treatment.

Obesity

Obesity is another non-communicable disease on the rise in the Western world and Africa.

It is one of the highest contributors to morbidity and mortality from myriads of pathologies. Its association with reproductive performance can be sub-optimal, but its direct effect on ART outcome is not clear

Obesity is associated with infertility, miscarriage, hirsutism, menstrual irregularities, and some other complication that arise during childbirth. Nearly half of the women in the reproductive age group are overweight and obese. A body mass index of 30kg/m and above signifies obesity. There is a strong association between increased body mass index and reduced pregnancy and live-birth rates, including miscarriages.

Uncontrolled obesity is known to diminish the reproductive system via a different mechanism such as hyperandrogenism (overactive male hormone), elevated leptin levels, and insulin resistance. It can lead to a lower implantation and pregnancy rate as well as miscarriages and complications during pregnancy for both the fetus and mother.

Weight reduction is not an easy task to achieve, as age advances in women within the reproductive age group. If not adequately controlled with adequate patient counseling, it may lower the probability of conception; besides, weight management and dietary modification can’t be overemphasized because of its improvement on reproductive function.

Cardiac disease

It is one of the leading complications of uncontrolled hypertension, resulting in high morbidity and mortality rates globally.

Couples should see their cardiologist for proper cardiac evaluation. Women willing to go through fertility treatment should be counseled to undergo proper evaluation if they are experiencing the following cardiac symptoms; shortness of breath, swollen legs, waking up multiple times to urinate, waking up in the middle of the night to gasp for air, difficulty in breathing when lying down, feeling of the heartbeat, early satiety and abdominal swelling. proper evaluation should be done by a cardiologist if these symptoms are present before or after ART.

It is advisable to monitor closely the cardiac health of women who underwent fertility procedures even after delivery.

Kidney disease

Couples with underlying kidney disease should be evaluated and treated before undergoing ART treatment to prevent unpleasant health complications. Some form of kidney disease is also associated with infertility due to the type of management they undergo such as hemodialysis and kidney transplant. The nature of renal diseases, for instance, it is known that patients with advanced chronic kidney diseases experience menstrual irregularities and those with end-stage renal disease become amenorrhea and later become infertile.

If this is not treated correctly, this can lead to death. Furthermore, it can lead to fetal and maternal demise if the pregnancy was achieved, from the body’s inability to cope with the regular pregnancy changes.

Couples with renal pathology must see a nephrologist for proper management and counseling before commencing ART treatment. Failure to adhere to this form of control before starting ART might hamper the mother’s health and pregnancy.

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