Text and Photos by Leandrae T. Lapinig
The Philippines is now home to more than 100 million people. Despite this fact, many Filipino couples are still facing the problem of infertility, defined as “the inability of a couple to achieve a pregnancy after repeated intercourse without contraception for one year.” The United Nations Development Program, in a 2004 report, said the infertility rate in the country was 7.90%.
A recent survey by a market research company showed that one in 10 couples are facing the challenge of conceiving a child. In the top cities survey, most of the childless couples were in the Greater Manila area (10.7%) followed by Davao (5%) and then in Cebu (3.8%).
In an interview with Health and Lifestyle, a monthly publication for health professionals, Dr. Anthony Marc B. Ancheta, a respected obstetrician and gynecologist and fertility expert in the country, thinks everything happens at the most unexpected time, especially for couples who are trying to get pregnant.
“If we think about it, in order to get pregnant, you just need an egg and a sperm and the two just have to meet at the opportune time, however, it’s not as easy as it seems,” Dr. Ancheta was quoted as saying.
In the said article, author Mylene C. Orillo identifies two types of infertility: primary and secondary. “Primary infertility is when the woman has never had a chance to get pregnant, whether it ended up as miscarriage or abortion; while secondary infertility is when the woman was able to get pregnant once, but developed a miscarriage, or was able to produce a pre-term conception but has difficulty getting pregnant again,” she explains.
“The cause of infertility may be due to problems in the man, the woman, or both,” says The Merck Manual of Medical Information. “Problems with sperm, ovulation, or the fallopian tubes each account for almost one third of infertility cases.”
Dr. Ancheta agrees. “Getting pregnant,” he says, “is a shared responsibility between husband and wife; 30% of the time there’s something wrong with how the eggs are being produced and the other 30% has something to do with the quality of the sperm.”
Let’s take a closer look at the causes. Among men, the most common problems are with making and growing sperm, which are ejaculated during sex. Sperm may not grow fully, be oddly shaped, not move the right way, be made in very low numbers and not be made at all.
“Sperm problems can be from traits you’re born with,” the American Urological Association (AUA) states. “Lifestyle choices can lower sperm numbers. Smoking, drinking alcohol, and taking certain medications can lower sperm numbers. Other causes of low sperm numbers include long-term sickness (such as kidney failure), childhood infections (mumps, for one), and chromosome or hormone problems (such as low testosterone).”
Other causes of infertility in men include varicoceles (swollen veins in the scrotum), retrograde ejaculation (when semen goes backwards into the body), immunologic infertility (where man’s body makes antibodies that attack his own sperm), obstruction (where sperms are blocked as a result of surgery, swelling or development defects), hormones, and chromosomes.
In some instances, the medications you are taking may be the cause. Examples are those medications used to treat health problems like arthritis, depression, digestive problems, infections, high blood pressure, and cancer.
Among women, age is a factor. “As women age, becoming pregnant becomes more difficult and the risk of complications during pregnancy increases,” says The Merck Manual of Medication Information. “Also, women, particularly after 35, have a limited time to resolve infertility problems before menopause.”
According to WebMd.com, other causes of female infertility include damage to her fallopian tubes (they get damaged when scars form after pelvic infections, endometriosis, and pelvic surgery), cervical issues (this happens when sperms are prevented from passing through the cervical canal), hormonal problems, and uterine trouble (have polyps and fibroids that interfere with getting pregnant).
“For about 20% of couples who have infertility problems, the exact causes are never pinpointed,” the WebMd.com says.
Fortunately, “there are many safe and effective therapies for overcoming infertility,” the Minnesota-based Mayo Clinic claims. “These treatments significantly improve the chances of becoming pregnant.”
The Merck manual, however, pinpoints that “up to 60% of the couples who have not conceived after a year of trying do conceive eventually, with or without treatment.” It adds: “The goal of treatment is to reduce the time needed to conceive or to provide couples who might not otherwise conceive the opportunity to do so.”
The Mayo Clinic urges couples to see a doctor about infertility if both have been trying regularly to conceive for at least one year. A woman may consider being seen earlier if she:
· Is age 35 to 40 and has been trying to conceive for six months or longer;
· Is over age 40;
· Menstruates irregularly or not at all;
· Has known fertility problems;
· Was diagnosed with endometriosis or pelvic inflammatory disease;
· Has had more than one miscarriage; and
· Has had prior cancer treatment.
A man may wish to be evaluated sooner if he has:
· Low sperm count or other problems with sperm;
· Swelling in the scrotum;
· Has had a previous vasectomy
· Undergone prior scrotal or inguinal surgery;
· Small testicles or problems with sexual function or desire;
· Prior cancer treatment; and
· Desire to know his fertility status.
“Treatment of infertility depends on the cause, how long you’ve been infertile, your age and your partner’s age, and many personal preferences,” the Mayo Clinic says. “Some causes of infertility can’t be corrected. However, a woman may still become pregnant with assisted reproductive technology. Infertility treatment involves significant financial, physical, psychological and time commitment.”
Treatment for men
Approaches that involve the male include treatment for general sexual problems or lack of healthy sperm. According to the Mayo Clinic, treatment may include the following:
Treating infections. Antibiotic treatment may cure an infection of the reproductive tract, but doesn’t always restore fertility.
Treatments for sexual intercourse problems. Medication or counseling can help improve fertility in conditions such as erectile dysfunction or premature ejaculation.
Hormone treatments and medications. Your doctor may recommend hormone replacement or medication in cases where infertility is caused by high or low levels of certain hormones or problems with the way the body uses hormones.
Surgery. For example, a varicocele can often be surgically corrected or an obstructed vas deferens repaired. In cases where no sperm are present in the ejaculate, sperm may often be retrieved directly from the testicles.
Assisted reproductive technology (ART). ART treatments involve obtaining sperm through normal ejaculation, surgical extraction or from donor individuals, depending on your specific case and wishes. The sperm is then inserted into the female genital tract, or used to perform in vitro fertilization or intracytoplasmic sperm injection.
Treatment for women
While men’s treatment, women’s treatment is different and complicated: “Although a woman may need just one or two therapies to restore fertility, it’s possible that several different types of treatment may be needed before she’s able to conceive,” the Mayo Clinic says.
Among the treatments available for women, the Mayo Clinic says, are the following:
Stimulating ovulation with fertility drugs. Fertility drugs are the main treatment for women who are infertile due to ovulation disorders. These medications regulate or induce ovulation. Talk with your doctor about fertility drug options — including the benefits and risks of each type.
Intrauterine insemination (IUI). During IUI, healthy sperm that have been collected and concentrated are placed directly in the uterus around the time the woman’s ovary releases one or more eggs to be fertilized. Depending on the reasons for infertility, the timing of IUI can be coordinated with your normal cycle or with fertility medications.
Surgery to restore fertility. Uterine problems such as endometrial polyps, a uterine septum or intrauterine scar tissue can be treated with hysteroscopic surgery.
Assisted reproductive technology (ART). ART is any fertility treatment in which the egg and sperm are handled. An ART health team includes physicians, psychologists, embryologists, lab technicians, nurses and allied health professionals who work together to help infertile couples achieve pregnancy.
“While a couple is undergoing treatment for infertility, one or both parents may experience frustration, emotional stress, feelings of inadequacy and guilt,” the Merck manual says. “They may alternate between hope and despair. Feeling isolated and unable to communicate, they may become angry at or resentful toward each other, family members, friends, or the doctor.”
According to the Merck manual, all the above problems can be lessened “if both partners are involved in and are given information about the treatment process, regardless of which one has the diagnosed problem.”
“Knowing what the chances of success are, as well as realizing the treatment may not be successful and cannot continue indefinitely, can help a couple cope with the stress,” the Merck manual says. – ###
