INFERTILITY

Infertility is usually defined as the failure to conceive after 1 year of sexual intercourse without contraception.

It is divided into 2 categories:

  • Primary: The woman has never conceived in spite of having unprotected sexual intercourse for at least 12 months
  • Secondary: The woman has previously conceived but is subsequently unable to conceive for 12 months despite unprotected sexual intercourse.

Causes of infertility include the following:

  • Tubal factor: There is bilateral occlusion of fallopian tubes as a result of PID.
  • Male factor: The sperm ducts are damaged as a result of previous STIs leading to abnormalities of sperm function.
  • Endocrine disorders affecting the woman.
  • Tropical diseases in male and female, including leprosy, filariasis, schistosomiasis, or tuberculosis.
  • Cervical mucus abnormalities.
  • Congenital disorders.

Any couple desiring children who do not achieve a pregnancy within 1 year of adequate exposure should have a systematic evaluation of their reproductive function. Most patients will require a detailed work-up, thus patients should be referred to a gynaecologist after a good history and examination rule out immediately treatable causes. Since infertility results from female OR male
problems, both partners should be prepared to undergo evaluation.

Diagnosis depends on:

  • History from couple and individually.
  • Physical examination of both partners.

Investigations

  • Basal body temperature
  • Semenalysis
  • HSG for tubal patency
  • Hormone assays where indicated
  • Dye laparoscopy.

Management

  • Definitive treatment depends on the cause as per the investigations above and may include:
  • Counselling on sexual technique and fertility awareness
  • Ovulation induction: Clomiphene citrate 50mg OD for 5 days starting from day 2–5 of menstrual cycle
  • Tubal surgery
  • Vas surgery
  • Assisted reproduction
  • Adoption