Effect and Treatment of Infertility Among Married Couple
Chapter One
Objective of the study
The broad objective of this study was to investigate the causes and effect of infertility and its management in Ede North Local Government, Osun State, Nigeria.
The Specific Objectives of this study were:
To determine the perception of married men towards infertility.
To assess the perception of married men toward management of infertility.
To evaluate the knowledge of married men on infertility
To assess married men‘s knowledge on management of infertility
CHAPTER TWO
LITERATURE REVIEW
Concepts of infertility
According to World Health Organisation, (2015) – Primary infertility is the term used in reproductive medicine for a woman (couple) who failed to achieve a pregnancy for 1 or 2 years and who was never pregnant before. Secondary infertility is the term applied to women who meet the criteria for primary infertility but at some time in the past have been pregnant. In reproductive medicine, the term infertility can be used in a descriptive manner to define the situation in women (couples) who are unable to conceive or have a pregnancy leading to live birth, during ≥ 1 year. But it has also absorbed the meaning of the term as used in common language in the sense of impossible to conceive, synonymous with the demographic term infecundity.
Ajuwon, Owoaje, Falaye, Osinowo, Christopher and Adewole, (2007), viewed infertility / sub-fertility as inability of a couple to obtain a clinically recognisable pregnancy after 12 months of regular and unprotected sexual intercourse (involuntary failure to conceive). Cooper, Noonan and Eckardstein, (2010), reported that the definition of infertility frequently used by reproductive endocrinologist is when a woman under 35 years has not conceived after 12 months of contraceptive- free sexual intercourse or when a woman over 35 years has not conceived after 6 months of contraceptive-free sexual intercourse.
Mascarenhas, Flaxman, Boerma, Vanderpool, and Stevens, (2012) said primary infertility is defined as the absence of a live birth for women who desire a child and have been in a union for at least five years, during which they have not used any contraceptives and Secondary infertility is defined as the absence of a live birth for women who desire a child and have been in a union for at least five years since their last live birth, during which they did not use any contraceptives
For a woman, infertility (or a state of subfertility) can manifest itself as either: the inability to become pregnant, an inability to maintain a pregnancy or an inability to carry a pregnancy to a live birth. (WHO, 2014). Gurunath, Anderson and Bhattacharya, (2011), wrote that definitions of infertility differ with demographers tending to define infertility as childlessness in a population of women of reproductive age while the epidemiological
definition is based on ‗trying for‘ or ‗time to‘ a pregnancy, generally in a population of women exposed to a probability of conception. Cowden, (2010) said ―infertility is not an inconvenience; it is a disease of the reproductive system that impairs the body’s ability to perform the basic function of reproduction‖
Prevalence of infertility in developing countries
Global infertility prevalence rates are difficult to determine, due to the presence of both male and female factors which complicate any estimate which may only address the woman and an outcome of a pregnancy diagnosis or live birth. One in every four couples in developing countries had been found to be affected by infertility, when an evaluation of responses from women in Demographic and Health Surveys from 1990 was completed in collaboration with World health organisation in 2004. The burden remains high. A WHO study, published at the end of 2012, has shown that the overall burden of infertility in women from 190 countries has remained similar in estimated levels and trends from 1990 to 2010, (WHO 2014). Only a limited number of papers report on the prevalence of infertility in developing countries. According to Boivin, Bunting, Collins & Nygren (2007), the 12-month prevalence rate ranges from 6.9 to 9.3% in less-developed countries. Substantial geographical differences in the prevalence are noted, and these differences are largely explained by different environmental, cultural and socioeconomic influences.
In sub-Saharan Africa, the prevalence of infertility differs widely from 9% in the Gambia (Biovin et al, 2007,Tabong and Adongo, 2013) and 15% in Ghana (Donkor and Sandall, 2009) compared with 21.2% in northwestern Ethiopia (Haile, 1990, Ombelet et al, 2008) and between 20 and 30% in Nigeria (Larsen, 2000, Ombelet et al. 2008). Even less data are available from Asia and Latin-America, but a report compiled by the World Health Organization (WHO) indicated that the prevalence of infertility in these regions fell within the globally expected range 8 – 12% of couples of reproductive age and was thus lower when compared with African countries (World Health Organisation, 2014). Current estimates of infertility in developing countries are primarily based on demography and health survey (DHS) birth history data and do not include the self reported time to pregnancy question. However these estimates show that primary infertility, or childlessness, remain relatively rare, with rates between 1 – 10 % in woman aged 25 – 49. In contrast, the percentage of women experiencing secondary infertility, or an inability to
produce a live birth after at least one previous birth ranges from 9% – 38 % (Rutstein and Shah, 2004, Dhont et al, 2010). Available data indicate that countries in sub-Saharan Africa have some of the highest rates of infertility in the world. Infertility rates among married couples in African countries range from 15% to 30%, compared to reported rates of 5% to 10% in developed countries. There is now conclusive evidence that much of the infections in Africa are attributable to infections that produce irreversible reproductive tract damage in men and women. In Gabon, for example, more than 30% of couples are infertile at the end of their reproductive lives due to longstanding tubal occlusion in women and occlusion of the vas deferens and/epididymis producing azoospermia in men (Okonofua, 2003). Purefoy and Kermeliotis, (2011), said the prevalence of infertility in Nigeria is about 25%, compared to 10 to 15% in the U.S. and UK.
Causes of Infertility
American Society for Reproductive Medicine,(2012), while expounding the causes of infertility said some factors called ―fertility factors‖ when affected one way or the other are responsible for infertility. These factors include:
CHAPTER THREE
METHODOLOGY
Study Design
A descriptive cross-sectional design was used for the study of men‘s knowledge and perception towards infertility and its management in Ede North Local government Area (ENLGA), Osun State, Nigeria.
Study Area
The study area is Ede North Local Government Area (ENLGA). Ede is an urban town which has two local government areas; Ede South and Ede North Local Government Areas. Ede South Local Government Area (ESLGA) has population of 76,035 consisting of 36,025 males and 40,010 females while Ede North Local Government Area has population of 83,831, consisting of 40,210 males and 43, 621 females (Population, FOS, 2006). Projecting Ede south and Ede North local Government Area to 2015, using yearly 3% increment for its calculation, will make Ede north Local government Area 109,379 males and females and Ede South Local government Area 99,207 people. Ede South Local Government Area has 10 wards, 5 wards at the town and 5 wards at the villages while Ede North Local Government Area consists of 11 wards, all of which are in the town. There are 3 higher institutions of learning (one Federal Polytechnic and 2 private universities), 22 public primary schools and 7 public secondary schools, in Ede town. Also, there are 18 public health institutions (state hospital, comprehensive health centres and primary health centres) and 17 registered private health institutions (specialist hospital, hospitals, clinics, nursing homes, maternity homes and convalescent homes) in the town and people access fertility cares in nearly all the health institutions.
Population for the Study
The target population is the married men in Ede North Local Government Area of Osun state.
CHAPTER FOUR
RESULTS
The results for the both qualitative and quantitative data are presented in this chapter.
Socio- demographic profile of the respondents.
The ages of the respondents ranged from 22 to 80 years with the mean age of 40.1 ± 10.3 years. Almost all the respondents 99.1% were married, 98.7% were Yoruba, 0.6% were Hausa, 0.3% Ibo, and 0.3% others. About two third 69% were Muslims, 35.1% had secondary education and 43.0% were civil servants. Slightly more than half of the respondents 52.3% had 3-5 children. Most of the respondents 81.6% had lived in the community for 7 years and above, 7.3% for 3 to 4 years, 5.7% for people that had lived for 1 to 2 years and 5.4% for 5-6 years. Details are shown in Table 4.1.
Table 4.1: Socio – Demographic Profile of the Married Men ( N = 316)
CHAPTER FIVE
DISCUSSION AND RECOMMENDATION
Socio-demographic characteristics
The age of the respondents ranged from 22 to 80 years which falls within the reproductive age of the married men in Ede North Local Government Area. The communities were also dominated by Islam as a religion, having majority of the respondents as Muslims, a similar findings was documented by Sumera, Raafay, Ayesha, Faisal, Syed. F, Annum and Syed Farid-ul-Hasnain, (2011).
Perception of married men about infertility
Few of the respondents perceived that men are responsible for infertility problems, a finding that was at variance with the study carried out by American Society for Reproductive Medicine (2012) which shows that in approximately 40% of infertile couples, the male partner is either the sole or a contributing cause of infertility. This opinion might not be unconnected with cultural perspective that usually put the blame on the female partner. About half of the respondents disagreed that infertility is caused by witches and witchcrafts this may be due to the religion which they practice and their level of education, as this was at variance with the documentation of Sumera et al (2011) and Tabong and Adongo (2013). Sumera et al (2011) stated that there is a prevalent belief in the society that infertility can be caused by supernatural causes like jinn (evil spirits) and black magic. To know about people‘s views on these beliefs, two options were included in the list of causes of infertility. It was found that one third of the people interviewed, believed jinns to be a cause of infertility while almost two fifth believed that black magic could be a cause of infertility. Whereas in Tabong and Adongo, (2013) findings, some respondents; one third believed that if the female is not able to conceive, she may be possessed by an evil spirit. The less educated participants were more likely to attribute the causes of infertility to evil forces or supernatural power, outside human control because some of the respondents agreed that infertility is caused by witches and witchcraft.
It was also perceived in the study that watery sperm can also lead to men becoming infertile. Majority of the respondents in the study also stated that eating certain foods like okra cannot cause infertility in men, this does not corroborate with the study carried out by Olatunji-Bello, Ijiwole and Awobajo (2009) which evaluated the deleterious effects of aqueous fruit extract of Abelmoschus esculentus (okra fruit) on some male reproductive parameters in Sprague dawley rats. The study showed that there was a reduction in the weight of the testes of treated rats, secretion of testosterone and sperm production (spermatogenesis). It was also stated further that several vegetables that are eaten or used for medicinal purposes have been reported as having effects on both male reproductive functions. These include aqueous extract of Spondias mombin bark, referred to as Iyeye among the Yoruba speaking communities. Others are water extracts of seeds of Ricinus communis and pawpaw as well as neem.
Most of the respondents in this study agreed that infertility has more negative effects on women than men, because it is believed that women that are infertile had lived wayward lives, some may even be speculating that such person‘s womb has been removed. This is in line with the focus group session conducted by Tabong and Adongo (2013) in Northern Ghana where it was reported that ―the highest biological factor that has been blamed for infertility among females was previous use of contraceptives. This was also directly attributed to past promiscuous lifestyle of the woman as the contraceptives were used to prevent unwanted pregnancies‖. Most of the respondents disagree on inheriting infertility from parents. This is at variance with the study conducted by the America Society for Reproductive Medicine study (2011), which documented that some men and women may carry genetic abnormalities that make it more difficult to become pregnant and more likely that a pregnancy ends in a miscarriage.
Perception of married men towards the management of infertility.
As regards the aspect of management, majority believed that if it is properly managed the couples can achieve pregnancy and this corroborates the findings of Sumera et al (2011), where nearly all the respondents believed that couple should seek treatment for infertility. The respondents also believe that spiritual means is the best way to treat infertility problems, this was in support with the study conducted by Daniluk (2001), in Tanzania where the use of spiritual means to solve infertility eventually leads to practices of
spiritual methods ranging from the post coital exercise of standing on one‘s head to the unpleasant and dangerous traditional remedies of eating feces and inducing vomiting. Daniluk study also opposed the response of some respondents that the only way of managing infertile couple is through medical treatment. In this study, the respondents also said that is easier to manage infertility in men than in women because cost of management is higher in women. They also spoke further on the person who always carries the blame for infertility within the society; the respondents said mostly, women are blamed for infertility. Probably due to the cultural belief that men are created complete and that woman is the main cause of infertility.
Respondents Knowledge on the causes of infertility
Infertility was also seen as a minute problem since it can be treated which corroborates the American Society for Reproductive Medicine study, (2011); which stated that the factors affecting fertility are easily detected and treated. Respondents‘ knowledge of diseases such as urinary tract infections, gonorrhea, and diabetes being causes of infertility, upheld previous findings reporting same (Tabong and Adongo 2013). Knowledge on the relationship between STIs and blocked tubes was high as it was unanimously agreed in FGD and cited in in-depth interviews. Participant mentioned gonorrhoea, syphilis and Chlamydia infections as common causes of infertility in the community because of the sexual promiscuity that is rampant in the society.
Majority of the respondents, agreed that unsafe abortion can lead to infertility and this corroborates the qualitative study carried out by Tabong and Adongo (2013), where it was reported that abortions in all forms (safe and unsafe) are believed to cause infertility, most especially those conducted by unqualified individuals. This finding stemmed from the cultural belief that, all women are born with a fixed number of children to conceive and when these children are aborted, they believe the consequential effect is infertility. However, men are believed not to have such fixed number of children and are therefore capable of producing uncountable number of children. One of the causes of infertility that the respondents supported was the one caused by low sperm count. This was also supported by studies which revealed that most common cause of male infertility is due to a problem in the sperm production process in the testes. About two thirds of infertile men have sperm production problems. Low numbers of sperm are made and/or the sperm that are made do not work properly McLachlan (2001).
Knowledge on prevention of infertility
Knowledge of health education on reproduction and sexual life for teenagers and sexual counseling were reported as key strategies to preventing infertility, a findings that corroborates those of Tabong and Adongo (2013) and Centre for Disease Control (2010): The importance of education was documented by Tabong and Adongo (2013) qualitative study, which shows that the prevention of infertility was also unanimous and education was seen as the core preventive strategy especially for the younger generation as many of the perceived causes are consequences of illicit behaviours during youth. Some respondents, during the FGD suggested that drugs used for abortion should be banned even though there were other herbs that were believed to be capable of inducing abortion, which are believed to be relatively safer than medical abortificients. Early treatment of sexually transmitted diseases has been proved to be effective in the treatment of infertility.
Conclusion
In conclusion, childbearing and family are considered a right of every human being. Infertility is a health problem that requires appropriate treatment strategy and modern medical science has developed advanced therapies to assist reproduction over the last 20 years, (Roupa et al 2009). So community-based health education programmes should be organised using existing male platforms to promote right perception of respondents with regards to early diagnosis and management of infertility in Ede North Local Government Area.
Recommendation:
In this study, most men believe that infertility cannot be from men instead it is believed that women are the major causes of infertility. The following recommendations for perception of married men are made.
- The need for health education in re-orientating the men that women are not the only major causes of infertility, men are also be responsible most of the time.
b.It was mentioned that some of the sexually transmitted infections such as gonorrhea and urinary tract infection can cause infertility. Therefore, the need to educate the general public about safer sex and avoidance of multiple sex partners to prevent sexually transmitted infections is crucial.
The link between poorly managed STIs and infertility should be highlighted.
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