Infertility is typically defined as the inability to achieve pregnancy after one year of unprotected intercourse.Worldwide more than 70 million couples suffer from infertility, affecting up to 15% of the couples in their reproductive age.
In Africa, the situation is worse. WHO demographic studies from 2004 have shown that in sub-Saharan Africa, more than 30% of women aged 25–49 suffer from secondary infertility, the failure to conceive after an initial first pregnancy.
Causes of Infertility
Main cause of infertility in Africa is the result of genital infection, which may have been sexually transmitted, or caused by traditional practices, such as female genital mutilation or unsafe abortions and home deliveries in unhygienic circumstances. These infections, if left untreated often result in bilateral tubal occlusion.
Other causes of infertility include ovulatory dysfunction (approximately 20%), for example in poly cystoid ovary syndrome (PCOS), diabetes and or in severe obesity. In a significant number of cases no cause for infertility can be diagnosed.
Diagnosis of Infertility
Standardized investigation of the couple should include accurate history taking, physical examination, screening for infections and STDs (VDRL, Chlamydia, Hepatitis B and C and HIV), gynecological ultrasound of uterus and ovaries, hysterosalpingography to determine fallopian tube patency and semen analyses incl. calc IMC, inseminating motile count. On indication hormonal tests such as (3rd day) Estrogen, FSH, LH and Progesterone for the female and Testosterone for the man could be done. Other tests may include Thyroid hormone and Prolactine.
Because of the wide range of psychological and social implications, counseling, education and guidance is an important part of the process of infertility investigation and treatment. The couple should be well informed of their chances and possibilities, possible consequences of the treatment and the importance of compliance. Both men and women should be involved; scenarios of success as well of failure of treatment should be discussed with them.