19 June 2017

Tanzania: The Quest to Solve a Failed Conception


As a general practitioner, I meet patients and people of all sorts. From children, mothers, to male adults. I have personally encountered several women who come with queries and problems of infertility. Most of them try to solve the problem first through pastors, traditional healers and at last they may resort to acquiesce into the idea of going to a doctor.

One such case was Elizabeth's who came at the Out-Patient Department (OPD) at the hospital where I work, purported to have come to check if she was pregnant or not. Unfortunately, when the results came out negative, she decided to open up to me about her story.

She said, "Dokta naomba nikuambie ukweli (doctor, let me tell you the truth), you know it's been five years since I got married, but every time we [my husband and I] attempt to conceive, we do not succeed.There was a time when I tried to have sex with another man, surprisingly, I got pregnant, but I didn't tell my husband that the pregnancy was not his. It's unfortunate that the pregnancy didn't survive, I got a miscarriage in the second month."

Despite Elizabeth encouraging her husband to visit a clinic for a fertility check-up, he refuted by saying that he had once impregnated a girl during his secondary school years, and assures that he is not the one who is infertile. Is this not a vile attitude?

She further narrates, "There was a time I advised my husband to allow me to have sex with a fertile man in our vicinity, so that I can just get a baby. I must get a baby regardless of the baby's paternity. Though I still love him, he doesn't allow me to do that. However I want to try to get pregnant through my concubine."

She pleaded, "Dokta naomba unishauri nifanyeje?"

Self-diagnosis by cheating

Just like Elizabeth's case, some women have resorted to desperate means to cheat on their partners by having sex with another man as a means of ruling out infertility problems. But does the approach hold water ?

Experts define infertility as a failure to conceive after 12 months of regular penetrative sexual intercourse without the use of contraceptive methods.

A key issue that many couples wish to know is if a woman doesn't conceive, what might be the cause of the problem. Many do think that the underlying cause must be of the woman and not men, is this what we call in Swahili "mfumo dume" (male chauvinism)? Probably not.

Studies indicate that slightly over a half of all cases of infertility are a result of female conditions. According to Mayo Clinic, it is said that in USA about 40-50 per cent of cases of infertility are due to a problem in woman and about 30-40 per cent in both men and women and about 20 per cent of cases of infertility are to problem in men. In USA about 10-15 per cent of couples are infertile. Do we really have such documented data in Tanzania for both men and women?

Many infertility cases are treatable, but not all. Here I must emphasise that infertility may have a single cause in one of the partners or it could result in a combination of factors.

What causes infertility in female?

There are a number of possible causes; it is very unfortunate that in 1/3 of the infertility cases, no cause is ever identified.

- Ovulation problems, which is the monthly release of egg, popularly known as "kupevuka kwa yai" in Swahili. The problem occurs where by in some cases , a woman doesn't release an egg.

- Probelms in the uterus or fallopian tubes. An egg usually travels from the ovary to the uterus (womb) where the fertilized egg grows, thus if there is something amiss in the uterus or fallopian tubes, the woman may not be able to conceive naturally. This may be due to scars formation after pelvic surgery or fibroids, endometriosis, fallopian tube blockage due to infections or previous sterilisation.

- Other causes may include, thyroid gland problems, AIDS, cancer, long use of some medication, chemotherapy, radiations, illegal drugs such as marijuana.

Risk factors

Risk factors for infertility include, smoking, alcohol consumption, being obese, being a vegan, over-exercising (exercising more than 7 hours a day), not exercising at all, sexually transmitted diseases and exposure to some chemicals such as pesticides, herbicides.

"Wanaume hawazeeki" , this is a Swahili street clinical aphorism with regards to fertility. But what about women?

It is said that a woman's fertility begins to drop after she is 32 years of age and continues doing so.

So does mens' fertility decline with age? It is said that a 50-year-old man is usually less fertile than a man in his 20's (male fertility progressively drops after the age of 40). That's veridical, though bad news ?

Additionally being obese or overweight and a sedentary lifestyle are often found to be the principle causes of female infertility, however, an overweight man has a higher risk of having an abnormal sperm.

Studies indicate that female ovulation and sperm production may be affected by mental stress production.

If at least one partner is stressed; it is possible that the frequency of sexual intercourse is less, resulting in lower chances of conception.

My word of advice to the couples

It takes two to make a baby, thus it is prudent for both female and male parents to see a doctor together. Sadly, you will seldom find this tendency gaining ground in Tanzania.

Then a doctor, after running an initial clinical assessment will order some tests. During that time I would advise my esteemed readers to be committed and persevere as it may take a long time to plan a baby again, even after testing.

Tests may include certain exams like seminal analysis (male), blood tests, ultrasound, chlamydial test or thyroid function tests.

No specific cause is ever found for 30 per cent of the infertility cases.

The author is a medical doctor, public health activist and a researcher.


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