The Basic Facts About Infertility

Infertility, whether male or female, can be defined as "the inability of a couple to achieve conception or to bring a pregnancy to term after a year or more of regular, unprotected intercourse". The World Health Organization (WHO) estimates that approximately 1 in 4 couples experience some form of infertility problem. However, the incidence of infertility may vary from region to region. In Nigeria, the prevalence is estimated between 20 and 25 percent among married couples, according to experts. However, 40 to 45 percent of all consultations in gynaecological clinics are infertility-related.

Male infertility/female infertility

The incidence of infertility in men and women is very similar. Infertility is exclusively a female problem in 30-40% of the cases and exclusively a male problem in 30 - 40% of the cases. Problems common to both partners are diagnosed in 5 – 10% of infertile couples, After thorough medical investigations, the causes of the fertility problem remain unexplained in only a minority of infertile couples (5-10%).

Approximation of infertility in females:

Condition Average Percentile
Tubal blockage and or peritoneal factors Approximately 35%
Irregular or abnormal ovulation Approximately 25%
Endometriosis Approximately 30%
Unexplained Infertility Approximately 10%
Normal fertile couples = 25% chance to conceive during each menstrual cycle

This simply means that when we consider success rates for any type of infertility treatment, the average chance to conceive for a normal fertile couple having regular unprotected intercourses, is around 25% during each menstrual cycle. It has also been estimated that 10% of normal fertile couples fail to conceive within their first year of attempt and 5% after two years.

Effective treatment = up to 25% per cycle of treatment

It is important to note that effective treatments can be expected to have on average up to a 25% success rate per cycle of treatment when compared to normal cycles and may therefore need to be repeated several times before a pregnancy is achieved. Simple ovulation induction to compensate for hormonal imbalances has a very high success rate more than 80% of women suffering from such disorders are likely to conceive after several cycles of treatment with drugs such as clomiphene citrate or gonadotrophins.

Factors influencing the success of a treatment

In any type of infertility treatment, important factors need to be taken into account when referring to success rates. The age of the woman and the duration of the couple's infertility are likely to influence the success of treatment. In women, the quality and quantity of eggs decreases as age increases, particularly after 40 years of age. When the woman is being treated, her chances of conceiving can be lessened if her partner also has infertility problems (e.g. poor quality sperm).

Success rates of IVF equal or superior to 25%

Success rates for IVF have steadily improved over the last ten years globally. Our team at Lifelink Fertility Center (LFC) have over the years been able to achieve success rates ranging from 40% – 65% with cycle to cycle variation, and with our international and local collaborators we expect this to rise over the coming years.

Natural Conception Process

The natural conception i.e. fertilization, takes place in the lateral part of the Fallopian Tubes. Following an intercourse, the spermatozoa will swim up into the tubes via the cervical canal. After the fertilization, the fertilized embryo will take its journey down the tubes and enter the uterine cavity 4 days later. At this time the embryo has cleaved and comprises more than 100 cells. At day 6 after fertilization, the embryo, now called the blastocyst, will be implanted into the uterine wall.

Causes of Infertility

A woman less than 35 years old, having timed unprotected intercourse within the first one year or a woman older than 35 years having timed unprotected intercourse within the last six months would require evaluation by a fertility specialist. However, infertility is a challenge that affects the couple and as such both partners need to be screened. This is even more so, as infertility has been found to be dependent on the age of the woman and the couple’s general health and life style. The methods used for infertility treatment have improved immensely throughout the last 10 - 20 years. Today, there is a better understanding of the causes and treatment of infertility. The causes of infertility can be due to female, male, combined or unexplained factors.

Female Infertility:

Female infertility, may be caused by one of the following:
  • Ovulation disorders
  • Tubal blockage
  • PCO – Polycystic ovary
  • Endometriosis

Ovulation Disorders:

Ovulation Disorders: Inability or the reduced frequency to ovulate, occurs in about 25% of infertile couples resulting from problems with the regulation of reproductive hormones by the hypothalamus or the pituitary gland, or problems in the ovary.

What Causes Lack of Ovulation:

Anovulation and ovulatory dysfunction can be caused by a number of factors. The most common cause of ovulatory dysfunction is polycystic ovarian syndrome, or PCOS. Other potential causes of irregular or absent ovulation, premature ovarian failure.

Most of the hormonally dependent disorders can be corrected by a proper hormonal treatment such as mild stimulation etc. This stimulation is often followed up by intrauterine insemination or IVF.

Polycystic ovarian syndrome (PCOS) is a condition in which small follicles in the ovaries don't develop into the larger, mature follicles that release eggs. It's also characterized by hormone imbalances and unpredictable ovulation patterns. Possible symptoms: irregular periods, excessive hair growth, acne, and obesity. The treatment is often a combination of a specific diet, physical activities, metformin and possibly also ovarian stimulation in combination with intrauterine insemination or IVF

Tubal Blockage

Fallopian Tube Obstruction is a major cause of female infertility. Blocked fallopian tubes are unable to let the ovum and the sperm converge, thus making fertilization impossible. Fallopian Tubes are also known as oviducts, uterine tubes, and salpinges (singular salpinx). The only way to become pregnant with blocked tubes is to bypass this blockage. This is done by Invitro fertilization (IVF) where the oocytes is taken out from the ovaries and the fertilization done outside the woman’s body. After fertilization the embryos are placed back into the uterus.

Endometriosis

Endometriosis is a common disorder that affects the tissue that lines the uterus, causing it to grow outside the uterine cavity. The tissue becomes attached to reproductive or abdominal organs, and swells with blood during menstruation as if it were still in the uterus. Women can be treated medically or surgically:
  • Medically: Ovulation can be blocked, or the menstrual cycle can be stopped for four to six months.
  • Surgically: Laparoscopy or laparotomy can be performed to cauterize the endometrial implants to destroy the endometriosis.

Symptoms of endometriosis are typically:

  • Pain prior to and during menstruation
  • Pain at the ovulation
  • Pain during coitus
  • Infertility

Even endometriosis without pain or symptoms for the women can cause infertility. Due to the different distribution of the endometriosis and the severity several different treatment strategies can be taken. Very often endometriosis is removed by laparoscopy or hormone treatment before ovarian stimulation for insemination or IVF.

Male Infertility

Poor sperm quality is usually caused by:

  • Compromised sperm production in the testis
  • Compromised transport of the spermatozoa

The reason for this can be:

  • Non-descended testicles
  • Infections
  • Fever
  • Testicular cancer
  • Antibodies in the sperm cells

Compromised sperm production in the testis

The man first discovers the bad sperm production, when he is investigated for infertility. LFC offers men, Fertilink Profile male (put a link to fertilink profile male)) . There are no other symptoms associated with this condition. Non-descended testicles is a major cause of male infertility where the testis arrive late into the scrotum. This can cause reduced sperm production considerably. The process may require surgical or medical intervention by urologists.

Infections

Infections like chlamydia or gonorrhea can result in a blockage of the passage of sperm cells in the epididymis or the sperm duct. Mumps in grown-up men can lead to sterility because the sperm producing tissue is destroyed. This can however be resolved by surgical or medical intervention by urologists. Fever High fever (even for short periods) can reduce the sperm quality for up to 3 months. Therefore, if the man has suffered from fever, the semen sample should be checked before procedure.

Testicular cancer

Today, we know that men with very low sperm count have over 40% higher risk of getting testicular cancer, and it is advisable that Doppler scans be done for them.

Chromosome Failure in the man

This occurs in about 2% of the infertile male population with severe low sperm production. Blood tests should be done for proper screening. This can be done through Fertilink Profile Male

Antibodies against the spermatozoa

This situation is often seen after trauma and male sterilization. In some cases, the sperm mobility, although the sperm is perfectly normal, is compromised by antibodies against the sperm cell. This will immobilize the spermatozoa and make the man infertile.

Treatment of male infertility

In moderate oligospermia, intrauterine insemination is used. In severe cases the only treatment is micro insemination. Azospermia, (no sperm) TESA is performed.

Other FAQ’S

1.

Should my husband come with me on the first visit?

Ans: As mentioned above, when treating infertility it is essential that the couple is treated together, as you both complement each other. On the backdrop of this YES….it is advised that you come in as a couple.

2.

Why should we choose LFC?

Ans: We are Nigeria's premium fertility clinic and as such we are poised to give all our clients the best possible chance of achieving a pregnancy within the shortest possible time. Our team over the years have successfully assisted with the birth of numerous healthy babies. We pride ourselves in client centric treatments that are safe, using best practices and quality management systems to ensure minimal risks to both you and your unborn child. We have a full complement of top medical expertise with state of the art equipment. We work and walk with you every step of the way.

3.

What kind of support is available for me at LFC?

Ans: Throughout treatment you have a care partner, doctor, nurse and counselor to support your every need. We have also come to realize that sometimes the best support comes from those who have been through the treatment themselves so, we also offer support from couples who have undergone treatment at Lifelink Fertility Clinic through a group called Lifelink haven

4.

Do Fibroids affect IVF?

Ans: To help you answer this question you would be reviewed by our gynecologist / fertility specialist. A detailed ultrasound scan which clearly shows the location and size of the fibroid would be carried out and this would ensure the best and safest treatment plan is obtained.

5.

What is OHSS (Ovarian hyperstimulation syndrome)?

Ans: Ovarian Hyper stimulation Syndrome is one of the most common complications of IVF. If it is not aggressively prevented and managed it could be life threatening. At LFC we minimize the risk of the development of OHSS by implementing safe mild stimulation protocols.

6.

Is IVF treatment painful?

Ans: Most of the procedures in IVF treatment are not painful. For those that may experience slight discomfort, pain relief is administered.

7.

How many embryos are transferred?

Ans: At LFC we transfer a maximum of 2 embryos to minimize the risks of multiple pregnancies and to ensure the safety of both you and your unborn child.

8.

How can I be sure the embryos are mine?

Ans: At LFC we have strict quality and safety systems in place (IEGC – Individualized Electronically Generated Coding) to minimize any risk and prevent ‘gamete mix-up’ so you can be assured your baby is indeed yours. For further reassurance, please feel free to speak to any of our specialists directly.

9.

Are children born from IVF normal?

Ans: The answer is a resounding YES…. children born through IVF are absolutely normal. The vast majority (99.999%) of children born following ICSI are also normal.

10.

Are there any side effects from taking IVF drugs?

Ans: You may experience a few common side effects when taking IVF drugs during treatment. These side effects are similar to those experienced in menopause such as hot flushes, some dizziness, headaches, weight gain and so on. These effects are short lived and are usually gone once you have finished taking the drugs.