Pregnancy Awareness Week

Reproductive health involves the maintenance of an individual's reproductive health system and fertility. When we talk about reproductive health, we can refer to a wide range of issues such as birth control, sexually transmitted diseases (STIs) and your ability to become pregnant. Factors such as your overall health, your lifestyle and your age all influence your reproductive health.

This month we turn our attention to infertility, an aspect of reproductive health which is not often talked about. As your medical aid, GEMS believes that we have a responsibility to inform you about these kinds of issues, especially as having children is such an important part of life for most people.

Wanting to start a family
Khaya (36) and Sipho Zidwala (38)* had been married for three years when they decided that they wanted to grow their family and start trying for a baby. Khaya hoped for a girl who she could dress up in pretty clothes and Sipho longed for a little boy who he could teach how to play soccer. But after a year of trying for a child, Khaya still wasn't pregnant. She knew that her age might be a factor in her not falling pregnant immediately, as she had read a health article in a magazine which said that women over the age of 35 could have difficulty falling pregnant.

Khaya and Sipho thought that it was important to consult a medical practitioner for assistance and so they made an appointment with Khaya's gynaecologist, Dr Ingrid Pillay*. Dr Pillay told them it was possible that one or both of them may be infertile. Infertility, she said, was when a couple was not able to get pregnant even though they were having frequent, unprotected sex for at least a year, as in the case of the Zidwalas.  She noted that it was important for a woman to consult with her doctor if:

• She is 35 to 40 and has been trying to conceive for six months or longer
• She is over 40, so that she can begin testing or treatment right away
• She menstruates irregularly or not at all
• Her periods are very painful
• She has been diagnosed with endometriosis or pelvic inflammatory disease
• She has had more than one miscarriage
• She has known fertility problems
• She has had prior cancer treatment

Dr Pillay also noted that it was important for a man to talk to his doctor if:

• He has a low sperm count or other problems with sperm
• He has a history of testicular, prostate or sexual problems
• He has had prior cancer treatment

Risk factors that can prevent pregnancy
Dr Pillay explained that the risk factors which contributed to a couple's infertility included the following aspects:

• Age - a woman's fertility declines with age, especially from her mid-30s. This is due to the number and quality of her eggs declining and to health problems that may interfere with fertility. In addition, men over age 40 may be less fertile than younger men are.
• Being overweight - If a woman is overweight and has a sedentary lifestyle with little exercise, this may increase the risk of infertility. In addition, a man's sperm count may be affected if he is overweight.
• Being underweight - Women who have eating disorders, such as anorexia or bulimia, are at risk of fertility problems, as are women who follow a very low calorie or restrictive diet.
• Tobacco use - if either partner is a smoker, a couple's chances of falling pregnant is reduced. Miscarriages are more frequent in women who smoke. Smoking can increase the risk of erectile dysfunction and low sperm count in men.
• Alcohol use - drinking alcohol increases the risk of birth defects in babies, and may also make it more difficult to become pregnant. For men, heavy alcohol use can cause a decrease in sperm count and mobility.
• Medication - the side effects of some medication can affect one's fertility. This is why it is important for both partners to mention any non-prescription medication they are taking, including herbal medicines, to their doctor so that alternative treatment options can be discussed.

Khaya realised that one of the reasons she may not be falling pregnant is because she was about 10 kilograms overweight and did not exercise regularly. She also admitted that she drank alcohol about four times a week, and so could cut down on her alcohol usage. Sipho was a heavy drinker, and a smoker. The Zindalas acknowledged that they could make a few significant changes to their lifestyles to help increase their chances of falling pregnant.

Treatment options
Dr Pillay told the Zindalas that 10 to 15% of couples are infertile but explained that there were many safe and effective therapies for overcoming infertility which significantly improved a couple's chances of becoming pregnant.

She noted that, in men, fertility is treated with:

• Surgery
• Antibiotics - to treat infections of the reproductive organs
• Medications and counselling - to address issues with erections or ejaculation
• Hormone treatments - to treat low or high level of certain hormones

Dr Pillay then explained that infertility in women is addressed with:

• Fertility drugs and hormones - to help the woman ovulate or restore levels of hormones
• Surgery - to remove tissue that is blocking fertility (such as endometriosis) or to open blocked fallopian tubes

Dr Pillay noted that infertility in men and women could also be treated with assisted reproductive technology, or ART, of which there were several types:

• IUI (intrauterine insemination) - this is where sperm is collected and placed directly inside the woman's uterus while she is ovulating.
• IVF (in vitro fertilisation) - here, the sperm and egg are collected and brought together in a laboratory. The fertilised egg grows for a few days and the embryo is then placed in the woman's uterus.
• GIFT (gamete intrafallopian transfer) and ZIFT (zygote intrafallopian transfer) - the sperm and egg are collected, brought together in a laboratory, and placed in a fallopian tube.

A happy ending
Dr Pillay advised that Khaya and Sipho make a few important lifestyle changes over the next three months as a first step in treatment. Sipho stopped smoking and both limited their alcohol consumption. Khaya also embarked on an eating and exercise plan. Within two months, they were overjoyed when Khaya fell pregnant and nine months later little Thula was born, weighing in at a healthy 3.2 kilograms and delivered by Dr Pillay.

Not all problems with infertility are solved as easily, however. If you have been trying to conceive for a year, then GEMS recommends that you consult your GP or gynaecologist for professional medical advice. Women over the age of 35 should consult a doctor if they have been trying to get pregnant for six months and women over the age of 40 wishing to have a child should visit their doctor immediately.

*Names have been changed to protect the privacy of the individuals.

References
The Daily Courier: www.dcourier.com
Mayo Clinic: www.mayoclinic.com
National Health Service: www.nhs.uk
Web MD:  http://www.webmd.com/