By Lilian Nuwabaine Luyima

Globally, every human being has a right to the enjoyment of the highest attainable standard of physical and mental health.

Individuals and couples at large have the right to decide the number, timing, and spacing of their children.

Infertility can negate the realisation of these essential human rights. Addressing infertility-related issues is, therefore, an important part of realizing the right of individuals and couples to form a family.

Care and treatment for infertility in couples in Africa is a serious problem. In Africa,” marriage”, whether traditional or modern has little chance of being stable if the union does not produce children. For a Ugandan and African in general, children are regarded as a source of strength, pride, social confidence, assurance in old age and guarantee of the continuation of the family line.

As such, infertility may work as a painful emotional experience that can cause a lot of psychological issues including stress, anxiety, depression, diminished self-esteem, declined sexual satisfaction and reduced quality of life.

In turn, the resulted psychosocial issues affect the female gender adversely more than her spouse especially in societies where there are prejudices against women like in Uganda and Africa.  

As such, an infertile woman may show a relatively high level of frustration and anger which mostly affects her relationship with her family, friends and even her spouse. Likewise, available literature shows that infertile women are more likely to develop mental illnesses, marital dissatisfaction and impaired quality of life compared to their counterparts of the fertile groups.

According to the World Health Organisation (WHO), infertility is a disease of reproductive system defined by failure to achieve the clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. Infertility can be classified as primary or secondary. According to WHO, primary infertility is used when a woman has never conceived and secondary infertility is the incapability to conceive in a couple who have had at-least one successful conception in the past. It is very important for us to note that infertility can be attributed to anomalies associated with either male or female reproductive systems or with both partners. However, sometimes, it’s not possible to explain the causes of infertility.

Some of the causes of male infertility include;

1. Obstruction of the reproductive tract causing dysfunctionalities in the ejection of semen. This blockage can occur in the tubes that carry semen such as ejaculatory ducts and seminal vesicles. Blockages are commonly due to injuries or infections of the genital tract.
2. Hormonal disorders leading to abnormalities in hormones produced by the pituitary gland, hypothalamus and testicles. Hormones such as testosterone regulate sperm production. Example of disorders that result in hormonal imbalance include pituitary or testicular cancers.
3. Testicular failure to produce sperm, for example due to varicoceles or medical treatments that impair sperm producing cells such as chemotherapy.
4. Abnormal sperm function and quality from conditions or situations that cause abnormal shape and movement of the sperm negatively affect fertility.

In the female reproductive system, infertility may be caused by:

1. Tubal disorders such as blocked fallopian tubes which are in-turn caused by untreated sexually transmitted infections (STIs) or complications of unsafe abortions, postpartum sepsis or abdominal/pelvic surgery.
2. Uterine disorders which could be inflammatory in nature such as such endometriosis, congenital in nature such as septate uterus, or benign in nature such as fibroids.
3. Disorders of the ovaries such as polycystic ovarian syndrome (PCOs) and other follicular disorders.
4. Disorders of the endocrine system of hypothalamus and the pituitary glands causing imbalances of reproductive hormones. Examples of common disorders affecting this system include pituitary cancers and hypopituitarism.

It is also important for us to note that environmental and lifestyle factors such as smoking, excessive alcohol intake and obesity can affect fertility in both men and women. In addition, exposure to environmental pollutants and toxins can be directly toxic to gametes (eggs and sperm) resulting in their decreased numbers and poor quality leading to infertility.

With that, health policies need to recognize that infertility is a disease that can often be prevented, thereby mitigating the need for costly and poorly accessible treatments. Incorporating fertility awareness in the national comprehensive sexuality education programmes, promoting healthy lifestyles to reduce behavioral risks, including prevention, diagnosis and early treatment of STIs, preventing complications of unsafe abortion, postpartum sepsis and abdominal/pelvic surgery, and addressing environmental toxins associated with infertility are policy and programmatic interventions that all governments including Uganda can implement. In addition, enabling laws and policies that regulate third party reproduction and Assisted Reproduction Technology like IVF are essential to ensure universal access without discrimination and to protect and promote the human rights of all parties involved.

The writer is a BSc Nurse and MSN-Midwife and Women’s Health Specialist working with Aga Khan University as the Continuous Professional Development Coordinator