Well-meaning friends and relatives may suggest "infertility is all in your head" or "if you'd stop worrying so much, you'd get pregnant. In fact, one or more physical causes are identified in the vast number of infertile couples. So while relaxing, going on vacation, or finding positive ways to de-stress can improve your overall well-being, these lifestyle changes won't solve your infertility problems.
New methods of diagnosing and treating infertility have improved many couples' chances of having a baby. According to the American Society for Reproductive Medicine ASRM , more than half of all couples who pursue treatment will achieve a successful pregnancy.
On the other hand, it's important to remember that infertility is a medical disease and that problems sometimes remain untreatable -- no matter how hard a couple "works" at solving them. This particular myth is not only painful for infertile couples to hear, but it's also untrue.
First of all, it suggests that adoption is simply a means to an end a pregnancy , and not, in and of itself, a valid and wonderful way to form a family. Secondly, only about 5 percent of couples who do adopt later become pregnant.
This success rate is the same for couples who don't adopt and become pregnant without further treatment. As stated earlier, infertility is a medical condition that affects both men and women equally.
In fact, about 40 percent of the time, the male partner is either the sole or contributing cause of infertility, according to ASRM. While many couples do find the process of infertility testing and treatment rigorous, stressful, and intrusive not to mention costly , they do get through it -- together.
Many partners also find new and deeper ways of relating to each other and discover that their marriage has become even stronger.
Being unable to conceive a much-wanted child or carry a pregnancy to term can fill a couple with sadness, grief, anger, despair, and even a sense of personal failure.
While it's normal for infertile couples to experience a range of powerful emotions, most people do move through this life crisis successfully and gradually put it into better perspective. For some couples, "moving on" means letting go of their initial dreams of having a baby. Other couples decide to adopt. But in either case, couples do learn that there is life after infertility and find myriad ways to fulfill themselves -- with or without children.
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Infertility Infertility means not being able to get pregnant after one year of trying or six months if a woman is 35 or older. What is infertility? Pregnancy is the result of a process that has many steps. To get pregnant: A woman's body must release an egg from one of her ovaries ovulation.
The egg must go through a fallopian tube toward the uterus womb. A man's sperm must join with fertilize the egg along the way. The fertilized egg must attach to the inside of the uterus implantation. Infertility can happen if there are problems with any of these steps. Is infertility a common problem? Is infertility just a woman's problem? What causes infertility in men? This happens when the veins on a man's testicle s are too large. This heats the testicles. The heat can affect the number or shape of the sperm.
Other factors that cause a man to make too few sperm or none at all. Movement of the sperm. This may be caused by the shape of the sperm. Sometimes injuries or other damage to the reproductive system block the sperm. What increases a man's risk of infertility? Some things that may reduce the health or number of sperm include: Heavy alcohol use Drugs Smoking cigarettes Age Environmental toxins, including pesticides and lead Health problems such as mumps, serious conditions like kidney disease, or hormone problems Medicines Radiation treatment and chemotherapy for cancer.
What causes infertility in women? Less common causes of fertility problems in women include: Blocked fallopian tubes due to pelvic inflammatory disease , endometriosis , or surgery for an ectopic pregnancy Physical problems with the uterus Uterine fibroids , which are non-cancerous clumps of tissue and muscle on the walls of the uterus. What things increase a woman's risk of infertility? Many things can change a woman's ability to have a baby.
These include: Age Smoking Excess alcohol use Stress Poor diet Athletic training Being overweight or underweight Sexually transmitted infections STIs Health problems that cause hormonal changes, such as polycystic ovarian syndrome and primary ovarian insufficiency. How does age affect a woman's ability to have children? Aging decreases a woman's chances of having a baby in the following ways: Her ovaries become less able to release eggs She has a smaller number of eggs left Her eggs are not as healthy She is more likely to have health conditions that can cause fertility problems She is more likely to have a miscarriage.
How long should women try to get pregnant before calling their doctors? So, women should talk to their doctors if they have: Irregular periods or no menstrual periods Very painful periods Endometriosis Pelvic inflammatory disease More than one miscarriage It is a good idea for any woman to talk to a doctor before trying to get pregnant.
How will doctors find out if a woman and her partner have fertility problems? A woman can track her ovulation at home by: Writing down changes in her morning body temperature for several months Writing down how her cervical mucus looks for several months Using a home ovulation test kit available at drug or grocery stores Doctors can also check ovulation with blood tests.
Doctors inject a special dye into the uterus through the vagina. This dye shows up in the x-ray. Doctors can then watch to see if the dye moves freely through the uterus and fallopian tubes. This can help them find physical blocks that may be causing infertility. Blocks in the system can keep the egg from moving from the fallopian tube to the uterus.
A block could also keep the sperm from reaching the egg. Laparoscopy lap-uh-ROS-kuh-pee : A minor surgery to see inside the abdomen. The doctor does this with a small tool with a light called a laparoscope LAP-uh-roh-skohp. She or he makes a small cut in the lower abdomen and inserts the laparoscope. With the laparoscope, the doctor can check the ovaries, fallopian tubes, and uterus for disease and physical problems. Doctors can usually find scarring and endometriosis by laparoscopy.
How do doctors treat infertility? Doctors recommend specific treatments for infertility based on: Test results How long the couple has been trying to get pregnant The age of both the man and woman The overall health of the partners Preference of the partners Doctors often treat infertility in men in the following ways: Sexual problems: Doctors can help men deal with impotence or premature ejaculation.
Too few sperm: Sometimes surgery can correct the cause of the problem. In other cases, doctors surgically remove sperm directly from the male reproductive tract. Antibiotics can also be used to clear up infections affecting sperm count. Sperm movement: Sometimes semen has no sperm because of a block in the man's system. In some cases, surgery can correct the problem. In women, some physical problems can also be corrected with surgery. What medicines are used to treat infertility in women?
Some common medicines used to treat infertility in women include: Clomiphene citrate Clomid : This medicine causes ovulation by acting on the pituitary gland. It is often used in women who have polycystic ovary syndrome PCOS or other problems with ovulation.
This medicine is taken by mouth. Human menopausal gonadotropin or hMG Repronex, Pergonal : This medicine is often used for women who don't ovulate due to problems with their pituitary gland.
It is an injected medicine. It causes the ovaries to begin the process of ovulation. These medicines are usually injected. Gonadotropin-releasing hormone Gn-RH analog: These medicines are often used for women who don't ovulate regularly each month. Women who ovulate before the egg is ready can also use these medicines. Gn-RH analogs act on the pituitary gland to change when the body ovulates.
These medicines are usually injected or given with a nasal spray. This drug helps lower the high levels of male hormones in women with these conditions. They talk too much. They gossip a lot about it. Participants in this study reported unhappiness in their marriage as their ultimate dream of marriage is to have children.
Their unhappiness also had a direct impact on their sexual life as many reported a reduced interest in sexual activity with their partners. Males especially reported that having sex was both for pleasure and for procreation, although procreation was the driving force for sexual intercourse among couples. However, with consistent failure of attempts to have children, the desire to have sex diminishes.
Males especially resorted to heavy drinking of alcohol or the local spirit known as akpetseshie to ward off their frustration. In a drunken state, sex with their partners was not a priority. Participants reported that a marriage without children is often perceived as a curse from God as the Bible states that children are a blessing from God, hence childlessness is a curse.
Any marriage union without a child is therefore perceived as not sanctioned by God and is therefore a fertile ground for divorce or separation. There were mixed responses concerning the experiences of couples within the extended family setting.
While some people reported support from their families, others blamed their families for their unhappiness. Other respondents reported having a good relationship with the extended family. Elite group of respondents reported more support from their families than uneducated couples. Elite couples were under less pressure to beget children because the families were reliant on them for financial support. Men without children therefore do not receive the same respect as fathers.
Some men reported that they were excluded from leadership roles in their communities because they did not have children. However, this does not take away the humiliation and stigma, as the biological fathers in such arrangements are not able to keep this contract secret. The biological fathers in such a partnership are also reported to abuse the women sexually in some instances.
Other individuals determined to prove their fertility have intercourse with multiple partners, hoping either to become pregnant or to get a woman pregnant. Both males and females were reported to engage in sex with multiple partners to prove their fertility.
However, extramarital sex is generally unacceptable and attracts serious social consequences especially for women. A woman caught engaging in extramarital sex has to go through some purification rituals before she can either cook for, or have sex with, her husband. This is because the bride price that is paid to the family of the woman confers on the man the exclusive sexual rights and any contrary behaviour attracts serious social consequences.
Some childless men are compelled to acquire a second wife in an attempt to prove their fertility in an effort to escape the ridicule and stigma that goes with being childless in the community. I asked if he was selling the pawpaws for me to buy some. My neighbour looked me in the face and told me that it was only an impotent man that sells pawpaw; implying that because I did not have a child I did not know that pawpaw was a fruit for children, and men with children save pawpaws to give to their children.
Couples without children are denied membership in the ancestral world. Rituals that confer membership in the ancestral world cannot be performed because it is the practice that the children of the deceased go to the bush to harvest a special stick known as the kpiendaa which is kept at the ancestral room after some rituals symbolizing that the individual has reached the ancestral world. This rite of passage is very important in the lives of all adults as it indicates the final transition of the individual to the ancestral world.
The general belief is that there is another world after death and individuals who become ancestors will have the opportunity to live again. If this does not occur, it implies extinction of the family lineage and unrest for the soul of the deceased. Such souls are believed to wander about and will never reach their maker.
Infertility also presents stressors in the financial domain. A couple may incur tremendous financial expenses in an attempt to stop at nothing until a pregnancy or a live birth is achieved.
Respondents stated that fertility services were available as spiritual and herbal remedies were readily available in the community. However, the cost of treatment was a challenge as items often requested are not within the financial capability of the couples. The biomedical health facilities resourced for infertility are often at the district level and are limited in terms of assisted reproductive technologies. In addition, many of the procedures are not covered by the national health insurance scheme.
A National Health Insurance Scheme Manager alluded to the fact that many of the treatments for infertility are not covered by the scheme and they have had reported instance of exploitation of couples even for procedures that were covered by the scheme. A check with private insurance companies also revealed that currently their policies do not cover infertility.
In the hospital, once they write infertility on your card, you are made to pay for every treatment including those covered by the national health insurance. The people of Northern Ghana believe in pronatalism to the extent that childlessness is highly stigmatised and this was a well-entrenched theme across all groups and interviews with community members. It is not simply the absence of children, which can create problems for couples.
For a significant majority of participants, bearing no sons, or having only one child constituted a form of infertility where community norms dictate that large families are preferable and that sons are indispensable. All participants in the study agreed that women are blamed for childlessness.
Many of the interviews with childless individuals and couples in the study also revealed negative experiences; unsupportive reactions to infertility from family members and painful social scrutiny.
Participants indicated that there are days when the reality of life without children just seems too much to handle, but that they have found ways to deal with it. Participants reported that having a coping strategy was important in order for them to continue their lives without children. Methods of coping included depending on internal resources such as inner strength, self-confidence, and true acceptance of their fate, being able to rely on a support structure or trying to move on by focusing on the future.
Infertile couples narrated going through stages similar to the grieving process described by Kubler-Ross : denial, anger, bargaining, depression and acceptance [ 23 ]. Many individuals went into marriage with a strong hope to become mothers and fathers. However, the possibility of infertility began to occur to them after several months of unprotected sexual intercourse with their partner without conception. Even where no official diagnosis was established, many reported becoming angry because of failed attempts to become pregnant or make their wives pregnant.
Denial was a common theme and many reported mixed angry-denial mood or a fluctuation between anger and denial. Denial is facilitated by the assumption that, since their parents were fertile, they will also be able to beget children.
They subsequently begin to shop for solutions whilst bargaining with God or gods depending on their religious belief. Many couples reported that their initial reaction to the diagnosis of infertility is also denial. Women reported coping very well with male partners who are clinically diagnosed as infertile. However, women who were perceived to be responsible for the childlessness of a couple live in perpetual fear of acquiring rivals.
Coping in the social context or in the community was avoidance of situations that may provide a reminder of their childlessness. Others take inspiration from the biblical story of Abraham and Sarah who had to wait until their old age before begetting a child Genesis 21 , hoping for a miracle to happen.
Female respondents reported aspiring for excellence in others areas of their lives as this was another way to earn respect in the community. Infertile individuals adopted both healthy and unhealthy coping mechanisms. Acceptance of the situation and remaining faithful whilst praying to God for mercy was widely reported among Christians and some Moslems. Another healthy coping strategy that was also reported in both individual interviews and FGDs was redirecting their energy into economic ventures.
This was another way to earn respect in society. However, many reported unhealthy coping strategies. Social isolation, abuse of alcoholic beverages, and engaging in sex with multiple partners were widely reported among men. The fact that the first author was a man and interviewed women as well as moderated the FGDs with women could have affected the results of this study. This according to feminist theorists can affect the responses of interviewees.
However, the women seemed to have participated freely and actively. The women also indicated that they were more comfortable discussing their childless status with men than with women.
Another limitation of the study was related to the translation of the interviews and FGDs into English for analysis. Though independent individuals were used to undertake the translation and the translations were verified, it is possible that some of the statements could have lost their original meanings. Some of the local terms used could not be directly translated to English.
To help mitigate this problem, emphasis in analysis was placed on overarching ideas rather than specific word choices or phrasing. The results of the study indicate that infertile couples are stigmatised in Northern Ghana. Both men and women are stigmatized with men being described in local terms such as Lankpolosoba man with rotten testes or Yokuusoba man with a dead penis in the Upper West Region.
Similar findings were found in a study in South Africa where it was reported that infertile men are stigmatized, verbally abused and lose their social status in the community [ 24 ]. However, participants in a study conducted in Cape Town indicated that women had to deal with being called Idlolo , meaning barren and stjoekoe meaning failure [ 5 ]. Contrary to these findings, the present study did not reveal the use of such local terms to described infertile women.
Both men and women were reported to be denied leadership roles based on infertility; however, men appeared to be better placed to adapt to that as they could arrange with another man to impregnate their wife for them. This practice of allowing a different man to sleep with your wife to beget children on your behalf or having sex with multiple partners have implications for the prevention and control of Sexually Transmitted Infections STIs in Northern Ghana.
The use of condoms is one of the key strategies advocated for the prevention of STIs. However, since the principal reason for having sex with multiple partners is to achieve a pregnancy, condom use is clearly impractical.
This therefore has health implications, as this can lead to high incidence of cross infections with STIs if one of the partners should have an infection. Women who engage in sex with multiple partners are also more predisposed to cervical cancers. The greater the number of sexual partners a woman has without the use of condoms, the greater her risk of coming into contact with Human Papilloma Virus the virus that causes cervical cancer , and later developing cervical cancer [ 25 ].
The effects of infertility on inter-partner relationships varied. As some couples reported cordial relationships, other reported a decline in sexual activity.
Those who reported marital instability were mostly engaged in excessive alcohol intake, which has untoward effects on their health. The abuse of alcohol, apart from predisposing the individuals to cancer of the stomach and cirrhosis of the liver, can also result in spousal abuse.
Poverty is endemic in Northern Ghana and many women are not empowered. The findings of this study therefore indicate that partners and families may secretly be abusing women as a result of childlessness. Stripping a woman naked and scouring her private parts with thorns, as a ritual to purify a woman caught in extramarital affairs is one such example. Gender advocates should be concerned about the role of infertility in spousal abuse and efforts should be tailored towards empowering women in Northern Ghana.
Previous studies have revealed that infertility has some positive effects in marriage such as bringing partners closer together in the search for a solution to their problem [ 16 ]. In contrast, the present study did not reveal the search for remedies as a source of intimacy for couples, since many couples sought either individual treatments or the women were the one seeking treatment alone. Seeking remedies individually emanates from couples blaming one another for their inability to have children and this reinforces the practice of the partners engaging in extramarital affairs to demonstrate their fertility.
The study further revealed that childlessness affects both the physical and spiritual well-being of the individual. Infertility has inter-generational effects, as couples without children do not have the opportunity to live again. Reliving is achieved through either reincarnation or having the opportunity to live in an unseen world.
Among the people of Kassena-Nankana in the Upper East Region in Northern Ghana, the unseen world is believed to harbour all departed souls and forms a spiritual home for ancestors [ 26 ]. Respondents reported both healthy and unhealthy coping strategies. Though previous studies have shown that women are expressive and therefore will talk about their infertility [ 15 ], this study generally revealed that among women in Northern Ghana, infertility is not usually discussed in public and infertile women would have to rely on internal coping strategies.
Having faith in God and hoping for a miracle to occur was an essential coping mechanism that was employed by infertile couples. Some also redirected their energy to excel in other areas that are respected in society such as academic achievement. Similarly, women were reported to cope through drawing on their Christian faith [ 27 ]. Aspiring for higher achievements in their field was also a common coping strategy reported by women in the study.
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