Angelique Mukashemana, 26, a resident of Remera, Kigali, recently underwent treatment at La Croix Du Sud Hospital where her tubes were opened to enable her conceive. Mukashemana had been married for two years without a baby.

"With two years of trying to conceive without success, I concluded that I was infertile and will never be able to have a child of my own. But when I consulted a gynecologist, I have been treated and assured that I will soon be able to conceive,” she says.

According to Iba Mayale, a gynecologist at Doctors Plaza Kimironko, Kigali, some women assume they are barren after trying to conceive for quite a long time without success. What is even more depressing is that after consultations, some are found not to have any medical issues.

"This shouldn’t happen, and in most cases, some of these factors that bring about delayed conception can actually be ruled out and treated if there is thorough assessment by an expert, who will be able to carry out all the important tests,” he says.

Female factors

Mayale, however, says there are factors that may hinder fertility, which, if examined and ruled out well, can be overcome completely.

According to him, these factors are categorised into four; those that akin to females, males, combined and undetermined.

Mayale says female factors are related to issues of the brain, ovaries, tubes, uterus as well as cervix.

"Female infertility factors contribute 40 to 50 percent. They are based on the hypothalamic pituitary thyroid axis. This is because in order for a woman to conceive, there must be some hormones which are produced from the hypothalamus (from the brain) that stimulate the pituitary glands.

"These two glands are induced by the uterine tubes to produce enough hormones to stimulate ovaries that produce progesterone and estrogen, which will provoke ovulation that facilitate fertilisation and pregnancy,” explains Emmanuel Semwanga, a gynecologist/obstetrician at La Croix Du Sud Hospital.

For instance, he says that if there is a problem in the level of the hypothalamus, it means the pituitary glands will not be stimulated, leading to ovaries not producing hormones that assist in fertilisation.

Semwanga notes that if there is any tumor, the levels of the hypothalamus or pituitary glands are affected, thus the woman can’t concieve. Also when there is constant ovarian syndrome, it can also bring about delayed conception.

Another risk factor, John Muganda, a gynecologist, says is if someone has undergone surgery for abortion (frequently), the most common one being known as D&C (dilation and curettage). This is a surgical procedure that is done after a first-trimester miscarriage.

One can also have problems in conceiving if they did oophorectomy (surgical removal of one or both ovaries). After this procedure, there could be no conception at all unless they undergo treatment.

"Again, factors related to the tubes can also hinder fertilisation. For instance, if the tubes are blocked, there will be no meeting of the ovum and sperm, thus no conception,” says Muganda.

He adds that, sometimes this can be due to surgeries or tubal ligation that was done to prevent pregnancy. When one wants to conceive again, it can’t happen due to closed tubes.

Semwanga says in case the uterus is having any abnormalities or repetitive cartilage due to abortion, it can result in a scar which leads to difficulties in getting pregnant.

"No conception can happen in such cases. This is due to scared walls of the uterus, as there will be no implantation of the foetus. In this case, for a woman to conceive again, they need to visit obstetricians to remove the scars and give them some hormones to build the uterus mass again, which will facilitate implantation,” he says.

Semwanga notes that a woman may also have a closed cervix that does not allow the sperms to pass through.

He, however, maintains that all these factors can be identified, ruled out and treated so that a woman can restore their fertility.

Semwanga says this is only possible if they seek medication from the right gynecologist/obstetrician.

"Consulting a gynecologist will allow proper assessment; one is able to be assessed on whether the hormones from the brain are being produced in normal amounts. Again, laboratory and preclinical exams should be carried out to check if the tubes are normal or blocked, as well as to assess the cavity of the uterus,” he says.

However, Semwanga points out some factors such as distanced relationship could be the other reason behind delayed conception.

"Although many may regard it as a negligible issue, this factor can play a big role when it comes to conception. There are situations where a husband comes home once in a while only to find the woman not ready for conception,” he says.

Semwanga explains that during that time, a woman might not be ready for conception because it is not time for ovulation. The couple could even go as far as two years together without conception, he says.

"This can make them think they have a problem yet they don’t. Working together on how to solve such cases is ideal for the couple to be able to increase their chances of conception, particularly, if they have been assessed and no other factor is discovered.”

Are fibroids a risk factor?

Mayale says female factors can also cause disorders.

"For instance, in case of fibroids, since they are based on the uterus, they may reduce fertility by 70 per cent. However, if treated there are high chances of a woman conceiving again,” he says.

Apart from that, Mayale says fibroids may also cause pregnancy complications such as miscarriage, abnormal position of the foetus, as well as preterm delivery.

He, therefore, notes that consulting a specialist in case of difficulty in conceiving could rule out fibroids, which can later be treated and fertility restored again.

Mayale adds that depending on the type of fibroids, treatment is given to prevent them from growing or they can be removed to allow fertilisation to happen.

Male factors

According to Muganda, there are several factors in men that hinder fertilisation too, such as azoospermia, or low sperm count.

Oligospermia (deficiency of sperm cells in the semen) could be another factor, he says, adding that there are drugs that can be given to boost spermatogenesis.

"The sperm disorders are normally backed by some factors such as chromosomal abnormalities like genetic disorders,” says Francis Kazungu, a general practitioner in Kigali.

Just like in female factors, Kazungu says production of sperms is also based on the release of some hormones, especially from the hypothalamus and pituitary gland.

Some sexually transmitted diseases such as gonorrhea and syphilis also brings about male infertility. Treatment also depends on thorough assessment. For example, if the sperms are inadequate, boosting production will ensure more chances of conception.

He says during assessments, ruling out infections, metabolic disorders such as diabetes and other factors that could be the reason behind their infertility ensures male fertility again.

Counselling is also important for the couple to improve the chances of conception.

Another good way of maximising the chances of conception for the couples that have a problem of conceiving, Mayale says, is encouraging them to have sex many times (two to three times) a week.

Combined and undetermined factors

Kazungu says both partners might be having problems resulting in infertility. For example, a man could be having sperm disorders, while at the same time a woman has tube blockage or another disorder around the brain.

Depending on the factor, they have to be managed accordingly.

For the undermined factors, Mayale says if the couple has been assessed and found not to have any infertility problem, the best solution is to get counsel on the need to be patient.

Secondary infertility

According to Semwanga, these are factors that can come as a result of family planning. Although they are rare, sometimes they can happen.

He says some family planning methods cause hormonal changes, for example, the intrauterine device (IUD or coil).

"Having a coil as a method of family planning is the safest, but can also lead to delay in conceiving,” he says.

Semwanga explains one of the risk factors of this method is infections in the tubes which can cause adhesion on the inside leading to their blockage.

He says maintaining good hygiene and going for check-ups frequently (after every three to six months) is recommended to rule out any sign of infections for immediate treatment.

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EXPERT TIPS

Joseph Uwiragiye, nutritionist at University Teaching Hospital, Kigali In men, taking a diet that is rich in zinc such as beef, poultry, dairy and nuts, as well as whole grains, is important as it helps in boosting the production of sperms and testosterone. Also, going for tests in case of challenges is vital as it aids in ruling out any abnormalities.

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John Muganda, gynaecologistSome people are unable to conceive because they are naturally infertile. This is due to genetic factors which are commonly caused by chromosomal conditions that interfere with sperms or eggs. The best option is to go for screening as a couple to assess the individual risk for infertility, which gives them an alternative option for having a child.

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Crispin Gishoma, director of Rwanda Diabetic Association Fertility can be hindered by various reasons, for instance, diabetes in men. Diabetes can bring many complications, and one of the most common ones is diabetic neuropathy which damages the nerves and leads to impotence (erectile dysfunction). Eating right and maintaining a normal weight is essential in preventing this.

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Erick Musengimana, nutritionist at Rwanda Diabetic Association For women, in order to prepare for pregnancy, dwelling on a fertility diet improve chances of conception, prevents recurrent miscarriage and supports a healthy pregnancy. For instance, foods that are rich in antioxidants are good as they help in protecting the egg and sperm from free radicals, thus boosting fertility.