Infertility: When IV, IUI are the only option

In a story published by The New Times last week, a midwife’s desperate attempt to fake a pregnancy and steal a mother’s new-born baby is just one of the many examples that portray the despair that comes with inability to conceive among couples. Cases of infertility have been on the rise over the recent years and as Dr Mohamed Okasha, an obstetrician and gynaecologist at Heritage Medical Park, Kigali explains, there are various causes of this condition. “The factors that help one to get pregnant are mainly four; the sperms, healthy uterus, the egg and the fallopian tube. When these are not normal and the sperm count is below 10ml, chances of conceiving are minimal. Also, the fertility chances reduce for women at the age of 35,” he says. Dr Iba Mayele, a gynaecologist at Doctor’s Plaza in Kigali, also explains that certain infections might lead to infertility and urges couples to always go for check-up as some of the infections may not have symptoms. “For example, chlamydia is easily spread because it often shows no symptoms and may be unknowingly passed to sexual partners. In fact, about 70 per cent of infections in women and 50 per cent in men are without symptoms. Chlamydia destroys the fallopian tube and all infections can destroy the cervical layer. So, couples should test for any kind of infection as chlamydia can also be responsible for low sperm count,” he says. But thanks to advancement in research and technology, in vitro fertilisation (IVF) and Intrauterine insemination (IUI) come in handy to help couples have a chance to conceive. Dr Heritier Gashema, a senior resident in obstetrics and gynaecology at University Teaching Hospital in Kigali (CHUK), says artificial insemination is necessary in specific cases for couples. “In cases of ejaculatory dysfunction, discordant couples and for cervical and male factor infertility, this is when one should consider trying IUI or IVF,” Gashema says. How IUI and IVF work According to Okasha, Intrauterine insemination (IUI) is a form of assisted conception. During IUI, the doctor places sperms into the uterus (womb) at the time of ovulation. This procedure is often combined with stimulating drugs to increase chances of conceiving. “We put the sperms directly in the uterus. This helps the sperm because during normal sexual intercourse, as the sperms move, some will die and others will try to continue to the cervix and to the uterus and fallopian tube. To reduce this distance, we put some of them directly into the uterus, and so the chances to reach the fallopian tube will be higher,” he says. Okasha adds that when couples face infertility they should seek medical advice. “When they come, we assess them and according to the results, we can choose which procedure to use. IUI is helpful mainly when we have minor male infertility problems. The normal criteria for sperm check up is to have at least 15 million sperms per ml and to have 40 per cent of them in good form and 50 per cent of them moving fast enough. When you have between 10-15ml, this is when you can have IUI, below 10ml is not helpful. For severe male fertility problems, IUI cannot help,” he explains. Okasha says that depending on one’s particular fertility problem, they may need to use fertility drugs. “The process of taking fertility drugs is called a stimulated cycle, because the drugs stimulate ovulation. If drugs are not used it’s called an unstimulated cycle or natural cycle. In unstimulated cycles, IUI is timed to take place at the time of natural ovulation. The doctor may track the female cycle using blood tests and ultrasound scans,” Okasha explains. He further says that the success rate of IUI is about 10 per cent and that the procedure can be repeated up to three times. “IUI is still very new here in Rwanda but we receive between 30 and 35 couples per day facing fertility challenges. Ten per cent of these are usually fit for IUI, while the rest need fertility treatment. If compared to the normal chance of having pregnancy which is 78 per cent, 10 per cent is a good success rate because after all it gives a chance to infertile couples to be able to conceive,” he says. Couples should consider IUI if they have not been able to conceive for at least one year says Okasha. “Couples should be patient. The cause could be the woman not have ovulation or tube blockage. In men, it could be the sperm quality or small count. Once all the investigations are done, we determine which procedure will be used to conceive. If it is an ovulation problem, it can be sorted and sometimes they conceive. If it doesn’t work, we go for IUI if the spermatozoa are destroyed at the level of the cervix,” he explains. On the other hand, In vitro fertilization (IVF) is a fertility treatment in which sperm and eggs are combined in a laboratory. The resulting embryos are assessed for quality and one or more are placed in the uterus through the cervix. Eugen Ngoga, an obstetrician and gynaecologist at Mediheal Diagnostic and Fertility Centre in Kigali, notes that IVF can only be used when the IUI option has totally failed. “With a severe male problem, and when the tubes are not working or the couple has been trying for more than one year without success, then IVF is an option,” he says. Ngoga says under this procedure, the woman is stimulated on day two of her menses to be able to get the egg. “Once they are mature, we take them out. The embryologist checks out the quality ones and we inject the spermatozoa into the eggs. They are kept in the laboratory for a maximum of five days and if the embryos have been formed, the best quality one is placed in the uterus. We keep checking on progress of the pregnancy,” he explains. Ngoga says IVF success rates are at 30 per cent. Risk factors Dr Okasha notes that although there are risks that come with IUI, they can be prevented by proper hygiene and cautiousness. “When doing IUI, we give the woman medicine to stimulate the eggs. In cases of hyper stimulation, the ovary size becomes very big and with this risk, we monitor using ultrasound. When we predict danger, we cancel the stimulation process. This is major risk factor although small incidences like infection may occur. But when done in a clean hospital environment, the risks do not occur,” he says Like Okasha, Dr Ngoga also explains that the risk factors associated with IVF are easily preventable. “Anything you introduce in the uterus can bring infection because the vagina is the area where germs should stop but we normally prevent that by giving antibiotics and washing it properly. Also while taking the eggs out, other organs can be injured although this is a very rare case,” he says. Dr Okasha says the cost of IUI varies between $400 and $1,000, adding that it is a cheaper option than IVF. What couples can do to improve their fertility chances Daniel Gahungu Daniel Gahungu, a medic at Polyclinic Ectoile Kigali First of all, improving their lifestyle is essential. For instance, a woman who is exposed to drinking alcohol lowers her chances of conceiving. For men, alcoholism can lower their sperm count which can lead to infertility. However, finding out the cause of infertility is ideal because if it’s treatable. Francis Kazungu Francis Kazungu, general practitioner Parents should make sure that their children have a healthy lifestyle. A poor lifestyle can lead to obesity or overweight which is a major cause of infertility mostly in women. For men, obesity can lead to low sperm count. Staying healthy and regular exercise improves fertility chances in both sexes. Oliver Habiyaremye Oliver Habiyaremye, a nurse Before one is married, having protected sex is always ideal because unsafe sex, especially with multiple partners, can lead to contraction of sexually transmitted infections, which is a risk factor of developing fertility problems. Giving birth early is ideal as aging is also related to lower chances of conceiving, especially from the age of 35 and above. Elias Ntwali, Elias Ntwali, a medical student Working to improve your health first is better than trying to get children. Doing yoga daily, for instance, is healthy and helps keep one fertile. At any cost, couples should avoid stress as it’s linked to infertility cases. In case of infertility in couples, the best way to find a solution is for both of them going for tests. Nsabimana Jean Marie Nsabimana, a gynecologist Smoking is one of the risks that could cause infertility in both sexes. In case a woman conceives and they are still smoking the possibility of miscarriage is high. Couples should avoid smoking at any cost if they want to stay fertile.

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Infertility: When IV, IUI are the only option