Human destiny and fertility

Oladapo Ashiru

Continued from last week

Twenty-five per cent of infertility is partly due to some of the reasons given in last week’s column. The remaining couples suffering from infertility that cannot be explained need not be pessimistic. The new infertility technologies of IVF, GIFT, ICSI and micro surgery with TESA can help most — if not all — infertile couples to conceive.

New technology in conception

This refers to the process of solving seemingly impossible or difficult infertility problems with new technology. Such technology usually involves the complex handling of human gametes consisting of the sperm and egg, in order to achieve conception and subsequent pregnancy, leading to the delivery of a healthy baby.

In the United States of America, after the initial errors in California in which gametes were improperly handled, resulting in a black couple giving birth to a white baby, while a white couple gave birth to a black baby, mandatory training and examination was stipulated and required before someone could be appointed the director of an IVF programme or laboratory.

They must be licensed, through examination, as High Complexity Clinical Laboratory Director by the American Board of Bio-Analysis. The board has helped in maintaining the practice of Assisted Reproductive Technology in USA.

There are several problems that can be helped with the new technology as follows.

Male infertility problems

Low sperm count and congenital absence of the sperm duct can be helped by the new technology. In this situation, men who were born with missing sperm ducts, today, are now able to have children of their own by ART procedure.

Female infertility problems

Anovulation: This occurs in 10 per cent in most cases of infertility. This female may go through a menstrual cycle but she is not ovulating, that is, not producing eggs. The process of ovulation is complex and involves secretions of several hormones in the brain, hypothalamus, pituitary and the ovary, as well as other related endocrine glands like the thyroid gland, adrenal, pancreas and the parathyroid.

These endocrine glands secrete hormones, which work like the orchestra in a symphony to cause ovulation. If any of these hormones should play out of tune, ovulation will not occur. It is now possible to control this process externally by administering various hormones to the patient. This is done after a very careful analysis of the patient’s hormonal status and deficiencies.

Tubal blockage

The tubes that carry the egg to the site of fertilisation may be blocked or restricted in their movement. This may result in failure to conceive, even though the patient may be ovulating normally. Blocked tubes occur in about 20 per cent of infertility cases. The cause is usually from previous infections. Sometimes, the woman may not know she had these infections. Even a simple appendicitis, when young, can lead to a scarring around the area of the tube, which can interfere with the pick-up mechanism of the eggs from the ovary.

An X-ray called “hysterosalphinogram,” which is a slightly painful but non-surgical procedure that does not require hospitalisation can determine if the tube is structurally sound.

Most recently, there is a virtually painless procedure that is able to determine whether the tube is structurally intact. It is the use of ultrasonography with saline infusion. It is called Hysterosonography.

Immunology

This includes cervical hostility. In this situation, the woman’s cervix recognises the sperm as a hostile foreign body (antigen) and immediately produces antibodies to kill the sperm. Invariably, most of the sperm cells are destroyed just at the cervical entrance and do not pass beyond the cervix. This condition can be detected by examining a swab of the sperm removed from the cervix after intercourse. It is called Post Coital Cervical Sperm Analysis. There are a number of other immunological factors that can affect pregnancy and conception, on to the implantation of embryo phase.

Hormonal factors

Apart from the hormones that control ovulation directly, some hormones can indirectly affect ovulation. Prolactin, a stress hormone, is one of such hormones. The elevation of this hormone can cause the secretion of milk in the breast of a non-pregnant woman. This is a disaster situation if left untreated. It makes ovulation difficult, if not impossible. Even if ovulation does occur, this hormone will attack fertilisation and embryo implantation processes, doing everything possible to terminate the conception.

In layman’s term, the high prolactin acts as if the woman is already pregnant and tries to prevent the occurrence of another pregnancy in that pregnant cycle. New hormones have recently been recognised as having an inhibitory effect on ovulation or implantation. They include prostaglandin, the growth factors and receptor hormones. They can disrupt any of the conception stages. Measuring the hormones in the blood and getting a good interpretation of the result with good clinical judgment can detect a number of these conditions.

High FSH hormone level

Specifically, some women may have elevated follicle stimulating hormone. This is only elevated just before ovulation. When it is elevated at other times of the cycle, like the third day of the period when it is supposed to be very low, there is a big problem. FSH is also high in women who have reached menopause. Consequently, the ovary of the menopausal woman is inactive.