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By Dr. Charles Muriuki – MP Shah Hospital

Subfertility is defined as the inability of a couple to conceive after 12 months of regular intercourse without contraception in women less than 35 years of age and after six months of regular intercourse without contraception in women 35 years and older.

It is important to highlight that resumption to fertility is immediate with contraceptives, except for the contraceptive injection that can cause a delay of resumption to the fertility of up to a year. Overall, the single most important factor regarding fertility is the woman’s age, and research has demonstrated a steady decline in fertility potential from the age of 35.

Factors causing subfertility are not new. Advances in science increased access to information, and the health-seeking behavior of patients has made fertility concerns even more apparent. Conditions affecting the female partner contribute to approximately four out of ten subfertility cases, while those affecting the male partner contribute to one out of ten. Conditions in both partners contribute to another four out of ten while one to two out of ten couples have unexplained causes.

A consultation with the gynecologist should be done when concerns of delay in conceiving arise to assess situations in which early intervention is deemed pragmatic. However, if the clinical history is unremarkable, most couples would generally require more time before the threshold for investigating is attained.

The recognition, evaluation, and treatment of infertility is stressful for most couples and their emotional state, which may include depression, anger, anxiety, and marital discord, should not be ignored. Fertility investigations include hormonal tests to evaluate conditions that directly affect ovulation, like reduced ovarian capacity or function or indirectly like a thyroid condition. A pelvic scan should pick any fibroids, especially those in the cavity of the uterus or cysts in the ovary that could contribute to subfertility. Assessment of the fallopian tubes is often recommended either by a contrast x-ray (HSG) or through keyhole surgery (laparoscopy) when performed for other fertility affecting conditions like endometriosis. Occasionally a look into the cavity of the uterus (hysteroscopy) is performed. A semen analysis is often sufficient for the male partner to pick any changes in sperm parameters, and subsequent hormonal tests can be done based on the results. Treatment modalities are varied depending on the test results and range from medication to surgery to assisted reproduction- all ideally done with couple counseling.

In my opinion, the expectations of the modern-day woman to lead the pack in her career and be an excellent wife are incongruent with self or cultural expectations of being a doting mother. Perhaps there is a need to evaluate whether the delay in childbearing is warranted. Occasionally, scientifically unexplained causes of subfertility can be elucidated by causes like physical distance necessitated, for instance, my work. Lastly, child adoption is another non-scientific solution that has often not been canvassed due to cultural barriers and perhaps should be offered to those interested in it.

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