Recently, there has been a concerning rise in the number of married women seeking medical assistance to conceive. Fortunately, various medical techniques are available to help them achieve their goal. As a result, many doctors are finding specialization in fertility medicine increasingly attractive and lucrative. It is estimated that worldwide, about five to eight percent of couples experience infertility at some point in their reproductive lives. Unfortunately, this figure can be as high as 32% in certain African countries. Unlike advanced economies, where primary infertility is the most common form, the majority of infertility cases in Africa are classified as secondary infertility.
The World Health Organization defines infertility as “a disease of the male or female reproductive system defined by the failure to achieve pregnancy after 12 months or more of regular unprotected sexual intercourse.” Infertility can be categorized as primary or secondary. Primary infertility refers to individuals who have never achieved pregnancy, while secondary infertility applies to those who have previously been pregnant at least once. Infertility can stem from issues related to either the wife, the husband, or both partners. Globally, approximately 48 million couples and 186 million individuals are affected by infertility.
Several factors can contribute to infertility, and in some cases, the cause may remain unexplained. In females, common causes include tubal disorders, such as blocked fallopian tubes due to untreated sexually transmitted infections or complications from unsafe abortions, postpartum sepsis, or pelvic surgery. Uterine disorders, which can be inflammatory, congenital, or benign (like fibroids), and ovarian disorders, such as polycystic ovarian syndrome, are also prevalent. Additionally, endocrine system disorders that result in hormonal imbalances can affect fertility.
For males, infertility may arise from various issues, including obstruction of the reproductive tracts, which can hinder sperm ejection. This blockage often results from injuries or infections in the genital tract. Hormonal disorders stemming from abnormalities in the pituitary gland, hypothalamus, or testicles can also play a role. Furthermore, abnormal sperm function and quality, often influenced by factors like anabolic steroid use, can contribute to infertility. In some cases, the testicles may fail to produce sperm due to conditions like varicoceles or medical treatments such as chemotherapy. Environmental factors and lifestyle choices, including smoking, excessive alcohol consumption, and obesity, can also lead to infertility, as can exposure to environmental pollutants and toxins.
The issue of abortion is particularly relevant for adolescents in our region. In countries with advanced healthcare systems, elective abortion may not lead to future fertility complications when performed according to medical guidelines. However, when a curette is used during an abortion, there is a significant risk of scarring the inner lining of the uterus, a condition known as Asherman’s syndrome. This condition can make it difficult to become pregnant later in life. Unfortunately, many underdeveloped countries have made abortion illegal, with only a few African nations, such as Tunisia, Benin, Mozambique, Cape Verde, and South Africa, permitting legal and safe abortions under specific conditions. It is anticipated that Sierra Leone and Nigeria may soon follow suit.
In countries where abortion is prohibited, the only legal grounds for the procedure often involve situations where the mother’s life is at risk or, as in Zambia, socioeconomic reasons. Access to safe abortion is extremely limited, and even in some advanced countries, such as the USA, recent legal changes have restricted abortion rights. When abortion is made illegal, many women resort to unsafe procedures that jeopardize their health and future fertility. This can lead to severe complications, including infection, excessive blood loss, and incomplete abortions, which ultimately affect their ability to conceive in the future.
In conclusion, due to the rising incidence of secondary infertility linked to unsafe abortions in our region, it is advisable for adolescents to avoid seeking abortions from unqualified professionals. Ideally, they should refrain from sexual activity until they are married or mature enough to manage pregnancies and care for their children. If abstaining is challenging, the consistent use of condoms during sexual intercourse is recommended to reduce the risk of unintended pregnancies.
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