Causes of childlessness in marriages and there solutions
Medically, we say that there are two basic factors that could cause childlessness in marriages; there are male factors and female factors. Each of the factors above has sub-factors.
When we talk about male factor, we are talking about the Semen quality of the man. Once a man qualifies for what we call the rule of 60, he can fertilize any woman. There are four things that need to be checked in a man’s semen:
The minimum volume of the semen of a man should be 3-5ml per ejaculation after five days of abstinence from sex. Once a man does not meet this, he may be having problem.
2. PH Value
The semen of a man must be alkaline. It should be a PH of around 8.0. If the semen of a man is alkaline, there is a high possibility that it will fertilize the egg of any woman.
3. Sperm concentration
The concentration of sperm in the semen is very important. Semen is just an organic fluid that may contain sperms. The sperm inside the semen should be at least 20 million per ml. if a man is to produce minimum of 3ml as pointed out above. That mean a man should have at least 60 million sperms per ejaculation. This is called the rule of 60.
Furthermore, 60% of the 60 million must be normal in structure. This means that there must be 36 million sperms per ejaculate that are normal in structure. Also, 60% of the 60 million must be very motile. That means, 36million of the sperms must be moving purposely. The sperms must be progressively motile.
4. Semen Viscosity
A normal sperm should coagulate upon ejaculation and liquefies usually within 1-3 min. on ejaculation, the semen must be thick and have easy dissolution. If it does not liquefy fast, all the sperms will be dead after they enter the body of the woman. In the event that the semen is too viscous, it wouldn’t release the sperm in time and this result in the death of the sperms.
This is a condition in which there is no sperm at all in the semen of a man after a routine semen analysis. Ones there is no sperm in the semen of a man, no doctor can correct it. On the other hand, if the volume is low, doctors can boost it. In this day and age, there is nothing called low sperm count.
The only condition that will make a man not to be able to fertilize the egg of a woman is when the woman’s blood is stronger than his own (Rhesus (Rh) factor). Ideally, a man’s blood should be stronger than the blood of his wife. Once the blood of the woman is stronger than the blood of the man, it will be difficult for the man to impregnate the woman. This is when Rhesus (Rh) factor comes in.
Because the woman’s’ body carries the baby, there are a lot of factors.
1. The womb
This is the most important of all female factors. The womb must be structurally normal. Womb has three parts;
- The womb proper, which is called the Uterus.
- Cervix –this is the entrance of the womb
- The arms of the Uterus, which is called the Fallopian Tubes
Each of these areas could have problems. A woman must be clean before marriage. Clean in the sense that the womb should not be touch before marriage. Once the womb is touched, anything can happen.
The commonest cause of childlessness (female factor) anywhere in the world is when the womb has blocked tubes. Also, the commonest cause of tube blockage is infection. Once the womb of a woman has been touched, the possibility of having tube blockage is very high. Tube blockage is the cause of about 50% of childlessness (female factor) in the world.
2. Hysterosalpingography (HSG)
Unfortunately, a lot of women do not know that they have tube blockage. A good number of women marry for several years before they eventually meet a Doctor that will check the state of their tubes. The only test of the tube anywhere in the world is called hysterosalpingography (HSG) which is an x-ray evaluation on the tube.
Because of the pain of SHG, a lot of women run away from it. As long as a woman runs away from HSG, the integrity of the tube cannot be determined and then cannot guarantee her fertility. The pain of labour is second to none in the world, therefore the pain of SHG test cannot be compared with the pain of labour.
If you say you want to have a baby and you don’t want to have an SHG test because of the pain, then it means that you are not keen on having a baby because the pain you go through in labour is far greater than that of SHG. So, the only way you can test the tube integrity of a woman is SHG. Therefore, SHG test (digital) should be the first test that to be done.
3. Womb Structure
The structure of the womb matters. There are people, who have had their wombs accessed in a bad way. So if somebody has had D&C at one time and the period becomes irregular and it doesn’t come the way it should come, you would suspect that they have had an abortion at one time and it wasn’t properly done and that womb may have gummed together. We call it Asherman’s syndrome. Once the womb of a woman is damaged, it will be very difficult for her to get pregnant unless the womb is repaired.
4. Pelvic inflammatory disease (PID)
Most women, before they start having children, do have what we call Primary dysmenorrhea (painful menstruation). This condition at this stage of a woman’s life is normal. But if a woman has had a baby in the time past, she should never have painful menstruation again. In the case that a woman who has had a baby has painful menstruation, this may be as a result of a serious infection in the uterus. An infection that causes menstrual pain after giving birth to the first baby is very dangerous. PID can cause infertility in women. Women who have discharge of any colour at all should see a medical doctor.
Normally, a baby does not stay in a dirty womb. The womb must be sterile and clean for it to carry a baby till delivery. Once there is infection in the womb, a baby cannot stay there, if the woman conceives, the baby falls off.
5. Hostile cervix or uterus syndrome
This is the situation where the entrance of the womb is not receptive to sperm. The sperm does not have the ability to fertilize a woman’s egg until the sperm has been giving a PASS by the Cervix. Once sperm passes the Cervix, they get capacitated, they become more active to fertilize egg. Some women have normal Cervix. They receive there husband’s sperm without any difficulty. While the Cervix of other women are very hostile, they do not accept any sperm. They kill sperm at the entrance. This is one of the reasons women go for assisted fertility (IVF). Before a woman with a hostile Cervix get, pregnant, the Cervix will need to be by-passed.
6. Hormonal balance
The coordination of the body of a woman is done by the brain. There is a place called pituitary gland, or hypophysis cerebri, then there is the hypothalamus which contains very vital hormones. If a woman does not have a balance of this setup; from hypophysis cerebri and hypothalamus, it will be very difficult for her to get pregnant.
This is a condition when the breast of a woman makes milk when she is not pregnant or breastfeeding. The milk may come from both breasts or only one. In this situation, what the body is saying is that the woman is breastfeeding or pregnant. As long as this continues, the body of the woman cannot produce eggs.
Hyperprolactinemia is a condition in which a woman has higher-than-normal levels of the hormone prolactin in the blood. The primary function of prolactin is to stimulate the production of breast milk after childbirth. High prolactin levels are normal in pregnancy but not for a woman who has not giving birth before. Stress can cause the level of prolactin to go up but not to the extent that the person will start producing breast milk. There are drugs that can be used to handle this condition.
This is an abnormal enlargement of the thyroid gland. It is painless most of the time. If the woman present with hyperthyroidism, it should be handled first, else, she will find it difficult to conceive.
9. Adrenal Glands or suprarenal glands
These are endocrine glands that produce many hormones which include adrenaline and the steroids aldosterone and cortisol. When this station in the body of a woman has issues, it will prevent the woman from conceiving.
10. Rhesus(Rh) factor
This is a very big issue in fertility. Before a man and a woman takes themselves to the alter they need to know there blood group. A lot of people do not know that blood group plays a very important role in fertility and child bearing. If the blood group of the man and that of the woman are incompatible, they may have a very big issue giving birth to children.
However, if the woman did not mess herself up by having abortion or miscarriage before getting married, blood incompatibility will not prevent her from taking in the first time. This is because her blood does not recognize anything.
The strongest blood group in existence is the negative blood group (O-, B-, AB- etc). When a pregnant woman is negative, at the point of her delivery, the blood of the baby touches her blood, if the baby is blood group positive (the opposite of that of the woman, which is often the case), the blood of the woman detect the blood of the father (which often babies carry) and get sensitized, she will never have child for any positive man again except a treatment (Anti-D immunoglobulin) is administered to her with 72 hour of delivery.
Negative blood groups are several times stronger than positive blood groups. Over 95% of human beings have positive blood group. The few that have negative blood group do not accept any blood that is negative. The only way a woman with negative blood group will take in is never to abort or miscarry a pregnancy from a man with positive blood group before marriage, unless treatment (Anti-D immunoglobulin) was administered within 73 hours of the incident.
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Intending couples and childless couples should check for the quality of the semen of the man and the woman should scan to know if she has fibroid, infections, blocked tubes etc.
Dr Femi Akinola: +234-802-333-3123 (King of Kings Medical Centre – Lagos, Nigeria)