Fertility Consultant, Prof. Oladapo Ashiru Tells How Couples Can Boycott Infertility Caused By Infectious Diseases

In his previous writings, fertility consultant and IVF expert, Prof.  Oladapo Ashiru alluded to the fact that infection is the most frequent cause of infertility. According to him,  in every given population of humans, infectious diseases are an ever-present risk, a number of them having the capacity to jeopardise the fertility of an infected person.

Professor Ashiru names the common infectious diseases that have an impact on fertility and even resultant pregnancy to include Human immunodeficiency virus, Gonorrhoea, Syphilis, Hepatitis B (Hep B), Hepatitis C (Hep C), Rubella. In other countries, Toxoplasmosis, Cytomegalovirus is a considerable concern in addition to the above.

READ ALSO: Specialist, Dr Abayomi Ajayi Answers Questions On Infertility, The Many Solutions Available To Battle This Threat To Marriages

In a new piece, he wrote for PUNCH, Prof Ashiru explains more on the dangers that infectious diseases pose to fertility and how intending parents can have healthy children despite it.

Read his article below:

The sexually transmitted infections like HIV, Syphilis, Gonorrhoea, Chlamydia, Candida albicans, Trichomonas vaginalis, Bacterial vaginosis, Lymphogranuloma venerum, and others are highly prevalent in developing countries especially Africa despite all efforts to prevent the spread of the diseases.

The clinical manifestations are usually asymptomatic. However, they cause infections in both male and female genital tracts leading to salpingitis (infection of the fallopian tube) and tubal blockage.

Women usually bear the brunt of disease burden more than men. It is supported by preliminary data from the March 2019 National summary sheet of the Nigeria HIV/AIDS Indicator and Impact Survey, which reported that young adult women aged 20 to 24 years, had four times the prevalence of HIV among males in the same age group.

The bacteria Neisseria gonorrhea and chlamydia trachomatis are significant causes of pelvic inflammatory disease, which in untreated women results in tubal factor infertility in about 10 and 40 per cent of the cases and increases the chances of ectopic pregnancy. Chlamydia ‘the silent epidemic’ tends to cause an estimated four to eight million new cases each year. Neisseria gonorrhea and, to a lesser extent, C.trachomatis is associated with male fertility, and both bacteria have a link to increased risk of perinatal complications.

While it seems clear that STIs increase the risk of infertility in infected persons, there appears to be no proof for the adaptive traits. N. gonorrhea infects non-ciliated cells of the tubal mucosa. It destroys predominantly the uninfected ciliated cells that have a crucial role in the transport of fertilised eggs to the uterus. Available data from previous studies suggest that STIs constitute a high medical, social, and economic burden in Nigeria. Recent surveys report gonorrhea prevalence to be as high as 2.3 per cent with a reported incidence of 49.7 per 1000 population. The prevalence of C.trachomatis in women in the African region is 2.6 per cent, with a reported incidence of 22.3 per 1000 population.

In addition to these significant bacterial STDs, several other bacteria can potentially be transmitted via sexual contact like ureaplasma urealyticum, mycoplasma genitalium, Gardnerella vaginalis, mycoplasma hominis, Treponema pallidum. Also, the eukaryotic parasite Trichomonas vaginalis tends to infect more than 270 million people per year and increases preterm birth, PID (Pelvic Inflammatory Disease), female and male infertility.

Genital herpes, HIV, Hepatitis B transmitted via sexual intercourse. Diseases present with genital ulcers (genital herpes, Lymphogranuloma venereum) are essential because they increase the risk of acquiring HIV.

All these diseases can impact on infertility, and even infertile couples can affect the modalities needed to be employed for conception to take place.

To paint a realistic picture, couples in which one partner has the Human immunodeficiency virus may need to practice protected sexual intercourse (which is counter-intuitive to achieving pregnancy) until the viral load is an acceptably low affected partner. The use of Pre-exposure prophylaxis (PrEP) and Post-exposure prophylaxis (PEP) for HIV, as recommended by the Centre for Disease Control, have revolutionalised natural conception in this regard.

Alternatively, such a couple can opt for in-vitro fertilization to hinder the attendant risk of acquisition to the uninfected partner during unprotected sexual intercourse.

Infections like Hepatitis B and Hepatitis C can impact on the health of the woman is infected, as she stands the risk of progression of her own (Hepatitis) disease on its merit as well as the risk of vertical transmission to her baby (in the case of Hepatitis B). Peradventure the mother develops an active disease while pregnant, she will need medical attention for her illness, which may also impact fetal well-being.

If a woman is non-immune to Hepatitis B and her partner is, she should get vaccinated before unprotected sexual intercourse occurs. It protects her and all the ‘products’ of her reproductive career.

Hepatitis C transmitted through contaminated sharp instruments and blood products; the use of sterilised sharp equipment and screening of blood and blood products can stem this infectious disease.

In the case of infection like Rubella, it is prudent to check that the woman embarking on getting pregnant is immune to it. If she is found not to be immune, she should receive the vaccine as soon as possible. The Royal College of Obstetricians and Gynaecologists recommend a one month wait period after vaccination, before getting pregnant. It is crucial because if she is exposed to, and acquires the disease while pregnant and non-immune, her foetus can suffer severe congenital anomalies in uterus.

Infections like Syphilis, Chlamydia can be treated with oral or parenteral medications depending on the clinical presentation; and this will cure the disease.

Among couples where one partner has an infectious disease and the other does not, Assisted Reproductive Technologies step into achieving results without increasing the risk to the uninfected partner.

Through several techniques such as sperm washing for HIV, excellent labelling, and storage during cryopreservation, it is now possible for couples to have embryos free of the infection they carry.

ART bridges the gap from the impossible to possible, ensuring that a generation can be born healthy and safely, thereby completing their parents’ joy.

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