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Couples struggling to conceive may spend months trying for a pregnancy without knowing the underlying cause, while misconceptions about fertility can lead to blame and delay medical assessment.
Dr Charles Muteshi, a consultant fertility expert at Aga Khan University Hospital, urges couples to seek medical assessment together to identify the factors preventing conception and determine the appropriate treatment.
Muteshi explains that fertility depends on several factors, including regular ovulation, open fallopian tubes, healthy sperm and regular sexual intercourse that allows the egg and sperm to meet.
He cautions couples against assuming that having regular sex guarantees pregnancy. Instead, they need to understand that conception depends on several reproductive processes working together.
Couples trying to conceive should have sex two to three times a week rather than relying solely on identifying the exact day of ovulation, he advises.
The recommendation accounts for the short lifespan of an egg after release, while sperm can remain viable in the female reproductive tract for several days.
Muteshi recommends seeking medical advice after 12 months of trying to conceive without success. He notes that nearly 85 per cent of couples conceive within that period.
A fertility assessment examines the quality of a man's sperm, checks whether the woman is ovulating and determines whether her fallopian tubes are open.
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“Overall, half of fertility issues may be related to sperm and the other half to female factors including ovulation and tubal blockage,” observes Muteshi.
He recommends starting with semen analysis and an ovulation assessment before proceeding to tests to determine whether the fallopian tubes are open. This approach can help doctors reach a diagnosis while avoiding unnecessary investigations.
One test used to assess the fallopian tubes is hysterosalpingography (HSG), which involves injecting a special dye into the tubes and taking X-ray images.
Another option is hysterosalpingo-contrast sonography (HyCoSy), which uses ultrasound and a special dye to assess whether the tubes are open. It also allows doctors to examine the uterus and ovaries without exposing the patient to X-rays.
Muteshi explains that HyCoSy can be more comfortable than HSG and may reduce the need for separate examinations, although it requires a specially trained practitioner.
Once doctors establish the cause of fertility problems, they can discuss appropriate treatment options with the couple.
Some couples may require assisted reproductive treatment, including in vitro fertilisation (IVF).
However, Muteshi warns that such decisions require careful consideration because treatment involves financial commitments, uncertainty about success and potential risks.
Couples should receive clear, up-to-date information and counselling before deciding whether to proceed with treatment. Both partners should participate in consultations to understand the options and make informed decisions.
Fertility investigations and treatment can also cause emotional distress, frustration and tension between partners, particularly when doctors identify problems such as blocked fallopian tubes, severe sperm abnormalities or ovarian failure.
Muteshi stresses that health care teams should provide emotional support and counselling to help couples navigate the process and avoid blame.
Where treatment is not feasible or does not meet a couple's needs, other options may include donor eggs or sperm, adoption, foster care and surrogacy, depending on individual circumstances.
He also points to family support and groups such as Waiting Wombs Trust as potential sources of support for couples dealing with fertility challenges.
Muteshi maintains that treatment decisions should reflect each couple's circumstances, values and preferences, with health professionals providing guidance without pressuring them into particular choices.
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