When Muwina got married, she envisioned the number of kids she would want to have, 2 boys and 1 girl. She even had names which she would give to her kids, Ariel, Ethan and the other after her late dad, David. Since tradition demanded the man names the first child, she would let her husband give all the first names while she gives the middle names. A year later, she still hadn’t fallen pregnant. She figured all the anxiety of being a newly-wed, demanding work load and constant travel was contributing. She requested for a change in departments and withdrew from her further studies, changed her diet to eat healthy in the hope of preparing her body for pregnancy. Three years later, she still hadn’t fallen pregnant and relatives were now beginning to whisper asking her what she was waiting for. A visit to the hospital showed that all was well with the couple. While friends suggested she turns to a well-known papa in a foreign country and some relatives were suggesting visits to the village with messages that said, God helps those who help themselves.

Infertility is a big problem among many couples in our society. Many believe, having a child means living a fulfilled life. Couples who cannot do so feel barren and incomplete. Therefore, infertility is more than just a medical problem. It affects all aspects of life, the most important being mental health due to the pressure society puts on a couple more especially, a woman. Although both men and women can contribute to infertility, women are exclusively held responsible, leading to more significant stress while undergoing treatment.

Infertility is a disease of the male or female reproductive system defined by the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse Infertility affects millions of people of reproductive age worldwide and has an impact on their families and communities and there are different factrs that can cause infertility. However, it is sometimes not possible to explain the causes of infertility.

In the female reproductive system, infertility may be caused by:
• tubal disorders such as blocked fallopian tubes, which are in turn caused by untreated sexually transmitted infections (STIs) or complications of unsafe abortion, postpartum sepsis or abdominal/pelvic surgery;
• uterine disorders which could be inflammatory in nature (such as such endometriosis), congenital in nature (such as septate uterus), or benign in nature (such as fibroids);
• disorders of the ovaries, such as polycystic ovarian syndrome and other follicular disorders;
• disorders of the endocrine system causing imbalances of reproductive hormones. The endocrine system includes hypothalamus and the pituitary glands. Examples of common disorders affecting this system include pituitary cancers and hypopituitarism.
In the male reproductive system, infertility may be caused by:
• obstruction of the reproductive tract causing dysfunctionalities in the ejection of semen. This blockage can occur in the tubes that carry semen (such as ejaculatory ducts and seminal vesicles). Blockages are commonly due to injuries or infections of the genital tract;
• hormonal disorders leading to abnormalities in hormones produced by the pituitary gland, hypothalamus and testicles – hormones such as testosterone regulate sperm production. Example of disorders that result in hormonal imbalance include pituitary or testicular cancers;
• testicular failure to produce sperm, for example due to medical treatments that impair sperm-producing cells (such as chemotherapy); and
• abnormal sperm function and quality. Conditions or situations that cause abnormal shape and movement of the sperm negatively affect fertility. For example, the use of anabolic steroids can cause abnormal semen parameters such sperm count and shape.

Lifestyle factors such as smoking, excessive alcohol intake and obesity can affect fertility. In addition, exposure to environmental pollutants and toxins can be directly toxic to the eggs and sperm, resulting in their decreased numbers and poor quality.

Even though infertility is not a mental condition, being diagnosed as infertile can cause psychological distress, emotional stress and financial difficulties for couples. Couples may feel emotions like anger, guilt, sadness, depression, anxiety, and loss of self-confidence and self-esteem. Apart from this, the financial cost of infertility treatment also significantly contributes to the stress. One needs to have a large amount of money to consider IVF and it is does not guarantee success and because of such a high cost, some couples cannot get treatment.

Children in our society are considered as what strengthens a marriage so this social pressure may add to the existing stress of fear of failure to have the bond, which are the children. Furthermore, it may also harm a person’s relationship with their partner as well as with that of friends and family members. This may result in detachment from the family and decreased social interaction especially with pregnant women and friends who have children.

Couples struggling with infertility require someone to listen and acknowledge their feelings. They need our support without intruding in their privacy. Most couples will not share their true feelings of anxiety, depression or low self-esteem. So even as relatives, we must avoid asking couples when they will fall pregnant or making their issue seem small by telling them it will happen soon enough. Or giving them examples of someone else’s situation when every journey of infertility is different. Avoid statements such as, “have you tried ABC, you can always do IVF, maybe you should consider… or why not just adopt?”

Be sensitive when talking about your own pregnancy or children. Talking about lack of sleep from caring for a new born can be painful reminders of what your friend has not been able to experience. Approach children or baby conversations with sensitivity. Even though couples struggling with infertility may be uncomfortable attending events centered around kids, extend the invitation to show you value your friendship but do not question them if they do not show up.

Counselling is an important intervention that should be recommended for couples suffering from any form of infertility as it helps boost coping strategies or assists in decision making during treatment.

Government policies could assist look into the many biases to safe and affordable fertility care by recognizing that infertility is a disease that can be prevented and mitigating the costly treatment by offering insurance to carter for fertility treatment. The prevention of unsafe abortions, addressing environmental toxins associated with infertility, diagnosis and early treatment of STI’s and promotion of healthy lifestyles that reduce behavioural risks especially among the youth is very vital.

Let us learn to respect couples and their decisions, its mainly us relatives especially fwe baku chaume (the man’s relatives) who add to the stress of couples battling with infertility when we do not know the cause or cannot offer any form of intervention to achieve a resolution.

Seek help when in need, visit a Counsellor near you!

About the author

Aka Monde, is a licensed Professional Counsellor who holds a Master of Science in Counselling from the University of Zambia. She believes in the adage “a problem shared, is a problem half solved.” Speak to your pastor, church elder, elderly family member or see a professional counsellor when in need.

Email: [email protected]