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Infertility, not just a Woman’s problem (Part 1)

Dr Boima
HEALTH ESSUES

Infertility is often thought of as a women’s condition. We are told in the past when a couple could not conceive, all fingers would point towards the woman. So unfair was our culture that all sorts of derogatory terms implying infertility were formed around and used to refer to a ‘woman’. I seriously hope this mentality does not exist anymore in this century, as it is far from being the truth.

What is infertility?
For fertility to be successful there are requirements that need to be met.

A woman should be ovulating (releasing eggs from the ovary)

A woman should have patent fallopian tubes for the egg to move after release

A man’s sperm should be of good quantity and  quality and be able to move and fertilize the egg in the fallopian tubes

A woman should have a uterus where the fertilized egg will implant and grow into  baby

Infertility ensues if there are problems with any of the steps above.


By definition, infertility is the inability to get pregnant after one year of trying (unprotected sex). However, women who are above 35 years of age should get worried and seek medical help if they have not managed to conceive by 6 months. According to the report released by Centres for Disease Control and Prevention (CDC), about 10% of women of child-bearing age in the United States are infertile. Infertility is not only due to women’s issues. In fact, men contribute an equal share to this condition as do women.  About a third (33%) of causes has been implicated on a woman, about a third (33%) to a man’s factors and the last third (33%) to both or unidentified causes.

Woman’s causes

Most cases of female infertility causes are due to ovulation problems. Conditions like polycystic ovarian syndrome (PCOS) and Primary ovarian insufficiency (POI) lead to hormonal imbalances and hence interfere with ovulation.  Without ovulation, there are no eggs released for fertilization. Signs that can alert that a woman is not ovulating normally are irregular or absent menses.

Blocked fallopian tubes – there are conditions that affect women that can lead to scarring or adhesions of the tissue surrounding fallopian tubes like pelvic inflammatory disease (PID),  endometriosis, recurrent STIs or previous surgery e.g. ectopic repair.

Uterine problems – conditions that affect the uterus like fibroids can make it impossible for sperm to reach and fertilize the egg or implantation. They can also increase chances of recurrent miscarriages in cases where conception had taken place.

There are other risk factors in a woman that are not absolute causes, but increase chances of a woman not being able to conceive.

Age – the older a woman gets, the lesser their chances of conceiving easily. While 35 has been used as the cut of age, studies show that chances of conceiving actually declines rapidly every year from the age of 30.

Smoking – studies have shown that smoking affects hormone production. This can make it harder for women smokers to get pregnant

High alcohol intake

Stress

Over/underweight

Man’s causes

Infertility in a man is due to problems that affect his sperm production and transportation. Conditions that affect sperm production are either genetic or congenital like undescended testes or acquired e.g. testicular torsion, infections and varicocele. A varicocele (dilated veins in the scrotum) can make the testicles hotter than normal and this can affect the quality of the sperm produced.

Damage of the reproductive system – due to radiation, blunt injury e.g. in sports

Medications – like chemotherapy

Smoking – smoking is a cause of erectile dysfunction (ED). A man with ED can’t have and maintain an erection that is adequate for satisfactory sexual performance which can affect reproduction. Smoking also

damages the DNA in sperm

Heavy alcohol use

Medical illnesses – like mumps, kidney disease, and hormone problems

Advanced age

Diagnosis
Finding the cause of infertility can be a long and emotional process, but patience and cooperation in this condition pays a great deal. Diagnosis is through a detailed history of both partners, physical examination of both partners and tests done on both partners.

It almost does not make sense for a woman to present to a Doctor alone for work- up of infertility. Both partners should be assessed and investigated for the root cause, first by the general practitioner and if need referred to a specialist (Urologist for a man and gynecologist/ fertility endocrinologist for the woman).

Woman – first step is to find out if a woman is ovulating or not.  Few changes take place in a woman around ovulation so these should be noted by the patient; changes in morning body temperature, changes in cervical mucus or otherwise an ovulation test kit can be used.

Ultrasound of the pelvis can be done to assess the uterus, ovaries and look for any pathology affecting them.

Hysterosalpingography is a special test that assesses the patency of the fallopian tubes. A dye is injected into the uterus through the vagina and an X-ray is taken to see if the dye moves freely through the uterus and the fallopian tubes.

Laparoscopy – is a keyhole operation in which  a small cut is made in the abdomen and a laparoscope (small tube with light attached at the end) is inserted to assess the uterus, fallopian tubes, ovaries and look for any abnormal tissues or diseases like endometriosis.

Man – after a physical examination, a test called sperm analysis is ordered to check the sperm count, shape and motility in the semen. A sperm analysis is a common test, so a man need not feel uncomfortable about it. If the first analysis is normal, a second sample may be ordered to confirm the results. Two normal tests imply that a man does not have any significant infertility problems.

For comments email agboima@yahoo.com

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WeekendLife

The King’s journal 

23rd November 2021
Kgafela Kgafela II

This book is a true-life story of an African King based in South Africa. The Last Frontier is a resistance stand by Bakgatla Ba Kgafela tribe and its line of Kings from 1885 against a dark force called ‘western democracy’ that is insidiously destroying lives, peoples, nations and threatens to wipe away whole civilizations in Africa.

The story flows through four important episodes of history, beginning in about 1885 when Bechuanaland Protectorate was formed. This section briefly reveals interactions between Kgosi Linchwe 1 and the British Colonial Government, leading to the establishment of Bakgatla Reserve by Proclamations of 1899 – 1904.

The second episode deals with Kgosi Molefi’s interaction with the British Colonial Government in the period of 1929-36. The third episode records Kgosi Linchwe II’s interactions with the British Colonial Government and black elites of Bechuanaland. It covers the period of 1964-66, leading to Botswana’s independence. Kgosi Linchwe ii resisted the unlawful expropriation of his country (Bakgatla Reserve) by Sir Seretse Kgama’s government of 1966 to no avail. He wrote letters of objection (December 1965) to Her Majesty the Queen of England, which are reproduced in this book.

The fourth episode covers the period between Kgafela Kgafela II’s crowning as King of Bakgatla in 2008 to 2021. It is a drama of the author’s resistance to the present-day Botswana Government, a continuation of Bakgatla Kings’ objection against losing Bakgatla country to the Kgama dynasty assisted by the British Government since 1885. The story is told with reference to authentic letters, documents, and Court records generated during the period of 1885-2019. There is plenty of education in history, law, and politics contained in The Last Frontier for everyone to learn something and enjoy.   

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WeekendLife

Gospel concerts make a comeback

16th November 2021
Bishop Benjamin Dube

Hailed for being the prime gospel concert after the Covid-19 pandemic had put events to a halt, Golden Relic, in conjunction with Sweet Brands, recently unveiled the Arise and Worship Concert, Botswana. The show marks the return of worshippers and fans to enjoy music and worship together after what seemed like “cooler box” events were taking over the entertainment scene. 

The concert to be held on December 11th 2021, at the Molapo Showcase, has a packed lineup with the Headlining acts being Bishop Benjamin Dube, Lebo Sekgobela from South Africa and Botswana’s very own Obakeng Sengwaketse. More international acts from Nigeria and Ghana are also expected to grace the event. The show organizers have invested an effort in diversifying the lineup with live performances. 

The promoter of the Arise and Worship Concert, David “DVD” Abram revealed in an overview of the event that; “We have lost a lot of loved ones this year, and when that happens, one’s spirit goes down, and we need a light to ground us once more, to heal our souls. Therefore, the two main purposes of this event are to do the work of God and, secondly, to make sure that we nurture and develop talent in Botswana. With challenges that come up with events of such magnitude, the team and I have been committed to seeking guidance from God through having night prayers.” 

Abram added that as promoters, they usually have a bias towards already established artists, thus neglecting the upcoming ones and wanting to change that. “We approached the Melody Gospel TV Show since we aim at nurturing new talent and agreed on having one of the winners as a headliner for the event to allow them to share the stage with gospel giants so that they are exposed to the industry. This resulted in securing the Second Winner of the Melody Gospel TV show; Thabiso Mafoko as a local headlining act.”

The concert also aims at celebrating a Motswana. Multi-Award Winner; with the most recent title; BOMU Best Traditional Gospel under his belt, also best known for his soulful voice and heartfelt lyrics, Obakeng Sengwaketse enthusiastically said, “I want to thank the organizers of the Arise and Worship concert, it means a lot to me after recently winning two awards that are currently the highlight of my career.

I regard this as a great revival because the Covid-19 pandemic has muffled events such as this. I am looking forward to sharing the stage with the great Bishop Benjamin Dube, Lebo Sekgobela and more artists from Nigeria and Ghana. Sengwaketsi urged Batswana to come and witness the greatness of the Lord as their lives will never be the same.”

Tickets are selling like fat cakes with VVIP tickets having only five tickets remaining; the VVIP tickets include rounder access backstage to all the performing artists. The event will also comprise a seated Gold Circle Ticket, which accounts for 50% of revellers to allow for easier enforcement of COVID-19 protocols and avoid a potential stampede.

In a bid to entice merrymakers to buy tickets, the promoters have come up with a layby strategy and buying tickets on an instalment basis for the attendees to be able to buy their tickets since the COVID-19 Pandemic has left many Batswana in financial ruin but having the interest to attend the event.

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WeekendLife

Fame vs Mental health

9th November 2021
Lizibo

One can only imagine what is like being in the public eye. It is not a walk in the park; and not as easy as people might think it is because of the pressure from the public. Celebrities or influencers are perceived to be perfect, perfect bodies, perfect families, perfect parents, financially stable, healthy, and always smiling and patient with everyone – Is this for real?

However, when people’s expectations of celebrities are not met, the same celebrities are often victimized, body shamed, or blamed, fairly or unfairly. As a result of them not having a personal life, they are often scrutinized in all aspects of their lives; their lives are aired for the public to see and judge. Celebrities are often extra careful about everything that they do, they have to go an extra mile as compared to how ordinary people live their lives.

To understanding this experiences by public figures, this reporter made a case study of Mr Lizibo Gran Mabutho, the firstborn in his family with only one sibling, his younger brother. Lizibo describes himself as a simple Kalanga guy who was chosen by music and did not choose music.

He said being raised by his mother and grandmother, he grew up surrounded by music from birth. Lizibo said his grandmother was a religious person who held church services at their house in Zwenshambe, “for me singing was from Monday to Sunday. I was not like any ordinary child who only sang at church on Sundays or sometimes in school assembly, for me it was a daily thing. My mother was also a talented dancer in our village that is what I mean when I say I did not choose music, but music chose me.”

Lizibo said though he grew up surrounded by music, it was hard for his parents to accept the path he has chosen to be a musician. Lizibo said he had to prove to his parents that music was his passion and that it could pay the bills like any other profession. He said eventually they saw his passion for music and supported him.

Lizibo said being exposed to music from a tender age made him venture into the music career from a tender age. He said he was part of the Kgalemang Tumediso Motsete (KTM) choir, Lizibo said being in the public eye for the longest time has taught him that he is living for the people and that he does not have a life. He said the very society that is watching him has so much expectation for him and that means he has to conduct himself in a good manner because people are looking up to him.

Lizibo said he understands the saying that great power comes with great responsibility, “when people see me, they see a role model. I realize and understand that people are and have been modelling me even when I was not aware of it, I know of six mothers who have named their sons after me because they felt that I inspire them somehow.”

He said he has accepted his fate that he will never have a normal life because people are looking unto him. He said he is grateful to be in the public on a positive note by bringing hope to the people because he has always wanted to be part of people’s solutions and not their problems.

He said, “people should understand that our careers are our calling. One needs to be spiritually connected to their calling as an artist. The most rewarding part about being in the public for me is not about payment but about being the solution to someone’s problem.”

Lizibo said the greatest challenge that he has ever faced about being in the public eye has been the issue of trust, not able to know which friends are genuine and which ones are not. He said as a way of avoiding fake friends he has always kept his four close friends who have been there for him through thick and thin. Lizibo said being close to his family has also helped him as they have been his strength when things were not going well for him, “most of the time people say we change when we taste fame. That is not necessarily true because people are the ones who changed when we became famous. People always want something from us, nothing is ever genuine with people and that is why I chose to keep my circle very small.”

Lizibo said as much as he travels a lot because of the nature of his work because it is naturally demanding, he said he always ensures that he creates time for his family. He said that at home he is Lizibo who is sent to do errands, he is Lizibo the son, not a celebrity.

He said there is a lot of pressure that comes with being in the spotlight, “the public puts so much pressure on us mostly about the material lifestyle they portray us to have. We are often compared with South African celebrities, but people fail to understand that we are two different countries. Most people fell into the trap and are living above their means resulting in them living in debt. I often tell youngsters not to fall into that trap of being tempted to live life above their means.”

The advice Lizibo gave to upcoming celebrities was that they should know that being in the public is not about them, but it is about the people. He said, “one of my mentors once asked me if I make music about myself or the people. He said I need to make music for the people because it is my responsibility to feed them with what they need, he said they might not even be able to know that they have a need but that I need to identify that need and meet it. Our responsibility is to serve people what they need, our music is to feed people’s hunger. My music is about love, I feed people love.”

Lizibo said it is important for celebrities to seek counselling and take care of their mental health, he said he has been investing in his mental health for years because he understands the importance of mental health especially when one is in the public.

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