Sharing the burden of infertility

Counselling for couples facing challenges in conceiving should guide them towards a shared sense of mutual support rather than finger-pointing, says an expert.

“Infertility affects one in seven couples. Some of the causes include lack of regular ovulation—which is commonly seen in patients with polycystic ovaries—blocked or damaged fallopian tubes, endometriosis, and poor semen quality,” said Dr Farah Leong Rahman, consultant fertility specialist, obstetrician and gynaecologist. “However, in a quarter of cases, it is not possible to identify the cause, in which case we label it as ‘unexplained infertility’.”

Often conceptualized as a women’s health issue, the sociocultural burden of infertility often falls on the woman’s side of the affair. However, infertility is an issue that affects both sexes; the National Population and Family Development Board (LPPKN) found an estimated 60 percent of sperm analysis tests conducted among Malaysian men between 2010 and 2019 had reported abnormalities

Couples who face difficulties in conception may go through emotional and mental exhaustion, with some falling into depression, bouts of frustration, anger, or loss of self-esteem, said Farah. Patients should be counselled on the importance of giving and receiving support, not only between the couple, but between them and their respective family members and friends.

“It is important [for them] to be honest about [their] feelings and to be able to express it in the right way. There are also support groups out there and counsellors if one needs help. Good mental and emotional health should be present throughout this period and continue [through a pregnancy],” she added, noting that the couple should be reminded frequently that they are not alone on their journey.

When to pursue further intervention

According to Farah, lifestyle changes can address some cases of infertility. These can include a healthy and balanced diet, abstaining from smoking and alcohol, regular exercise, and healthy body weight maintenance. She also stressed that pre-existing chronic medical conditions, eg, diabetes, should also be under control prior to pursuing fertility treatment, so as to prevent potential adverse events.

Farah suggested that couples should visit a fertility doctor—preferably together, rather than individually—if they have been unsuccessful in conceiving after a year to decide on their next steps, particularly if the woman is 35 years and older. She added that physicians should account for other factors such as previous treatments that may have resulted in infertility (eg, for cancer), or previous surgeries related to reproductive organs.

In the case of men, those with a history of undescended testes, problems with pubertal development, previous genital surgery or infection, fertility problems in current or previous relationships, or problems with erection or ejaculation are also advised to seek help.