Subfertility, not a curse

by Dr. Hemantha Wickramatillake

There are thousands of married couples seeking help to bear a child. There is a strong likelihood that something may be interfering with their efforts to have a child.

Subfertility, also known as infertility, is the inability to conceive a child during the early years of marriag. Sometimes, as in couples who live separately and who do not indulge in intercourse regularly, the reason may be due to lack of opportunity to have intercourse during the fertile period, rather than a real case of subfertility.

This is quite common among military couples or those who travel out of home for days at a stretch. Infertility may also be due to a single cause in either the husband or the wife, or a combination of both that may prevent a pregnancy from occurring or continuing.

Most men with fertility problems will not show any signs or symptoms. Some men with hormonal problems may note a change in their voices or pattern of hair growth, enlargement of their breasts, or difficulty with sexual function.

Subfertility in women may be signalled by irregular menstrual periods or associated with conditions that cause pain during menstruation or intercourse. The human reproductive process is complex.

To accomplish a pregnancy, the intricate processes of ovulation and fertilization need to work just right. For many couples attempting pregnancy, something goes wrong in one or both of these complex processes and causes subfertility. Because of the intricate series of events required to begin a pregnancy, many factors may cause a delay in starting your family.

If a couple is unable to achieve conception within a reasonable time and would like to do so, they should seek help.

The female's gynaecologist, the man's urologist or the family doctor can determine whether there is a problem that requires a specialist or clinic that treats infertility problems.

Some couples have more than one cause for their subfertility. Thus, a doctor will usually begin a comprehensive infertility examination of the couple, starting with a male cause. In Sri Lanka, there are specialized centres which conduct clinics to evaluate the status and also to provide assistance in becoming pregnant.

Family Planning Association of Sri Lanka conducts a clinic of this nature, apart from other sexual and reproductive health services. Soon, the clinic will also expand its services, more as a "Healthy Family" Clinic, to other areas including childcare and adult men's care.

Subfertility evaluation is usually expensive and in some cases involves operations and uncomfortable procedures. Finally, there is no guarantee, even after all the testing and counselling, that conception will occur.

However, for couples who are eager to have their own child, such an evaluation has to be done. Other than in cases where there are non curable causes, it may result in a successful pregnancy.

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What is subfertility

A couple that has tried unsuccessfully to have a child for a year or more is said to be subfertile. The couple's fecundability rate is approximately three to five per cent. Many of its causes are the same as those of infertility.

Infertility is a condition of one or both partners who have physiological abnormalities that prevent them from conceiving and maintaining a pregnancy.

Male factors include: lack of sperm, congenital defects, blocked epidermis or vas deferens, testicular damage, impaired ejaculation and impotence. Female factors include: absence of ovulation, egg formation, viability of fallopian tubes and uterus, endometriosis and frequent miscarriages.

Both partners can also be affected by hormonal imbalance, anti - immune disorders and damage from sexually transmitted diseases. Some of these physiological deficits could be overcome by surgery to clear blockages, stimulate hormones or artificially inseminate using IVF or GIFT.

A couple is classified as infertile when they have had regular (2-3x per week) unprotected sexual intercourse for 12 months. Recurrent miscarriages and inability to sustain a pregnancy also indicate the need for thorough evaluation.

Male and female factors contribute about 40 per cent each and the remaining 20 per cent are a result of a combined problem or unknown causes. Secondary or Subfertility is a decreased capacity to conceive, including miscarriage. It also covers the 20 per cent of unknown causes.

The important distinction between infertility and subfertility is that it may take considerably longer for subfertile couples to conceive, but there is still a possibility that they can.

Why the increase in Subfertility?

Numerous factors contribute to subfertility. The environment is heavily laden with pollution. Our reproductive systems are very sensitive to many pollutants, which undermine their ability to reproduce.

What is sufficient capacity to sustain an adult is often insufficient to facilitate a conception. The peak period for women's reproductive health is in their late teens and early twenties.

As women get older, their chances of conceiving can be diminished by disease, allergies, toxicity of environment and early menopause. However, with specific nutritional care many women do go on to conceive healthy babies into their early forties.

Our soil is nutrient - poor, mostly farmed with unsustainable practices using high doses of fertilizer and pesticides. The nutritional content of food deteriorates with preservation, heating and additives. A nutrient depleted food uses up the bodies store of vitamins and minerals. Illness and allergies also require nutrients in the body to fight infection. Lifestyle factors such as: alcohol, tobacco, oral contraceptives, prescribed and social drugs further stress the body and leach essential nutrients from the body.

Diet and lifestyle

It also recommends that both partners need to drink pure water, avoid caffeine e.g. coffee, cola, chocolate etc., and eat whole, mostly raw food grown on healthy soil e.g. organic foods. It is necessary to reduce stress, do moderate exercise and maintain optimum weight.

It is important to have infections and allergies treated and reduce exposure to environmental pollutants in our homes, gardens and workplace.

Source : Natural Parenting

Chikungunya fever in Sri Lanka?

by Dr. Mass R. Usuf

Chikungunya fever (CF) is a viral disease. The medium of infection is through mosquitoes infected with the Chikungunya Virus (CHIKV). The CHIKV is a member of the genus Alphavirus (family Togaviridae). The time from infection to illness (incubation period) can be 2-12 days, with an average of 3-7 days following the pattern of most illnesses of viral origin.

The Aedes aegypti mosquito (daytime bites) is a primary vector of CHIKV to humans. Aedes albopictus is also suspected in transmission of the virus to humans. The Aedes aegypti mosquito is the primary carrier for viruses that cause degue fever as well.

CF can easily be misdiagnosed as dengue fever since symptoms are more or less alike in both types of fever. In case, a particular area is having a dengue fever epidemic along with a CF epidemic, in all probability proper clinical diagnosis of CF would not be made to any appreciable extent.

Moreover, silent infections too can occur sans manifestations of any gross symptoms or symptoms may be so mild so as to escape serious attention.

CF is a self limiting febrile disease of viral origin that can be very debilitating. It is characterised by symptoms of arthralgia (typically in the knee, ankle and small joints of the extremities), myalgia (muscle pain) fever (which can register 39 degrees C), headache, fatigue, nausea, vomiting, mild haemorrhage (especially in children), great prostration, insomnia.

In a recent outbreak of CF in Southern India certain dermatological features were observed such as: petechial of maculopapular rash (usually involving the limbs and trunk), buccal and palatal enanthema, nasal blotchy erythema, freckle like pigmentation over centro-facial area, flagellate pigmentation on face and extremities, lichenoid eruption and hyperpigmentation, ecchymotic spots (mostly in children), vesiculobullous lesions (in infants), aphthous like ulcers over scrotum, crural areas and axilla, lympoedema in acral distribution.

Dengue fever too has some of these characteristics but a single characteristic of CF sets it apart from dengue fever -in that , CF produces severe and prolonged arthralgia (joint pain), which an be crippling - which is not typical of dengue fever. An lgM capture ELISA will distinguish the disease from dengue fever.Currently, there is no vaccine or antiviral treatment available to counter CF.

Symptomatic treatment such as administration of NSAIDS (not aspirin), fluids, bed rest would help reduce fever and bring relief from myalgia and arthralgia.As a dengue fever, homeopathy however, has an array of wonderful drugs that would act not only as a preventive but also would act effectively against the derangement and bring about quick relief. These drugs when administered in time would even preclude complications from setting in.

Drugs such as Eupatorium perf, Pyroginum, Rhus tox, Cedron, Ledum pal, Influenzinum, China, Arnica, Belladonna, Bryonia etc can be put to effective use depending on manifesting symptoms.

Eupatorium perf combined with Ledum pal, effective as a preventive against dengue fever, can also be used as preventive against CF during epidemics. Administration of Eupatorium perf Q (mother tincture - 3 to 5 drop dose) would ameliorate the debilitating joint pains and reduce the intensity and duration of the disease.

(The writer is the Senior Vice President of the National Association of Homoeopaths & Affiliates)

How parents can deal with... Bedtime resistance

Almost all young children go through a period when they will resist going to sleep. Resistance in going to bed is shown by the long hours of bedtime rituals as the child will ask for one more drink of water, just one more story or another trip to the bathroom.

Children below the age of 3 years are often disinterested in going to bed and will often wake up at night and demand to be held and attended to.

Reasons why

1. Child is anxious or overstimulated.

2. Child craves for parents' attention and company.

3. Parents show excessive concern and distress or inability to be firm in getting the child to sleep.

4. Child already has too much sleep because of afternoon naps.

5. Child is put to bed before he is ready and able to fall asleep. Like adults, children vary in their sleep needs.

6. Child gets lonely sleeping by himself and needs parental reassurance.

How to prevent

1. Establish a regular routine and bedtime ritual for going to bed and for waking up. You can have your child bathe, brush his teeth and put on his pyjamas in the same order every night.

2. Enforce firmly the time for bed. If your child states that he is not sleepy, still expect him to rest quietly in bed until sleep comes.

3. Push back your child's bedtime much later if you come home relatively late from work. This will allow your child some time to play with you.

4. Give your child 5 or 10 minutes advance notice that bedtime is approaching.

5. Provide your child with quiet and relaxing activities like reading, story telling an hour before bedtime. A warm bath or a bedtime snack can help prepare a child for sleep.

6. Associate sleep with pleasure, affection and relaxation; for example, you can tell a bedtime story, say an evening prayer or sing a goodnight song after the child is in bed.

7. Give your child a security object like blanket or cuddly stuffed animal. This can help him to make the transition from wakefulness to sleep.

8. Provide your child with plenty of attention and affection through play before bedtime.

9. Make exercise a daily habit.

What to do

1. Promptly return your child to his bed whenever he pops out of bed after being put to bed.

2. Reduce or eliminate your child's daytime nap or consider a later bedtime.

3. If your child is fearful of the dark, encourage him to talk about it and give him plenty of assurance. You can also have a dim light on and leave the child's door open.

4 Set up a star chart and reward your child for each night that he goes to bed readily without any fuss. Several stars can earn him a treat or special privilege.

5. Play Beat-the-clock. Set the timer to fifteen minutes. Reward your child if he beats the time in getting ready for bed (get into his pyjamas, brush teeth, get a drink and go to the bathroom).

What not to do

1. Allow child to watch horror movies or indulge in rough and active play just before bedtime.

2. Insist that child fall asleep immediately.

3. Punish child by sending him to bed early.

4. Threaten, criticise or spank.

5. Allow child to control his bedtime.

Source: Handling Common Problems of Children.