Hypertension and diabetes: Contributory factors to infertility

“Shieee wooww! She’s elegant,” Laryea muttered to himself.

“Hiii, Pognaba (Queen),” he greeted in an unusually romantic tone that revealed a side of him his colleagues rarely saw. He was determined to get to know the beautiful young woman who had just walked in, filling him with an indescribable feeling in the process.

However, the very describable sensation of a full bladder needed his attention first, so he quickly dashed into the washroom and hurriedly emerged a couple of minutes later, eager to reach her before his friends, Toure and Olufemi—dubbed the company’s “bad boys”—could make a move. “Hiiii, my name is—”

“You haven’t washed your hands. Please go and do that before we talk,” Amina interrupted, her voice gentle but firm, as Laryea reached out to introduce himself.

“Shieee wooww! She’s gorgeous, intelligent, soft-spoken, hygienic, and assertive! What a combination! What a jackpot!” Laryea exclaimed to himself, dashing back to wash his hands, gleefully skipping along like a child instructed by his mother to clean up before getting his favourite meal.

“That was the beginning of our love story,” Amina told me, holding tightly to Laryea’s hand as they reminisced about how their friendship blossomed into a blissful marriage. Blissful initially, but not anymore. Nine months into their “happily ever after,” the marriage was on the rocks.

Laryea’s family was pressuring him to either divorce Amina or marry a second wife, believing Amina was barren because she hadn’t conceived.

This is why the couple was at my clinic when most people were already tucked away in bed.

“How often do you have sex in a week?” I asked, my usual opening question when a couple reported difficulty conceiving.

“Well, Amina and I are both busy. I’m constantly stressed at work. I urinate frequently, eat more than I want to, and I’ve been getting these headaches that won’t go away, no matter how much Paracetamol or Brufen I take,” Laryea said, clearly embarrassed by the question. His attempt to deflect the conversation was, however, leading us somewhere.

“About once or twice a month, but neither of us is really in the mood,” Amina added, her voice tinged with worry. She clutched her husband’s hand even tighter, afraid of losing him even within the walls of a consulting room.

After hearing this, I took a detailed history and examined them. Laryea’s blood pressure was elevated (above 140/90 mmHg), and his random blood sugar levels (the measure taken without fasting) were alarmingly high (above 11.1 mmol/L). Amina’s weight was also above the healthy range (Body Mass Index over 24.9 kg/m²). I advised them to return the next morning for another check.

The next day, Laryea’s blood pressure remained high, and his fasting blood sugar (measured after not eating for at least 8 hours) exceeded 7.0 mmol/L. It became clear that Laryea was unknowingly living with both hypertension and diabetes.

These conditions had been affecting his physical and mental health to such an extent that they impaired his desire and ability to fulfill his marital responsibilities. Amina’s weight, meanwhile, was contributing to her constant fatigue, further reducing her libido.

I then began a lengthy conversation with the couple in the consulting room.

Infertility and Its Causes

“Infertility, according to the World Health Organization (WHO), 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,” I explained. “The American Society for Reproductive Medicine (ASRM) recommends that evaluation should begin after 12 months for women under 35, and after 6 months for women aged 35 and older if there is no known cause for impaired fertility.”

I continued, “Infertility is a common issue affecting millions around the world. The WHO estimates that about 1 in 6 people of reproductive age will experience infertility at some point. But the good news is, there are many ways to address it.”

“Oh really? So, it isn’t just us? And there are solutions?” Laryea asked, somewhat relieved to discover a community that understood their situation and was willing to help, drawing even closer to Amina—his work partner turned forever partner.

“Infertility has many causes that can affect either or both partners. In men, it may stem from blockages in the reproductive tract, testicular failure due to varicoceles (enlarged veins of the testicles), mumps infections, or abnormal sperm quality, which can be caused by steroid use for bodybuilding. For women, common factors include blocked fallopian tubes, ovarian disorders like Polycystic Ovary Syndrome (PCOS), and uterine conditions such as fibroids,” I explained. “Stress, obesity, smoking, excessive alcohol consumption, diabetes, and hypertension can also contribute to infertility in both men and women.”

“In fact, a study by the WHO found that the causes of infertility are almost evenly distributed, with 37% of cases due to female factors and 35% involving both male and female factors.”

Taking Action to Address the Issue

“Therefore, it is incorrect for your families to assume that Amina is to blame,” I said. “You’ve only been trying to conceive for nine months, which is less than the 12 months suggested by the WHO and ASRM as the benchmark for diagnosing infertility.

Additionally, the combination of Amina’s stress levels and Laryea’s uncontrolled hypertension and diabetes has likely interfered with the recommended regular sexual activity of every 1-2 days during Amina’s fertile window.”

At this point, the couple sighed in unison and leaned back on the sofa, visibly relieved. Their marriage might not be over after all. Elated, Laryea asked, “What steps can we take to save our marriage?”

I began by congratulating them on sharing the responsibility of conception and seeking professional help together at an accredited medical facility. Then, I provided them with a series of recommendations:

1.Medication: Laryea started taking his prescribed hypertension and diabetes medications daily, with Amina reminding him every morning during breakfast.

2.Physical Activity: The couple committed to taking 30-minute brisk walks every day after work along the Timbuktu Road.

3.Lifestyle Changes: They completely cut out alcohol and began drinking 2-3 litres of water (4 to 6 sachets) daily. They also quit smoking shisha, cigarettes, and marijuana.

4.Dietary Changes: The couple reduced their consumption of processed and fried foods, opting instead for meals rich in fruits, green leafy vegetables, whole grains, and legumes. Amina, who enjoyed experimenting with recipes, added various vegetables such as kontomire (cocoyam leaves), cabbage, bito/kanzaga, shuwaka (bitter leaf), efo gbure (water leaf), and kerenkere (jute leaves) to their dishes.

5.Salt and Sugar Intake: They drastically reduced their salt intake to less than one teaspoon per day and limited sugar consumption to fewer than six teaspoons daily.

6.Stress Management: The couple made a conscious effort to lower their stress levels by spending quality time together, enjoying outdoor activities, and getting at least seven hours of sleep each night.

7.Intimacy: With their improved health and renewed energy, they prioritized regular, satisfying sexual activity.

A Happy Outcome

Exactly two months after meeting the couple and while I was wrapping up my work for a well-deserved Christmas break, the couple returned to my office with another complaint. This time, Amina had missed her period for a month. Further tests confirmed that she was pregnant. Nine months later, they joyfully welcomed their first child.

The Takeaway

Infertility can arise from a variety of factors in both men and women, but many of these are treatable with expert medical guidance.

It is therefore important for couples and their families to share in the responsibility of conception, and not just blame it on women.

Hypertension and diabetes, which nearly tore Laryea and Amina apart, are just two examples of conditions that can be managed to improve fertility. Don’t let these health issues define your story. Seek help, because help is available.

Note: Although this story is based on real events, the names and locations have been changed to protect the individuals’ privacy. Any resemblance to actual persons, living or dead, is purely coincidental.