African Journal for Infertility and Assisted Conception

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The background history of counseling in assisted reproductive technology (ART) relates to when technology was introduced into the infertility treatment of clients. The public reaction then was intense on concern over the vulnerability of potential users and the welfare of children either created or affected by it. As a response, the development of Human Fertilization and Embryology Act (HFEA) in 1990 established infertility counseling with recommendations to address the public perception of moral and social acceptability of ART by the society. The recommendations outlined requirements for clinics offering infertility treatment to individuals and couples to provide counseling for the associated symptoms and treatment consequences that clients may experience with ART. The purpose, definition, indications, types, and scope for counseling in ART were also addressed. Infertility counseling in ART incorporates a clinical team approach consisting of the fertility doctor, fertility nurses, professional counselors and embryologist who through information empower and support clients to cope well with the infertility experiences.

Context: Invasive office procedures such as office hysteroscopy are usually carried out without analgesia as they are thought to cause minimal or no pain to the patient. Hysteroscopy has been found to be a cause of significant pain in some patients. Aims: To determine factors inherent in infertile patients experiencing pain during office hysteroscopy in Port Harcourt, Nigeria. Settings and Design: A cross-sectional comparative study amongst infertile women undergoing office hysteroscopy. Methods and Material: Assessment of Pain perceptions using a numerical pain scale in 101 women following office hysteroscopy. Demographic, Social, and gynecological factors of these patients were analysed for association with to pain perception. Statistical Analysis Used: Bivariate logistic regression analysis was conducted for associations between pain perception and suspected factors with P≤ 0.05 as statistically significant. Results: The mean age of the patients was 35.95±4.65 years. 53(52.5%) and 48(47.5%) of the patients experienced moderate/severe pain and mild/no pain respectively. Moderate/severe pain in participants was not associated with age, parity, type or period of infertility, dysmenorrhea or previous pregnancy terminations. However, it was associated with education below secondary level (OR=1.82; P value=0.21, 95%CI 0.81-4.11) and over one previous miscarriages (OR=1.11, P value = 0.948.;95% CI 0.51-2.43). Conclusions: Moderate/severe pains at office hysteroscopy occurred in more than one half of the patients increased risk of pain occurred in patients with miscarriages and those with less than secondary education. We recommend analgesia for patients undergoing office hysteroscopy.

Sub-Saharan Africa is one of the regions with the highest prevalence of infertility in the world. Despite the high prevalence of infertility in sub-Saharan Africa, it is the region with the least number of assisted reproductive technology (ART) facilities in the world. The challenges facing the rapid development of ART in sub-Saharan Africa stem from the socioeconomic, political, religious, and cultural background and the ethical issues surrounding the practice of ART. The establishment of ART centers in this subregion is a welcome development because it creates awareness and improves access to care and follow-up with the technological advancements in other regions of the world. However, the society has the responsibility to ensure that the advances made through ART are implemented in a socially responsible and acceptable manner. National governments should address the infrastructural problems such as power, roads, security, manufacturing, importation clearance, and healthcare facilities in their subregions. At the regional levels, training centers should be established across the region for proper formal training for all cadres of ART practitioners—doctors, embryologists, nurses, counsellors, and administrative staff. The governments of the various countries in sub-Saharan Africa should encourage, regulate, and control the practices of ART in line with local sociocultural norms.

Online since 12^th Aug, 2016