WORLD Pharmacist Day celebrated yesterday, Saturday September 25, 2021 recognised the contributions and service of pharmacists to humanity, promoting safe use of medicines and enhanced clinical outcomes. This event is mostly promoted by the professional pharmacy bodies both locally and internationally since the majority of pharmacy owners here are business people and not pharmacists. It is my fervent hope that the wide gap be narrowed between Guyanese pharmacists and their colleagues in countries where the pasture maybe greener. With 25 continuous years of service in this profession under my belt, inclusive of hospital pharmacy, management and higher level administration at the Board and the Council, my view is that pharmacists need to earn their respect by displaying a responsible role. Focus in today’s article is on infertility treatment.

Infertility is defined as the inability of a couple to conceive or get pregnant after unprotected intercourse for a minimum period of twelve months if the female partner is younger than 35 years or six months if she is older than 35 years. However only 60 per cent of younger couples (both male and female between the ages 29 – 33 years) get pregnant within the first six months and this percentage goes up to about 90 per cent after trying for 12 months depending on the overall health of the individuals. Some older females might conceive but are unable to carry the pregnancy to full term. Primary infertility is where the female was never able to be pregnant whilst secondary infertility is where the female was only able have one pregnancy successfully.

It is important not to stigmatise or play the “blame” game since the reason for infertility could be due to the male partner (1/3RDof the time), or the female partner (1/3RD of the time) or both persons or unknown cause (1/3RDof the time). Twenty per cent of couples may never know why they cannot conceive. However the reason(s) for the infertility must be ascertained prior to treatment plan and execution.

Key Terms explained
* Ovulation – the process when the egg is released from the ovary in the female
* Fertilisation – the process where the sperm from the male fertilises the egg from the female
* Sperm count – the number of sperms produced by the male
* Sperm Motility – the ability of the sperm to move to fertilise the eggs

The female body is so designed to facilitate fertilisation at the right time. With the help of ovulation kits, you can narrow down the “most fertile time” for the woman to have unprotected intercourse to facilitate pregnancy. The basal body temperature is an “after-the-fact” indicator to confirm that ovulation has occurred. It is important to know that the woman’s fertile time is personalised and can be calculated using your menstrual cycle or period. So charting your cycle is a critical success factor.

The female fertile period is important especially if the male partner had been diagnosed with a low sperm count. Men with low sperm count are advised about the appropriate hormonal medications or surgical procedures which can be employed to increase their sperm health, which is the sperm count and motility. In cases when there are other disorders in males such as premature ejaculation, underlying diseases or structural dysfunction, spot on diagnosis is the key to success.

Poor reproductive health in both men and women are attributed to inappropriate nutrition, obesity, smoking, alcohol abuse and illicit drug use (marijuana, cocaine and anabolic steroids which some athletes use), overexposure to pesticides and chemicals, cancer treatment (both chemotherapy and radiation), medications (sulphasalazine, calcium channel blockers – a type of pressure meds and antidepressants), medical illness and age. Specifically for men overexposure to sun, delayed puberty or anatomically narrowing of the vas deferens among others could also be factors.

With respect to women, there are a number of disorders which can cause infertility namely hormonal imbalance, endometriosis (the overgrowth of the uterine lining), damage or blockage to the fallopian tube mainly from an STD (sexually transmitted disease such as chlamydia and gonorrhea), PCOS (polycystic ovary syndrome), PID (pelvic inflammatory disease) uterine fibroids and pelvic adhesions. There are also some other associated diseases such as sickle cell disease, diabetes, kidney disease and Cushing’s disease.

The stats from a WHO published study suggest that 80 per cent of the general fertility problem are attributed to ovulation problems, fallopian tube blockage or sperm health. Treatment options are medications, surgery or IVF (in vitro fertilisation).

Some men may undergo surgical widening of the veins in the scrotum if there is a blockage in the vas deferens which is the tubes that transport the sperm. If an infection exist then antibiotics are prescribed to address these concerns. Medication and counselling are recommended to deal with any erectile or ejaculation problem if this is identified as an area of concern.

IVF (in vitro fertilisation) for eligible women if fallopian tubes, which are the passage-way that carries either a fertilised or unfertilised egg to the uterus, are damaged or blocked. Or if the female partner has fibroids which are benign tumors that affect implantation of the embryo (fertilised egg). Another consideration for IVF is if ovulation is infrequent or absent where fewer eggs are available for fertilisation. However, in vitro fertilisation procedures are time consuming, invasive and not affordable by a majority since insurance does not compensate for this.

Medications are recommended after evaluation or screening on your eligibility. Vitamins or fertility meds such as clomiphene helps to release eggs during the ovulatory cycle. These ovulating inducing drugs are in oral formulation which have as a side effect 30 per cent chance of twin birth. However not all patients will respond to these types of meds. If the patient suffer from PCOS the gynaecologist may prescribe metformin for restoring cyclic ovulation and regular menses. In other situations FSH or LH injections are administered to enhance the woman’s natural hormone production capabilities and stimulate the ovaries promoting follicular development. Alternatively exogenous (synthetised) injections called GnRH (gonadotropin releasing hormone) are administered when no response to clomiphene is observed.

The role of the pharmacist is a resource personnel for patients who have been prescribed treatment for infertility. The regimens are often complicated and require full comprehension for optimal results. So guidance on timing, medication safety and administration, treatment options and referrals are some of the value added benefits to expect when engaging the pharmacist.

For further advice consult the pharmacist at Medicine Express PHARMACY located at 223 Camp Street, between Lamaha and New Market Streets. If you have any queries, comments or further information on the above topic kindly forward them to medicine.express@gmail.com or send them to 223 Camp Street, N/burg. Tel #225-5142.