Gonadal Insufficiency

CHEMICAL PATHOLOGY PRESENTATION CASE STUDY ON GONADAL FUNCTION Presenter: Kyei K. Stephen LECTURER:DR FAY

OUTLINE OF PRESENTATION INTRODUCTION TO CASE STUDY • Definition of sub fertility • General causes • Hypothalamic -Pituitary -Gonadal axis for male and female • LABORATORY INVESTIGATIONS • SOCIAL AND REPRODUCTIVE HEALTH • PUBLIC EDUCATION ON SUB FERTILITY

Case History • Dr. Abebreseh has been married to Portia Abebreseh for the past 4 years without any issue. Dr. Abebreseh’s family has started speculating that Portia is the cause of this misfortune. • One evening Dr. Abebreseh was called by his parents in his village and advised to take Agya Daesbreh’s 21 year old daughter Yaa Dufie to ensure they receive their grandchildren before their death. Abebreseh is confused and as a close friend he has come to see you for an advice as a colleague. • What should be the medical approach in investigating this couple? Do you think subfertility is a social or reproductive health issue? How can the public be educated on it to avoid stigmatization and suspicions?

SUB FERTILITY • Definition: Is defined as less than normal capacity for a couple to conceive after one year of regular, unprotected sex.

GENERAL CAUSES OF SUFERTILITY IN MALES • Impaired shape and movement of sperm. • Low sperm concentration • Hormonal deficiency (male hypogonadism) • Genetic defects • Infections

GENERAL CAUSES OF SUBFERTILITY IN FEMALES • • • • • •

Genetic defects Infections Fallopian tube damage or blockage Endometriosis Ovulation disorders Hormonal defects

MALE HYPOTHALAMICPITUITARY-GONADAL AXIS GnRH

Testosterone Inhibin LH, FSH FSH acts on Sertoli cells LH acts on Leydig cells

FEMALE HYPOTHALAMICPITUITARY-GONADAL AXIS GnRH

Estradiol Progesterone

LH, FSH

FSH stimulates follicular growth LH stimulates ovulation

LABORATORY TEST FOR DR ABEBRESE

Sperm morphology

LABORATORY TEST FOR PORTIA ABEBRESE

SUBFERTILITY A SOCIAL ISSUE • Societal expectation of married couple is to conceive and propagate the family name, therefore, if a woman is not able to have children, she is singled out, ridiculed , ostracised and stigmatised. • There are some misconceptions and myths regarding sub fertility such as "a barren woman has been cursed by God , and being punished for the sins of a prior life“.

Sub fertile couples are easy and soft target for everyone - ranging from; • Friends ( "life is incomplete without a baby !"); • In-laws ( "when will I become a grandmother ?"); • Relatives ( "what do they want to earn money for - they do not have any children to leave it to !"), • Neighbours ( "they may have a lot of money, but what's the use, they don't have any children" );

• Acquaintances ( " no good news yet ? Go see this doctor my sister-in-law's cousin went to - he's the best !") ; • Co-workers ( "you don't have any kids, so can you stay on a little longer to finish this job - I need to go back to take care of my children !"); • Right to servants ( " the reason she shouts so much is because she doesn't have children - serves her right)

• Not only do marriages break up, many women are abused by their families or relatives and many suffer in silence because they are ashamed to talk about it. • Such couples go through a lot of emotional stress, that can affect productivity at the work place.

• Sub fertility is like a chronic illness that uses up a large amount of a couples' resources - emotional and financial - and involves the expenditure of a considerable amount of time, money, physical and intense emotional stress • Sub fertile couples come under great stress which affect them psychological and emotionally.

SUBFERTILITY:A REPRODUCTIVE HEALTH ISSUE • It has now been well established that sub fertility is an illness, which is caused by various medical conditions, which result in the abnormal functioning of the reproductive systems ( such as genetic, blocked fallopian tubes , ovulation disorder, elevated prolactin (hyperprolactinemia),polycystic ovary syndrome, a low sperm count etc); and that these can be successfully treated in most cases.

EDUCATION ON SUB FERTILITY

• Using the media, organizing seminars, counseling sessions, religious bodies, the following would undertaken: • Public should be made to understand that giving birth is a matter of choice, and sub fertility is not a curse but a temporary condition that can be resolved. • Counseling centres in various churches would be advised to explain to the would be couples and their families on this subject .

• The public should be made aware that marriage is not only meant for procreation but also for companionship.