Lower fertility rate & ageing population may constitute a serious state problem in next few years

As a result of the combination of a lower fertility rate and ageing population in the country, Dr Serge Velazquez, gynecologist at Panafricare Clinic, has expressed his concern for the pressure that this may place on the provision of pensions and health care by the government.

In the following interview, he lists some of the main causes of infertility among our local population, explains the disadvantages of a lower fertility rate and ageing population, and shares his advice for those seeking to improve their fertility.

Seychelles NATION: What is infertility?

Dr Serge Velazquez: Infertility 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.

Infertility can be primary or secondary. Primary infertility is when a pregnancy has never been achieved by a person, and secondary infertility is when at least one prior pregnancy has been achieved.

Infertility affects millions of people of reproductive age worldwide, and has an impact on their families and communities. Estimates suggest that between 48 million couples and 186 million individuals live with infertility globally.

Fertility care encompasses the prevention, diagnosis and treatment of infertility.

Seychelles NATION: What are some of the main causes of infertility among the local population?

Dr Serge Velazquez: Infertility may be caused by a number of different factors, in either the male or female reproductive systems. However, it is sometimes not possible to explain the causes of infertility.

Female causes in order of frequency in our experience in Seychelles:

• disorders of the ovaries, such as polycystic ovarian syndrome and other follicular disorders

• tubal disorders such as blocked fallopian tubes, which are in turn caused by untreated sexually transmitted infections (STIs) or complications of unsafe abortion, postpartum sepsis or abdominal/pelvic surgery

• disorders of the endocrine system causing imbalances of reproductive hormones. The endocrine system includes hypothalamus, pituitary glands, thyroid glands, suprarenal glands and metabolic disorders

• uterine disorders which could be inflammatory in nature (such as endometriosis), congenital in nature (such as septate uterus), or benign in nature (such as fibroids)

In the male reproductive system, infertility may be caused by:

• obstruction of the reproductive tract causing dysfunctionalities in the ejection of semen. Blockages are commonly due to injuries or infections of the genital tract

• hormonal disorders leading to abnormalities in hormones produced by the pituitary gland, hypothalamus and testicles. Hormones such as testosterone regulate sperm production. Examples of disorders that result in hormonal imbalance include pituitary or testicular cancers

• testicular failure to produce sperm, for example due to varicoceles or medical treatments that impair sperm-producing cells (such as chemotherapy)

• abnormal sperm function and quality. For example, the use of anabolic steroids can cause abnormal semen parameters such as sperm count and shape

Environmental and lifestyle factors such as smoking, excessive alcohol intake and obesity can affect fertility. In addition, exposure to environmental pollutants and toxins can be directly toxic to gametes (eggs and sperm), resulting in their decreased numbers and poor quality, leading to infertility.

Seychelles NATION: What are the disadvantages of having a low fertility rate or high precedence of infertility in a small country like Seychelles?

Dr Serge Velazquez: Seychelles’ population grew rapidly during the second half of the 20th century, largely due to natural increase, but the pace has slowed because of fertility decline. The total fertility rate dropped sharply from 4.0 children per woman in 1980 to 1.9 in 2015, mainly as a result of a family planning programme, free education and health care, and increased female labour force participation. Life expectancy has increased steadily, but women on average live 9 years longer than men, a difference that is higher than that typical of developed countries.

The combination of lower fertility and longer longevity has resulted in an ageing population, which will cause low productivity due to a lack of a young workforce, and this will put pressure on the provision of pensions and health care by the government, constituting this a serious state problem in the next few years.

Seychelles NATION: What is your advice to people who wish to conceive in future, for improving their fertility?

Dr Serge Velazquez: The majority of research in this area is epidemiological; there are some investigations randomized controlled trials (RCTs) regarding weight loss and other abnormal lifestyle behaviours that significantly affect the reproductive health of the couple.

High or low Body Mass Index (BMI), alcohol, vigorous exercise, nicotine, antidepressant medications and inappropriate lifestyles, have an adverse impact on fertility.

Patients do not appear to follow recommendations for lifestyle behaviour modifications during infertility treatment. The impact of lifestyle behaviours on fertility is poorly understood then it is vital for healthcare professionals to understand which lifestyle behaviours can have the greatest negative impact, in an effort to improve patient recommendations.

Therefore, it is important for the reproductive health of the couple to carry out frequent exercises, especially aerobics, to maintain an adequate BMI, a balanced diet with a significant contribution of vegetables, fresh fruits, meats and carbohydrates, which positively contribute to improving reproductive capacity. On the other hand, reducing, controlling or eliminating toxic habits such as alcohol, nicotine, marijuana and other known drugs as well as antidepressants will help to improve fertility.

Source: National Information Services Agency