MANILA, Philippines – Conception has been made less difficult for couples due to the number of medical breakthroughs in the field of reproductive science. There is “assisted reproductive technology” which involve manipulation of both the sperm and the egg; there are also early interventions such as drugs that stimulate the production of eggs. (READ: When conceiving is a problem)

But what of economic limitations prevent you from accessing these cutting-edge treatments? And what if societal norms and community expectations put having children at the center of an individual and family’s identity? And what if, as a woman, you were viewed to be incomplete without a child?

What options would be open to you?

That’s what Dr. Linda Bennett of the University of Melbourne attempted to find out in a four-year study she conducted in Indonesia where estimates of infertility range from 15% to 22%.

Given that there are 39.8 million Indonesian women are of childbearing age, at a 15% female infertility rate, this translates into 6 million women experiencing infertility.

The study focused on unexplained infertility (when it appears that a couple have healthy fertility components but conception is not occurring despite regular intercourse) and was presented by Bennett at the recently conclude 7^th Asia Pacific Conference on Reproductive Sexual Health and Rights held in Manila last week.

Addressing infertility

“Most Indonesian couples who experience infertility will not visit expensive infertility specialists. Less than 10% of infertile couples access biomedical infertility treatment,” said Bennett.

Bennett and her research team conducted extensive interviews, research and field work among women in 6 areas in Indonesia to find out about their reproductive health history, knowledge about their bodies and copulation behavior.

They found that many of these women had no reason to experience infertility, but their knowledge gaps and the behavior practices that were passed on them had an impact on their rate of conception.

Fertility window

“Women had very low knowledge of their fertility window,” said Bennett, referring to the days of the menstrual cycle during which intercourse is most likely to result in conception.

“They had no knowledge of the physiological signs of ovulation and commonly avoided intercourse during ovulation – to avoid what they felt was excessive vaginal wetness,” Bennett added.

Bennett and her team found that some women used drying agents to absorb vaginal wetness around the time of ovulation, causing vaginal dryness.  In addition, women typically washed immediately after intercourse and typically did not raise their legs/pelvis after intercourse, usually getting up quickly to bathe.  All of these factors decreased the probability of conception.

“It was partly due to what they were taught about hygiene practices, but also because it is very hot in Indonesia,” she explained.

It may sound very basic compared to the state –of-the-art assisted reproductive technology that is available, but Bennett and her team wanted to test to see if the chances of conceiving for women would improve if their knowledge about menstrual cycle, ovulation also improved.

Bennett experimented on two groups of women and conducted discussion groups where the women were taught the basics: how to count their menstrual cycle, tell the difference between healthy and unhealthy vaginal discharge, and the symptoms of sexually transmitted infections, which also hamper conception.

Group A was comprised of 8 women; all married and had been trying to conceive for at least 12 months to 3 years. Group B was comprised of 7 women, all married, had all been trying to conceive for at least 12 months up to 7 years.

In Group A, six months after the discussion group, three women became pregnant. Twelve months after the discussion group, two more women were pregnant. A total of the 5 of the 8 women delivered healthy babies after applying the simple knowledge learned in the discussion groups.

In Group B, there were similar results. Six months after the discussion group, 4 women were pregnant. One woman miscarried after 3 months, and three women delivered healthy babies.

Many of the women in the test group were able to resolve their infertility by applying simple knowledge about their own bodies and the process of natural conception.

“Rates of successful conception following women’s improved understanding of their bodies and fertility window were very promising,” said Bennett who also stressed that the test is by no means conclusive and  that more studies are needed to study the role of men in infertility. However, it does show promise for preventing and curing infertility among those who cannot afford or do not want biomedical infertility treatment.

Women are likely to change their behavior (when it comes to avoiding vaginal drying and changing time of intercourse) when benefits are well explained and simple reproductive health education on fertility and conception is not costly and is highly suited to primary health care were the conclusions of Bennett’s initial study.

This knowledge is especially relevant to women of rural and grass root communities where Bennett says the impact of infertility is highly gendered, typically resulting in greater social suffering for women.   

“It is urban women who are choosing to have children later in life or not having them at all. But for these (rural) women, when having a child and having someone to love is all they have to look forward to in life, this information is crucial and should be made available to them.” – Rappler.com

Image of mother and doll from Shutterstock.