Dorcas came to the sexology clinic to seek treatment for infertility.
She was not on any contraceptive. She and James, her partner, had sex two to three times a month but no baby came for five years.
"You kind of have sex rather infrequently," I retorted, noting that couples looking for a baby should ideally have sex two to three times a week.
"Well, we attempt sex almost three times a week but my husband loses erections most of the time, hence the infrequent successful attempts," she explained.
So James had erection problems for which he had never sought medical help. This was a pertinent point in the medical history and I documented it as we continued to explore possible causes of infertility.
I examined Dorcas and failed to identify anything that could have caused her infertility.
I ordered for a battery of tests to check her reproductive hormones, uterus, fallopian tubes and ovaries. I asked her to bring her husband so that I may examine him too.
Dorcas came back to the clinic a week later. She was not accompanied by James.
"He says he has had a baby with another woman previously and that the infertility issue is my problem," she said.
This is a common line of argument by many men whenever there is infertility in the family. The truth however is that in up to 25 per cent of infertility cases are caused by male problems.
In another 15 per cent, the problem is contributed to by problems existing in both parties.
It is only in about 60 per cent of cases where infertility is caused by problems exclusive to the woman. Dorcas results were all normal. I explained that we could not proceed without examining James.
Three months passed before Dorcas reappeared in the clinic. This time she was accompanied by James.
"I am here because I need to talk to you about erection problems," James said. He looked distressed.
He could not look at me directly in the eye, a sign that his self-confidence was rather low.
Incidentally, after Dorcas sought treatment for infertility James went dead flat. He had not had an erection in three months.
Couples with sexual dysfunction have a worsening of their condition when they seek treatment for infertility.
This is because when they start to have sex for the sole purpose of achieving conception, it becomes mechanical, and if there was an existing sexual dysfunction, the will power to overcome it vanishes.
I took James' medical history and examined him. I ordered tests to rule out common causes of erectile dysfunction.
I also ordered for semen analysis and put him on erection stimulants to enable him to produce the sperms for testing.
A week later James brought results of the tests to the clinic. His sperm count was low.
Most of his sperms were dead or abnormal. He could not for sure make a woman pregnant. I concluded that he was the cause of infertility in his family.
"But surely, what is causing this now?" He asked. "I am sure I got a baby with another woman so all this is not adding up."
Well, the issue of having a baby with another woman was an allegation we had no evidence on.
Results of hormone tests further showed that James had high levels of prolactin. Prolactin is found in small amounts in males but when levels rise above normal, they depress sexual function and cause erectile dysfunction.
High prolactin levels also interfere with sperm formation. All the problems James was facing were attributable to high levels of prolactin.
Dorcas listened attentively as I explained to James his problems. She was lost in her thoughts.
"So all these years I have been demeaned, discriminated and called all manner of names for not conceiving when it was James who had a problem?" she asked.
"Do you remember your mum saying that I was useless and good for nothing? That I was squandering your money and preventing you from marrying a woman who could give you babies?" She said and broke down into a fit of emotions.
James did not utter a word. I counselled the two to help resolve their deep-seated conflict.
I put James on a long term medical treatment to lower the high prolactin. He had to take a tablet daily.
I did not hear from the couple for close to nine months then one evening I got a phone call from Dorcas.
"Sorry to call you so late, I could not sleep without talking to you. I did a pregnancy test today and you know what? I am pregnant!"