Everyday habits such as smoking, excessive alcohol consumption, poor sleep, chronic stress, and unhealthy body weight are increasingly linked to infertility among couples, according to medical experts. These lifestyle factors disrupt hormonal balance, affecting both egg and sperm quality. Dr. Kenneth Ruzindana, a senior consultant at Kigali University Teaching Hospital, said smoking reduces egg quality in women and damages sperm in men. Excessive alcohol intake, he added, interferes with hormonal regulation, suppressing reproductive hormones and impairing ovulation and sperm production. ALSO READ: Infertility affects one in six couples globally – WHO Alcohol disrupts what doctors refer to as the hormonal axis, the system linking the brain and reproductive organs by reducing the release of gonadotropin-releasing hormones. These hormones are essential for ovulation in women and testosterone production in men. The result can be irregular menstrual cycles, reduced sperm production, and diminished fertility. Body weight also plays a critical role. Being underweight can halt ovulation as the body conserves energy, while obesity disrupts hormonal and metabolic processes. “In underweight individuals, low body fat reduces hormone production and can lead to amenorrhea, or absence of menstruation,” Dr. Ruzindana said. “Obesity, on the other hand, lowers testosterone levels in men and impairs sperm production. In women, it affects egg development and ovulation.” ALSO READ: IVF in Rwanda: Breaking taboos, bringing hope to couples facing infertility Stress and sleep deprivation further complicate fertility. Chronic stress increases cortisol, a hormone that suppresses reproductive hormones, while also raising prolactin levels, which can prevent ovulation. Poor sleep disrupts cortisol and melatonin levels, interfering with reproductive cycles. Understanding infertility Infertility remains a common but often misunderstood condition in Rwanda, with stigma and misinformation delaying diagnosis and treatment, said Dr. Stephen Rulisa, Professor and Head of Obstetrics and Gynecology at the University of Rwanda. He defined infertility as the inability to conceive after one year of regular, unprotected sex. The process involves multiple organs, including the ovaries, fallopian tubes, uterus, and the brain’s hormonal control system. Disruptions at any point can prevent pregnancy. Common causes include ovulatory disorders such as polycystic ovary syndrome (PCOS), blocked fallopian tubes, and uterine conditions like fibroids or infections. “All these factors can lead to infertility, but most are treatable depending on the cause,” Dr. Rulisa said. Primary infertility refers to couples who have never conceived after 12 months of trying, while secondary infertility affects those who have conceived before but cannot do so again. For women over 35, evaluation is recommended after six months due to age-related fertility decline. Globally, infertility affects 10–15 percent of couples, with Rwanda showing similar trends. Secondary infertility, often linked to infections or pregnancy complications, is common. However, stigma and reliance on traditional remedies continue to delay care. While IVF services are available at Rwanda Military Hospital and Mediheal Diagnostic and Fertility Centre, high costs limit access for many couples. Not just a woman’s issue Experts stress that infertility is not solely a woman’s problem. About half of cases involve male factors such as low sperm count or poor sperm quality. “Cultural beliefs often place the blame on women, while many men avoid testing,” Dr. Rulisa said. “This delays diagnosis and treatment, sometimes compounded by misconceptions such as attributing infertility to witchcraft.” Treatment options Treatment depends on the cause, the couple’s age, and how long they have been trying to conceive. Initial approaches include ovulation induction and intrauterine insemination, where sperm is placed directly into the uterus. If these methods fail after several cycles, in vitro fertilisation (IVF) may be recommended. IVF involves fertilising an egg outside the body before implanting the embryo in the uterus. “IVF is not always the first option, but it becomes necessary when natural conception is unlikely,” Dr. Ruzindana said. “In some cases, it helps overcome subtle fertilisation or implantation challenges that are difficult to detect.” Awareness and early action Doctors advise couples to seek medical advice after six months to a year of trying to conceive without success. “There is little benefit in pre-marital fertility testing, as fertility cannot be fully predicted in advance,” Dr. Rulisa noted. “What matters is early consultation once challenges arise.” He emphasised that infertility is common and often treatable, calling for open conversations to reduce stigma and encourage timely care. Dr. Ruzindana urged couples to prioritise preconception care, including medical check-ups, lifestyle adjustments, and early identification of potential risks to improve chances of conception.
