According to the World Health Organisation, infertility — which is defined by the failure to achieve a clinical pregnancy after 12 months of regular unprotected sex — is a disease.
Dr Alfred Murage, a reproductive medicine consultant at Aga Khan University Hospital’s obstetrics and gynaecology department, has worked for more than 10 years with couples who were unable to conceive naturally.
He says: “If you look at the statistics, roughly speaking, 30 per cent of the time, the problem is the man, 30 per cent of the time, it’s the woman, and the rest of the time, it’s combined factors.”
He says there are different options available for someone seeking fertility help.
When the woman has regular periods, and the man is young and physically healthy, couples should seek medical help if they cannot conceive after having regular intercourse for at least 12 months.
However, this is not the blanket rule for everyone.
Dr Murage adds: “People who are older, 35 years for women and men in their 40s, you give them six months because with advancing age, there is a decline in potential to conceive.”
“With people who have problems, for example women with irregular periods, which means they aren’t ovulating, or men with erectile dysfunction, you also don’t wait for a year to seek help.”
The most common cause of infertility in Kenya is blocked tubes. These can be caused by pelvic inflammatory diseases, which stem from unprotected sex with multiple partners and delays in treating sexually transmitted diseases.
The focus on men is on the quality of the sperm. Men who are healthy, don’t smoke or take any drugs, aren’t overweight or have any other diseases like diabetes, are likely to have normal sperm.
Once the problem has been identified, the correct intervention can be chosen.
MEDICATED CONCEPTION
For women, Clomiphene citrate (Clomid) is prescribed. It induces ovulation in women who do not develop and release an egg on their own. It can also be used to stimulate extra follicles to develop in the ovaries of women who already ovulate without medication. The success rate for the use of Clomid is usually 5.6 per cent.
Because the same hormones in men and women control reproduction, the same fertility drugs that stimulate ovulation also stimulate sperm production.
Costs for the medication will generally not be more than Sh10,000 per cycle.
INTRAUTERINE INSEMINATION
This involves giving medication to stimulate ovulation, then placing a sperm sample inside the uterus. The goal is to increase the number of sperms that reach the fallopian tubes and therefore increase the chance of fertilisation.
This option is often used in cases where there might be a hostile cervical condition such as cervical mucus, cervical scar tissue from past procedures that may hinder the sperms’ ability to enter the uterus, and in cases of erectile dysfunction.
The costs vary depending on the clinic, but will range between Sh20,000 and Sh70,000.
INVITRO FERTILISATION (IVF)
This is the most complex of the fertility treatments available. Fertility medications are first prescribed to stimulate egg production, after which they are extracted through a minor surgical procedure.
Prepared sperm is then combined with the eggs in the laboratory.
Once the eggs are fertilised and become embryos (usually within five-three days), they are transferred to the uterus. Overall, the success rate for IVF is about 35 per cent.
IVF is also the most expensive option and will cost around Sh500,000.
Dr Murage says Kenyan insurance companies do not cover fertility treatment.
“That’s unfair, they should look at IVF and infertility as a disease, as defined by the WHO.”
In Europe, many countries offer IVF on their national health services, albeit with a number of limitations and criteria that must be fulfilled.
However, Dr Murage says: “We’ve had a chat with a few insurance companies, to be fair to them, and they have given some indication that they may be willing to cover some of the treatments on a trial basis.”