So here you are, having tried to get pregnant for a year and nothing… Not a miscarriage or a missed period. You and your partner are looking at each other askance, scared to say "let’s go to the doctor". Your situation might even be worse. Perhaps you have been to the doctor and have been tested and you sat there trying to make head or tail of the bad news of your combined infertility and the options available to you.
Now that you have staggered, found your footing and absorbed the news, what are the options available to you? Can you afford them?
The subject of conception and any problems in the area is filled with shame and secrecy. Parents do not speak of trying to conceive for years. Those who have failed to carry a baby to term rarely mention their miscarriages, and when it comes to men and abnormal sperm, well, just mentioning that is sacrilegious to African manhood.
So what is infertility and are you actually dealing with it? I have had women write to me saying they are concerned that they are not pregnant two months after the wedding. Trying for two months effectively means you have only tried twice because a woman is only likely to get pregnant during ovulation, which only occurs about once a month. According to the American National Library of Medicine, infertility occurs when a couple has been unable to conceive after a year of having unprotected sex. When women reach age 35, the timeframe is cut to six months. More than 30 per cent of couples in which the woman is older than 35 have fertility problems, according to the Centers for Disease Control and Prevention.
There is a tendency to play the blame game when it comes to infertility. But doctors will tell you that in about 40 per cent of couples dealing with infertility, the problems may lie with the man or the woman. The other 20 per cent is due to unknown causes.
Treatment for the woman
Treatments for women are dictated by what is keeping them from getting pregnant. That said, the more successful treatments benefit women who have problems with ovulation.
A woman’s reproductive system is controlled by a delicate balance of hormones secreted by different organs – the thyroid gland in the throat, the pituitary in the brain and of course, the ovaries in the pelvis. Diseases in these organs will affect regular hormone production and ovulation. Medication to treat these organs and correct these imbalances might be all that is needed; such as: to stimulate your ovaries to release eggs, to treat polycystic ovarian syndrome (PCOS) and to correct high levels of the hormone prolactin, which hinders ovulation.
Blocked or damaged tubes
Each month your ovary matures an egg and releases it into the fallopian tube. It is here that it is fertilised by sperm and the zygote travels down the tube into the uterus where it will grow into a baby. Blocked or scarred tubes (caused by infection such as gonorrhoea or chlamydia) can hinder this process, and they may be treated through tubal surgery.
Each month the uterine lining develops in preparation for a zygote to implant. Sometimes this tissue migrates into other parts of the reproductive system. If mild to moderate endometriosis seems to be impairing your fertility, a laparoscopic surgery may be used to remove endometrial tissue. This treatment may not be an option if you have severe endometriosis.
This is used to remove uterine fibroids, polyps or scarring, which can all hinder fertility. If the above methods do not work, then a woman can opt for more complex procedures called Assisted Reproductive Technology (ART):
Intrauterine Insemination (IUI): This is the placement of a man’s sperm into the uterus using a long narrow tube. It is effective for women who have scarring or defects of the cervix, men with low sperm count or low sperm mobility, men with erectile dysfunction and men whose sperm is ejaculated into the bladder as opposed to out of the penis.
In Vitro Fertilisation (IVF): Eggs and sperm are incubated in a dish to produce an embryo which is then implanted in the uterus where it will hopefully implant and grow into a baby. Each cycle of IVF costs roughly Sh450,000 and above.
Third party assisted ART includes: Sperm donation (you can get it donated or you can buy it for between Sh10,000 and Sh15,000), egg donation (the treatments to harvest eggs from a donor are much more involved, so an egg costs about Sh50,000), surrogates or gestational partners (you will have to support the woman carrying your child throughout her pregnancy and pay all her medical bills).
Treatment for the man
And now for the guys, about 200 million sperm are mixed with semen to form ejaculate. In most men, 15 to 45 million of these sperm are healthy enough to fertilise an egg, although only 400 survive after a man ejaculates. Roughly speaking, that’s like the entire population of Kenya running through the pearly gates of heaven and then only 400 national legislators (senators, MPs and women’s reps) making it to the promised land. Anything that interferes with these numbers will lower a man’s fertility.
The most common causes of male infertility are: Low sperm count, slow sperm motility (movement), abnormal morphology (shape and size of sperm), problems with semen, erectile dysfunction and blocked or scarred urethra (if the tube (urethra) that the ejaculate passes through on the way out of a man’s body is scarred or blocked then very little of the ejaculate will get through). This can be due to injury, surgery or infection such as gonorrhoea or chlamydia.
Dr Mburugu is a urologist at The Aga Khan and he says: "Smoking can narrow your blood vessels and mess up the smooth muscle cells, which are both necessary for erection. More than five units of alcohol per week are also not good for you."
So what are the possible treatments?
Medication: Hormonal imbalances can be treated with medicines, as can erectile dysfunction and premature ejaculation.
Surgery: To repair blockages in the tubes that transport sperm or to repair varicose veins in the testicals.
ART: Assisted Reproductive Technology (see above in the, treatments for women’ section).
For both men and women, the following lifestyle changes will improve your overall health and also your chances of conceiving and having a healthy baby:
Stop smoking cigarettes or marijuana: Smoking tobacco has been linked to low sperm counts and sluggish motility. Long-term use of marijuana can result in low sperm count and abnormally developed sperm. In women, smoking has been linked to premature menopause.
Decrease your drinking: Alcohol can reduce the production of normal sperm.
Watch your weight: Both overweight and underweight people can have fertility problems. With too much weight, there can be hormonal disturbances. And when a man's too lean, he can have decreased sperm count and functionality. The same is true for women, with acute hormonal imbalances resulting in few or no menstrual periods.
Eat lots of fruits and vegetables: These will keep your circulation in great shape, which is necessary to move all those hormones around, and also for your sex life.
Exercise: Again, this is not just great for your circulation but also for all bodily organs. Exercise will also help you deal with the stress of trying to conceive and increase your libido.
Avoid toxins: Landscapers, contractors, manufacturing workers, and people who have regular contact with environmental toxins or poisons (pesticides, insecticides, lead, radiation or heavy metals) are all at risk of infertility.
Adoption: The world is full of orphaned children in need of a good home. And with the new law banning foreign adoption of Kenyan babies, it is up to us to provide a solution. The process takes about a year. You must get a lawyer and you can expect at least two home visits from a social worker. Nobody expects a lavish home, just provide for the basic needs of a child and lots of love.
When you think about all that can go wrong and just how small the chances of conception are on a monthly basis, it is no wonder that sex feels so good and we are so driven to have it.
As you deal with infertility as a couple, here are some relationship issues that might come up:
Anger: One or both partners may be angry at the partner with the infertility issues. This might look like promiscuity, avoidance of sex altogether, withdrawal of intimacy or denial of what is actually happening.
In-laws: Running commentary from people who think they have a vested interest in your reproduction – opinions, rude comments about barrenness and ideas on what you can do and so on.
Differences in what each partner is willing to do to become a parent: Financially (treatments are expensive, would you mortgage your home?), and even scientifically (one might be willing to try medical treatment but not surgery).
Impact of hormonal treatments: High doses of hormones make you moody, frantic and very emotional. This can take a toll on a marriage.
Emotional exhaustion from trying to get pregnant and failing: Getting a negative result month after month can be heartbreaking, and you must both decide when enough is enough.
Seven things not to say to a couple dealing with infertility
Do not give up, it will happen: This is not actually true. You might think that you are encouraging your friend but remember that s/he is the one living with the disappointing results of trying for months on end.
So whose fault is it? This is a deeply personal question, so avoid it. Infertility is a couple’s issue, not an individual issue.
But you already have a child: Secondary infertility is real and painful, even for couples who already have a child. It is possible to be grateful for the child you have an still crave another.
Are you one of those career women? While this might be true, nobody wants to be judged for the choices they made and cannot change in the present moment. Be supportive or be quiet.
Can I give you my kids? Sure, raising children is challenging but acting like you would give yours up in a heartbeat does not make anyone feel better.
You just need to relax, anxiety causes infertility: This is unproven
Maybe you are not meant to be parents: Idiots, criminals, unwilling teenagers and abusive monsters have children. Do not pretend to know who is ‘meant’ to parent, there are no qualifications.
*Article written in consultation with fertility expert Dr Wanjiru Ndegwa