COSTLY BUT REWARDING

Desperate for a child? How to safely get one

In vitro fertilisation has saved many from divorce due to childlessness

In Summary

• Children are the glue that keeps many marriages intact, but infertility hinders birth

• Divorce is not the answer. As Dr Rajesh Chaudhary explains, medical solutions exist

Reproductive gynaecologist and IVF specialist Dr Rajesh Chaudhary during an interview with the Star at Fertility Point Clinic in Nairobi on October 25
Reproductive gynaecologist and IVF specialist Dr Rajesh Chaudhary during an interview with the Star at Fertility Point Clinic in Nairobi on October 25
Image: MARGARET WANJIRU

The realisation that a couple cannot bear children breaks hearts and even marriages, but the inception of correctional procedures has helped salvage many marriages in the country.

In vitro fertilisation expert Rajesh Chaudhary takes us through the procedure, from the start to conception.

First, the couple is taken through an ultrasound to determine where the problem is, and if indeed they are infertile.

“In women, we conduct an ultrasound to determine whether there is any tumour in the uterus or if the fallopian tube is open. Men are taken through a basic semen test,” Rajesh, the lead specialist at Fertility Point Kenya, said.

From this, the couple is allowed to select any method they prefer. If they choose IVF, which is most common, the patients are given medicine to boost sperms and eggs.

On the second or third day of the woman’s menstrual period, they are required to report to the clinic.

“We then advise them on the finances and expenses. We counsel them about the success rate, which depends on age, how good or bad their response is and how bad the womb lining is,” he said.

On the third or fourth day, the doctor monitors the follicle development. Once it's mature, the patient takes 9-10 days, when a final injection will be administered at night to make the egg mature.

When the couple is young, let’s say below 25 years, success rate is 70 per cent. Forty per cent is when, let’s say, the woman is at around 40 years. The eggs are less and the quality is a bit not good
Dr Rajesh Chaudhary

MAIN PROCEDURE

After 36 hours of that final injection, there’s egg retrieval. The woman is advised to come with the husband on an empty stomach. Harvesting is done under very short anaesthesia.

“The procedure is 10-15 minutes, and then once the egg is harvested, the patient resumes consciousness,” Rajesh said.

The same day, the doctor collects the husband's semen.

If the husband doesn't have the sperm in the semen, sperm retrieval surgery is done the same day.

“The sperm is processed in the lab and loaded in a fine needle and then injected in the egg,” Rajesh said.

The egg injected with the best-looking sperm is selected from that and kept in the incubator.

After 24 hours, the embryologist checks to see if it has fertilised. That egg has to multiply every day and once it reaches around 8, then the doctor plans for the embryo transfer.

After 14 days of embryo transfer, a pregnancy test is conducted.

SUCCESS RATE

The success rate of an IVF procedure is between 40 and 70 per cent, and that depends on age mostly.

“When the couple is young, let's say below 25 years, that's 70 per cent. Forty per cent is when, let's say, the woman is at around 40 years. The eggs are less and the quality is a bit not good,” the specialist added.

Rajesh said a failed procedure is biological, and that cannot be corrected. Some fertility boosting methods can be used, but it's not that significant.

Of the many couples Rajesh has served, he can't help but remember three women who had very critical issues he helped them conquer.

One is a 52-year-old who got an egg donor and is expecting twins. Another is a 47-year-old who had several failed IVF procedures. She is at least 22 weeks expectant now.

“There is also a lady who wanted to preserve her eggs. She had two egg harvesting procedures but we did not get any mature egg. So I did IVF  with a different protocol and we got a mature egg,” he said.

Some genetics in parents can be altered to prevent them from being transferred to the baby, including diseases.

Rajesh says parents can choose to ensure their kids do not inherit some illnesses by being taken through a correctional procedure called Preimplantation Genetic Testing.

“The same embryo, we take one or two cells from that embryo, we screen whether it is suffering from any diseases or not,” he said.

For example, it can be applied if a family member is suffering from Huntington's disease (brain disorder) and the parents want to stop the transmission to their children.

“The lab technician in the genetics lab will introduce a specific probe for that disease to see whether that sample is having the same problem or not. We test whether that embryo has that disease or not,” the specialist said.

Rajesh says most men are infertile but they don't own up to the condition. Of those men, low sperm count is almost a third.

“In women, maybe 30 to 40 per cent have a hormonal imbalance and are not able to ovulate in time. Other issues are fallopian tube blockage, age-related problems and fibroids,” he said.

MYTHS AND MISCONCEPTIONS

Most women fear using contraceptives because of the myths surrounding them, the most common being the fear of ‘not being able to keep a pregnancy’.

Rajesh points out that the Implanon does not cause any infertility since the menstrual cycle returns to normal after its removal.

“That implant will only have effect between three to four months after removal, and that effect is likely to go up to the fourth month, so it should not be a problem,” he said.

However, infections caused by intrauterine devices like copper might result in blockage of the fallopian tube and infection in the womb lining, leading to infertility.

Termination of pregnancies is said to be among the leading causes of secondary infertility in women.

Secondary infertility is where a woman has conceived before and then there’s a problem in their pregnancy.

When there’s abortion or miscarriage, some women experience difficulty conceiving thereafter because of unsafe termination methods.

“For example, not using the proper procedure when doing termination may lead to infection of the womb lining or blockage of the fallopian tube, leading to infertility,” Rajesh said.

Most people would ask what the appropriate age for conception is. The specialist advises couples to start their journey when they are ready.

However, he said, biologically women need to have been expectant by 32. For men, they are advised to have sired children by around 40 years.

“After 32, the quality and number of eggs will start declining. For males, before 40 is best. If not, before 45 because the decline in fertility is a gradual process,” he said.

Rajesh said Fertility Point conducts at least 200 correctional procedures a month, which is more than 2,000 annually.

Most couples, he says, break up whenever they are unable to bear children instead of seeking medical assistance.

SETTING STANDARDS

Before settling for IVF, a couple should consider a clinic that has properly skilled professionals, an IVF lab and clinic, ultrasound and pharmacy.

Rajesh called for regulation of the sector in reproduction to help the industry grow and only allow skilled professionals to run the clinics.

He says most couples fall prey to quack doctors, who end up extorting their money and never help them.

“They are desperate for children and go to even those who are not eligible to treat them, and then the patients get exploited financially,” he said.

The Assisted Reproductive Technology Bill 2019, sponsored by MP Millie Odhiambo, is currently in its second reading.

It proposes the formation of the Assisted Reproductive Technology Authority, which will develop standards, regulations and guidelines on assisted reproduction.

While moving the bill on the floor of the House, Odhiambo pointed out that assisted reproduction is not illegal but there is no legal framework.

"I know there may be many moral and ethical issues that will be raised, but we cannot bury our heads in the sand. I have read the Bible and I have found nothing that stops assisted reproductive technology," she said.

The lawmaker said many women have been abused and mocked in society. 

Other procedures used to help deal with infertility include Intra Uterine Insemination, (IUI) and Intra Cytoplasmic Sperm Injection (ICSI.)

If the semen counts are good and the fallopian tube is open, patients are advised on IUI. We give them medicine from the second or third day of the menstrual cycle for five days.

This helps develop one or two eggs. The husband’s semen is then processed and directly inseminated to the uterus during ovulation.

ICSI is applied in case the man does not have sperms during ejaculation. The sperms are retrieved directly from the testes in a syringe. It is then injected directly into the egg.

In case a couple wants a baby of a specific gender, they are offered Preimplantation Genetic Screening (PGS) of the embryo.

“We take one or two embryos and then we do a genetic biopsy. Then we determine whether the chromosomes of the makeup of that embryo is normal or not and what gender it is. Then we transfer it to the womb lining,” Rajesh said.

The cost of an IVF procedure ranges between Sh400,000 and Sh450,000 because few insurance covers can pay for it.

Edited by T Jalio