Is your lifestyle blocking your future babies?

The last few years have been characterised by a change in the tone of the fertility discussion. Infertility has been one of the most stigmatised medical conditions, resulting in the most heart-rending stories we have seen in recent times.

In biblical times, women like Sarah and Hannah were looked down upon for their failure to bear children, while others like Rachel were deemed to have done something wrong that resulted in God blocking their childbearing to teach them a lesson. In current times, not much has changed.

Couples who cannot have children are largely stigmatised and the women bear the brunt of this, despite science showing that the problem is shared three ways: a third of the cases demonstrate a problem in the woman, another third in the man and in the last third, in both concurrently. However, women go through agony that is beyond measure in the face of infertility.

Horror stories such as that of Jackline Mwende, whose story hit the headlines last year after her husband allegedly chopped off her hands for failing to bear him children, are rarely brought to the limelight but are uncomfortably common. Nevertheless, with modern advances in medicine, infertility is now spoken of rather than whispered about.

Technologies such as intra-uterine insemination and in-vitro fertilisation have become commonplace and the taboo subject is slowly getting demystified. It is with this in mind that we look at tubal blockage as a cause of female infertility and the impact our youthful lifestyles have on the future.

ELECTRIC AVENUE

In the basic female anatomy, ova (eggs) in a woman, are made in the ovaries and transported through the fallopian tubes to the uterus. Halfway through their sojourn, they meet up with the sperm, get fertilised and progress to the uterus as the basic human form called morula. Therefore, blockage of the fallopian tube effectively causes outright infertility.

Research shows that in Sub-Saharan Africa, 64 per cent of infertile women had tubal blockage resulting mainly from genital tract infections and sexually transmitted infections. What does this mean? Early on in their reproductive life, young women contract infections that lead to inflammation of the tubes with resultant damage and scarring that causes blockage.

Looking at young women in Kenya, the average age of coitarche (first sexual contact) is 17 years. This may be lower or higher depending on the girl’s background. For a long time, focus was on the young girl from a disadvantaged background: the poor, orphaned, displaced or neglected child. She was deemed to be at risk of sexual exploitation, and this may as well still be the case.

However, we have a new entrant into this scene. The urban college girl taking her first step in the world as an independent adult. Campus culture has changed over time and with this, new risky behaviour is rapidly emerging. Every town or city with a university now has what is popularly known as the ‘Electric Avenue’. From Westlands in Nairobi, to Eldoret to Kisii, these streets crammed with noisy pubs brimming with young merrymakers  at all hours of the day and night, have taken a life of their own.

The culture of heavy drinking, smoking, illicit drugs and casual sex has taken deep root. Young girls trying to fit in are drawn into this world without much orientation. These intoxicated encounters often lead to unprotected sex, date rape, abuse of the emergency contraceptive pill, unplanned pregnancies, unsafe abortions and genital tract and sexually transmitted infections.

All these make the perfect recipe for precipitating fallopian tube blockage. As scientific evidence continues being collected, case studies seem to suggest that abuse of the emergency pill seems to increase the risk for ectopic pregnancies. In our resource-limited setup, most of these young women will possibly lose a fallopian tube by the age of 22, with no surety of what is happening to the remaining tube.

This is light years away from the time they will consider becoming mothers. Unplanned pregnancies lead to many an unsafe abortion which is the leading risk factor for genital tract infections such as endometritis and salpingitis (inflammation of the fallopian tubes). This is because some of the places these abortions take place are unsanitary and infection control is unheard of.

HOME TO ROOST

Instruments used introduce infections to the womb and antibiotics are not prescribed. They then turn up seriously ill, seeking proper treatment and it may be too late to prevent damage to the very delicate fallopian tubes. In the worst case scenario, they may lose their wombs or end up with perforated intestines, bladder and ureters.

With the degree of unprotected sex evidenced by the volume of emergency pills consumed, it is a no-brainer how sexually transmitted diseases will have a field day in this population. Some of these infections like chlamydia may be mostly asymptomatic, causing damage to the tubes silently for years, resulting in blockage without the woman’s knowledge. The sexual partners of these young women also spread the infections around yet do not suffer as severely as the young women do.

By their late twenties, these young women are at the peak of their lives, making great career strides and settling down in marriage, having put the four years of college behind them.

This is when the chicken come home to roost. A trip to the doctor leads to one to the radiology unit for a hysterosalpingogram, commonly known as the HSG and it reveals that the tubes are blocked. The struggle with infertility is real. It does not choose race, class or social standing. Knowingly wading into a risky lifestyle for momentary pleasure is in no way a smart move for young women who are just starting out in life. We only get one pair of tubes. We must jealously guard them!