Infertility: Getting pregnant would give me great joy. If only I could afford it!

Thirteen years ago Ian* and Triza* formalised their marriage with traditional rites and a white wedding in Turbo, Uasin Gishu County. The couple hoped to live happily ever after in a home full of children, but a decade of trying without success has left them weary and wary.

Two years into their marriage and after many nights of trying for a child, hopelessness crept in and they sought the intervention of herbalists following the advice of friends who claimed to have had similar difficulties.

“We were hopeful because some friends told us that herbal medicine had worked for them. We spent a lot of money and even sold part of our land seeking traditional remedies, but we were not lucky,” says 40-year-old Triza.

In the eighth year of marriage, they decided to consult a gynaecologist at a private health facility, who told them that Triza’s fallopian tubes were blocked. Blocked or damaged fallopian tubes are a common cause of infertility – affecting seven out of 10 women who are trying to conceive.

Women have a pair of tubes – one on each side of the body – that carry eggs from the ovary to the uterus. During ovulation, one of the ovaries releases an egg that travels down one of the fallopian tubes, where if a sperm is present (having travelled up after unprotected sex) fertilisation takes place and the woman falls pregnant. If the tubes are blocked or damaged, the sperm can’t reach the egg, or the fertilised egg can’t move to the uterus, where it is implanted to grow into a baby.

Fallopian tubes can be damaged by pelvic infections (e.g. pelvic inflammatory disease), abdominal surgery, history of ruptured appendix, sexually transmitted infections (e.g. gonorrhoea, chlamydia), endometriosis, or swelling or fluid at the end of the fallopian tube. In most cases, these conditions or procedures result in scarring which blocks the tubes. A blocked fallopian tube can cause a fertilised egg to get stuck, leading to ectopic pregnancy (when the fertilised egg attaches itself in the fallopian tubes instead of the uterus).

CONCEIVING

Usually when a woman with blocked fallopian tubes wants to conceive, she is advised to use in vitro fertilisation, but in Triza and Ian’s case, the gynaecologist told them that the only option was to adopt a child. A second opinion with another gynaecologist opened the couple up to the possibility of getting a baby through in vitro fertilisation.

“This information replaced our sadness and desperation with hope. Hope that one day we will have our own children,” says Triza, who says that it is difficult to speak openly about infertility due to stigma. She knows five other couples struggling with infertility in their village, and like her, they have chosen to suffer in silence.

“Sometimes you meet people and they say, ‘are you that woman that people say is unable to conceive?’ People see barrenness as lack of blessing, rather than as a medical issue, and many couples have broken up due to lack of understanding,” she adds.
While we are talking under the shade of a tree in their homestead, a schoolgirl enters the homestead, greets us and disappears into a mud-walled house. Ian, Triza’s 38-year-old husband, mentions that she is one of two children they live with.

“They are children of our relatives. They keep us company during the school term, so that we don’t feel lonely, and go back to their parents during school holidays. But some relatives don’t let their children stay with us because of our ‘problems with getting our own children’,” he explains.

In centuries past, elders would have come up with an arrangement to enable the couple lead a “normal social life” – a life without stigma or being shunned by the community. For instance, Ian would sire a baby with another woman (a sort of surrogacy agreement) and the baby would be raised by Ian and Triza as their own. But that culture has fast faded away, with such arrangements having become rare, and Ian and Triza can only rely on modern assisted reproduction (in vitro fertilisation, in particular) to realise their dream of holding a child in their arms.

“We are covered by the National Health Insurance Fund and we also have another health insurance cover, but they told us they can’t cover in vitro fertilisation. They can’t help me get a child, yet this is a medical issue like any other. I don’t understand why the government cannot support women like me who want to become mothers, but the costs are out of reach,” says Triza.

INFERTILITY
In Kenya, it is estimated that 10 to 15 per cent of people have infertility, which is flagged when a couple have been trying to conceive by having regular unprotected sex for a year, without falling pregnant. The World Health Organisation estimates that one in four couples in Africa have infertility problems.

In 38 per cent of the cases, the infertility is traced in the female partner, while in 20 per cent of the cases, the infertility is traced in the male partner; 27 per cent of the time, infertility is in both the man and the woman, and in 15 per cent of the cases, the infertility is unexplained (no cause is found).

For couples like Ian and Triza, where assisted reproductive technologies such as in vitro fertilisation would come in handy, the cost means that their dream of holding a child in their arms remains just that. They work as casual labourers, and cannot afford to raise the Sh400,000 to Sh600,000 needed per cycle to enable them try for a baby through IVF.

Given that IVF has a success rate of only 40 per cent, the couple might need more than one cycle before it works, so the costs can go beyond Sh1 million depending on how many cycles the couple needs before the procedure is successful.

In 2017, the National Health Insurance Fund announced that it would cover fertility treatments, but only for civil servants. To make matters worse for NHIF contributors like Ian and Triza who are locked out of accessing fertility treatments under the NHIF cover, the service is not offered in public hospitals, where it would possibly be cheaper, and many cannot afford to seek services in private fertility clinics.

In Uasin Gishu County, where Ian and Triza live and work, IVF is offered in only two facilities – Eldoret Hospital and Mediheal Group of Hospitals – which are private.

ACCESS TO TREATMENT

Last month during their annual conference, the Kenya Obstetrical and Gynaecological Society called on health insurance companies including NHIF to incorporate infertility management as part of the essential package, so that more couples could afford to access treatments and interventions for infertility.

“The Constitution guarantees physical, mental and social health for all,” the society’s Secretary General Kireki Omanwa told the Daily Nation, making a case for fertility treatments to be made accessible and affordable to everyone who needs them. He added that lack of specialists and import charges for medication and consumables was what was driving the high cost of in vitro fertilisation in Kenya.

“Pharmaceutical firms push import taxes to the consumer. If the government does away with the taxes, in vitro fertilisation will be affordable,” he said.

In an interview with Healthy Nation, Dr Amon Chirchir, an obstetrician and gynaecologist at Eldoret based Moi Teaching and Referral Hospital, said that many couples – and especially the female partner, who is usually blamed when a couple can’t have a child – face stigma and condemnation from the community, which also affects their mental and emotional wellbeing.

“Women who are unable to get pregnant are looked down upon by society, ostracised, discriminated against and blamed for the absence of children in their union, even though infertility could be in both the man or the woman, or even in the man. And in most cases, stigma makes most people shy away from seeking help,” he said, adding that couples suffering infertility should seek medical attention together, instead of seeing it as the woman’s problem.

“Women are beaten up and mistreated so much to the point of suicide in some cases,” he added, noting that even for those who do seek medical attention for infertility, the costs of interventions such as IVF mean they can’t afford them anyway.

This is the case for Ian and Triza, but they are still holding onto hope.

“I am optimistic that God will allow us to hold our own baby one day, just like many of our friends who finally got their babies despite having fertility problems,” says Triza.

*names have been changed to protect privacy