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Infertility at fertility peak

These days, one is likely to find more young PEOPLE in their 20s visiting fertility clinics than the stereotypical mature over 40 couple. Almost 60 per cent of THOSE seeking fertility treatment in Kenya are under 30, with some of the causes for this being attributed to low condom use leading to the spread of infertility-causing infections, unsafe abortions, lifestyle and nature of some jobs, writes EVELYN MAKENA

Becoming a parent is one of the greatest worries for young people in their early 20s. Between trying to build a career and having carefree fun, getting a child is the last thing on their minds. There is a bigger worry, however, as increasingly, more people in this age bracket are confronted with the issue of infertility. It’s no longer a matter of not wanting to get pregnant, but more of not being able to, when they are finally ready.

American model Chrissy Teigen, 31 who is wife to award-winning soul singer John Legend, 38 in 2015 opened up about her struggle with infertility while in her 20s. In her talk show FABLife, she explained how together with her husband, they had wanted to start a family two years after getting married in 2013. “I will say honestly John and I are having trouble. We would have had kids five, six years ago if it had happened. But my gosh it’s been a process,” she said. In their struggle to conceive, they had seen fertility doctors and dealt with people constantly questioning why they did not have children just yet. The couple got their first child Luna in 2016.

Infertility clinics

In Kenya, infertility is also a huge issue of concern, if the number of fertility clinics coming up is anything to go by. A study carried out by Aga Khan Hospital in 2013 showed that one in every four couples in Kenya are faced with infertility. Surprisingly, it’s not only the stereotypical mature over 40 couple that you are likely to find visiting these clinics, but also young couples in their 20s, who are consumed with the struggle to conceive. While fertility declines with age, young people, supposedly at their fertility peak, are getting affected as well.

Growing up, Grace Ingati, 28 from Bungoma county did not think much about how and when she would conceive. She just knew that she wanted to have children someday, and it would come naturally. When she joined high school at the age of 14, she did not get her menses like most of the girls in her class.  This was no cause for alarm for her. In fact, she considered it a relief. She did not have to deal with painful cramps. Her mother assured her that maybe she was having delayed milestones, and that eventually she would get her menses.

Grace’s mother was partly right, as she later got her menses when she was 18 years old. They were irregular and excruciatingly painful. “There is one year when I got my periods only two times,” she recalls. It’s only after she joined college at 22 to pursue a course in medicine that she decided to see a doctor. She was diagnosed with polycystic ovarian syndrome (PCOS), which was causing hormonal imbalance, and doctors said that it would be difficult for her to conceive.

“At first I did not take it too seriously, because I thought I was not yet ready for babies,” she says. The doctor recommended that she undergoes surgery to remove the cysts, but, her mother, who was struggling to pay her college fees, couldn’t afford the treatment.

At 25, in 2014, when she was on her internship, she started dating, and also became sexually active. After close to seven months of engaging in unprotected sex without conceiving, she had every reason to believe that the doctor was right. “It became apparent that I was not going to have a child. The reality hurt so much,” she says.

She consulted a gynaecologist, who put her under medication to balance her hormones. “I was battling with acne, insomnia, weight gain and depression due to the hormonal imbalance,” she narrates. Furthermore, she was also dealing with a nasty breakup with her ex, who she had confided in, but who instead used her issue to emotionally abuse her. After the breakup, following eight months of dating, Grace resorted to heavy drinking.

She met her husband during this period. “I was a real mess; depressed, drinking excessively, dealing with a breakup and a nagging reality that it would be difficult to conceive. When he showed interest in me, I told him that I was infertile to scare him away. It did not work,” she says with a chuckle. The two got married five months after meeting. They have been married for two years. There have been some changes such as quitting drinking, more tests, more trying, more medication, and the discovery that the cysts are clearing, but, still more remain, hindering conception.

Untreated infections

According to Dr Isaac Wasike, a gynaecologist, there has been an increase in the number of couples in their 20s faced with infertility. In this age bracket, infertility is defined as the inability to conceive within a year after having regular unprotected sex. Almost 60 per cent of those seeking fertility treatment in clinics in Nairobi are below the age of 30. Complications as a result of untreated infections caused by sexually transmitted diseases (STDs) cause tubular blockage and account for the majority of infertility cases among men and women. Statistics by World Health Organisation (WHO) indicate that 85 per cent of all cases of infertility in Africa are attributable to untreated infections.

“Chlamydia Trachomatis bacteria, which is prevalent among almost 90 per cent of the African population, is the most common infection leading to infertility. The bacteria is spread through unprotected sexual intercourse,” says Wasike. Untreated infections affect the urethra in men and blocks women’s fallopian tubes, hindering conception.

He attributes low condom use among the youth to the spread of the bacteria. Young people are also becoming sexually active at a tender age and having multiple sexual partners, further predisposing them to contracting the bacteria. The nature of the bacteria in women makes it difficult to detect, and thus goes untreated. “The symptoms of the infection are silent in women. They only experience a discomfort in the abdomen, which soon goes away. In men, however, it is easier to detect since it causes pain in the urethra during urination, hence easy to treat,” explains the doctor.

Shared responsibility

Other causes of infections are gonorrhea, pelvic tuberculosis, unsafe abortions and female genital mutilation (FGM).

Problems with ovulation are also a common cause of infertility among women. Polycystic ovarian syndrome, with which Grace was diagnosed, has particularly been singled out as major cause of infertility among young women. The condition, whose cause is unknown, results in hormonal imbalance and disrupts normal ovulation, making it difficult to conceive. Exposure to toxins in the environment from pesticides and paints is also causing anomalies in ovulation.

Even though the burden of infertility has disproportionately been laid on women, men are also part of the problem. “Infertility is a shared responsibility between a man and a woman. For a couple unable to conceive, a third of the time it could be due to the man, a third because of the woman, and the other third because of combined factors between the two,” explains Dr Alfred Murage, a consultant gynaecologist and fertility specialist based in Aga Khan Hospital.

Riding boda boda 

In men, infertility is caused by poor sperm quality and low sperm count due to infections, excessive consumption of alcohol, smoking or the nature of their job. A study carried out by Dr Wasike in Bungoma revealed that boda boda riders were at a high risk of erectile dysfunction. Out of the 115 men under the age of 40 sampled in the study, 33 per cent had erectile dysfunction. There was a significant increase in cases of erectile dysfunction among men who rode boda boda for longer hours. For those that rode six to eight hours per day, 60 per cent of them had erectile dysfunction.

This is because cycling led to compression of the perineum, resulting in blockage of blood vessels that supply blood to the penis. “Even though erectile dysfunction is not infertility, it indirectly contributes to infertility, because if a man cannot erect, then it means he has no ability to make a woman conceive,” says Wasike. In this case, however, the problem is temporary. Once the men rest, they recover and are able to sire children.

The kind of lifestyle young men and women have adopted is making them susceptible to infertility as well. Smoking, excessive drinking, poor nutrition and being overweight are all habits that could hinder conception. “Men who smoke have low sperm quality while women who smoke produce eggs of poor quality, which may lower chances of conceiving. Overweight women have ovulation problems and men have poorer sperm quality. Excessive drinking, poor eating habits and sedentary lifestyle are other factors that contribute to the problem,” adds Murage.

Intervention

Experts say there is hope for young people faced with infertility if the problem is detected early and the right kind of treatment is administered. Depending on the cause of infertility that a couple is diagnosed with, they can either undergo medication or surgical intervention like in the case of tubular blockage, which are all readily available in Kenyan hospitals. For more complex cases, there is In Vitro Fertilisation (IVF), a procedure that involves extraction of the egg and sperm and manually combining them outside the body. On average, the procedure costs Sh400,000 in Kenya. The first successful IVF case in Kenya took place in 2006. Taita Taveta Women’s Representative Joyce Lay has in the past gone public about undergoing the procedure in 2012. There is unique intervention for every couple, with lifestyle change playing a major role towards the journey to parenthood. 

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