Saturday, January 24, 2015

COVER: Stress and distress of infertility

A woman faced with infertility listens to a

A woman faced with infertility listens to a doctor’s opinion. PHOTO  I FILE 

By Elizabeth Tungaraza; etungaraza@tz.nationmedia.com

After getting married, every couple’s dream is to have children. For women, the desire for conceiving and having children is immense. Bearing children is something that completes a woman. But for Isabella James, the dream and wish of becoming a mother is far from materializing. At the age of 39, Isabella is living a subdued life because it’s 12 years into her marriage and she’s yet to get pregnant, despite numerous trials that have all been to no avail. This has resorted Isabella to reckon that maybe she’s just not lucky to have children. Reality further hits when she realizes she’ll soon turn 40 without a child.

Further devastation is brought on by those who mock her for being barren. Some of the people who know her can’t help but question why she doesn’t have a child as her age continues to advance. The immediate person she should turn to for comfort, her husband, has also changed in demeanor, he spends late and long hours at work, sometimes he stays over a week without returning home, making Isabella question his loyalty to their marriage. “I get the feeling that he could be having an affair with another woman because he desperately needs a child. I feel so down and I don’t know what to do anymore,” says Isabella, adding, “My house feels so empty because there’s no child to play around. I don’t have anyone to call me mommy and sometimes I end up crying because the pain of not being able to become a mother can be overwhelming.” Isabella has visited the hospital multiple times but doctors have not been able to help her. “One of the gynecologists told me that my fallopian tubes have problems,” states a gloomy Isabella.

A prevalent problem

The situation facing Isabella represents thousands of women countrywide who have failed to conceive. There are plenty of such cases nowadays and many marriages are on the verge of collapse due to women’s failure to conceive. However, the problem has numerous causes. In most cases, the underlying cause is infertility disorder. Apart from that, psychological factors are only rarely the cause of an inability to have children, according to experts.

Shukuru Mohammed and her husband have been facing this problem for many years. When interviewed with this magazine, Shukuru noted that failure to conceive is a big problem more so to women. She thinks that because of globalisation, people can open up and speak out about the problem and share the pain together through various channels such as social media so that ideas can be exchanged on possible ways to solve the problem.

Opening up to Woman, Shukuru stated that several medical examinations found that she is the one with the problem. Till now she doesn’t know where the problem came from though she guesses it might be a life-style related problem. “I remember I used to eat a lot of junk food at school and at home. There was a time my mother disciplined me because I never used to eat food she prepared for her all familly. She kept on telling me that the junk food, which I mostly like to eat, is not healthy and if I will not change that habit it will cost me. Now I understand what she meant,” said Shukuru.

Now a married woman for almost nine years, Shukuru hasn’t been able to conceive. “I have already spent a lot of money trying to find a medical solution to my problem but so far there has been no luck,” she continues saying, “I have even sought the service of traditional healers but still the problem has persisted.”

Its toll on marriage

Another infertility victim is Eva Joachim, 33. Her husband chased her away from their house because of her failure to conceive. However, she blames his actions on her relatives stating that they encouraged him to leave her because of her condition.

 

The 2004 study by the World Health Organisation (WHO) shows that infertility affects up to 15 per cent of reproductive-aged couples worldwide. WHO demographic studies from 2004 have shown that in sub-Saharan Africa, more than 30 per cent of women aged between 25 and 49 years suffer from secondary infertility; the failure to conceive after an initial first pregnancy.

Primary and secondary infertility

According to Dr Agatha Lucas Shinyala, a gynecologist, the failure to conceive among couples is a wide topic, but it can be viewed into two infertility groups; primary and secondary infertility.

Primary infertility is the failure for a woman to conceive. Here couples fail to have a child despite several attempts. For secondary infertility, couples with one child fail to have a second born after several attempts to conceive.

According to Dr Agatha, couples who fall under the primary infertility group have hormonal problems. These are the most common causes of an ovulation. “The process of ovulation depends upon a complex balance of hormones and their interactions to be successful, and any disruption in this process can hinder ovulation,” she explained, adding that some women have male hormones and “it is very difficult to be detected because some hospitals can’t examine them.”

According to Dr Agatha, some women have only ovaries without uterus, this impedes their efforts to conceive. 

Apart from life-style related health problems, Dr Agatha stated that reproductive functioning requires both proper diet and appropriate levels of exercise. “Women who are significantly overweight or underweight may have difficulty becoming pregnant,” she added.  

Apart from obesity, infection is another problem. This problem faces people in secondary infertility group. “There is this Pelvic Inflammatory Disease caused by both bacteria and viruses and usually transmitted sexually. These kinds of infections commonly cause inflammation resulting in scarring and damage whereby a condition in which the fallopian tube is damaged,” she explained. Adding, “not only that but also previous surgeries/caesarian can cause tubal disease and damage. Pelvic or abdominal surgery can result in adhesions that alter the tubes in such a way that eggs cannot smoothly travel through them. Also diseases like diabetes, prior infections such as mumps and trauma can cause this problem.”

Word of advice to gynecologists

Dr Agatha has a word of advice to other gynecologists; She said whenever they come across a woman with health problems as those stated herein, and after medical examination it is proven that she has no problem with conceiving, they should always ask for her husband so that they can examine him as well to establish if he is the one with the problem. It should be noted that failure to conceive is not confined to women alone.  Male infertility can also cause a failure to conceive.

As the  2004 WHO study shows, although male infertility has been found to be the cause of couple’s failure to conceive in about 50 per cent of cases, the social burden falls disproportionately on women.

If there is no apparent health problem that hinders couples from having children, experts in reproductive health should re-check and cross-check various factors; behavioral ones, including certain personal habits and life-style related factors that have a negative effect on health thereby limiting women’s ability to conceive and ultimately couples’ ability to have children.

An obstetrician and gynecologist from St. Thomas Hospital in Arusha, Julias Msuya, said that there are two IVF hospitals in Tanzania. One is Dar IVF & Fertility Clinic which is at Mikocheni and the other is St. Thomas Hospital which is in Arusha.

The doctor states that he used to treat people with infertility problems but decided to stop due to inadequacy and unreliability of electricity, adding that IVF treatment heavily relies on stable supply of electricity. “I have already solved this problem by putting an inverter; very soon I will start treating people who are facing infertility issues. The treatment of this problem is very expensive. The cost can go up to $7,000 (Sh11,550,000) per treatment. Those who can afford such an amount are availed to the opportunity of bearing their own children,” noted the doctor who is also the director of St.Thomas hospital.

Illustrating more on the cost of the procedure, Dr Julius says that the medicines plus the facilities and embryologist are all very expensive. An embryologist is a scientist who works with sperm, eggs, and embryos. Human embryologists work with infertility programs with the goal of helping couples have a baby.

The embryologist in a In Vitro Fertilization program (IVF) plays a vital role in the journey to pregnancy for a couple struggling with infertility.

“We don’t have such medical experts in Tanzania, so I used to ask one from Italy to visit my hospital and conduct the procedure. However, it is costly as the journey to conceive needs time and it might take a month. During the course of infertility treatments, the embryologist will be involved from the start to finish of an in vitro fertilization – IVF cycle. During the testing phase before IVF treatments, the embryologist will prepare the embryology lab for infertility treatment by regulating and testing environmental conditions in the embryology laboratory including temperature, air quality, humidity and many more,” Dr Julius states. He also stated that after the whole process a woman has to wait and see if she has succeeded because at times the process fails and so it is repeated.

Dr Julius’ aim is to reduce the cost of the procedure  and also advise people in this society not to blame women for not being able to conceive because this problem can be as a result of men. Infertility in both men and women can be solved by doing IVF procedures and a child can have biological parents and a surrogate mother.

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