Ah, my daughter, the way those jaws are coming out o. Are you sure you have nothing to tell us?” Sandra silently sighed, forced herself to smile and responded “Ma, good news does not hide na. When it happens you won’t even have to ask me – I’ll break the news to you first”. While she enjoyed family gatherings like these, the invasive comments were getting deeper under her skin with every passing year. Like “What are you waiting for?” or “You don’t want to give me grandchildren before I die?” or “Abeg, book no be all ting na when you go born?” Sandra had been happily married to Terence for 5 years, the last 3 of which were spent in and out of appointments with fertility specialists around the country.
Every time someone brought up their childlessness so callously, she would bite her lip in an attempt to fight off the tears welling up in her eyes and the hurt she could feel like a distinct lump in her throat. For about 5 seconds, she would consider going into the details of why they had no children but how do you summarize a 3-year journey of infertility with countless medications/injections, procedures, disappointments and heartbreak?***
Infertility is defined as the inability to conceive after 12 months of appropriately timed, unprotected intercourse. It affects 10 to 15% of reproductive-aged couples worldwide. For every ~10 couples trying to start a family, 1 of them will be unsuccessful. When we quote numbers like these everyone looks around the room wondering who that 1 in 10 is. It could be you and you just don’t know it yet.
Anyways, to have a basic discussion about the causes of infertility, let’s address the 3 things that are required for conception to occur. 1. Healthy egg. 2. Healthy sperm 3. A conducive meeting point for that sperm and egg. Easy, right? I mean, for 85% of couples it is this straight forward. The woman ovulates like normal, the man makes cute little motile sperm that swim like champs.
They have intercourse at just the right time when the egg is released and the alpha sperm successfully fertilizes the egg somewhere in the fallopian tube. The combined genetic material does its thing, implants in the uterus and all things being equal, a successful pregnancy (and hopefully birth) is achieved.
For couples who struggle with conceiving, one or more of these pathways are not functioning as they should. In a small subset of couples though, all the parts appear to be working but for one reason or another, conception still does not occur (unexplained infertility).
So what happens next? If a couple has been attempting to conceive for 12 months without success, they should seek the services of an obstetrician/gynecologist or a reproductive endocrinologist if available. For women older than 35, see the specialist sooner (after 6 months of trying). I strongly recommend the couple go in together – infertility is not a woman only disease.
A complete evaluation will include some blood work for both, a semen analysis (male provides ejaculate to be microscopically examined for sperm quality), assessment of the structural integrity of the woman’s reproductive parts (will include an ultrasound of the uterus/tubes/ovaries) as well as obtaining a detailed medical history from both the man and the woman as this often yields relevant information that may point to a cause for infertility.
More often than not, a “treatable” cause for infertility is found and your doctor will make recommendations on how to proceed. These interventions range from something as simple as taking medications to enhance ovulation to something as complex as in vitro fertilization. For couples in whom all else fails, an adoption is sometimes a viable option.
So, for couples who struggle with infertility, talk to a doctor ASAP! To everybody else, mind your own womb. If you are genuinely concerned, sit your friend/daughter/son/sister/brother down and ask with empathy rather than pointless curiosity.
Exercise a little more emotional intelligence and do not probe, pressure or ridicule the childless couple because you never know what people are going through. The next time you feel the need to ask that couple about why they have no kids yet, may this article come to mind.
PS: May we all survive Corona season.
PPS: Long live feminism.
***Mildrede Bonglack is an ob/gyn resident physician. She enjoys working with women to educate and empower them to be advocates for their own health and social wellbeing. She believes fufu and fresh njama njama is the only meal that will be found worthy of being served in heaven.***