Like most young Nigerian ladies, 28-year-old Nneka (not her real name) got married to her husband with the lofty expectation of having all her their children before age 35. This is unsurprising as experts have often asserted that women have better chances of conceiving in their early 20s than in their late 30s and 40s. However, things didn’t pan out as planned for Nneka, as she couldn’t conceive until she was 40 years of age.
It was also a great surprise to Nneka’s husband, Chris (not his real name) that they could have such a delay in having their own children. Being ardent Christians, the young couple never imagined that they could wait for twelve long years before the arrival of their bundle of joy.
What Nnneka and her husband might not have realised is that scientists have established the prevalence of infertility globally, with about 5 to 8 per cent of couples affected. However, sub-Saharan Africa has a higher prevalence, with Nigeria alone having as many as 10 to 30 per cent of couples battling infertility. It is indeed one of the commonest reasons why women seek gynaecologic consultation, according to studies.
Search for solution
For Nneka and Chris, their journey began with trying for month after month, then year after year down the line, without a solution in sight. Concerned relatives and friends started offering different suggestions, all to no avail.
Nneka recalled: “I have actually lost count of places I visited in search of a solution to this challenge. As my husband sometimes declined in following me, I went all alone.
“Aside from being to different denominations, I have visited several herbal homes, where different concoctions are specially prepared for waiting mothers. I had all these, yet no way.
“Thereafter, discouragement set in and I began to wonder if that was how we would continue being childless till old age. I had countless sleepless nights, sobbing and crying to God for mercy, as it was becoming unbearable for me.
“One of such nights, I woke my husband, who wasn’t much bothered like me about the condition. I sought for his cooperation in getting to the root of the challenge, as both of us hadn’t gone for thorough medical examination, to know where exactly the problem lay.
“As usual, he initially turned down the plea, saying nothing was wrong with him, as we had been declared as being free from any sexually transmitted disease by one medical doctor close to us. However, after much persuasion and explanation, we booked an appointment with a fertility expert in town.
“On getting to the clinic, the fertility practitioner requested our medical history, examined us physically and collected samples from us for further investigations, assuring us that there is always a solution to every challenge.
“I was amazed by the many tests listed on the form to be conducted on us. Samples taken from me were used for hormone test, urine test, Pap smear; and there was this one called HSG. I also went through another examination called transvaginal ultrasound. The one that got me most perturbed was the test called hysteroscopy. The procedure was so irritating to me but I had no choice. They had to pass a thin, flexible tube, with a tiny camera attached at the end, through my cervix and into my uterus.
“My husband also had his own fair share of the investigations, as he was examined for different things, beginning with semen analysis, to confirm the quality of his sperm and other issues relating to sperm count. He told me that his hormone levels were checked; then ultrasound was done to evaluate his seminal vesicles and scrotum. Also, urinalysis, testicular biopsy and vasography were all conducted on him. After some time, we were asked to come back for the results.
“Meanwhile, while awaiting the results, a lot of things had been going through my mind. What if they said the issue was from me? Then my husband would be justified in claiming that nothing was wrong with him all this while? And if it was from him, would he submit himself for treatment? But if it was from both of us, could we shoulder the financial burden? All these ran through my mind for days until we received the results. Lo and behold, it was my husband that had a low sperm count.
“Expectedly, he initially contested the results, but he eventually surrendered himself for treatment. Thereafter, we were given two treatment options, hormonal treatment and in vitro fertilization (IVF). He commenced the hormonal treatment immediately – that was in early 2018; it lasted for a period of six months. After the treatment, we expected conception to take place immediately, but we were advised to still be patient and I wondered how much patience we needed again after eleven years of waiting.”
Nneka continued: “That year ended again for us in a childless state – until 2019, when the long-awaited miracle happened. I couldn’t believe that I was pregnant because I was still menstruating until the third month when I didn’t see my period. Initially, I was scared that another infection had crept into my system, preventing the flow from coming normally, but the sickly symptoms I was having made it urgent for me to see the doctor.
“On getting to the hospital, pregnancy test was conducted and I was informed that I was three months pregnant. What! It was incredible for me that pregnancy could just occur like that after several ordeals in search of a baby.
“That good news alone healed a lot of differences between my husband and me, as we became united than ever before. However, as the pregnancy progressed, there were different issues threatening the survival of the embryo in the uterus. Thanks to my doctor and his team who were monitoring us all regularly to ensure our safety.
“Eventually, my bundle of joy arrived at 12 midnight of 20 December 2019 and our excitement knew no bounds.”
The story of Nneka and her husband might just be an eye-opener for several couples having a similar challenge without any hope of getting the necessary solution, or after several attempts made on a recommended assisted fertility procedure without any successful outcome. Survey shows that some couples have even given up trying and have accepted their fate to go childless for the rest of their lives for reasons such as mentioned above or due to the lack of finance to embark on an assisted reproduction process.
In a bid to further help other couples in overcoming the predicament of childlessness, we inquired from a Fertility Consultant, Dr Abayomi Ajayi, CEO, Nordica Fertility Centre, Lagos, about the symptoms of infertility. Surprisingly, he said there may be no symptoms, unless couples take it upon themselves to make inquiries in the appropriate places.
The experienced obstetrician/gynaecologist advised couples to check for their fertility potential after trying to conceive for a year and six months, especially for women aged 35 and above. He listed the things to check to include seminal fluid analysis (SFA), hormonal assay, pelvic scan, tubal patency test and cavity check in the first instance.
“Abnormality discovered can prompt further test or surgery”, he advised.
Ajayi went on to highlight common causes of infertility in males and females respectively. He said: “Male related-causes can include: lifestyle factors like alcohol, smoking, substance abuse, obesity, environmental exposure to hazards agents, poorly treated infection and STI, chronic medical conditions and other co-morbidity. Genetic factors, anatomical/congenital iatrogenic, as well as unexplained factors are not excluded from the list.
“Female-related infertility could be due to age, anovulation, lifestyle (underweight/overweight), poorly treated infection/STI, drug abuse, anatomical-congenital or acquired chronic medical condition and unexplained factors,” he noted.
Regarding treatment options, Ajayi’s explanation aligned with that of Nneka who revealed that they were given different treatment options, and fortunately for them, the option they opted for worked for them.
“Treatment options differ, but advice is given based on outcome of fertility evaluation test in a particular couple. There may be need for corrective surgery (Laparoscopy/Hysteroscopy/HIFU). Treatment options may include ovulation induction, IUI, IVF, PGD, Surrogacy, TESA, own or donor gamete”, he explained.
Still, for couples who may have been trying any of the options without a solution and are considering giving up, the expert urged them not to throw in the towel, as the next attempt may result in their needed miracle.
Ajayi enthused: “Couples are advised not to give up, despite the seeming difficulties. We know that fertility is not 100 per cent guaranteed. However it’s possible to achieve the goal. Proper communication, along with pre-treatment and emotional support, is crucial.
“For those who have attempted IVF for some time without a good outcome, there may be need to re-evaluate and reconsider the subsequent treatment options, based on available evidence from the failed cycle. Most times, these are strictly due to implantation failure and the chance of implantation improves appreciably with subsequent treatment. It’s also a fact that some will benefit from a failed cycle rather, than a fresh transfer.”