NOT YET STERILE THOUGH

As a medical student, I had a challenge: Infertility.

Don’t get me wrong; I was not diagnosed as infertile neither did I have a problem with understanding it as a topic. I had the nebulous challenge with coming to terms that infertility, like most other medical terms (though English), can not be replaced by another English word, like, sterility.

While infertility is a surmountable health challenge, sterility refers to a permanent irreversible state. General definition explains infertility as the inability to achieve pregnancy despite regular, unprotected intercourse over a period of time, usually, at least, one year.

Infertility is classed into two major divide: Primary and Secondary.

Infertility is primary when no pregnancy has ever been achieved (so far in life) or secondary, when previous pregnancies have resulted irrespective of the outcome – abortion or ectopic pregnancies.

In Nigeria, the incidence ranges between 20-30% wherein genital infection has been ranked high among its cause.

I, personally, have experienced too many cases of infertility far beyond what I used to imagine the prevalence to be. At the teaching hospital and clinics, the number of patients astounds and considering the cultural importance attached to child bearing, it is sometimes even seen as a curse.

Often, lifestyle exacerbates infertility.

A case in point, which I will be sharing with you, is that of a 38 year old woman who presented with 9 years history of secondary infertility -by this I mean she has actually had some pregnancies (which she, voluntarily, terminated earlier before marriage).

Questioned further, her first marriage was in 2002 (at 27 years) which ended in 2006 when her husband died. She remarried in 2007 but the marriage crashed in 2010 due to her inability to conceive. Divorced, she got married to another husband in 2011; she is yet to conceive, prompting her to seek medical attention in our clinic.

In short, 3 different husbands within the space of eleven years have led to no pregnancy. Little wonder she was quick to halt me when I tried to question the fertility tendencies of the husbands. Not much was said about the first husband, but the second husband now has a child from another lady (after they divorced). The current husband is a polygamist who has 5 children from 2 (senior) wives.

While experience has shown that the current husband can not be absolutely trusted for paternity (I mean it’s actually possible for the two other wives to have had kids outside wedlock.( Yes, it happens!), all fingers now point more at our woman patient who is desperate more than ever to have kids.

But there are twists: historical and existing.

Her history of abortion is a Sisyphean twist. Another twist to her story is the fact that the last ultrasounds scan done announced fibroid occupying her uterus (womb). Fibroid makes it more difficult for babies to be formed. Or if a baby forms, jeopardizes its survival in the womb, if not properly managed.

Third twist, at 38 years, her chances of having healthy viable eggs for conception is reduced, the ability of the body to cope with the various physiological changes in pregnancy drops and I am saving this for the last, the likely compromised integrity of the womb and fallopian tubes (those structures that link the ovaries to the uterus/womb where fertilization occurs) due to her previous terminations of pregnancies.

She procured previous abortions from some ‘quack’ health practitioners who don’t know their onions well as par evacuating the uterus. Several sequelae must have followed which the woman would almost likely not remember or she might have even taken such for granted leading her to where she is today.

I’m writing this piece with the utmost conviction that someone reading this piece right now must have either been a victim of unsafe abortion, helped someone to procure unsafe abortion or who knows, might have even attempted abortion in an unsafe fashion. Caution!

Many thanks to science, that has provided a number of possible options to successfully attain conception even in conditions like this. But I must be quick to add that these assisted reproductive techniques cost a fortune and are not easy to come by. This is in addition to the recorded failed attempts in a number of cases.

Maybe the woman would still have luck smile on her face. Maybe someday and somehow, she would be carrying a baby of her own. Maybe the current husband will be financially buoyant enough to go the extra mile for this poor woman by procuring assisted reproductive technology. Maybe the husband will actually be convinced enough to ‘help out’ this 3rd wife despite having had 5 happy children from 2 other senior wives.

Just maybe she should have played safe and not have had those previous pregnancies. Maybe she would have procured abortion from a skilled medical practitioner.

I mean, maybe the Nigerian government would have liberalized abortion just the way her colonial masters did some decades back to safeguard the vulnerable populace from patronising ‘quacks’.

We can go on and on, asking questions and wondering what would have happened if the story had not gone the way it went, but then, the sincere though saddening truth to it is, it could have been prevented, the woman could have lived a happy life, if only she had not been too eager, to ‘enjoy the forbidden fruit’ before the appointed time.