By Makwato Siganga

After a year of marriage, the shine faded from Marceline’s marriage. After a period of bliss and happiness with her husband, little cracks began to appear in their picture-prefect life. Family functions stopped being as fun as they were during the couple’s dating days.

Looks lingered on Marceline for longer. And every so often she could hear people, whom she thought of as friends, talk behind her back.

“It was all so disheartening,” she says. “From the perspective of my family members, I was the one with the problem.”

However, those days are behind her. Now, she has a better outlook on life.

As she talks to Distory during a recent interview from her home in Kenya’s capital Nairobi, her four-year-old daughter jumps on and off her legs like any other child her age. Nothing about her smiles or her infectious laughter allude to the journey her parents walked before getting her.

“I wanted to give up more than once,” Marceline says. “But something kept me going. And I don’t regret it one bit.”

The World Health Organisation recognises infertility as a public health issue worldwide. Statistics from the global health agency state that one in four couples in developing countries is affected by infertility and that the overall burden of infertility in women from 190 countries has remained similar in estimated levels and trends from 1990 to 2010.

That’s not all. The numbers also say that one in seven couples worldwide experience some form of fertility problem at least once during their reproductive lifetime and that the current prevalence of infertility is estimated to affect between 8-12 % of women worldwide aged between 25 and 40 years.

Marceline and her husband became part of the growing number of couples struggling with infertility. Infertility can lead not only to heartache, but also broken marriages and broken spirits. Marceline was determined to chart her own path. From a young age she has lived life on her own terms.

“I have never run away from a problem,” she says. “While the lack of a child in our marriage was the elephant in the room of our marriage for years, I decided it was something we needed to confront as a couple,” she says.

The conversation was not an easy one, not just with her husband, but with her mother and sisters too. None of them understood the reasons behind her choice.

A choice that began with a single step of faith.

Sitting in his well established and busy practice, Dr George Ogweno, a reproductive health specialist in Nairobi with more than two decades of experience, knows just how hard this first step of faith is for many seeking fertility treatments.

He says that this this silence is often linked to the stigma associated with infertility.

Marceline knows all too well about this.

“I realised very early on that even the people closest to me had their own perceptions around fertility. Perceptions founded on nothing but their personal prejudices,” she says, adding that the choice she was about to make would send her on a lonely path.

After getting in touch with a fertility specialist, a course of treatment was prescribed for her.

“We settled on in vitro fertilisation (IVF),” she says. “My doctor said this is what presented the best chance of conceiving.”

In vitro fertilisation (IVF) offers a chance at parenthood to couples who, until recently, would have had no hope of having a biologically related child. In IVF, eggs are surgically removed from the ovary and mixed with sperm outside the body in a Petri dish.

After about 40 hours, the eggs are examined to see if they have become fertilised by the sperm and are dividing into cells. These fertilised eggs (embryos) are then placed in the woman’s uterus, thus bypassing the fallopian tubes.

IVF currently accounts for more than 99 % of Assisted Reproductive Technology (ART) procedures in the United States and is widely used globally. Marceline’s pregnancy fell within this statistic.

Even as she plays around with her daughter, the hurdles she faced on her journey are not forgotten.

Despite the growing number of fertility challenges, there are just not enough fertility centres around the country and within the East African region to cater for this high demand.

“In Nairobi we have 7 centres, one in Mombasa and nowhere else in the country. This is a big problem for a lot of couples since many have to travel all the way to Nairobi, and from other neighbouring countries, to access this crucial intervention,” Dr Wanjiru Ndegwa Njuguna, an OBGYN and fertility experts says.

She says that the region does not have enough fertility specialists. This lack of an adequate number of specialists has also contributed to a lack of awareness among the public, something that has resulted in rising levels of stigma within key populations.

“A lot of people do not know about fertility treatment and many do not want to go out to look for help,” Dr Ndegwa says. “When we started offering treatment, we tried having focus group discussions, but the patients just wouldn’t show up.  There is a lack of knowledge, especially in the rural areas.”

It is only through speaking up that the society will start addressing the stigma associated with fertility.

Dr Ndegwa

“The person who will unlock the stigma in the fertility discussion is the patient. The more people come forward and talk about their positive experiences, the better it will be,” she says. “These conversations are the ones that will win this battle.”

It is not easy though.

Four years after succeeding at IVF, Marceline still isn’t comfortable going on the record about it, and it’s not just her that feels this way.

“I am obligated to protect my baby,” she says. “Some of the people I have opened up to about my procedure still ask if my child is normal.”

Dr Ndegwa says people still judge children as a result of IVF.

“They ask if the children have normal IQs,” she says. “There are just too many myths and beliefs going around because many people do not have the correct information.”

 “It is not for everybody,” Dr Ogweno says. “Some people’s fertility challenges will be done away with as a result of something as basic as a lifestyle change. Not everyone will be required to go through the intricate IVF procedure.”

Marceline says that there can never be a price too high in pursuit of personal happiness. There can be no price to the goodnight hugs her daughter gives her every day before bed. There can never be a price to the million questions she asks every day.

“It’s priceless,” she says.

In addition to treatment options, many people are unaware of the causes of infertility. Key among these factors is age.

“There are really no two ways about this for women. They are always on a clock and at some point it becomes very difficult to carry a pregnancy,” Dr Ndegwa says.

For women, the number of quality eggs decreases naturally and progressively from the time a woman is born until the time she reaches menopause and those who become pregnant at an older age have a higher risk of complications during the pregnancy.

Lifestyle choice also plays a significant role in the fertility journeys of couples and individuals.

But even when confronted with seemingly hard facts from science, professionals insist the best thing to do for those struggling to conceive is to visit a specialist.

“Do not wait until it is too late,” Dr Ogweno says.

This article, in the interest of patient education, is proudly brought to you by Merck (Pty) Ltd. To learn more about infertility visit www.merckfertilityjourney.co.za

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