The pain and misfortune of infertility

Struggling with infertility for over three years has been a living nightmare for Maureen Katushabe, a 30-year-old resident of Kacyiru. She describes her barrenness as a very profound situation which resulted into estrangement from her husband and putting an end to her marital bliss. “It is difficult to describe what infertility feels like or the lasting impact that it has on one’s life. My husband and I tried conceiving for over three years and the fact that nothing worked really crushed me. The pain I have in my heart cannot be expressed in words,” Katushabe sadly narrates. “After a year of failed attempts to get pregnant, I went with my husband to the hospital for a checkup because it was obvious that I was the one with the problem since he had kids from another woman. Imagine my shock when the doctors said I had no problem and that I was able to conceive. But still, time passed without missing a single period. I then opted to use traditional herbs which I took for almost a year but nothing seemed to work, my husband started tormenting me about how I was not a full woman because I couldn’t have kids. Life was total misery,” she adds. The fact that the chances of carrying her own baby were limited made Katushabe realise the effect it would have on her marriage and life in general. Most barren women experience a lot of psychological and emotional stress and sometimes lack enough information on this heartbreaking situation. What the health experts say Dr. Rachna Pande, a specialist in internal medicine at Ruhengeri Hospital, explains infertility as failure to conceive after one year of regular unprotected intercourse. She says that the problem can be with either of the partners, though women bear the brunt of society and hence suffer more from stress and depression. “Women may fail to conceive due to chronic pelvic infections, hormonal disorders, ovarian cysts and tumors and sexually transmitted diseases; these can cause infertility as a result of blockage of the tubes responsible for carrying eggs or sperms,” Dr. Pande explains. She also says that the sign of infertility is infertility itself; both partners wait but fail to see any sign of pregnancy. On detecting the problem causing the infertility, she points out a few processes, for example, diagnostic curettage of the uterine inner wall to check for normal changes, hysterosalpingography to check for patency of fallopian tubes, and ultrasound studies to check for ovulation. “Women go into depression if they do not conceive within a year of marriage, but family support can help at this stage, the biggest problem is to make men come forward for investigations because most of them do not readily agree, this sometimes results in broken marriages. Counseling is therefore needed for both partners; there are various treatment options like artificial insemination from a donor. There are advanced techniques like surrogate mothers and test tube babies. But also correction of a clear underlying cause enables the woman to become pregnant,” the doctor says. Dr. Pande tells women not to give up because there is no time limit for conceiving. According to her, opting for adoption is the best option and a very noble idea. “I have a friend who did not conceive for twelve years because of uterine fibroids but the day she adopted a baby and brought it home, is the same day her pregnancy test returned positive. I myself conceived ten years after marriage. After waiting for about three years for a baby, my husband and I decided to adopt a baby. By the time we were looking around for a suitable baby to adopt, I discovered that I was pregnant. Thus women should never lose hope,” says Dr. Pande. Dr. John Muganda, head of gynecologist department at King Faisal Hospital Kigali, says that one has to understand what infertility is. He also says that the cause can be on the husband’s or wife’s side. On the side of women, he points out the causes as infection, for example pelvic informatory disease (PIV) though there are also other causes like disturbance in the level of hormones which affects ovulation. “The first sign of infertility is to have a delayed conception, but if you haven’t tried to conceive you cannot know if you’re barren or not unless when one goes for a routine checkup and a specific problem is singled out. When a woman confirms that she is barren, the response she gives depends on her age, and those with the age range of 21 to 30 are not affected much like those ones in their 40s because they still have hope. But we give these women counseling since it sometimes results in some serious cases,” Dr. Muganda says. “These women’s lives are affected especially when the husband doesn’t want to collaborate to go for checkups so as to critically analyse the problem, most of the time conflicts arise in homes and these women become depressed. There are also cost implications that depend on the level of infertility and the cause too,” he adds. 36-year-old Agatha Natukunda was convinced for a long time that she couldn’t have kids. Her husband seemed supportive at first, she says, but after five years, his patience ran out. “He started with snide remarks that at first he said were jokes. When I suggested adoption, he threw a fit, saying that if he couldn’t have his own kids, he would rather not have any,” Natukunda recalls. However, after a lot of pushing on her part, she convinced him to go for a checkup with her. It was then that she found out that he was the problem. It was embarrassing to say the least, she says. “I will never forget the look on his face. It was like his heart had fallen out of place. He just sat there quietly then got up to leave. On the way, he didn’t say a word. I asked him if he was okay but he did not respond. I actually thought he had gone into shock. But when we got home, he cried, and apologised to me,” she says. Natukunda adds, “We are still married and are now considering adoption. I think a child is a child, blood or not. And I will love the one we are blessed with like she/he was my own.” Dr. Muganda says that women shouldn’t give up unless when one is in menopause because with other cases there is always a solution. “We are now very advanced; we have a fertility centre here in Rwanda which deals in vitro fertilisation (IVF). The procedure involves fertilising an egg outside the body, in a laboratory dish, and then implanting it in a woman’s uterus.” Dr. Teckle G.Egiziabher, a gynecologist at Rwanda Military Hospital Kanombe, defines infertility as when a married woman or a woman with a partner fails to conceive at least after one year of regular and unprotected sexual intercourse. To him, the blame goes both ways with the woman accounting for 70 per cent. “The causes of infertility in women include sexually transmitted diseases, infections like pelvic inflammatory disease which can block the fallopian tubes, the other could be the abnormality of the uterus, and advanced age of the woman. It is a really stressful situation for the woman when she gets to know that she is infertile. Most of them receive it with shock, but we do counsel them,” Dr. Egiziabher explains. He says, however, that infertility shouldn’t be a cause for stress because there are now many ways of having one’s own biological children thanks to the new technology, because even a woman without a uterus can have a child of her own through surrogacy. editorial@newtimes.co.rw ******************** Symptoms The main symptom of infertility is the inability of a couple to get pregnant. A menstrual cycle that’s too long (35 days or more), too short (less than 21 days), irregular or absent can be a sign of lack of ovulation, which can be associated with female infertility. There may be no other outward signs or symptoms. When to see a doctor When to seek help depends, in part, on your age. •If you’re in your early 30s or younger, most doctors recommend trying to get pregnant for at least a year before having any testing or treatment. •If you’re between 35 and 40, discuss your concerns with your doctor after six months of trying. •If you’re older than 40, your doctor may want to begin testing or treatment right away. Your doctor also may want to begin testing or treatment right away if you or your partner has known fertility problems, or if you have a history of irregular or painful periods, pelvic inflammatory disease, repeated miscarriages, prior cancer treatment, or endometriosis. Mayo Clinic **************** Signs it’s time to let go of getting pregnant Is trying to have a baby a healthy goal for your life and marriage, or is it causing anxiety, depression, and other problems? Giving up on your dream of getting pregnant may be a healthy thing to do…but the trick is knowing when it’s time to give up or when it’s time to try different strategies (e.g., in vitro fertilization (IVF) instead of intrauterine insemination (IUI), or adoption instead of conceiving a baby).Couples coping with infertility – or women who can’t get pregnant no matter what infertility treatments they try – might decide it’s time to pursue different family goals when they: •Have lost their joy and passion for having a baby – and instead feel depressed, anxious, and unhappy •Realise their marriage is suffering, and their attempts to overcome infertility might lead to divorce •Are “talking the talk” but not “walking the walk” (e.g, talking about how much they want to have a baby, but refusing to visit fertility clinics or adoption agencies) •Spend more time surfing the internet and reading pregnancy forums than creating a healthy, happy life apart from getting pregnant •Are pursuing goals that aren’t in line with their beliefs, values, personality, and future plans •Realise that their pregnancy goals – and the process of achieving those goals – don’t resonate with who they are •Dread the thought of achieving their goal of getting pregnant •Resent the time and energy getting pregnant (or infertility treatments) takes •Refuse to try different ways to get pregnant, such as creating a vision board for fertility or talking to a naturopathic doctor about different problems that prevent pregnancy Agencies

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The pain and misfortune of infertility