When couples want to conceive, many will achieve a spontaneous pregnancy almost effortlessly. But others may struggle with infertility, or simply the inability to achieve a pregnancy without medical help. There still remains some unwarranted stigma with infertility, even though it should be regarded as a disease entity like any other.
I'm reminded of a unique situation that we faced years ago with a couple who had travelled from overseas to seek help in our fertility clinic. They had been trying to conceive for five years without success.
A friend had recommended they come to us. He was 35, and she was 32. Fertility treatment was still rudimentary in their country and they had therefore been put on treatment without comprehensive evaluation. "You need additional tests before commencing any treatment," I explained.
Further tests confirmed the man had no sperms in his semen, whereas basic evaluation in the female was all normal. Whatever treatment they had been subjected to was all futile. Subsequent specialised tests confirmed he had a rare syndrome and was incapable of making any sperm.
Men with this condition look normal but they lack special cells that are necessary for sperm production. The specific cause remains scientifically elusive, and there is as yet no known treatment for the condition either.
The man was devastated, "You must do something about it" he said. I thought he didn't understand my explanation, "there is no known effective treatment" I repeated. It turned out I was the one who didn't understand what he meant.
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They needed successful treatment at whatever cost, otherwise he would face grave social exclusion from his society. The use of donated sperm was barred by their culture. We were at a stalemate.
"We can only go back to our country when she is pregnant," the man said. With the only viable option barred by their cultural norms, I couldn't see how this was possible. But they had a plan. On the third month of their stay in Kenya, she missed a period.
I did a scan that confirmed pregnancy, and couldn't hide my surprise. "We secretly searched for a willing look-alike and paid a fee," they said.
He didn't need to spell out the details, the agony of their decision was reflected in their eyes. Several months later, I received a postcard from them. It was a picture of a handsome boy with the following inscription, "Born of Kenyan roots, by all means".
I inadvertently stored the picture in our collection of babies conceived through fertility treatment. It doesn't count as one of our clinic's successes though. Their conception was unconventional but had circumvented unwarranted societal pressures.
Dr Alfred Murage is a Consultant Gynecologist and Fertility Specialist. amurage@mygyno.co.ke