The inability to conceive and ultimately become a mother is the stuff of muffled murmurs at family gatherings.
"Where is your child? Give birth first before you send other people's children to do chores for you," Diana Wanjiku* recalls being told a few years ago.
Wanjiku, 34, says it is tough being childless. "I have been childless: If I was to choose, I would give up my legs to be a mother."
Wanjiku was 24 in 2013 when she settled into marriage. After two years of trying for a baby without much success, she became concerned.
"I went to see a doctor. They referred me to a specialist. And then tests followed. I did an HSG test - to check the state of the fallopian tubes," she says.
The prognosis showed that Wanjiku's Fallopian tubes were both blocked and surgery to open the tubes was recommended.
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"The surgery was successful. I conceived approximately nine months later," she says. However, the pregnancy turned out to be ectopic; necessitating surgery to remove it.
With just one fallopian tube left, Wanjiku tried again for a baby and hit the same wall as before: "Nothing was happening," she says.
Her doctor recommended that she does another HSG test. Known in full as hysterosalpingogram, the HSG test is "very uncomfortable," she says. "Let me say 'painful' even."
She was not ready for another one and asked her doctor if he could recommend other options.
The doctor recommended IVF (In vitro fertilisation) where eggs are harvested and fertilised in the laboratory and then introduced in the womb of the woman.
Wanjiku decided on IVF. She spent over Sh700,000 - money from fundraising and loans - for the IVF round and successfully conceived twins.
Blocked tubes, when a woman has ambitions of becoming a mother, can cost one a fortune indeed.
Dr Kireki Omanwa, a fertility specialist says that many women experience blocked fallopian tubes. "About 80 per cent of the women who visit my clinic and can positively be identified as experiencing a fertility problem, present with blocked tubes."
Which begs the question: what would lead to blocked tubes? Also, at what point should a woman be concerned? Well, the medical definition of infertility is the inability to conceive within 12 months of regular unprotected intercourse. This can be a guiding factor.
Dr Omanwa, who doubles as the President of the Kenya Obstetrical and Gynaecological Society (KOGS), says there are five main causes of blocked tubes.
INFECTIONSInfection is an infestation of the human body - either tissues, organs or organ systems - by microscopic organisms such as bacteria, viruses, fungi and protozoans.
Pelvic Inflammatory disease (PID) is an infection of a woman's reproductive organs. "Most of the time sexually transmitted infections (STIs), like chlamydia, syphilis and gonorrhoea, are to blame for PID," Dr Omanwa says.
Chlamydia is of great importance because the disease presents with no symptoms. As such, it may go unattended, with the consequences being infertility. People living with HIV and AIDS, the doctor observes, may be at a higher risk of infections that lead to PID. Other infections, such as tuberculosis (of the pelvis) can lead to PID and cause blockage of fallopian tubes.
Timely treatment of an STI would most certainly protect one from adverse effects. However, the best way to protect oneself from PID is through practising the ABC of sex: abstinence, being faithful to just one (healthy) partner, and using a condom.
PREVIOUS SURGERYSurgery is a treatment method doctors often use as a last resort to alleviate suffering from an illness or a disease. Surgery may cause scarring or adhesion of tissues, which then block the tube.
"The surgeries we are talking about here are those that are in or around the uterus (womb) - inside the abdomen," says Dr Omanwa. For instance, appendectomy (or appendix removal surgery) is usually carried out on an emergency basis to treat appendicitis (inflamed appendix).
Another common surgery among young women is the removal of fibroids - painful non-cancerous growths in the uterus. Surgery may also be done to remove cysts in or around the ovary. Lastly, abortion could also lead to tube blockage. "The most dangerous one would be backstreet abortion; which often results in extensive complications," Dr Omanwa says.
ECTOPIC PREGNANCYAn ectopic pregnancy is one where the fertilised egg implants itself outside of the womb, usually in one of the fallopian tubes. "An ectopic pregnancy is dangerous. It cannot be allowed to continue to term; otherwise, it would cause death.
"Following an ectopic pregnancy - whose symptom is severe abdominal pain - surgery is done to remove the pregnancy, sometimes together with the fallopian tube," says Dr Omanwa. If surgery is done early enough the tube may be spared but chances are that it would block.
HYDROSALPINX (FLUID IN THE TUBES)A fallopian tube affected by a hydrosalpinx looks awkwardly large, variegated, and abnormal.
The condition may be caused by an untreated infection or damage that may have occurred in one way or another. The fluid may be blood, pus, or just clear fluid. "Treatment for the condition includes draining and repairing the tubes or removing them altogether (salpingectomy)," says Dr Omanwa.
Out of every 10 women with blocked tubes, about one will present with a hydrosalpinx, he adds. The hydrosalpinx causes infertility in two ways; first, it blocked the fallopian tube. And two, the fluid it contains might trickle back into the womb, making the uterus unfavourable for pregnancy.
ENDOMETRIOSISThis is a condition in which tissue similar to the lining of the uterus, grows outside the uterus: in this case in or around the fallopian tubes.
The most critical sign of endometriosis is severely painful periods.