When natural fails...a guide to making a baby

For almost half of couples having problems conceiving, the cause of infertility is sperm-related. With natural conception, success is regarded as between six months to a year of trying to conceive repeatedly, month after month. Fertility specialists advise couples under the age of 35 to try for 12 months on their own while couples over the age of 35 try for six months before seeking fertility assistance.

Intrauterine insemination

IUI is a fertility treatment that involves placing specially washed sperm directly into the uterus during ovulation. IUI is mostly used by couples who need donor sperm, in cases of unexplained infertility, mild endometriosis or reduced sperm motility. IUI is a relatively safe, simple and noninvasive procedure and is cheaper than IVF. IUI is common among same-sex couples or single women who want to conceive.

Its success rates are however not very high, with the numbers varying among studies. Generally, IUI cycles have live birth rates per cycle of between five to 15 per cent. Success largely depends on the age of the woman, with women under 35 having a 15-20 per cent per cycle chance of success. Most fertility specialists will not recommend IUI to women over 40 who only have a five per cent chance per cycle of conceiving with this treatment.

Because conception rates drop considerably as a woman ages due to egg quality, many repeated IUI cycles are required in order to conceive. The more IUI cycles you undergo, the higher your chances for pregnancy. Multiple studies show that 90-95 per cent of successful IUIs will happen within three to four attempts. If this is still not successful, a couple might have to consider in vitro fertilization as an alternative.

The treatment cost of IUI in Kenya ranges between Sh50,000 and Sh200,000.

In vitro fertilisation

IVF is a common treatment for couples who are unable to conceive naturally and is usually pursued after other fertility treatments have failed. The procedure starts when the woman is given drugs that will stimulate her ovaries to produce several eggs. The eggs are then retrieved from the ovaries and mixed with sperm (obtained by masturbation) in a laboratory. If all goes well, sperm cells will fertilise some of the eggs to produce several embryos. The embryologist will then choose one healthy embryo to be implanted into the woman’s uterus.

Apart from cases of severe male infertility where sperms will need extra help in the fertilization process, a woman’s age is the single best predictor of IVF success. For instance, a woman who is under 35 and undergoes IVF has a 39.6 per cent chance of having a baby, while a woman aged above 40 has an 11.5 per cent chance, according to a 2017 CDC study.

The treatment cost of basic IVF in Kenya ranges between Sh300,000 and Sh500,000 per cycle.

Intracytoplasmic sperm injection

ICSI is a special procedure done as part of IVF where a sperm cell is injected into the cytoplasm of an egg. Unlike in vitro fertilization where multiple sperms and an egg are left in a petri dish to fertilise on their own, in ICSI, an embryologist chooses a healthy single sperm and injects it directly into an egg. This increases the chances of fertilization especially when a couple has tried conventional IVF and failed.

ICSI is the most common and successful treatment for male infertility. This procedure is best suited for men who have a very low sperm count, if one has abnormally shaped sperm or in the case of poor sperm movement. It is also used for men who need surgical sperm extraction when sperm does not reach the ejaculate due to certain health conditions or when one has had a vasectomy.

Advanced IVF and ICSI in Kenya cost between Sh400,000 and Sh600,000 per cycle.