ARE YOU BLOCKING YOUR FUTURE BABIES?

The last few years have been characterized by a change in the tone of the fertility discussion. Infertility has been one of the most stigmatized medical conditions in society, resulting in the most heart-rending stories we have seen in lately.

From biblical times, women who could not have children were looked down upon as is clearly epitomized in the story of Sarah and Anna; or were literally paying for their wrongdoing as God was deemed to withhold their childbearing to teach them a lesson as was in the case of Rachel.

In the current society, not much has changed. Couples who cannot have children are largely stigmatised and the women bear the brunt of this despite science showing that the problem is shared three ways: a third of the cases demonstrate a problem in the woman, another third in the man and in the last third, it is in both concurrently.

The women go through agony in the face of infertility that is beyond measure. Horror stories such as Jackline Mwende’s, the lady from Machakos who’s husband chopped off her hands, are rarely brought to the limelight but are discomfortingly common.

With modern advances in medicine, infertility is now spoken of rather than whispered about. Technologies such as intra-uterine insermination and in-vitro fertilisation have become common-place and the taboo subject is slowly getting demystified.

It is with this in mind that we look at tubal blockage as a cause of female infertility and the impact our youthful lifestyles have on the future. In the basic female anatomy, ova (eggs) in a woman, are made in the ovaries. They are transported through the fallopian tubes to the uterus. Halfway through their sojourn in the tubes, they meet up with the sperm, get fertilized and progress to the uterus as the basic human form called morula. Therefore, blockage of this tube effectively causes outright infertility.

Research shows that in Sub-Saharan Africa, 64% of infertile women had tubal blockage resulting mainly from genital tract infections and sexually transmitted infections. What does this mean? Early on in their reproductive life, young women contract infections that lead to inflammation of the tubes with resultant damage and scarring that causes blockage.

Focusing on the early phase of the reproductive phase, looking at young women in Kenya, the average age of coitarche (first sexual contact) is 17 years. This may be lower or higher depending on the girl’s background. For a long time, focus was on the young girl from a disadvantaged background: the poor, orphaned, displaced or neglected child. She was deemed to be at risk of sexual exploitation, and this may as well still be the case.

However, we have a new entrant into this scene. The urban college girl taking her first step in the world as an independent adult. The campus culture has changed over time and with this, new risky behaviour is rapidly emerging. Every town or city with a university now has what is popularly known as the ‘Electric Avenue’. From Westlands in Nairobi, to Eldoret to Kisii, these streets crammed full of noisy pubs full of young people making merry at all hours of the day or night, have taken a life of their own.

The culture of heavy drinking, smoking and casual sex has taken deep root. The youngsters are up all night from Friday evening till Monday morning, gyrating to the latest hits with abandon. Every counter prominently displays the condoms on sale and illicit drugs have been known to change hands under the table for a pretty penny. The young girls are drawn into this world without much orientation. They are trying to fit in with their peers and end up living a lifestyle way beyond their means, resulting in falling back to unsuitable relationships.

The result of these intoxicated encounters range from unprotected sex, date rape, abuse of the emergency contraceptive pills, unplanned pregnancies, unsafe abortions and genital tract and sexually transmitted infections. All these make the perfect recipe for precipitating fallopian tube blockage.

As scientific evidence continues being collected, observational and case studies seem to suggest that abuse of the emergency pill seems to increase the risk for ectopic pregnancies. In our resource-limited set up, most of these young women will possibly lose a fallopian tube by the age of 22, with no surety of what is happening to the remaining  tube. This is light years away from the time they will consider becoming mothers.

Unplanned pregnancies lead to many an unsafe abortion which is the leading risk factor for genital tract infections such as endometritis and salpingitis. This is because some of the places these abortions take place are unsanitary and infection control is unheard of. Instruments used introduce infections to the womb and antibiotics are not prescribed. They then turn up seriously ill, seeking proper treatment late and it may be too late to prevent damage to the very delicate fallopian tubes. In the worst case scenario, they may lose their womb or end up with perforated intestines, bladder and ureters.

With the degree of unprotected sex evidenced by the volume of emergency pills consumed, it is a no-brainer how sexually transmitted diseases will have a field day in this population. Some of these infections like Chlamydia may be silent and mostly asymptomatic, causing damage to the tubes silently for years, resulting in blockage without awareness. The sexual partners of these young women will spread the infections around yet do not suffer as badly as the young women do.

By their late twenties, these young women are at the peak of their lives, making great career strides and settling down in marriage, having put the four years of college behind them. This is when the chicken come home to roost. A trip to the doctor leads to one to the radiology unit for a hysterosalpingogram, commonly known as the HSG and it reveals that the tubes are blocked.

The struggle with infertility is real. It does not choose race, class or social standing. Knowingly wading into a risky lifestyle for momentary pleasure is in no way a smart move for young women who are just starting out in life. We only get one pair of tubes. We must jealously guard them!