Amid the talk of "having it all" with the right technology, the conversation is now slowly shifting to beating the odds on infertility; when we can make babies, with which genes or donor sperm or egg.
Playing god is what medicine is for.
What happens when your husband works in China and the time is ripe to make baby number three? What if your partner wants a baby and your prostate cancer treatment is likely to impair your fertility? Or your sperm is not of good quality to sire a baby?
Getting pregnant is becoming an elusive and frustrating dream as more career women postpone child-bearing and young men lose sperm quantity and quality due to a myriad of reasons.
But as elective egg and sperm freezing, high-tech in-vitro fertilisation (IVF), use of donor eggs and sperms and surrogacy take off, these technologies are seen as a game changer for many who felt they had lost chances of getting babies.
In an attempt to curb some causes of infertility in Kenya, doctors are now encouraging young men and women to embrace sperm or egg preservation.
Freezing of sperms for later use—even after 10 years—is a common practice in Kenya, but egg freezing technology is yet to take off in the country, although plans are underway to introduce it next year.
Dr Wanjiru Ndegwa, a consultant gynaecologist and fertility specialist says sperms need to be of good quality and quantity to increase a couple’s chances of having babies.
But certain procedures—such as chemotherapy or radiotherapy treatment for prostate or other cancers of the reproductive organs—can adversely affect the health and the amount of sperms produced, rendering men unable to sire children.
“But this can be prevented if sperms from the patients are harvested and stored before cancer treatment is given,” Dr Ndegwa says.
Sperm freezing is also the safest bet to beat the biological clock. Sperm quality is often high in younger men and those who cannot find partners in their 20s and early 30s are opting to freeze them.
“I have done it because I don’t want to risk infertility when I am older,” says a 38-year-old banker who requested anonymity.
Men at risk of death or injuries, like soldiers, and those about to undergo a vasectomy could also freeze their sperms.
Men whose sperm quality deteriorates over time or who sporadically release quality sperms should also harvest them and have them stored, says Joyce Noreh, a fertility expert at Nairobi IVF clinic. Some men are also opting for sperm freezing so that their partners can continue having babies as they work or study abroad.
In Kenya, fertility clinics offering the sperm freezing services include the Nairobi IVF Centre, Mediheal, Nairobi Hospital, Aga Khan Hospital and Footsteps to Fertility Centre.
It costs between Sh10,000 to about Sh50,000 annually for the storage of frozen sperms.
When the egg freezing technology takes off, Dr Ndegwa notes that it will benefit Kenyan women racing to beat the maternal clock.
Apart from quantity, the quality of eggs diminishes as a woman ages, increasing chances of abnormalities that can lead to miscarriages and birth defeats. Freezing eggs will buy them time to build their careers and seek ideal partners.
In the West, women have also begun freezing the ovarian tissue. Slices from the ovary are surgically removed, preserved, then transplanted back into the woman’s body when she’s ready to try to get pregnant. This is ideal for also young women undergoing cancer treatment.
But as more assisted reproductive technologies come into the Kenyan market, infertility still carries a lot of stigma.
During a debate on the In-Vitro Fertilisation Bill, Joyce Lay, the Taita Taveta women representative gave an emotional speech on the frustrations she went through when she had to use a surrogate mother.
Her struggle ignited a fresh debate on surrogacy and the expensive IVF gamble. Without laws, women who bear children through surrogates faces an uphill task of having legal ownership of their biological babies.
Hospitals put the surrogate mother’s name on the birth notification, with the real mother forced to adopt her own baby. For those who have no volunteer surrogates, they pay between Sh400,000 to Sh1 million.
For couples seeking IVF, one of the biggest obstacles is the cost, which is not covered by insurance companies. A session of IVF costs about Sh350,000. And if the procedure is not successful in the first round, the cost can go up to Sh1 million depending on how many times it is done.
Ms Noreh attributes the steep cost to high taxes on IVF medication and equipment, as well as the unavailability of trained healthcare workers to perform the procedure.
Kenya currently has only one embryologist who has specialised in performing IVF. Most hospitals therefore liaise with foreign embryologists who come at specific times of the year to perform IVF.
“The cost of flying them into the country plus their medical fees is high, and the patients bear this cost. That’s why we need to train our own local specialists,” Ms Noreh says.
Infertility is also still seen as woman’s curse. For men, understanding why they are producing less or quality sperms has implications beyond male fertility; it presents a roller coaster of emotions and a threat to masculinity. They rarely seek treatment.
And Cecilia Karanja, who started Fertility Kenya - an organisation that supports men and women facing infertility challenges - knows this too well.
Infertility killed the bliss in her marriage, one year after a dream wedding. Childlessness, she says, dealt a blow to her self-esteem, making her feel worthless. When she decided to seek medication attention, her husband was a bystander. It was a woman’s disease.
“Society tends to see a woman as the one responsible for making children,” says Ms Karanja. But she found out she was not the problem. Her reproductive system was clean, but the doctor still gave her fertility drugs, just in case.
“I took the drugs religiously, but nothing happened. I was getting desperate to get a child and save my marriage,” she says.
Her husband finally decided to see a doctor, the test results came back – low sperm count. The diagnosis dented her husband’s ego and he became possessive, controlling and abusive.
“He didn’t want me near relatives or friends, he feared I would reveal his condition,” she says. They divorced after six years of marriage. Two years later, she decided to give marriage a second chance. But soon, infertility stalked her, tearing apart the second marriage.
Medical tests showed she had developed fibroids that blocked her fallopian tubes, a complication which required surgery. But before she could do the surgery, her husband left her and married another woman.
“Some of my friends advised him to flee due to my history of a childless marriage,” she says.
Ms Karanja plunged into depression. Eventually, three years ago she got a baby boy after undergoing surgery to unblock her fallopian tubes. Shortly thereafter, her second son was conceived, opening a fresh chapter in marriage.
Dr Koigi Kamau, an IVF consultant and lecturer at the University of Nairobi says that women tend to bear the burden of infertility alone as the society demonises and stigmatises.
Because most men have been socialised to believe that it’s a woman’s duty to give birth, he says, they rarely take the blame for infertility.
When the men finally come to hospitals, he says, many are resistant to semen analysis and show poor compliance to fertility treatments.
“Fertility is a shared responsibility between the man and woman. And it’s okay to seek help when couples can’t have children. It doesn’t make you less of a man or woman,” he says.
Fertility Kenya is among the few scattered in the country, filling a huge gap that has existed in Kenya for long and that offers financial support to men and women to access various fertility treatment options. Kenya has made great strides in birth control programmes, but not treating infertility.
Dr Kavoo Linge, a consultant gynaecologist says that fertility challenges are not a priority for the government yet.
“Population control is a problem...sorting infertility problems will mean encouraging more births,” he says.
As the debate on the IVF Bill continues, many are banking on a new law so that they can afford to make a baby or adopt. The Bill proposes the establishment of at least one IVF centre in all Level 5 hospitals across the country.
These centres will also act as linkages to adoption agencies.