I was tempted to use the word barrenness but I am not comfortable with the fact that it suggests a lack of productivity. Infertility appeals more to me especially because it does not carry that obnoxious meaning as it is a scientific term. Africans invest enormous emotional and financial resources in wedding ceremonies rather than the marriage itself which makes them give infertility many absurd definitions. This is usually from a selfish, investment paradigm mostly from the parents-in-law to the wife who is seen to be barren and unproductive despite enormous investments.
The gynecologists do not take issues of failure of conception seriously until 12 full months after marriage with a provision that the circumstance of the marriage facilitates adequate sexual intercourse especially at the most fertile periods in the menstrual cycle. Another point that must be cleared is that factors that contribute to infertility are not only from the woman. Medical literature has established that both sexes carry the equal weight of risk factors for infertility which is totally different from our African perspective that recklessly draws conclusions even without scientific evidence that it is the woman that is not productive.
This background attempts to describe the psycho-social expectations and oftentimes inconsiderate pressure on the couples who have issues with conception. The challenge is not just five years of infertility as we often describe the experience in medical or social parlance, but it is four weeks of psychologically traumatic dashed expectations in 5 years. Each time the woman sees her menses; it is usually a dark day for the couple and that for the number of years. The psychological state I am describing may escape the eagle eye of the gynaecologist and may remain undetectable by our diagnostic psychiatric instruments. Apart from the distress of not having a baby; the couple is often faced with the task of having to explain or apologize to other stakeholders especially the parents-in-law. Preference for particular sex especially male is still a contentious issue in our African marriage and a risk factor for developing mental illness after childbirth. The irony of the situation is that it is the man’s spermatozoon that determines the sex of the baby.
This psychological burden is unnecessary because it prevents couples from taking rational steps at tackling this challenge. Such couples may need counseling on issues of fertile days of the menstrual cycle and timing of sexual intercourse even before seeing a gynecologist for a thorough medical investigation after 12 months. The choice of the doctor is crucial because this challenge requires the expertise of the specialists and not generalists who have some interests in gynecology that the family has consulted for decades. This is important because some of the risk factors of infertility are correctible and it is better when detected early by the gynaecologist.
Another major issue arises when the couple attributes infertility to a supernatural cause that is capable of delaying medical intervention and can actually destroy the marriage if the woman becomes paranoid against in-laws and the husband.
This may disrupt adequate and timely sexual exposure. The disturbed state of the mind, coupled with inadequate sleep and prolonged fasting can actually disturb the hormonal mechanisms that regulate the cyclical release of the eggs crucial for achieving pregnancy. The men are equally disturbed especially in Africa where the inability to have a child connotes questionable manhood. This may result in failure to sustain an erection because of anxiety, arising from fear of failure as he drinks more alcohol and engages in sexual escapades to prove his manhood. In some cases, he may become aggressive and avoid his wife especially around the time she sees her menses which he considers as proof of his failure. Couples having infertility issues need creative support from parents, in-laws and other stakeholders but not pity.
Our gynaecologists should also have a fair assessment of the mental state of their clients and make appropriate referrals when there is a need for intervention. Some of the investigations for infertility may be psychologically challenging and it’s expected that our attending doctors will deploy sound professional skills and consideration when attending to them. Decisions for the assisted reproductive intervention should be done promptly assisted by the gynaecologist. Adoption is also a valuable option in cases where all the options have been explored. Parenting is a sophisticated social role that transcends the biological facility of having a child. There is a growing number of biological progenitors who lack the emotional maturity to be parents. Infertility does not annihilate parenting skills which can find creative expression in adoption as wonderful children can be raised by such couples.
In conclusion, a wholesome relationship with God and appropriate medical consultation can help to confer sound mental health to cope with challenges of infertility especially in our environment