How In Vitro Fertilisation brought back the smile of barren woman

Arusha. Thirteen years, spanning approximately 4,700 days, could not discourage Josephine (not her real name) from her unwavering determination to conceive, regardless of the daunting cost of over Sh20 million.

Now Josephine, 49, is blessed with twin boys who are five years old. She considers them a source of comfort after enduring years of suffering.

“Having a child at my age is a gift from God,” says Josephine, a resident of Arusha.

She explains that her husband played a supportive role throughout their journey, which ultimately led to success through In Vitro Fertilisation (IVF), a process where an egg is removed from a woman’s ovaries and combined with sperm in a laboratory.

Josephine and her husband spent over 10 years searching for a child, undergoing four IVF cycles and spending more than Sh60 million, with Sh40 million being provided as assistance from the hospital.

Community perspective

She says that some people, including her husband’s relatives, doubted her ability to conceive due to her age.

“When grappling with infertility, society often blames the woman, using hurtful words and stigmatising labels. Without courage, it’s easy to waver and lose hope. Initially, those words hurt me deeply,” she recalls. Josephine sought advice from many people and tried various remedies. She also attended prayers in different churches, seeking divine intervention.

She explains that during the first four years of marriage, they did not seek medical help or take any medication.

“During those years, the only traditional remedy I tried was Maasai concoctions because some of my family members thought they would work.

She explains that even at the hospital, the tests showed that she did not have any problems that caused her to fail to get pregnant.

“When I was told I didn’t have any problems, I asked myself many questions, but I could not get answers. I didn’t think I was cursed, though. I was just considering if my husband had any intentions of marrying someone else and if that affected our situation,” she explains.

The journey towards conception

She notes that a glimmer of hope appeared when she met one of her brothers, who informed her about Avinta Care Hospital in Arusha, which provides IVF treatment.

“I decided to visit this centre in hopes of achieving pregnancy through implantation because my desire for a child was strong,” she says with a smile, adding, “On the way to Arusha, thoughts of becoming pregnant consumed my mind. I eagerly anticipated meeting the doctor and learning about my condition.”

She explains that they didn’t immediately begin with IVF upon arriving at the hospital. Instead, they underwent various tests and treatments for one year, attempting to conceive naturally. Unfortunately, this approach proved unsuccessful.

“When it became evident that natural conception was not working, the doctor advised us to pursue IVF as our age was a limiting factor. Transplantation was our only remaining option,” she explains.

She further elaborates that it took them eight months to contemplate and make a decision. During this time, they also fervently prayed for success, considering the high cost associated with IVF.

Cost of the procedures

“The first IVF journey was challenging as it cost Sh12 million, not including the expenses for medication and tests. I had to secure a Sh20 million loan to afford the treatment,” says Josephine, who works as a teacher. “Given my profession, I couldn’t accumulate the entire sum of money on my own. I underwent over 38 injections in my stomach. I visited the hospital daily for two weeks, causing disruptions to my work schedule. There were instances when I had to lie at work to receive treatment,” she explains.

During the treatment, the woman receives injections of the FSH hormone for nine to twelve consecutive days. This hormone stimulates egg production.

The first attempt

After completing the injections, they proceeded with egg harvesting and embryo transplantation. She had to rest and refrain from any strenuous activity for 14 days while awaiting a pregnancy test.

“For those 14 days after the transplantation, I just ate and slept. I continued receiving injections throughout that period. It truly requires patience,” she shares. He goes on to explain that after the 14 days, they went to the hospital for a pregnancy test, but unfortunately, they did not achieve pregnancy, which was disheartening and disappointing.

Josephine reveals that the doctor provided encouragement and advised her not to disclose the results to her husband.

“The doctor assured me that he would inform my husband of the results. The weight of the news made me contemplate a lot. We still had the loan to repay, but we didn’t succeed. At times, it felt like we were losing hope, but we prayed for strength,” she explains.

Despite the setback, she says her husband remained supportive. “He was the one who uplifted me. He assured me that even if we didn’t conceive, he wouldn’t abandon me. He gave me courage and strength.”

She adds; “The doctor suggested that we try the transplantation again. However, I hesitated for about three to four months. The financial burden of the treatment and the ongoing recovery to repay the loan made me uncertain about undergoing the procedure again.”

Second attempt

After receiving the doctor’s advice, they were informed that the hospital would cover the cost of the second phase of treatment, which amounted to Sh15 million, while they would be responsible for the expenses related to tests, medication, and injections.

“We agreed to proceed with the second round of treatment, but even with the hospital covering the costs, there were times when we struggled to afford the injections. Our salaries were our only source of income, and we ended up using most of it for treatment and repayment,” she explains.

During the treatment, she explains that it felt like starting from scratch as they underwent the process of egg and sperm implantation. Despite their efforts, she did not achieve pregnancy, and the results were no different from the previous attempts.

“This made me question what the problem could be and why I was not getting pregnant. These thoughts kept swirling in my mind, despite receiving advice from the doctor and his team. I started doubting my ability to conceive,” she says.

The third attempt

Even during the third round of embryo implantation, she did not achieve pregnancy. “The results were disappointing. I couldn’t help but feel sorry for the doctor. For this third attempt, the hospital covered the cost of Sh15 million, and we were responsible for the medication and tests.”

“My body needed rest, especially from the numerous injections. In the first phase, I received over 38 injections in my stomach, one injection every day for 14 days. The second and third phases involved the same number of injections and medications. My mind and body were exhausted, and I needed to take a break,” she explains.

Fourth attempt

She explains that in 2018, after recovering from her broken heart, she made the decision to resume treatment.

She says that for the third time, they opted for Intrauterine Insemination (IUI) instead of In Vitro Fertilisation (IVF).

IUI fertilisation is a fertility treatment procedure in which sperm is placed directly into a woman’s uterus to facilitate fertilisation.

After a 14-day wait, she underwent a pregnancy test and received the joyful news that she was pregnant. “I was overjoyed; my dreams had finally come true. My life completely changed within just one month of being pregnant,” she exclaims.

Miscarriage

She recalls a day when she attended a friend’s wedding party. As she went to get food, she suddenly experienced intense stomach pain. With each step, she realised she was bleeding from her pubic parts.

“I was shocked. I rushed to the hospital and received the devastating news that the pregnancy had miscarried. It was a painful blow, and my happiness was abruptly shattered.

“However, the doctor had a different reaction. Instead of expressing sadness, he laughed and explained that my situation was clear: I had the ability to conceive. He suggested that my husband and I should undergo the treatment again—a fourth IVF transplant, just one month after the previous pregnancy,” she recounts.

A smile returns to her face

They proceeded with the fourth IVF, which involved a new treatment involving hormone injections for 10 days to stimulate egg production, followed by implantation and continued hormone injections for 14 days. They anxiously awaited the outcome.

After 14 days, Josephine took a pregnancy test and received the joyous news that she was pregnant. For the next three months, she continued to receive hormone injections, with each injection costing between Sh10,000 and Sh15,000.

After three months, she transitioned to using the cyclost pessary, which cost Sh90,000 for a 20-day dose. This treatment continued for three months.

Nine months later, Josephine gave birth to twin boys through surgery. Today, they are five years old.

The doctor provides insights:

Dr Nichalous Mazunguni explains that some women undergo multiple IVF treatments without success, while others achieve pregnancy after just one attempt. The outcome depends on factors such as the woman’s body, her response to medication, and the specific issue being addressed.

According to statistics from the World Health Organisation (WHO), the success rate of IVF in achieving pregnancy or having a child ranges from 15 to 45 percent. The chances vary based on the woman’s age and the underlying problem.

The cost of IVF typically ranges from Sh7 million to Sh15 million.

Dr Mazunguni treated the woman for three years, including one IUI (intrauterine insemination) and four IVF cycles.

“Out of 10 women who undergo IVF for the first time, two to three can achieve pregnancy. These women face different challenges that prevent natural conception. I encourage women to persevere and follow the recommended conditions without giving up.

“When repeating the treatment, everything starts anew, from the hormone injections to stimulate egg production. The cost varies depending on the specific problem each woman faces. We advise patients to be prepared for any outcome during the transplant service and not to lose hope,” he advises.

The total cost of four IVF cycles amounts to Sh60 million. The woman paid for the first cycle, while the hospital provided assistance for the remaining four cycles, including IUI. The high cost is attributed to the drugs used to prepare the mother, equipment, and medications required for egg harvesting and embryo transfer.

Dr Mazunguni recalls that they performed the transplant procedure on the woman four times.

“I informed them that this treatment may not always result in pregnancy. There are instances where a woman may undergo the procedure multiple times before achieving success. I prepared them for both possibilities, and once they were ready, we proceeded with the treatment,” Dr Mazunguni explains.

He emphasises that the woman’s successful pregnancy and childbirth brought great joy to the centre.

Reasons for difficulties in achieving pregnancy

Dr Mazunguni highlights that women between the ages of 18 and 35 have a higher likelihood of successful egg production when using fertility drugs compared to those aged 36 and above.

“Therefore, younger women have a greater potential for success. There are various factors that contribute to success or failure, and we consider all of them,” he states.

Since 2018, the centre has performed transplants for 1,400 women, resulting in the birth of 600 children. One of the challenges is the societal expectation that IVF must always lead to success. Some individuals even take out bank loans to fund the treatment, making it even more emotionally challenging if the desired outcome is not achieved.

In a week, Dr Mazunguni treats over 180 patients, although not all of them require transplant services.

Only four percent of the patients who visit the centre undergo transplant services. In some cases, further testing reveals that individuals may require alternative medical care, which can eventually lead to successful pregnancies.

Supported by Bill & Melinda Gates Foundation