Oh, BABY!

WHILE the road to motherhood is easy for some women, having conditions like endometriosis, Polycystic ovary syndrome (PCOS) and blocked tubes mean that, for others, it’s fraught with challenges. It’s often an expensive journey for those who take the route of fertility treatments, and for those who don’t and manage to be successful, it can be years and years trying, before that eventual positive pregnancy test.

What options are available to women with illnesses like these to have children? If all else fails there’s in vitro fertilisation (IVF)– the ‘all-inclusive’ cost for one round at the Hugh Wynter Fertility Management Unit (HWFMU) is approximately US$7,500. This cost has been touted as the best regionally, but that amount is still too high for young families, who are focused on achieving other life goals.

Before going the fertility treatment route, many couples use other methods of achieving pregnancy, some of which three women share below.

A baby after blocked tubes

Tiffany Powell, 38:

When I got married, my husband had already had two children from his first marriage, so there was no question about his fertility. We started trying for a baby immediately, and nothing was happening. At this time, I was 30 and really wanted to start my family as I was at a point in my career where I could pause to accommodate that. I went to my doctor and had a HSG test done (Hysterosalpingography, or X-ray to outline the internal shape of the uterus and show whether the Fallopian tubes are blocked), which showed that both my tubes were blocked. I don’t know the cause, but at that point, no matter the cost, I was willing to pay just to be able to have a child.

Luckily, the lining of my tubes were not extensively damaged; however, the doctor warned that there would still be the risk of an ectopic pregnancy, even if she cleared the blockage.

I had a couple consultations and procedures, including a laparoscopy probe to evaluate the tubes to see the extent of the damage, as well as laparascopic surgery to clear the tubes. I was warned that if that didn’t work, my next option would have been IVF, but luckily for us the procedure worked, and in just a few months I was pregnant.

I am now the mother of an active five-year-old, and I couldn’t be more thankful for the team of doctors who helped to make me a mother. I hope to have another child and hopefully, everything will go smoothly.

Total spent: I spent in excess of $500,000 just for the initial procedures, and that did not include my prenatal care.

Doctor’s note: If both Fallopian tubes are blocked, this is most likely due to an infection that caused the tubes to be damaged. Gonorrhoea and chlamydia are common sexually transmitted infections that result in significant damage to the Fallopian tubes if there is failure to diagnose and treat these infections early. Surgery can sometimes be done to clear the blockage, but this is not always possible, especially if the damage is severe. In some cases pregnancy occurs but this results in the implantation of the embryo in the Fallopian tube (ectopic pregnancy). This is because the lining of the tube is damaged and the embryo is not carried along the length of the tube into the lining of the uterus. This is a surgical emergency and can result in rupture of the Fallopian tube, shock, and even death in severe cases.

A baby with endometriosis

Terry-Ann Newell, 29:

Before I was diagnosed with endometriosis, as a teen my menstrual cramps were so horrible that sometimes I blocked out from the pain, and missed a lot of school. The severity of the pain was such that I was even told that pregnancy would be the only thing to alleviate it. And so, as soon as I was ready, I started trying. But getting pregnant was harder than I expected, and when I was examined, my physician theorised that my endo was causing excessive scarring that was compromising my fertility. At 24 years old, basically my ‘endo’ was scarring my Fallopian tubes and ovaries.

I didn’t give up hope, and neither did my doctor. I did surgery to remove some of the scar tissue, and then I was placed on Clomid (Clomiphene) to stimulate my ovaries. I was pregnant in months, but the worry didn’t stop there. Women with my illness are at greater risk for preterm delivery, pre-eclampsia, and other issues in pregnancy; so I was carefully monitored and induced at 28 weeks.

I am now a mother to a happy, healthy son.

Total spent: I spent over $1 million for surgery and treatments, and also for the initial part of my prenatal care.

Doctor’s note: Endometriosis is a disease that occurs when tissue similar to the lining of the womb (endometrium) implants outside the womb and continues to grow. It can be found on the ovaries, bowel and even in the lungs. Endometriosis affects about 10 to 15 per cent of women of the reproductive age group. Of the women with endometriosis, 30 to 50 per cent may have trouble getting pregnant. Severe endometriosis causes scarring. It behaves almost like glue and causes structures in the body to stick together and distort the normal anatomy. This can lead to blocked Fallopian tubes which prevents the natural process of conception. There are several options for treating infertility in women with endometriosis; these include fertility drugs to stimulate the release of more than one egg, thus increasing the chance of pregnancy; intrauterine insemination (IUI) and IVF.

A baby with PCOS

Kareen Hutchinson, 32:

I was diagnosed with PCOS in my first year in college. At that time, I weighed close to 200 pounds, and had just some of the classic symptoms, including irregular periods, uncontrollable weight gain, and excessive hair growth on my body. I didn’t mind the fact that my periods would come very occasionally, but when I graduated, got married, and started thinking about family, it was at that point that I understood how problematic my illness could be.

When I spoke to my doctor, he recommended a few changes, including dietary, and I was put on Metformin. Weight loss was critical (at this point I was hitting 260) and I immediately started to exercise. The Metformin was supposed to improve my chances of becoming pregnant, while at the same time reducing some of the effects of the PCOS. Later, I was also put on Clomid to help regulate my ovulation.

I understood throughout my treatment that for some women none of these treatments help in them becoming pregnant, but my faith in God helped me believe that this would not be the case. It took a year of consistency, but I did get pregnant, and welcomed a little girl three years ago.

Total spent: The medications were the most expensive; I’d say I spent about $300,000 over several months on tests and meds for myself and my husband.

Doctor’s note: PCOS is the number one cause of infertility in women, and affects one in every 10 women. It is an endocrine disorder that is characterised by insulin resistance (a condition in which the cells fail to respond to the insulin hormone). This leads to the production of higher levels of androgen (male hormones) in the ovaries, which in turn causes irregular/no ovulation to occur. The treatment of PCOS symptoms includes managing and slowing the progression of PCOS. Women are usually placed on the diabetic medication Metformin, which is geared towards managing insulin levels as well as regularising menstrual cycles. Also, birth control medications are used to regularise menstrual cycles.

If all else fails, it’s on to fertility treatment

The HWFMU at the University of the West Indies (UWI) offers a range of assisted reproduction technology techniques that aid fertilisation, including IVF, the most well known of assisted reproduction techniques. There is also IUI, a process in which prepared sperm is placed into the woman’s uterine cavity via her cervix, using a tiny soft catheter; Intracytoplasmic sperm injection (ICSI), where a tiny needle, called a micropipette, is used to inject a single sperm into the centre of the egg; Surgical sperm retrieval (SSR), a treatment option for men who have no sperm in their ejaculate; gamete donation, where the egg donor’s ovaries are stimulated to produce multiple eggs using routine IVF; and egg freezing, where a woman’s eggs are extracted, frozen, and stored for later use. The eggs are stored until she is ready to become pregnant, at which point the eggs can be thawed, inseminated, and the resulting viable embryos transferred to the uterus in hopes of achieving a pregnancy.

In 2019, JMMB Bank signed an agreement with HWFMU to provide up to $5 million in loan financing for individual patients to help offset the cost of infertility treatments and other related services offered by the unit, after a call from HWFMU urging financial institutions to respond to the growing levels of infertility by providing financial solutions to enable potential parents to better plan their fertility and to make parenthood a possibility for these individuals.

Up to 25 per cent of couples in the world, according to statistics, is said to be affected by infertility; while a local study done by the UWI, Mona, in 2002, showed 31 per cent of Jamaican women being affected by fertility impairment.

The HWFMU confirmed with the Jamaica Observer, then, that they had seen an increase in the number of interested clients since the financial solution has been put on the table.