At 5:00 a.m., when the first roosters crow in Vihiga County, Sarah Nangami (name changed) is up and about, attending to her wifely and motherly duties.
By 6:30 a.m., she’s walking the dusty path of Idabwongo Village to the local secondary school where she teaches, a beloved figure known for her bubbly nature and the menstrual health initiative she runs for teenage girls in Vihiga County.
But behind her radiant smile lies a pain she’s carried for years: the agony of infertility.
60% of African women struggling with infertility, like Sarah, face divorce or abuse, forcing them into silence, a United Nations Population Fund (UNFPA) report indicates. Sarah has thus chosen to use a pseudonym to avoid further judgment, isolation, and ridicule due to the deep stigma surrounding infertility in her community, where a woman’s worth is often tied to motherhood.
“The Problem Must Be You”
Sarah married in 2017, full of hope. When a year passed without a pregnancy, the whispers began. She was 28 years old.
“My husband already had a child from another relationship,” she says, her voice tightening. “To his family, that meant only one thing: I was the problem.”
Her in-laws brought herbal concoctions. Neighbours suggested she wasn’t “woman enough.”
The stigma cut deeper when her periods vanished for six months, only to return with a flood of embarrassment.
“I was teaching when I felt warm blood running down my legs. The students saw everything,” she recalls. “That day, I cried not just for the shame, but because my body felt like a betrayal.”
After several consultations with doctors, working with their prescriptions, and spending vast chunks of money, Sarah conceived in 2020. Getting a second child, however, remains a challenge to date.
The Infertility Paradox: A Global Crisis, A Silent Burden
Sarah’s story mirrors a global health crisis with a uniquely African sting:
According to the World Health Organization (WHO), 1 in 6 people worldwide struggle with infertility.
As detailed by the Guttmacher Institute, female infertility rates in Africa are double the global average, yet 90% lack access to treatment.
Before Sarah got a prescription that worked, she underwent several tests that, she states, were expensive.
“Costly medical tests and treatments drained me financially, forcing me to spend beyond my means,” she reveals, emphasising that this is a barrier that prevents many from accessing necessary reproductive healthcare.
For Sarah, medical tests ruled out endometriosis, fibroids, and cysts, leaving her with unanswered questions:
“Why do my periods disappear? Why does conception feel like a mirage? The doctors say I’m ‘fine,’ but my body tells another story.”
Causes of Infertility
Dr. Sarika Sukhija, founder of Myra IVF and Medical Centre, highlights that irregular periods in women aged 20–30 may signal hormonal imbalances, which can affect fertility and conception.
She notes that the uterus bleeds according to how the hormones are building in the body, and the most common reason in girls experiencing irregular periods is Polycystic Ovarian Syndrome (PCOS).
“In PCOS, ovaries develop numerous follicles that fail to ovulate naturally. Each follicle secretes hormones, elevating overall levels and thickening the uterine lining,” Dr. Sarika explains
She notes that the absence of ovulation can lead to infertility issues, and that alongside irregular menstrual cycles, individuals may also experience obesity, acne, hair loss, and other complications.
“Maintaining regular menstrual cycles is crucial for reproductive health. When patients come to our clinic with irregular periods, we first prescribe medication to regulate their cycle. Once stabilised, they transition to ovulation-inducing treatment to stimulate egg production, which significantly improves their chances of conception,” she states
Another condition is endometriosis, which affects 20–25% of women, “frequently causing irregular and painful menstrual cycles and compromises egg quality, contributing to infertility,” Dr. Sarika explains.
However, Dr. Charles Muteshi, Assistant Professor, Gynaecology at Aga Khan University Hospital, says the link between endometriosis and infertility is not very direct.
“If endometriosis is severe, it causes scarring, resulting in adhesions, obstructing the fallopian tubes and preventing the egg from reaching them,” he says
He notes that endometriosis can cause significant inflammation even when fallopian tubes are normal, potentially disrupting fertilization and mildly impairing egg implantation in the womb.
Even with this, Dr. Muteshi emphasizes that many women with endometriosis can still conceive naturally, and if unsuccessful, assisted reproductive technologies like In Vitro Fertilization (IVF) often provide a viable solution.
According to Dr. Sarika, fibroids located within the uterine wall (myometrium) typically do not interfere with fertility, provided they do not encroach on the cavity itself. In such cases, conception remains possible even in the presence of fibroids.
However, “large fibroids can divert blood flow, restricting the blood supply to the baby and resulting in infertility,” she explains, adding that elevated estrogen and progesterone levels produced during pregnancy can stimulate fibroid enlargement, as these hormones directly promote tissue growth.
While some women may consider surgical removal of fibroids during pregnancy, Dr. Sarika cautions against this approach.
Options for treating infertility and difficulty in conceiving
While the causes of infertility are varied, there is hope: proven treatments exist. Like Nangami, who successfully conceived with medical support, many individuals can achieve pregnancy.
For starters, every woman of reproductive age needs to know about the Anti-Mullerian Hormone (AMH) blood test that assesses ovarian reserves and helps estimate the number of eggs remaining in a woman’s ovaries.
AMH is a hormone produced by small follicles in the ovaries. Higher AMH levels typically indicate a large pool of remaining eggs, while lower AMH levels suggest diminished egg quality.
“Any girl with diminishing AMH should visit a doctor to freeze their eggs in case they have plans of conceiving in future,” says Dr. Sarika.
Dr. Sarika suggests that with increased age, the quality of eggs decreases, reducing the chances of conceiving to about 15 to 20 % at the age of 40.
Individuals who freeze their eggs at a younger age, particularly between 33 and 35, and later attempt pregnancy using those thawed eggs, have significantly higher success rates compared to using eggs frozen at older ages.
Misconception about infertility and conception
Despite advancements in infertility treatment, persistent myths endure. According to Dr. Sarika, there is a widespread misconception that a prior successful pregnancy guarantees continued fertility.
As illustrated in Nangami’s case, efforts to achieve a second pregnancy since 2020 have remained unsuccessful, an indication that she could be among the 30 % of secondary infertility cases as outlined by the Mayo Clinic. Causes include age, new medical conditions or lifestyle changes.
Another common misconception is that infertility is a woman’s issue.
According to the WHO, infertility affects both men and women equally. Male factors (e.g., low sperm count, poor motility) contribute to 40% of infertility cases, female factors (as outlined above), to 40%, and unexplained factors to 20%.
Another misconception is that life choices don’t affect fertility.
According to the Centers for Disease Control and Prevention (CDC), smoking, excessive alcohol, obesity, and poor diet can harm fertility in both men and women. For example, smoking reduces ovarian reserve and sperm quality.
Nangami is 35 years old. In case she has higher AMH levels, this is the time to freeze her eggs for future use. Whether this is possible or not is for medical specialists to advise.
Beyond her journey, Nangami advocates for systemic reforms, urging governments to prioritize reproductive healthcare equity by regulating and subsidizing infertility treatment costs, ensuring access to vital services, from diagnostics to advanced procedures, for all, regardless of socioeconomic status.