My test tube baby is 10, here’s our journey so far

As Feodor Kipsang disembarks from the school bus, his mother, Achieng Radol is all smiles. She patiently waits by the gate, her arms wide open. Nothing gives Achieng, 51, as much joy as the warm embrace of her 10-year-old son. She tears up, overwhelmed by a mixture of delight and disbelief.

The mother of one is a Kenyan-Russian. Her husband died in 2021. Every day, though, she wonders what joy they would experience as a couple if he were alive to witness their love blossom into a young, vibrant man. Having Kipsang was not easy, Achieng says. For years, it was a trial-and-error affair. 

With every attempt, the woman failed to conceive as frustrations soared.

Then came the shocker of her life, 12 years ago. Achieng, then 39, was told by her doctor that her uterus was damaged. She could not conceive. Not then, not ever.

That this news was delivered to her four years after experiencing a miscarriage shattered her to the core. Achieng was devastated. 

Achieng, a tour guide and translator in Mombasa, first got pregnant at 35. The discovery was both a joy and a relief. ‘‘I had been searching and praying for a baby for five years since my wedding,” she narrates.

The joy was, however, short-lived. Six weeks after conception, she started bleeding. The bleeding followed bouts of excruciating pain in her abdomen. Upon being rushed to the hospital, it was discovered that she had miscarried. “The doctor could only clean my womb,” she tells Healthy Nation.

The loss of her pregnancy tripped in her a rollercoaster of emotions. “I was angry. I could not understand why this was happening to me.”

All she and her husband had ever wanted after their traditional wedding in 2006 was to have a baby.

As her search for a baby went on, one doctor put her on fertility pills for months after her miscarriage. Meanwhile, her abdominal pain persisted, growing worse during her menses. “It felt as though someone had shoved a knife and was turning it in my abdomen,” she says.

After suffering for months, a friend would recommend that she sees a gynaecologist at a fertility centre in Eldoret.

She says: “After a series of tests, the doctor found two conditions. I had a retroverted uterus and adenomyosis. She recommended an immediate operation.”

Retroversion of the uterus occurs when a woman’s uterus (womb) tilts backwards towards the spine rather than forwards. This condition is commonly known as a tipped or tilted uterus.

This problem is caused by the weakening of the pelvic ligaments at the time of menopause. Globally, the condition affects one in every five women.

The National Library of Medicine explains that the uterus is more commonly found in a straight vertical or anteverted (tipped forward) position.

Scar tissue or adhesions in the pelvis can also hold the uterus in a retroverted position, with the scarring coming from infection in the uterus, a pelvic surgery or endometriosis.

Retroversion of the uterus has no symptoms and rarely causes pain or discomfort.

According to John Hopkins Medicine, adenomyosis is a gynecologic condition that causes endometrial tissue in the lining of the uterus to grow into the muscular wall of the uterus.

Adenomyosis enlarges the uterus and may lead to heavy menstrual bleeding.

The tissue that lines the uterus (endometrium) is a special type of glandular tissue that responds to hormones. Each month, it prepares for a pregnancy by getting thicker. If the pregnancy doesn’t occur, the endometrial tissue sloughs off, coming off as the period.

In adenomyosis, however, some of this tissue grows into the myometrium, the muscular inner wall of the uterus. The tissue still behaves as it would if it lined the uterus, so it thickens and bleeds out with a woman’s monthly cycle. Such was Achieng’s situation. 

Age is one of the main risk factors, with most women with adenomyosis being in their later childbearing years, often between 35 and 50. Childbirth is also a risk factor as endometrial tissue could invade the myometrium when an embryo implants in the uterine wall. A significant proportion of women with adenomyosis usually have given birth to more than one child. 

Additionally, previous surgeries such as caesarean section or dilation and curettage could make adenomyosis more likely. 

For Achieng, facing the scalpel was the way out. “I was in a lot of pain. But after I was operated on, the painful periods vanished,” she narrates.

The making of baby Feodor  

It was after surgery that her doctor introduced her to in-vitro fertilization (IVF). This is one of the widely known types of assisted reproductive technology (ART) and works through a combination of medicines and surgical procedures to help sperm fertilise an egg. The method also allows the fertilised egg to be implanted in a woman’s uterus.

Thankfully, her husband was open to the idea. He played his part by making the sperm available. “The doctor was reassuring. She said I would conceive immediately and carry the child to term. She also told me that mine would be a normal pregnancy,” recounts Achieng. 

Achieng would go on to take multiple fertility pills and injections during the IVF procedure. At 39, she was the second oldest patient at the facility, the oldest being 45 – the latter’s procedure was unsuccessful.

“The hospital harvested five eggs from me and fertilised four in the lab on a petri dish. All the four embryos were transferred to my uterus. This was to maximise my chances of getting pregnant,” she recalls. 

Out of the four, one egg was fertilised. Achieng was pregnant. ‘‘I carried the pregnancy to term,” she tells Healthy Nation.

When the time came for her delivery, she was asked to do a cesarean section. Achieng declined, opting for induced labour. This is the form of labour that is started artificially using mock hormones. This type of labour is common when the baby is overdue or there is any risk to the mother or baby’s health.

There are two main ways labour can be induced. Hormones can be put inside a woman’s vagina using a vaginal tablet (pessary) or a gel. It is done using a device such as balloon catheter (a small balloon full of water). It can also be done through an osmotic dilator, (a type of sponge) which is used to widen the cervix.

“I was uncomfortable with a cesarean section given the possibility of later complications. I went the hormonal way, which was painful. But I was firm about my decision,’’ she says.

After going into labour at 11am on February 20, 2014, Achieng would give birth to her son at 6.45am the following day, after 19 hours in labour. It was a natural birth.

Costs and lessons

By the time of Feodor’s birth 10 years ago, the IVF procedure cost roughly Sh280,000. Today, the cost has more than doubled, going for about Sh600,000 in most facilities in Kenya. “I am on a mission to create awareness and to help fight the stigma around IVF,” the mother says, adding: “I live a positive life because there is no shame in seeking fertility treatment.” 

Sharing her journey, she says, encourages other women and couples searching for a baby. ‘‘There is hope,” she says, noting that a baby conceived via assisted reproductive technology is as normal as one conceived naturally.  “Some people refer to IVF babies as aliens. This is unfortunate. Procedures such as IVF only assist those grappling with fertility complications to have a baby. The only difference is that fertilisation in this case happens outside the body; in a lab,’’ she says.

“There’s need for much more awareness and reducing the cost of fertility treatment as well as assisted reproductive technology procedures like IVF because I know many Kenyans who would love to get the same services but they just can’t afford them.”

Feodor, a young, energetic and eloquent boy, looks as normal as other children his age in his neighbourhood. “I want to be a veterinary doctor when I grow up. I love maths, science and football. I like to spend time with my friends and grandmother,” he tells Healthy Nation. To deal with the misconception of aliens, Achieng says awareness is critical and adds that the cost is also a barrier that locks out women who do not have the means to pay for the procedure. ‘‘I know some women who wish to conceive but just can’t afford the service.” 

A step-by-step look at the IVF process

>>Dr Rajesh Chaudhary, an IVF specialist at Fertility Point Kenya, explains that in vitro fertilisation (IVF) is the most effective, commonly performed infertility treatment in the world.

>>It is a type of assisted reproductive technology that works by using a combination of medicines and surgical procedures to help sperm fertilise an egg and help the fertilised egg implant in  a woman’s  uterus.

>>The procedure is effective for people seeking to have children but have fertility problems such as low sperm count or quality, blocked or damaged fallopian tubes, endometriosis, polycystic ovary syndrome), uterine fibroids or are at risk of a genetic disease or disorder.

>>Dr Rajesh discloses that the success rate of IVF in Kenya is 60 per cent though studies have found that in African women, the success rate is 20 per cent.  “During IVF, the first step is ovarian stimulation and monitoring, where the doctor will prescribe parenteral hormones such as follicle-stimulating hormone to stimulate simultaneous egg maturation and so a woman will have many eggs ready for retrieval in the same session,” he explains. 

>>The doctor retrieves the egg, where he or she administers mild sedation medication to lessen the discomfort. Through the vagina, a thin needle is directed to the ovaries under an ultrasound guide to retrieve mature eggs from each follicle. The eggs are placed in a lab dish containing a specialised solution then kept in an environmentally controlled incubator.

>>The next step is fertilisation, where an embryologist will perform the intracytoplasmic sperm injection. According to Dr Rajesh, usually 70 per cent of mature eggs will fertilise and if there are a lot of mature eggs and a woman does not want to fertilise all of them, the excess embryos can be cryopreserved for future use.

>>The embryologist will monitor the development of embryos; with around 50 per cent of fertilised embryos successfully becoming blastocysts (a cluster of dividing cells made by a fertilised egg).

>>The last step is the embryo transfer, which takes 30 minutes. Before the transfer, one has to take oral hormones for 14-21 days to prepare the uterus for embryo implantation. Oestrogen and progesterone hormones can help thicken the uterine lining and increase chances of successful embryo implantation and pregnancy. 
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