POSSIBLE EXPLOITATION OF THE YOUTH FOR SPERM/EGG DONATION IN KENYA

 There has been an organ (mainly kidney) donation scandal being addressed in the nation that has gotten many talking . This reminds me of another ‘organ’ or ‘product of an organ’ that we don’t discuss enough ; the subject of sperm or ovum(egg) donation .  I have had the chance and opportunity to work/learn in a few fertility IVF clinics both locally and abroad . The regulation abroad is very stringent to the extent of people buying gametes abroad (from developing countries in Africa and Asia) to avoid the very tight regulations of such transactions in countries like Canada and U.S.A. There are no proper regulations in the Kenyan Legislature and so as long as a donor is over 18 years and signs a legal document , there are no real legal frameworks to safeguard them . Our law (or is it a Millie Odhiambo Bill that is yet to become law) however discourages financial gain from the same but it’s a very grey area because tokens of appreciation to ease the process  are not categorically banned . 

In Kenya, the Assisted Reproductive Technology (ART) Bill, 2022 outlines the legal framework for gamete donation and other assisted reproductive technologies. The Bill prohibits the use of sperm/ovum from donors under 18 years of age, except with parental consent for a minor's future procreation e.g in those minors undergoing cancer treatment that may permanently affect their fertility. It also prohibits the sale and transfer of gametes, zygotes, and embryos. Additionally, the Bill regulates the licensing and operation of facilities offering ART services, including sperm banks. 

Here's a more detailed look at the key aspects of the law: 

1. Donor Eligibility and Consent:

• A donor must be a fit, healthy, typically between 18 and 45 years of age, willing to undergo rigorous testing. 
  
• The donor must agree to relinquish all legal rights to any children resulting from the donation. 
  
• Sperm/egg from donors under 18 is prohibited for use in assisted reproduction, unless for the minor's future procreation with parental consent. 
  

2. Prohibition of Commercialization:

• The sale or transfer of gametes, zygotes, and embryos is prohibited, meaning they cannot be bought and sold.
• The Bill aims to prevent commercial exploitation of assisted reproductive technology. 

My focus today will be on the young over-18 female university students. For male donors , it’s a simple masturbation with no prior drugs , invasive theatre procedures or possible life threatening complications from unregulated donations .

I had a recent discussion with my mother ; Madam-Z and we agreed that unto age 24, one needs to be under guidance and may not be trusted with major life changing decisions - I do not support marriage ; especially of men below this age - this my own personal view . The same applies to organ or gamete donation by our very young college girls . Most end up getting serious mental health issues later ; they may worry about their anonymous multiple offsprings out there in the world, some may get some complications from the egg-retrieval processes that may bring serious uncertainties and anxiety , others may end up perpetually guilty for secretly doing what their parents would never consent to . 

I remember recently reading in a doctor group about a young university girl who had to undergo a major abdominal surgery following a pelvic abscess(pus accumulation) obtained following an egg-retrieval process gone wrong . She had only been pain 30,000 Kenya Shillings and the I.V.F centre did not want to be involved in her care because this was beyond the contract she had signed . Such a surgery that she underwent would cost not less than 100,000 shillings in the rural setting ; the costs may be triple that in Nairobi and this many not be fully catered for by SHA. What about the possible resultant future Subfertility that may arise from this iatrogenically caused infection ? Is 30,000 shillings worth this headache ?

One notable personality , talked about how she almost died from OVARIAN HYPERSTIMULATION SYNDROME (OHSS). You see , a woman ovulates one mature ovum per month unlike a man who ejaculates more than 20million sperms per ejaculate . More eggs are usually required to assist in the IVF process and so a series of hormonal drugs and injections are usually given to stimulate production of many eggs in the cycle sometimes to more than 20 . Depending on the dosages , some girls may over-react and get into a hormonal crises called OHSS which if not well managed can be life threatening; this results from over-stimulation with many follicles produced and resultant very high oestrogen hormone levels  . The body swells up with fluid everywhere including the lungs and these patients may develop life threatening blood clots . Most most of these cases have to be managed in HDU or even ICU with supportive management of all organs affected . In countries with well regulated practices , OHSS occurs in about 1-3 % of women undergoing IVF egg retrieval ; the situation may be worse in our country . Rarely the over-stimulated ovary with many follicles may twist (torsion)due to the abnormal heaviness from many follicles leading to a a major surgery or sadly  loss of an ovary from this torsion. Management of OHSS may end up costing hundreds of thousands all from earning less than 100,000 from egg donation ; the price depends on ‘quality of egg and profile of donor with beautiful students doing STEM courses or courses known to attract exceptionally bright students earning more; it is what it is !!

My take is that these students must be protected .A 19 year old may not be as mature as a 38 year old hustler . Is thorough patient education done ? I doubt it . Holders of national I.D cards automatically become eligible for these unregulated transactions.

Has anyone also thought about future consanguinity ? Of siblings marrying in the future ? There are medical students (male) who survive fully in university by sperm donations and some may donate more than 50 times ; helping over 50 families get multiple babies (do the math, we may be talking about total 200 children over a 5 year college period) . There is no regulation whatsoever  in Kenya on how many times one can donate gametes  . One day we will have siblings marrying each other or procreating together . The future isn’t far because this has been a practise for close to two decades in Kenya  - I have personal friends who donated a a few times in sperm banks in Nairobi when they were younger.

I have no problem with gamete donation ; I have a number of very grateful women in my clinic who have benefited greatly from ‘anonymous purchase’ of eggs from ovum banks and are on their 2nd/3rd pregnancies . I also have a few couples with male infertility problem whose marriages and image in society has been saved by sperm donation from strangers . I fully embrace it but let us protect our very young girls from exploitation unless if helping their relatives . I’m worried both about physical complications and also unseen mental health issues that may arise . 

I want to beseech parents to move with the times and stay alert on these emerging issues in society that may never have been in existence during our times . A new expensive phone by your daughter may not necessary be from a sugar daddy but may be from unregulated egg donation . Talk to your girls , befriend them , be open and make sure they are well provided for and that they learn to live within their means; I believe hardly no girl donates eggs to an anonymous stranger for the goodness of humanity but mostly for financial gain. For those girls who are very sure about these donations , let us make sure that the contracts protect them fully and that any possible mental issue is dealt with accordingly . Dear girls can we open up to our mothers/sisters/gynaecologists before embarking on donation if we are not very sure ? I have no problem with older women(especially those with children) who take it up . Let us keep talking . Thank you!

A WAVE OF VERY YOUNG BABY-MAMAS /BABY-DADDIES IN SOCIETY

 

Jasmine* walks in , tears and confusion is evident from the look in her eyes . I take a quick history, she is in her early 20s , had a caesarean delivery 8 months ago and now is surprised that she has not seen her menses for 1 month and wants me to investigate for a hormonal imbalance . I ask her if she is sexually active currently and she bluntly denies; last sexual contact was before her baby was born . She is not on any family planning method . I  take more history , I ask her to allow me do a pregnancy test first and she refuses . She is in my office for investigation and treatment for hormonal imbalance and I should stop going round for baseless tests. I still proceed and do a serum pregnancy test as I ordered for other blood tests; she didn’t understand that the wording of the test still meant a pregnancy test but not the usual routine urine test . Surprise , surprise , the test was positive . So after all the missed menses were due to a an early pregnancy . Ultrasound doesn’t show much other than a bit of a thickened uterine lining . I break the news and diagnosis but she is annoyed that I didn’t respect her refusal for a pregnancy test . She breaks her own theory that the positive test could be from effects of the delivery 8 months ago ; there is no scientific plausibility to this unless we are dealing with a BHCG producing tumor which would have been picked on imaging anyway. She insists on this fact and wants medicine to ‘clean her up’ and get rid of this positive hormonal test and return her menses. I go into full Reproductive Health expert mode and enquire about any possible rape and she is confident that nothing of that nature happened. I call my secretary and ask her to hold the queue to enable me take time with my patient . I make a final diagnosis of an early pregnancy approx. 4 weeks gestational age . I refuse to issue any medications other than pregnancy supplements . She is not happy with me but finally blunts out ‘Doc wewe unajua vile baby-daddy ni stress half sasa niongeze baby-daddy mwingine kwanza mwenye hataki hiyo story?’.  To me this was in itself a confession of a recent unprotected intercourse . We start talking . I ask her why she is not on family planning and she tells me that she fears that family planning is not good for an unmarried woman and that she fears that it may affect her future fertility . I dismiss these as myths and explain to her on efficiency of family planning and go deeper on what may compromise fertility and family planning is definitely not one of the causes . She still denies the pregnancy and I warn her about dangers of abortion if she decides to take that illegal route. Fast forward , I gave her a return date after 4 weeks in which as expected we had a bouncing 8 week fetus on ultrasound . 

Then I remembered Rhodah, a tiny university student  . She came in with her boyfriend . Again had very irregular and missed menses mainly contributed by the very frequent use of emergency pills. They had been together for 2 years and in all this duration , has never been on a family planning method other than the abuse of the e-pills.  They told me that they normally pray before intercourse that they hopefully do not conceive ; Kwani Maombi is a F.P method ? Maajabu !!.  This time I also insisted on a pregnancy test which gladly came back  negative . I counselled them on the dangers of unprotected intercourse  , dangers of abuse of the e-pill and asked Rhoda if she was ready to be a baby-mama because this was  definitely loading . She still expressed fear over regular longterm family planning despite the counselling ; I really wanted her to leave the office with a method in-situ but sadly she refused . The emergency pill not only causes disturbed hormonal balance but can also fail and cause a pregnancy : studies have shown that a failed e-pill significantly increases the risk of ectopic pregnancies which unfortunately can lead to the loss of a fallopian tube or be life threatening if not caught early . 

Unfortunately women take the brunt of the burden and a lifelong irreversible consequences of unplanned pregnancies. Men don’t have much to lose especially in a country where child support is hardly enforced . They go on with their studies , jobs and even marry easily in the future. Can one sue a jobless student for child support ? 

Whenever I have teenage clients, I promptly kick their parents out . 70% open up on unprotected interrcourse and express discomfort in taking up reversible long term family planning  methods. ( this is very legal in Kenya without parental consent as long the teenager is sexually exposed). Of course at this age , abstinence is emphasized over and above any family planning method. 

Abstinence is best as always for all young women  ; no one ever died due to lack of intercourse . It protects against unplanned pregnancies , HIV/AIDS, STIs(which can cause permanent tubal blockage and infertility), HPV and in essence future cervical cancer  and mental stress/indignity . I’m very sure that no mother would proudly announce that their 20 year old is unmarried and sexually active . I recently cringed watching a national TV interview of a very young man openly discussing his sexual relations with the very young girlfriend who was in studio at the time; I wondered how her parents felt , how her future husband would take this ( I may need to style up and catch up with later generations 😀; niwache ushamba ).

The other alternative in a young couple ‘unable’ to abstain would be to to take up constant barrier method i.e condom use or reversible longterm family planning methods like the non-hormonal intrauterine device (coil) , implants , injections or the daily pill. These young-ins want methods that cannot be seen by their parents or their church elders so we get into this and settle on a favorable one for an individual . They must remember that contraceptives don’t protect against infections and HIV. 

Family planning methods do not cause future infertility; it is risky sexual behaviors that cause this. The IUCD doesn’t cause pelvic inflammatory disease or tubal blockage: it’s exposure to infections like Chlamydia and Gonorrhea that cause this leading to tubal factor infertility . It’s important to note that the return to fertility is immediate with family planning methods like the IUCD and the combine oral daily pill unlike the notion in the public domain that return to fertility may be affected. The depoprovera injection may have a longer return to fertility but this can be managed . See your gyanecologist for detailed F.P talk or watch my prior you-tube videos for more details . 

So we have a long way to go to remind our youths about abstinence and to demystify myths about F.P amongst young unmarried women : until we do that we will continue to encounter the scourge of unwanted pregnancies and complicated parenting called Baby-Mama/Baby-Daddy issue because our young ones are engaging in sexual relations at very young ages before they can be mature enough to marry/settle.  Pregnancy is just one of the side effects as I had discussed earlier . 

This remains a very controversial topic but an important one nonetheless. Let’s keep the talk going . ABSTAIN or RUBBER-UP or TAKE UP F.P. Young girls , how much sacrifice are we willing to make to please men who will only be in our lives very temporarily or for a season ? 

P:S* - Jasmine* and Rhoda* are hypothetical cases bases on so many true scenarios I encounter , this is not a true story of particular individuals