At 63, Joy Mirembe’s lifelong yearning for motherhood was fulfilled this month with the birth of twin girls. A resident of Rwentobo, Ntungamo District, Mirembe’s hands bore the marks of decades spent nurturing others -relatives’ children, orphans from the village, even strangers’ offspring who found solace in her home.
She had educated them through primary schools, secondary institutions, and universities, watching them blossom into married adults with businesses and families of their own. Despite her boundless generosity, the one dream that remained out of reach was bearing children of her own.
‘It has been a long period of time trying to have children, but I failed to conceive,’ Mirembe narrates to the Monitor.
‘I visited many hospitals, but they couldn’t really get the real problem, which was making me not conceive and have children,’ she adds.
Mirembe says things turned right side up for her last year when a friend connected her to the fertility specialist in a Kampala-based facility, Sali International Hospital.
She was managed jointly by medical workers in Sali International Hospital in Bukoto and Mukyala Mabirizi Hospital in Makindye until she gave birth.
Dr Hassan Twineamatsiko, a doctor at the Kampala-based Mukyala Mabirizi Hospital, who also managed her, says he referred her to Sali International Hospital because the Makindye-based facility doesn’t yet provide fertility services.
‘Several tests were performed: ultrasound scans and hormonal essays, and they came out very fine. No fibroids, no other abnormalities,’ he explains.
Intervention Dr Twineamatsiko adds that after the tests, Mirembe was started on hormonal treatment to reactivate her reproductive system since she has already reached menopause.
‘The mother was started on hormonal therapy. And that was a treatment scheduled to happen for a full month for her to regain her menses,’ he explains.
‘She started on the treatment, and she saw her menses back. She went back to the hospital. Of course, they had planned everything to do In Vitro Fertilisation (IVF) procedures,’ he adds.
IVF is a specialised medical procedure where the egg retrieved from the mother is fertilised with a man’s sperm in the laboratory and the embryo (fertilised egg) is transferred back to grow in the uterus.
The technology was first successfully applied in 1978 in England.
‘So, the egg and the sperm preparations were done, and then she had embryo transfer. And that was in early February,’ Dr Twineamatsiko says.
‘She was given a return date. Coming back next time, when they did a scan, they found two embryos, and from that time she started antenatal. Fortunately, she had a full antenatal.’
Dr Joseph Kafuuma, a fertility specialist at Women’s Hospital International and Fertility Centre in Bukoto, Kampala, says the chance of producing preterm babies is higher with IVF pregnancies. He says this is because multiple pregnancies involve multiples, ‘twins/triplets/quadruplets/quintuplets, among others. These are usually associated with premature delivery.’
According to a 2018 report by Sarah Murray from the University of Edinburgh, pre-term birth in multiple pregnancies is likely to be ‘multifactorial, different from singletons, and remains largely unknown.’
But Mirembe did not experience this. C-section birth Dr Twineamatsiko says Mirembe initially received her antenatal care at Sali International Hospital, and then later during her pregnancy and during birth she was managed at the Makindye-based hospital.
‘She was going to hit the nine months of pregnancy between September 26 and October 3. But before this, we had to start those injections we call corticosteroids, which we always give in case this baby is born premature, they are able to breathe well, and the risk of death is low,’ he explains.
‘The drug improves fetal lung development and reduces inflammation of the lungs. We also had to repeat a number of tests,” he adds.
The medical scientists also did tests to assess the performance of the heart, liver and kidneys.
‘We had to do an electrocardiogram (ECG) and echocardiogram (ECHO) to look at the performance of the heart because, as one ages, we expect these organs to weaken,’ Dr Twineamatsiko recounts.
‘We also did liver and kidney function tests on the mother. We also did other tests. ECHO came out with some significant issues, and we worked with cardiologists on this.’
The team of medical workers and experts scheduled Mirembe for elective C-section operation on October 4 at the Makindye-based facility.
Dr Twineamatsiko says they had to get a good team: an obstetrician and a paediatrician, an anaesthetist, a midwife, and a running nurse.
‘So it was a team of around six members in the theatre, so that we could get the best out of them. We went in at around 6am, and this was completed at 8am, and we came out with our two baby girls, twins, and the mother was fine,’ he shares.
The first one had a birth weight of two kilogrammes, and the second one was 2.6 kilogrammes. Surprisingly, the mother is also expressing breast milk despite her age,’ he adds.
Reward from God Mirembe, full of excitement and reflecting on her journey of how she raised other people’s children, says giving birth to the twins is a reward from God.
‘I think that’s why, even up to this age I am in, the Lord has been able to bless me with these children. It was not by my own making, but it has been really God’s blessing,’ she says.
She adds that the total cost of the IVF procedure and care until the fourth month of pregnancy was Shs30 million.
‘Then, for antenatal care, for the drugs, I used to pay for them separately. I got pregnant at the age of 63 years after trying several times and I failed to get pregnant,’ she says.