Quraish Kalyango lives with a spinal cord injury (SCI). Since he survived an accident in December 2013, the 32-year-old has struggled to have children through sperm injection, in vain.
Intracytoplasmic sperm injection (ICSI) is a specialised form of in vitro fertilisation (IVF). During the procedure, a single sperm is injected directly into an egg. The method is used to treat severe male infertility or when standard IVF has failed.
SCI is a devastating event in a man’s life. In most cases, although the victims continue to have normal sperm production, they cannot ejaculate naturally and require medical assistance to retrieve sperm.
Kalyango, a resident of Tula Village, Kawempe Division, Kampala City, has never succeeded in having children through sperm injection due to the high costs involved.
In government health facilities, a sperm injection procedure costs Shs10m, and more than Shs25m in private facilities.
‘In 2020, I got capital to start a business of selling shoes. I planned to save the profits for a sperm injection. In 2023, I visited Mulago National Referral Hospital twice, thinking that the medical team would sympathise with me, but the amount is fixed and cannot be reduced,’ Kalyango narrates.
Before the sperm is retrieved, one has to undergo extensive examinations to determine if they can still produce sperm. Kalyango was asked to pay Shs500,000 for the medical examinations.
‘After the checkup, the doctor said I was able to have children. However, I did not have the Shs10m to continue with the procedure. I only had Shs1m. My business can only cater for my rent and my daughter’s school fees,’ he says.
Kalyango’s wife abandoned him after the accident. His desire to have more children has pushed him into different relationships in the hope that when he gets funds, the women go through IVF treatment.
‘However, whenever I fail to raise the money, those women leave me. Unfortunately, during the relationships, I spent a lot of money on them to keep them interested in me. They needed active men. When you are disabled, women disrespect you,’ he laments.
With his daughter in Primary Seven, Kalyango wishes to have two more children.
A devastating fate
On December 19, 2023, Kalyango, then a driver, travelled with his boss to Lyantonde District. During the night, on their way back, his boss told him to rest and took over the wheel.
‘I slept off. When I woke up, it was 3pm, and I was lying on the floor at a hospital in Kyotera District. I heard someone calling my family members using my mobile phone. All the beds were occupied, but when my relatives came in, a doctor removed a dead body from a bed and I occupied it,’ Kalyango recalls.
He was paralysed from the waist down. In early 2014, he was transferred to Mulago Hospital for better treatment, where he remained for more than a year.
‘The medical bills were too high. The medication alone would cost between Shs250,000 and Shs500,000. My property was sold so that I could have another chance at life. When I was discharged, I found that my wife was living with another man in my home,’ he says.
In disappointment, Kalyango returned to his parents’ home in Mutukula Town. However, there was no one to care for him, as his mother was a businesswoman and often away from home.
‘I developed sores on my back and buttocks from lying in the same position for days. In November 2015, my wife called me to pick items from our home since she had moved on. She abandoned our two-year-old child in the house. She said she could not live with someone she could not have sex with,’ he says.
Like Kalyango, Andrew Mutebi, a resident of Njeru Municipality, Buikwe District, also suffered a SCI. The high cost of sperm injections has also blurred his hopes of having a child.
‘At the time I had an accident in 2015, I had not yet fathered a child. I had a girlfriend and we were planning to get married in 2016. During the accident, my spinal cord was fractured and I underwent several operations at Mulago Hospital, each costing Shs800,000,’ he narrates.
When the doctors informed his girlfriend that Mutebi would not have children sexual intercourse, she abandoned him. She eventually got married to another man in 2019.
‘The cost of a sperm injection has affected me mentally and psychologically. Sometimes, when I look at other men’s children, I cry,’ Mutebi says, tears flowing down his cheeks.
A study, Quality of life of patients with traumatic spinal cord injuries: a cross-sectional study at a tertiary hospital in Uganda, published in the African Health Sciences Journal in 2023, found that the overall self-reported quality of life among patients with traumatic spinal cord injury was generally poor.
‘Most participants (58.3 percent) had incomplete spinal cord injuries, and 84.5 percent had complications. The presence of complications and injury severity significantly affected quality of life,’ the study reads in part.
Traumatic SCIs are devastating and disruptive to an individual’s life. The study found that with the increasing long-term survival after SCI, health-related quality of life has become crucial in the rehabilitation process.
‘The self-reported quality of life in the vast majority of participants was rated as poor because a majority had no functional independence and already had complications. Uganda, as a country, does not have a single specialised institution or program dedicated to the rehabilitation and reintegration of SCI patients back in the community,’ the report reads.
The study further found that most patients with SCI are discharged from the hospital without any comprehensive follow-up or rehabilitation program. Oftentimes, they are referred to peripheral health facilities in their home districts for follow-up and rehabilitation.
However, most of these facilities are poorly equipped, do not have physiotherapists or occupational therapists, and community support is inadequate. Further, the available physical and occupational therapists have limited experience in managing these patients, and this predisposes them to complications and frequent hospitalisation.
‘All factors in this study were significantly associated with psychological well-being and social relationships. Furthermore, married participants reported a better quality of life than the single or separated individuals. They benefit physically and emotionally from their spouses and easily adapt to their new life situation,’ the report reads.
Spousal support also offers the much-needed social support and facilitates societal integration. On the other hand, caring for a patient living with SCI places a heavy economic, physical, and emotional burden on the primary caregivers.
A call to action
Myleen Kyomuhendo, a para-athlete and chairperson of the Spinal Injuries Association Uganda (SIAU), decries the limiting costs of artificial insemination.
‘Of the 372 men with SCIs, only five can afford sperm injections. These injuries torment them mentally and break their marriages because they cannot have sex normally,’ she says.
Kyomuhendo calls on the government to subsidise IVF services to enable these men to have children.
Sperm injections are more expensive than the usual IVF procedure because they involve injecting the sperm directly into a woman’s egg. Failure to conceive through ICSI is generally not due to the procedure but rather to challenges in sperm acquisition and sperm quality.
A 2022 study, Sexuality, intimacy, and reproductive health after spinal cord injury, found that SCI is a life-altering event often accompanied by a host of anxiety-provoking questions and concerns in the minds of affected individuals.
Questions regarding the ability to resume sexual activity, partner’s satisfaction, as well as the ability to have biological children are just a few of the unknowns facing patients following the devastating reality that is SCI.
‘Following SCI, men face numerous complications, including erectile dysfunction and infertility. It is estimated that 90 percent of men with SCI cannot father a child naturally. However, women with SCI can conceive and deliver children with nearly the same success rate as the general population,’ the report reads in part.
When surveyed, patients affected by SCI ranked sexual and reproductive functions as major factors affecting their quality of life.
‘To date, multiple safe and effective treatments are available to address many of the sexual and reproductive obstacles posed by SCI. Safe and effective methods of sperm retrieval maximise the chances of biological fatherhood in men with SCI,’ the report reads.
The availability of, the cost, and applying multiple pharmacological treatment modalities for sexual dysfunction strengthens relationships.