# The_Womb_Terminator

# Based_On_A_True_Life_Story
Infertility, they say, is a three-arm demon. It destroys a couple
inside out, pulls a gun at the marriage union, and dampens the
future. It should never be allowed into any home.

They had been married for three years now. They had
everything life could offer; well, almost everything. The man
was a 34-year-old successful entrepreneur with a tertiary level
of education but with chains of businesses across the world;
the woman was a 26-year-old former model, a university
graduate, and a dazzling sight to behold.

As a couple, they represented the perfect union of beauty and
wealth in its majesty and splendour. It was resplendent in
everything they did.

One problem, however, lingered: they had no child. To them, it
was a constant reminder of how unfulfilled and incomplete
they were. It was a perennial thorn in their flesh; a wild vicious
ghost that never ceased to haunt them.
As devout Pentecostals, they'd initially chosen to stick to their
religious beliefs rather than seek medical help.

At first it made sense. Mr and Mrs Iyekekpolor were
determined to upset the odds and prove their doubters of their
faith wrong. But something was fundamentally faulty. So the
years had come and gone: One. Two. And then three.

Yet the problem persisted. No conception. No child.
After a series of heated discussions with the members of the
extended family who were obviously at variance with their
strict religious approach, Mr and Mrs Iyekekpolor had
presented at the hospital.

University of Benin Teaching Hospital
Friday, 12.05.17
11.25am
The infertility clinic had been running smoothly as expected.
There were rows of couples seated at the waiting lounge,
eager to see one of the most prominent infertility physicians
of his generation.

Towards the extreme row of seats, Mr and Mrs Iyekekpolor sat
and waited patiently for their turn. Today was officially their
second time of coming to this infertility clinic. The first time
they visited, a week ago, Dr Paschal Erhabor had thoroughly
taken their history as it related to fertility. He'd then subjected
them to a barrage of imaging and laboratory investigations,
including semen analysis, for which sample was taken just
three days ago. Therefore, their visit today was more about
knowing the outcome of the laboratory and ultrasound tests
and to plan the way forward.

Nearly an hour later, their turn arrived and the beautiful couple
was ushered into Dr Erhabor's consulting room.

As was customary with medical students, I stood up to greet
them, and they acknowledged my greetings with a smile and a
wave of the hand.

The couple struck up a beautiful combination. The man was
dark and dressed in tight-fitting blue jean and white Louis
Vuitton T-shirt; while the woman, tall and fair with nice legs,
wore a beautiful blue designer gown with a Dolci & Gabbana
hand bag. Their cologne was all over the consulting room the
moment they stepped in. One didn't need to take another look
at them to imagine just how affluent they were.

After a brief exchange of pleasantries. Dr Erhabor produced
their case note which contained the results of the tests they'd
carried out a few days earlier.

I studied the face of the consultant keenly as he perused
through the result. I could tell that the couple did the same,
too.

"What exactly is wrong with us, Doctor?" Mr Iyekekpolor asked
after a few seconds. He was apparently eager to get the
fertility problem over with.

Dr Erhabor seemed to have barely heard him. "Nothing much I
can see so far," he said politely, his eyes still on the results.

Mrs Iyekekpolor shook her head as if to say: 'I knew it.
Hospitals are always a waste of time.'

Suddenly, Dr Erhabor raised his face to look at the couple.
Immediately, his eyes twinkled in a way I had never seen
before. He turned to face the woman. "Madam, last week you
said you often saw your menses regularly, right?"

"Yes," Mrs Iyekekpolor replied matter-of-factly. "The only thing
I complained of was pain while making love to my husband."

Dr Erhabor nodded subliminally, then studied the results again.
Slowly, he raised his eyes and then rivetted them on the
woman. "Madam, I need you to be very honest with me.
Please."

"I don't understand what you mean by that, Doctor," Mrs
Iyekekpolor spat out irritably. "What kind of a question is that?"

"Hey! Calm down, honey," Mr Iyekekpolor quickly said to his
wife, rubbing her palm as he did. He then turned to face the
doctor. "Doctor, is there anything wrong?"

I was beginning to wonder where Dr Erhabor was headed with
that question too. Why on earth would a woman lie to her
doctor about something as flimsy as her menstruation cycle
when she had come with her husband for infertility?

Dr Erhabor maintained his cool. It was clear that something
wasn't right. I could feel it. But wait, what was he trying to
establish with that off-the-cuff question about menstruation?
Was the woman having secondary amenorrhoea (that is, not
menstruating again after having menstruated before) and
covering it up? If so why would she do that? A thousand
thoughts were running through my head.

Dr Erhabor sat up in his seat and trained his eyes in the
woman again. "Madam, for the last time, I need you to be very
honest with me. Have you ever seen your menstruation
before?"
"I beg your pardon, Doctor!" Mrs Iyekekpolor suddenly shouted,
springing up from her seat. "What's the meaning of that?"

"Calm down, honey!" Mr Iyekekpolor intervened again. "Don't
create a scene here!"

But it was too late. Mrs Iyekekpolor's sudden outburst seemed
to have created an unnecessary attention from the outside as
a matron poked her head through the door to ensure that
everything was alright.

Then it occurred to me. The consultant's question had been
rephrased this time, and it made me shudder even more.
'Have you ever seen your menstruation before?' Was Dr
Erhabor thinking of primary amenorrhoea (that is, the woman
never menstruated at all up until 16 years of age)? How
possible was that? I took another glance at Mrs Iyekekpolor
and her robust boobs. Everything was in perfect order.

It wasn't possible!

Patients with primary amenorrhoea never developed breasts
(thelarche) nor achieved first menstruation (menarche)
because the hormone, oestrogen, needed for these was
lacking or not sufficient. But Mrs Iyekekpolor was 26 years old
with amazing boobs and fine hips. So what the hell was Dr
Erhabor thinking?

Dr Erhabor remained calm. Almost immediately, he peeled off
the ultrasound scan of the woman, turned it on its head, and
presented it to the couple. "Mr and Mrs Iyekekpolor," Dr
Erhabor said quietly, his eyes now trained on the husband, "I'm
sorry to tell you that your wife's ultrasound scan reveals that
she has no womb."

My jaws dropped. Wait, say that again!

Dr Erhabor waited patiently to let that sink in.

"I don't understand you, Doctor," Mr Iyekekpolor said, his voice
now a bit raspy. "Is this a joke or something?"

Mrs Iyekekpolor wanted to stand and protest but her husband
yanked her back to seat. "Sit down now!"

Dr Erhabor nodded twice. "It's not a joke, sir," he said,
addressing the man. "Your wife here has never had a womb
since she was born and so couldn't have menstruated at all. It
was why I asked her the question."

My heart skipped a beat. Instantly, I shot Mrs Iyekekpolor a
glance and she suddenly appeared defeated. She struggled to
hold back a tear.

"How possible is that, sir?" I instinctively interjected. I just
couldn't hold it back any longer.

Dr Erhabor turned to peer at me closely. "Caséy," he said,
"have you ever heard of Mayer-Rokitansky-Küster-Hauser
Syndrome?"

"Mayer-what?" I and Mr Iyekekpolor echoed the same time. I
was already bamboozled. Osikwa na o gini?

"Mayer-Rokitansky-Küster-Hauser Syndrome," Dr Erhabor
repeated, "or simply Rokitansky Syndrome, for short?"

I shook my head know. God in heaven knew I would not even
be able to spell that, not to talk of understanding what it
meant.

Dr Erhabor started to explain in fine details. Mayer-Rokitansky-
Küster-Hauser Syndrome, abbreviated as MRKH, was a
congenital disorder in females which arose due to failure of
the Mullerian ducts to form. Mullerian (or Paramesonephric)
ducts are responsible for the formation of the Fallopian tubes,
uterus (womb) and the upper two-third of the vagina in a
female embryo from the fifth week of pregnancy to the sixth
week. This anomaly happens in one in every 5000 females and
is a cause of infertility because the uterus is not formed at all.
It's also referred to as Mullerian Agenesis and there could be
two types: Type I results in a blind-ending vagina (whereby the
vagina ends like a purse with no continuation to any womb)
and Type II is also associated with kidney, skeletal, hearing
and heart problems.

In such people, sex is possible because the lower third of the
vagina is formed from the urogenital sinus, a different
structure, but then menstruation is impossible since there is
no womb at all.

In this anomaly, the development of breasts is possible
because the oestrogen needed for breast and hip development
comes from the ovaries which develop from the gonadal ridge,
a totally different structure from the Mullerian ducts.

Therefore, because it even affects the upper two-third of the
vagina, the patients would have painful sex (dyspareunia) as
the vagina, which should on the average be 9-10cm deep in
normal women, is not deep enough nor well formed. The
patients could also come down with cyclical pain, as if they
are having dysmenorrhoea (painful menses), but they will
never see any menstrual blood.

Immediately, I understood the import of this situation. Mrs
Iyekekpolor had lied about her menstruation. She had never
menstruated since she was born and she probably never
checked herself up in a hospital. More grieviously, it now
seemed she never told her spouse about her lack of
menstruation.

The marriage already seemed threatened.

Almost immediately, Mrs Iyekekpolor dropped to both knees
and broke into tears. "I'm sorry, Doctor. Please help me.
Please!"

I was spell-bound.

Mr Iyekekpolor couldn't believe his ears. He bowed his head as
the gravity of the news hit home. He was going to be
fatherless!

Dr Erhabor, having sensed their hopelessness at their fertility
potential, then resorted to counseling them. According to him,
pregnancy was impossible for Mrs Iyekekpolor; but to have
children, they had two options: the first would be to harvest
her eggs, do an invitro fertilization using her husband's
spermatozoa, and then injecting the zygote into a surrogate
mother - since Mrs Iyekekpolor had no womb. The second
option would be to adopt children. The goals of management
would include: to provide the woman with an unscarred vagina
by using dilators to dilate it (mostly by the McIndoe technique)
and ensure adequate sex; and to prevent endometriosis
(functional endometrial storms elsewhere in the pelvic cavity).

My goodness! What the hell was that?

Mayer-Rokitansky-Küster-Hauser Syndrome? It was just too
much for me to take in at that time.

The artificial insemination was going to be expensive, no
doubt, but looking at Mr Iyekekpolor as he bowed his head and
his wife pleading and tugging at him, I could feel that the cost
of the procedure wasn't a problem for him. He probably felt
deceived - and maybe rightly so.

Almost immediately, Mr Iyekekpolor stood up and stormed out
of the consulting room in a moment of unmitigated vexation.
He felt betrayed, disappointed, heartbroken. All the attempts
of Dr Erhabor to stop him failed. His crying wife trailed behind
him, pleading and crying as she followed suit.

All hell had been let loose.

As the couple left, I stood there, perplexed. What kind of sick
syndrome was this one again? "This Mayer-Roki-whatever
Syndrome is a total fertility destroyer," I said, thinking aloud.

"No, it's not exactly that," the consultant corrected me. "It is
not the most terrible. What if it also involved the ovaries?
Would there have been any eggs to harvest for artificial
insemination?"

My mouth gaped. Dr Erhabor was right. I shook my head no.

"Now that's my point," Dr Erhabor asked. "I think it's more of a
womb terminator, as it terminates the formation of the uterus
during the embryonic life."

He then peered at me closely again. He could feel I was
saddened by the entire saga. "Caséy, Medicine is filled with
the good, the mad and the bizarre," he said, patting my
shoulders. "And before I forget, it's Mayer-Rokitansky-Küster-
Hauser Syndrome," he corrected again, "not Mayer-Roki-what
ever."

I forced a smile. "Mayer-Roki-whatever," I muttered to myself
again, "your father there!"

# ChukwuGozieUnuNiile
ORIGINALLY POSTED: Monday, 15.05.17
DISCLAIMER
This may be a true-life story, but the names, characters,
places, and incidents either are the product of the author's
imaginations or are used fictitiously. Any resemblance to
actual persons, living or dead, events, or locales is entirely
coincidental.