Life is still meaningful even without having children 

It is a default expectation to want children after the wedding, except if you are an anti-natalist; people who choose to remain childless even after marriage. This view was popularised by Belgian writer, Theophile de Giraud in his book The Impertinence of Procreation.  He argues that ecological reasons explain why people choose not to have children. 

When some couples fail to have children involuntarily, probably due to infertility, their marriages are bruised and some end up separating, divorcing or seeking another partner.  Others stick it out for the covenant they made before God. The effects of infertility on a marriage include anxiety, stigma, depression, a feeling of exclusion and anger. 

The WHO defines infertility as a “disease of the male or female reproductive system defined by the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse.” Estimates are that between 48 million couples and 186 million individuals live with infertility globally. 

There are no conclusive studies that have been done to establish the exact level of infertility among Ugandans but those in infertility treatment put it at around 15 percent. Infertility can be primary or secondary; primary for those who have never conceived and secondary for those who have conceived previously at least once but failed to conceive subsequently. 

“Eighty percent of the couples will achieve conception if they so desire, within one year of having regular intercourse with adequate frequency (4-5 times a week). Another 10 per cent will achieve the objective by the end of the second year. As such 10 percent will remain infertile by the end of second year”, according to Dr  D.C Dutta in Textbook of Gynecology 6th ed. 2013. 

Causes of infertility
According to Dr Emmanuel Bahizi, a gynaecologist at Kisubi Hospital, the fertility potential in both male and female affects conception. The female is responsible for between 40-55 percent while the male is responsible for between 30-40 percent. He says the remaining 10 percent is unexplainable.  
In women, causes of  infertility inlcude ovarian factors, tubal and peritoneal factors such as previous tubal surgery, or sterilisation, where the tubes become damaged or blocked.

Uterine factors such as fibroid uterus, congenital malformation of uterus, cervical factors, vaginal factors, age, medical history, repeated abortions, consumption of toxic substances, infrequent intercourse are some of the conditions that cause infertility.
“Couples should both visit a doctor and their reproductive histories investigated regarding ovulation, semen and the fallopian tubes,” Dr Bahizi advies. 

Medical treatment
Assisted Reproductive Technologies (ART) such as In vitro fertilisation (IVF), are available in about eight centres in Uganda including Mulago Hospital, Neogenesis Fertility Centre on Bukoto Street, Paragon Hospital in Bugolobi, Life Sure Fertility Centre on Mawanda Road, Bethany Women’s and Family Hospital in Luzira and Women Hospital International in Bukoto. The average cost is between Shs18 to Shs25 million. 

Medical operations
For women with big fibroids that distort the uterus, Dr Bahizi says, a common operation known as myomectomy can be done to remove fibroids. 
“For those who have blocked tubes, hydrotubation or a modern procedure called laparoscopic tuboplasty can be done to wash the tubes. Conception is possible after these procedures,” he says.
 
Ovarian drilling can avert ovarian cysts and support women to concieve. Those with vaginal malformations and men with structural malformations can get them removed through surgery and their fertility can be restored. 

Child adoption
Many children are born and abandoned by their biological parents. Adoption is one way to extend a helping hand to children who would otherwise have no future. You can be a parent even if it is not biological.  

You are not defined by children
There is life with or without children. You can have a plan B of how you want to live through the child-free life. Do you want to travel, write a blog about it, or help others cope in a similar situation? 
Childlessness does not mean life has no meaning. Besides, you are not defined by children. You can be a huge blessing to others. Live your life with all fecundity. Do the things you love doing.      

Prayer
 If the reproductive system has failed and doctors have failed, divine intervention becomes necessary. Paul Masette, my good friends and his wife whom I was privileged to be the best man at their wedding sixteen years ago, had to wait it for 11 long years until God gave them a child. 
Pastor Catherine Bagyenda, another friend, spent many years without children but has now got two sets of twins. She shares her journey in her book, Pieces of Me: Finding Identity in God’s Amazing Grace.