5 ways for AS + AS couples to get married and still break the Sickle Cell Cycle

In recent times, there has been widespread awareness about the Sickle Cell Disease and ways to prevent more babies being born with the Sickle Cell Disease.

On the 19th of June 2018, the 10^th World Sickle Cell Day was celebrated.

The most common of these pieces of advice is for carriers of the Sickle gene (AS, SS, SC) not to marry fellow carriers of the Sickle gene. Thus, people with AS, SS and SC genotype are advised to marry only people who have the AA genotype to avoid the possibility of having SS babies.

This is good advice because the financial, emotional, psychological and physical stress that comes with raising a child with Sickle Cell Disease are unquantifiable. Even more so because the child shares in these burdens.

Many a love affair have been doomed to ruin because both lovers are AS; they have to part ways for the sake of their future children.

However, there are options for AS + AS couples who are determined to be married at all costs. These options may not be popular and they are sometimes expensive, but they are options nonetheless.

Here are 5 ways an AS + AS couple can get married and still break the Sickle Cycle.

1. Natural Conception:

When the couple conceive naturally, they wait till the pregnancy is about 10 weeks old. Then they take a test to check the genotype of the embryo. This is done by the Chorionic Villous Sampling (from 10 weeks) or Amniocentesis (from 13 weeks). A needle is inserted into the pregnant abdomen to collect the cells needed. The cells are cultured ad a genetic testing is carried out.

If the embryo has the SS genotype, the pregnancy is terminated. If the embryo des not have the SS genotype, it is left to develop to full term.

The major downside to this is that the procedure is expensive and not everyone can afford it. The test alone costs about N250,000 while a medical abortion costs between N10,000 to N20,000 and a surgical abortion costs between N25,000 to N50,000.

Other downsides include the risk of miscarriage. 0.5 to 1 % of women who undergo this test end up miscarrying the pregnancy.

There is also the anxiety of waiting for 10 weeks at least to find out the embryo’s genotype and another one week to get the result of the test. The couple also has to endure the emotional trauma of going through an abortion. It is also quite possible that the woman changes her mind about having an abortion and then she goes ahead to give birth to an SS baby.

2. Pre-Implantation Genetic Diagnosis (PGD):

Pre-implantation Genetic Diagnosis works like In Vitro Fertilization (IVF). Unlike with natural conception, this doesn’t involve termination of pregnancy. The couple goes through an IVF cycle; the sperm and egg are fertilized in a petri dish and allowed to grow, then after three to four days, a biopsy of some cells is carried out. Only non-SS babies are then transplanted into the mother. SS embryos are destroyed.

Most fertility centers in Nigeria do not have the ability to do the biopsy and so the samples are sent abroad for the test. PGD has a 99.99% success rate.

The downside to this is the cost. It costs about 4 million Naira.

3. In Vitro Fertilization (IVF):

In the past few years, assisted fertility has gained ground in Nigeria and IVF is one of the first options couples who are finding it difficult to conceive naturally turn to. IVF can also help AS + AS couples have babies that aren’t SS.

This is done by using the sperm or egg of someone else who isn’t a Sickle carrier. So, the sperm of an AA man or the egg of an AA woman can be used to make the embryo before it is transplanted into the mother.

Although it costs less than the PGD, it still costs more than going through the process of natural conception.

IVF procedure costs about 700,000 to 2 million Naira in Nigeria, depending on the center the procedure is done at. If the couple uses an anonymous donor, the sperm or egg costs about N50,000 to N100,000 extra. However, it may cost them less or even nothing if the sperm or egg is donated by someone they know, depending on the couple’s agreement with the donor.

The major downside is the anxiety the couple has to deal with as there is the risk of the IVF procedure failing.

4. Adoption:

There are lots and lots of babies who need a home and an AS + AS couple can provide them one. If the couple are bent on marrying, then they may decide not to have their children biologically and opt for adoption instead.

The downside to this is the stigma the couple may face from family and friends as adoption is not yet seen as a valid, viable option by a lot of Nigerians.

5. A childless marriage:

While your Nigerian mother may threaten to fall down and die if you don’t provide her with grandchildren, there are some people who do not want to have children of their own. And if two of these people happen to be AS and they happen to get married with the agreement that they will have no children, then they will not continue the Sickle Cycle.

 

The above options may be frowned upon by a lot of people for moral, religious or cultural reasons, but at the end of the day, they are valid options nonetheless. If two AS people want to get married against popular opinion, it is important that they are provided with all the available options so they can make an informed decision. That way, they can make better choices instead of continuing the Sickle Cycle by putting their ‘faith’ to the test.