Why couples should undergo medical screening before "I do"

Beatrice Mwange has endured years of silent pain and emotional turmoil over her inability to conceive. The 32-year-old woman from Mbale in Vihiga County has gradually withdrawn from friends, church activities and family gatherings.

What was once a source of joy and community has become a painful reminder of her situation, as conversations inevitably turn to children — a subject that now fills her with deep distress and anxiety.

Five years after marrying the love of her life, Litwa, she is yet to conceive. The pain is compounded by the fact that medical tests have confirmed she has no fertility issues; her reproductive system is healthy and functioning normally.

Yet her repeated, heartfelt attempts to persuade her husband to undergo similar tests have been met with hostility and defensiveness.

“I am often labelled a barren woman, yet doctors have told me my fertility is fine. I have no answers for why we are not getting a child,” Mwange says. “Whenever I ask my husband to accompany me to hospital for fertility tests, he becomes hostile. I do not know what else to do.” 

Like many newlyweds across Kenya, Mwange entered marriage filled with hope and excitement, dreaming of building a happy family filled with the laughter of children. Instead, infertility has become a persistent source of conflict, tension and resentment in her marriage. She is now seriously contemplating leaving the union altogether.

“I cannot continue carrying the blame alone. I would rather be single than live with accusations every day,” she says.

Avoidable tragedies

Mwange’s experience is far from isolated. It is shared by countless women across Kenya who face stigma, shame and unfair blame for infertility, often without knowing the real underlying cause. At the same time, many couples unknowingly pass on preventable genetic and medical conditions to their children simply because they did not undergo comprehensive medical screening before marriage or before starting a family.

These avoidable tragedies highlight the urgent need for greater awareness and uptake of premarital and preconception health checks.

In Nyagitha Village in Homa Bay, 35-year-old Judith Akinyi lives with a different but equally devastating reality. She is raising three children, all living with sickle cell disease. Her eldest son bears visible deformities in his limbs, while frequent painful crises — often triggered by even minor changes in weather — have repeatedly disrupted his education and robbed him of a normal childhood.

The family’s financial resources are stretched thin as they struggle to provide consistent, quality healthcare, including regular hospital visits, pain management and monitoring for complications. The experience has left Akinyi exhausted, fearful and emotionally drained.

“I have always wanted a daughter, but the thought of raising another child with sickle cell disease scares me to death,” she confesses.

The couple still does not know their own sickle cell status. Akinyi has repeatedly urged her husband to undergo testing so they can make informed decisions about expanding their family, but he has remained reluctant. “It is painful watching all your children suffer from the same disease. They spend day and night in pain. No parent should have to go through this,” she says.

Sickle cell disease is an inherited genetic disorder that affects haemoglobin, the protein in red blood cells responsible for carrying oxygen. The disease causes red blood cells to become rigid and sickle-shaped, leading to painful blockages in blood vessels, organ damage, severe anaemia and life-threatening complications.

When both parents carry the sickle cell trait, each child has a 25 per cent ,chance of being born with the full disease, a 50 per cent chance of carrying the trait, and a 25 per cent chance of being completely unaffected.

Health experts emphasise that such heartbreaking outcomes can often be avoided or effectively managed through timely premarital and preconception medical screening.

Dr Fredrick Kairithia, a gynaecologist and obstetrician, strongly advocates for both routine and specialised tests before couples tie the knot. Routine screenings include tests for major infections such as HIV, Hepatitis B and C, syphilis and Tuberculosis (TB). Many of these infections can worsen dramatically during pregnancy or be transmitted from mother to child, leading to severe complications.

“TB, in particular, is a very strenuous disease during pregnancy,” Dr Kairithia explains. “It is associated with high levels of maternal mortality, stillbirths, anaemia, and complications such as liver or kidney problems.”

Specialised tests are equally critical. These include screening for sickle cell disease, diabetes, haemophilia and blood group compatibility — particularly the Rhesus factor.

Dr Kireki Omanwo, a consultant obstetrician, gynaecologist, fertility specialist and President of the Kenya Obstetric and Gynaecological Society, highlights the dangers of Rhesus incompatibility. If a woman is Rhesus-negative and her partner is Rhesus-positive, there is a significant risk that her immune system may attack the baby’s blood cells in subsequent pregnancies, potentially leading to miscarriage, preterm birth, severe anaemia in the newborn or even fetal death.

Uncontrolled diabetes before or during pregnancy presents another serious threat. It significantly raises the risk of miscarriage, stillbirths and severe congenital abnormalities, including neural tube defects (such as babies born without parts of the brain) and complex heart conditions that are often incompatible with life.

“Some of these babies may survive in the womb but die shortly after birth,” Dr Kairithia notes.

Fertility assessment is also essential for couples planning to have children. Many couples assume conception will happen naturally and easily after marriage, only to face years of disappointment and intense pressure from family members and society.

Dr Kireki emphasises that medical screening helps couples understand their reproductive health, identify potential challenges early, and detect inherited conditions that could affect future children.

“It allows them to make truly informed decisions and prepare for any eventualities,” he says.

Fertility investigations

For women, key fertility investigations include Hysterosalpingography (HSG), an X-ray procedure that examines the uterus and fallopian tubes for blockages, adhesions or structural problems. Hormonal blood tests are also vital: Prolactin levels (elevated levels can prevent ovulation), Thyroid Stimulating Hormone (TSH) to ensure proper thyroid function, and Anti-Mullerian Hormone (AMH) which gives a reliable estimate of a woman’s remaining egg reserve.

A transvaginal ultrasound further allows doctors to assess the uterus, ovaries and developing follicles.

For men, the cornerstone test is semen analysis, conducted after a few days of abstinence. This examines sperm count, motility (movement), morphology (shape), volume and signs of infection. Problems in any of these areas can significantly reduce the chances of natural conception.

Early screening also helps identify and treat anaemia, a major contributor to postpartum haemorrhage — still the leading cause of maternal deaths in Kenya.

Despite the well-documented benefits, the uptake of premarital screening in the country remains alarmingly low. Experts estimate that fewer than one in ten couples bother to undergo these important tests. Importantly, screening is not only about enabling conception. In cases where a serious medical condition poses life-threatening risks, couples can make responsible choices. Alternatives encouraged by experts and supported by law include adoption, surrogacy, or assisted reproductive technologies such as IVF with sperm or egg donation.

mkahenda@standardmedia.co.ke