Doc, I have hit the bull’s eye this time and my wife is pregnant ...

A few years ago, on a Sunday evening, Marie persuaded me to watch a DVD with her at home. The title of the film was Buona Sera Mrs Campbell. If my fast fading memory serves me right, it was a hilarious wartime comedy about an Italian woman who drew financial support for her daughter from three American soldiers.

Apparently, after Mussolini surrendered to the Allies, the US Air Squadron established a camp in Italy. As often happened in wartime, three pilots from the camp established an amorous relationship with a voracious Italian lady who lived in a small town nearby. When the good lady found herself pregnant, she claimed support for her child from all three!

Of course, the bubble burst when, after the war, all the three pilots came to claim their long lost daughter! The film reminded me of what my professor of Medical Jurisprudence had drummed into our ears when we were undergraduate medical students.

“Maternity is a matter of fact while paternity is only a matter of presumption,” he told us often, a statement I have mentioned in this column before.

Even though DNA helps to confirm paternity now, I recently read shocking statistics in the popular press, which said that out of 20 children, one is not sired by the “official” father! I have a few cases in my surgical records to support this contention and prove the Italian lady and my professor right. I will relate one for the amusement of my readers.

This true story is about an infertile couple, who went to see the wife’s gynaecologist after three years of married life. Dr Eunice Kiano, as usual after finding nothing physically wrong with the wife, rang me. “Before I start elaborate investigations on Beatrice, I would like you to check Pascall,” she said after acquainting me with the details of the case.

I was surprised to see Pascall alone, considering that usually Dr Kiano sent the couple together to see me. Also, I had requested that they both come to see me.

The reason for this became obvious as the consultation progressed. “Any difficulty with sex?” I asked Pascall after putting him at ease.

“None.”

I asked him detailed questions of intimate nature and he convinced me that there was nothing wrong with his potency. My examination reinforced his assertion. His external genitalia were normal and both his testes were firm to feel and of normal size. “All we need is a semen analysis,” I said.

“That is one test I refuse to undergo,” replied Pascall firmly.

“Why?”

“Having been married for three years without my wife conceiving, I have naturally done a lot of reading on the subject. I have learnt that in 90 per cent of these cases, the cause lies with the woman. Secondly, I read that a man usually discharges four CC of semen at every ejaculation and each CC contains 100 million sperms.”

Looking smugly at me, he continued: “I also know that it only needs one solitary sperm to hit the egg to result in pregnancy.”

I realised that I had to be extra careful of what I said. “Your first statistics is widely off the mark,” I replied. “In recent studies, the ratio is only slightly higher in women. As for the 400 million in each ejaculation, one has to consider how many sperms are healthy and mobile and how efficient they are in reaching the egg and fertilising it. Also, nature must have a good reason for such profusion when, as you say, one would have been enough.”

“I didn’t bring my wife with me because that is the constant bone of contention between the two of us,” Pascall now explained the absence of his wife, and went on: “I have always told her that if I have normal potency and ejaculation, something she does not dispute, I can’t see how anything can be wrong with me. Not to hurt her feelings, I haven’t told her what my mother and sisters, in fact my whole kabila, advise me to do. They simply want me to pick up another wife from among the many in my clan.”

“Let me just tell you that in men, fertility and potency are two separate faculties,” I explained. “You can be super potent and still be sterile.” Then, to drive my point home and add some humour into this sterile situation, I added: “I have seen men who behave like a bull in season and are still unable to produce a living creature!”

I could see that I was not making any impression on the man and he was going to be resistant to my medical arguments, a point confirmed by his reply.

“At the most, against my better judgement, I am prepared to take some pep pills,” he relented.

“I have ethical difficulties in prescribing pills to boost your sperm population when we don’t know the baseline count.” I thought that the man was only finding an alibi to take another wife and, considering Beatrice’s interest, who may not be “guilty”,  I added: “If you don’t mind, give me a little time to think and also consult my peers.”

“No problem,” Pascall said, and we parted amicably.

I consulted a couple of senior genito-urinary colleagues, who specialise in male genital and urinary problems, including male infertility, and their consensus was that there was no harm in trying the blind drug therapy for a few months. As an added precaution, I contacted Beatrice whose mobile number I obtained from Pascall’s file in my office and asked her to come and see me.

“Yes, he is fine in bed,” she summed up after I cajoled her into answering some embarrassing questions and told her about her husband’s refusal to undergo a vital test. “He has a mental block about having semen analysis,” she added and readily approved of what her husband had asked for. “He will be very hyper with your pep pills but I will put up with his excesses because I am also very keen to become a mother.”

As a matter of professional courtesy, I apprised Dr Kiano of my plan and she approved it. I called Pascall and gave him a prescription for the supposedly sperm enhancing pills. “If they don’t work in six months, I hope you will agree to a semen analysis,” I said when he came to collect the prescription.

DISBELIEF

Four months later, he rang me. “Doc,” he said triumphantly. “I was right because I have hit the bull’s eye this time. My wife has just undergone a pregnancy test and it is positive.”

“Congratulations,” I said after I got over my shock of disbelief. “Another case which reinforces our belief that, like the customer, the patient is always right.”

It was seven years later when Muthoni Were, my “learned friend”, visited me. She and I had done a few medico-legal cases together. With my expert opinion, her clients had managed to get higher compensation after road traffic accidents than what the insurance companies were initially prepared to pay. “This is not one of those drab cases we have been doing. This is absolutely up your street,” she said. As I looked at her agog, she added: “This is a case of disputed paternity, where I am acting for the wife. Beatrice asked me to request you to give evidence in court.” The name rang a bell straightaway. Muthoni then provided more details. Beatrice and Pascall were married for 10 years and have a seven-year-old daughter.

“Over the past couple of years, the marriage has broken down and it is in the divorce court now. The husband is claiming custody of the daughter and the wife is refusing it on grounds that he is not the biological father.”

“I find it very strange,” I replied. “Pascall’s exact words when he rang me to announce that his wife was pregnant were, ‘Doc, I have hit the bull’s eye.’ I remember the words because they were so graphic.”

“It was obviously wishful thinking on his part,” Muthoni said. “Beatrice says that he declined to undergo semen analysis as suggested by you and she got tired of waiting. She is not growing any younger and started an extra-marital affair with a college friend who was keen on her and still not married.” Then, with a wicked glint in her eye, Muthoni added: “When Beatrice announced to Pascall that she was pregnant, the braggart jumped up with joy and concluded that he was the father. You know what men are.” Looking at me remorsefully, she added: “I take that back!”

“Where do I fit in this interesting saga?” I asked.

“Please come and tell the judge that Pascall refused to undergo a semen analysis and leave the rest to me. I will ask the court to allow me to enjoin Andrew, the “real” father in the case, and then seek permission to do DNA test on the little girl and Andrew, who is ready to be enjoined and also undergo the test.”

“Where does that leave Pascall?” I asked.

“He can also undergo the DNA test, if he dares.” Muthoni sounded heartless. “He can always marry the girls his mother and sister have lined up for him. Once his claim is dismissed by the court, wedding bells are going to ring for Andrew and Beatrice.”

With fire in her eyes, she added: “I want this case to get maximum publicity in the media, because the public perception is that invariably the woman is responsible for an infertile union.” Much as I felt sorry for Pascall, I thoroughly enjoyed the wedding of Beatrice and Andrew, with Nancy, their daughter, acting as the chief bridesmaid.