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Read Letter

Genotype Love

Dear Jack, she’s AS, you’re AS and you’re madly in love. Should you marry her? You want me to answer. You’re afraid one or more of your children will have the SS genotype. If she’s AS and you’re AS, there are three probable biological outcomes: AS, SS, AA. Nature will throw a biological dice! You can’t predict how many of your children will take on each of the genotypes. Has to do with inheritance patterns. All the children may wind up SS; and they may all wind up AA; or AS. Or nature can be a mixologist.

If you aim for 3 kids for instance the spread can be lopsided or even. No one can predict how many will be AA or AS or SS. Mendelian genetics dictates that your chance of having an SS is 1 in 4 EVERY TIME you seek conception. (You also stand a 25% chance of producing an AA. The odds are same every time). But if AS is a tolerable outcome for you, you have a 50% chance of producing one every time you want conception.

If you’re SS and she’s AS your odds are 50% SS, 50% AS every time she wants to conceive. You can however improve your chances drastically through fertility engineering. It’s a bit of a cost though. And some couples elect to adopt or go childless. These solutions however face tremendous cultural challenges. Whatever you choose, in general in these scenarios and circumstances nature constrains you. You can’t influence the numeric stackings into each genotype without engineering. But let me quickly say something. An SS genotype child is no less worthy of your love than your children with other genotype. In fact that child deserves more. He didn’t choose to be born with that genotype. The natural constitution of men in general can’t handle the extreme outcomes of that genotype in children. It’s why you see more of the mothers tending to the kids in crisis in hospital. The men are hardly around. Men tend to distance themselves from such circumstances. They can’t handle the emotion involved. Now, what this does is that it compounds the child’s psychology. He feels less loved.

There are however “tolerable” SS genotype cases. With good management and understanding of constitution, such people enjoy “fair” health. A man (or woman) with that blood group must not strain himself. Wisdom is profitable. But there are really bad SS genotype progressions. It’s for this that intending couples must carefully weigh their decisions. The pain these kids undergo, the struggle for normalcy, the unpredictability of lifespan… These are not things anyone should put a child through. The sufferings can be intolerable. If you’ve ever witnessed a crisis emotionally close you won’t want your child to go through it. These children endure pain that make some of our life’s trials lilliputian.

Let me tell you the story of my friend, Seun. He had SS genotype. We were in university together. Seun was a very spunky individual. Full of life, friendly. He never bore malice. He’s one of those you can’t hold a grudge against. He’ll hardly notice! You’re wasting your emotions. He experienced several crises but Seun was a brave soul. He bore each successive crisis with equanimity. He never complained, wasn’t one given to complaints. Not once! He lived a full life despite it all, dated like crazy. He had a full social life – movies, concerts, what have you…And people loved him. Seun was kind. His genotype of course affected his physical attributes. His eyeballs were fish lensed and often jaundiced. His proportions were lanky in places, his voice range was falsetto to coarse tenor, which can be alarming. But Seun was fun! He was extremely helpful to all, loved God and served him in capacities in Fellowship and Church.

Comes his final bar exam and Seun had a crisis- like a month to go. He was rushed to hospital. Seun not only beat the crisis, he passed the bar exam too, and he had just two weeks for final preparation. There’s the theory that after a certain age, the odds increase for an individual with SS genotype. I believe it’s 25. Now I’m not sure if it’s a myth but Seun crossed that age barrier and married a pretty girl. But just a few months after his marriage, Seun died. He died from a simple complication of what should never kill a beautiful soul. His life had just begun. Some say he strained himself on a travel, some say malaria. Whatever it was took Seun away. Seun came from such a lovely family. Wonderful sisters, brother, father, in laws and a special mother. She was strong, nurtured her son through crisis upon crisis, her faith kept Seun alive; she never complained. Now that I’m a parent myself I have an idea of what it might have cost Seun’s mother. You could see the strain.

I can’t tell you whether or not to marry your girlfriend… That’s shifting your responsibility to me. The choice of marriage partner should always be yours, after all no one will live with your choice but you. But I can see your dilemma. Innocent and true love is mixed up in the brew of genotype configuration. It may however be possible for you to exercise strong faith to overcome nature’s gambling instinct. Up to you. But if you lack the faith then all you have is luck- what the Bible calls “time and chance.” But if you’re “unlucky” in a manner of speaking, then you must have strength and constitution. And you must be ready to dedicate your life to your child if perchance he has a trying SS genotype. Only you can determine if you have this constitution. And if your girlfriend has. Your love must be strong enough to cope with the challenges. And thinking about this, perhaps we all need to do more in this direction. The NGOs involved need our support. There’s a need for more awareness campaigns, more education. It’s largely an African problem.

Now you can identify the genotype as early as 12-14 weeks of pregnancy. You still have fertility engineering option though, as well as other social options. There’s also cure through stem cell transplant. Seun was a brave soul. As are people with SS genotype in general. These are life’s soldiers. I can only analyse your options for you. The choice really is yours.

Your mentor,



This is dedicated to the memory of Seun Avoseh. © Leke Alder 2014

Tags : Sickle cell, Marriage

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