Can a couple be ‘incompatible’ when it comes to the desire for a child?”

Dear Doctor,

I have been in a relationship for three years, and we are now preparing our wedding. I have never undergone any preconception testing, and recently a friend told me that this was irresponsible. She frightened me by saying that perhaps my fiancé and I might be “incompatible” and therefore unable to have children together… Is this true?

Marie Anne, 27 years old *name anonymized

Dear Marie Anne,

The desire to have children is universal, but the journey is not always straightforward. Many couples, like you, ask themselves a delicate question: what if we were “incompatible”?This concern deserves to be addressed with seriousness and nuance, as it encompasses several dimensions – medical, genetic, and sometimes immunological.

Hereditary diseases: a major concern

Certain conditions only manifest if both parents carry the same mutated gene. In that case, the risk of transmitting the disease to the child is significant.

• A common example in Africa is sickle cell disease.

  • If only one parent is a carrier (AS), the child may be a healthy carrier without symptoms.

  • If both parents are carriers (AS + AS), each pregnancy carries a 25% risk of having an affected child (SS), a severe illness that can significantly impact quality of life.

Other hereditary conditions also exist, such as cystic fibrosis or metabolic disorders, though they are less common in the African context.

This is therefore not an “incompatibility” that prevents conception, but rather a shared risk that can affect the child’s health. This is why premarital or preconception screening is recommended in many African countries.

Blood group incompatibilities

• ABO incompatibility: this may sometimes cause neonatal jaundice but rarely leads to serious complications.

• Rhesus (D) incompatibility: if the mother is Rh negative and the father Rh positive, the child may inherit Rh+. This can expose the mother to immunization, leading to miscarriages or complications in later pregnancies. Fortunately, the injection of anti-D immunoglobulins now prevents this risk.

Does a “couple incompatibility” preventing conception exist?

Science has not shown that a couple can be sterile simply because two people are “incompatible” with each other, while each would conceive easily with a different partner.

In reality, two situations must be distinguished:

a) Individual factors

These are problems specific to one of the partners, such as:

• a genetic or chromosomal abnormality (like a balanced translocation),

• or rare maternal immunological reactions interfering with embryo implantation.

In these cases, the difficulty does not depend on the chosen partner: the person concerned would likely face the same challenges with someone else.

b) Couple-related factors

These risks appear only in a specific combination:

• when both partners are carriers of the sickle cell gene (AS + AS),

• or when the mother is Rh negative and the father Rh positive.

Here, the “combination” of genetic or blood characteristics can cause complications, but this does not mean the couple cannot have children together: medical prevention and support exist.

In summary: there is no such thing as an “absolute incompatibility” between two people. We rather speak of individual factors, present regardless of the partner, or couple-related factors, linked to certain specific associations.

The African context: awareness and prevention

In many African countries, sickle cell disease and Rhesus incompatibility are the main concerns. Preconception screening is essential:

• a simple genetic test for sickle cell (AS or SS),

• blood group and Rh typing to prevent complications.

Educating couples before marriage or conception helps anticipate risks, make informed choices, and avoid unnecessary suffering.

Conclusion

A couple is not “incompatible” in the sense of being biologically unable to conceive a child together.However, certain genetic or blood combinations can increase the risk of hereditary diseases or obstetrical complications.

The key remains screening, prevention, and personalized medical guidance, so that couples can pursue their parental project safely and with full information.

Take good care of yourself.

Sincerely,

Dr. Sandra Yene Amougui