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When IVF Fails, Other Therapies Can Help

Friday, January 15, 2010

TUBAL BLOCKAGE: IVF BETTER THAN SURGERY

The primary benefit of tubal surgery to repair tubal blockage is that it is done once. However, according to Consultant Gynecologist and Invitro-fertilization (IVF) expert, Dr Abayomi Ajayi, the success rate is very poor in the range of between 10-15 per cent. There is also the risk of tubal or ectopic pregnancy following tubal surgery.

He disclosed that in IVF, you can avoid surgery and pregnancy rates are in the range of 25-30 per cent.Dr Ajayi spoke on this and other issues.Tubal surgery vs lVF The primary benefit of tubal surgery to repair tubal blockage is that it is done once. However, its success rate is poor in the range of between 10-15 per cent. There is also the risk of tubal pregnancy (Ectopic) following tubal surgery and this may be life-threatening if rupture occurs. In-Vitro-Fertilization (IVF) has the advantages; you can avoid major surgery and pregnancy rates are in the range of 25-30 per cent. Complications following IVF are also minor. IVF however is more expensive than tubal surgery as it involves the use of hormonal preparations, there is also an increased risk of multiple gestation following IVF.

Various factors affect the success of IVF and the single most important is the age of the woman, the younger in age, the better the outcome. Older women however can benefit from IVF by using donor oocytes from younger women. IVF also has the advantage of overcoming male infertility through a process called Intra-cytoplasmic sperm injection for men with low sperm count (oligospermia). It is therefore imperative that tubal fertility problems be promptly referred to assisted conception units for care. Undertaking tubal surgery may not be the best option and it involves a lot of risks.

In-Vitro Fertilization and Embryo Transfer remains the most acceptable means of passing tubal factor infertility.Ectopic pregnancy The tubes may develop adhesions and thickened walls and close off completely. In that case, a woman’s hormones can be fine, her eggs can mature and she can even release healthy eggs every month, but the sperm may not be able to reach them. If the tubes are opened enough to allow the sperm through, fertilization may occur in the fallopian tubes. Then, when the growing zygote is traveling through the tube to reach its destination in the uterus, it may get stuck and implant in the partially-obstructed tube, resulting in an ectopic pregnancy, which may cause further tubal damage and even loss. There is a risk of recurrence of ectopic pregnancy and when both tubes are affected, the woman is unable to conceive by natural means.

Treatment
There are two basic approaches to treat infertility due to tubal blockage viz: Tubal Surgery and In Vitro Fertilization (IVF).

Tubal surgery involves techniques aimed at re- opening blocked tubes, while IVF replaces the functions of the fallopian tube with laboratory and minor surgical procedures that result in fertilization and transfer of fertilized eggs or embryos into the uterine cavity.

Since the advent of In Vitro Fertilization (IVF), reconstructive tubal surgery is becoming a lost skill. IVF is more popular than tubal surgery due to the better pregnancy outcome using assisted conception procedures. Sometimes, a woman’s inability to conceive is because the pathway from her ovaries to her uterus is compromised. The ovaries could be covered with adhesions that obstruct entry of eggs into the pelvic cavity. The fallopian tubes could be narrowed or even completely obstructed or perhaps the uterus is bound up with scar tissue that keeps it from holding the fertilized egg successfully. Blockages such as these may be caused by congenital defects, by scarring from past infections, by surgical procedures like tubal ligation. A blocked tube prevents sperm from being able to reach an egg and also prevents embryos from being able to reach the uterus. Tubal block can be intentional (such as in tubal sterilization) or unintentional (due to disease conditions that result in involuntary infertility).

Whether intentional or resulting from disease, tubal blockage may be corrected with reconstructive tubal surgery. Prevalence and causes An estimated five million women in Nigeria have had a tubal sterilization for one reason or the other. Approximately one-sixth of the cases of infertility in the country are due to tubal disease. Most of these cases are caused by pelvic inflammatory disease (PID) - an inflamatory condition of the fallopian tubes (salpingitis) and may also involve the ovaries (oophoritis), and pelvic peritoneum (peritonitis). In many, perhaps the majority of cases, PID is unrecognized or ‘silent’ and/or misdiagnosed. Endometriosis is another condition that can cause tubal blockage and is sometimes confused clinically with PID. Congenital abnormalities or malformations of the uterus and fallopian tubes may also result in tubal blockage. In these cases, the blockage is usually at the uterine, or proximal, end of the tube rather than at the fimbrial end as occurs with PID. Symptoms Most fallopian tube obstructions produce no overt symptoms other than infertility. Adhesions and scar tissue may cause pain and limit mobility.

Many women discover blocked fallopian tubes only after experiencing infertility and as a result of one or more diagnostic procedures, including a hysterosalpingogram (where dye is injected into the uterus and examined via x-rays to see if it spills into the pelvic cavity), laparoscopy or laparotomy. Mechanical Infertility Perhaps the most heartbreaking causes of mechanical infertility known to mankind is Pelvic Inflammatory Disease (PID). This infection is being singled out because it can destroy a woman’s fertility without warning, long before the woman even considers getting pregnant. PID is usually the result of bacterial infection that can involve the ovaries, fallopian tubes, uterus and cervix. The bacteria commonly enters the body through the vagina and cervix and spread from there throughout the pelvic cavity. Many women in their teens and 20s are routinely diagnosed with acute pelvic inflammatory disease (PID). The most common cause of PID is sexually transmitted diseases, especially Chlamydia and Gonorrhea. PID can also result from using an intrauterine device (IUD), complication from earlier pregnancy or infection following surgery of the reproductive tract. Depending on the infectious organism and the severity of infection, the acute phase of the disease may be characterized by lower abdominal pain, fever, painful sexual intercourse, irregular bleeding and profuse vaginal discharge. As with any bacterial infection, signs such as these should be treated as quickly as possible with antibiotics. On the other hand, some pelvic infections involving Chlamydia species, may not have symptoms of any kind, yet can cause extensive damage to the reproductive organs, especially the fallopian tubes. Most fertility problems associated with PID are not caused by active infection, but instead by scarring from past infections. Untreated, chronic PID creates a condition of long-standing inflammation within the pelvic cavity, and this sets up a reactionary environment within the reproductive organs, especially the fallopian tubes. One of the most common outcomes of PID is fallopian tube obstruction. The fallopian tube is the ‘golden path’ that the embryo must travel to reach the uterus. It is also the location for fertilization of the egg (oocyte). The tubes contain two specialized kinds of cells viz: those that produce mucus, glucose and other substances needed to nourish the egg (both before and after fertilization) and tiny hair-like structures that move the embryo through the tube and into the uterus. Unfortunately, the fallopian tubes are often the first locations attacked by the opportunistic bacteria. And because they have such narrow structures, it doesn’t take much to obstruct them. The tubes can become inflamed within (salpingitis), become filled with fluid (hydrosalpinx) or pus (pyosalpinx), creating a bulge and/or possibly destroying the lining and musculature needed to nurture the egg and move it along. Fluid from a hydrosalpinx can drain into the uterus and have an adverse effect on implantation.
SOURCE: SUNNEWSONLINE

Tuesday, January 12, 2010

Nigeria: IVF Treatment Has Come of Age in Country, Says Wada

THRICE his life was at stake while propagating the concept of Invitro Fertilisation (IVF) in Nigeria, but today, he is rest assured Nigerians need not seek IVF treatment abroad.

This statement sums up the travails of Dr. Ibrahim Wada from the Gwagwalada General Hospital, Federal Capital Territory to NISSA Premier Hospital, Jabi, Abuja, from where he now oversees the Garki General Hospital, Wada, Abuja. He opens up to Abayomi Adeshida. Excerpts:
Motivation into medicine
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From early childhood, I had bias towards any medical stories in the press. That was the earliest inkling I had towards my future, anytime I read the papers and anything I read about doctors, I just cut it and paste it on my little wall. Then of course, my performance in school made people to start calling me doctor, it was more or less expected. I found myself in medical school almost as a predestined situation, and then I became a gynaecologist ultimately as a choice.
I chose the option of fertility in terms of IVF because as I was training, i realised there was a group of women desperate to have children and IVF was the only way out.
That inspired me. If I was not a doctor, I would have been a cleric, Imam or something like that because of the extent to which I fear God, and the extent to which I see the balance of nature beyond human comprehension and the awesomeness of God and I have continued to learn it and to teach it, so I have continued to thank God for choosing my path for me along these two professions.
Challenges as a doctor
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Well, I like to look at myself as somebody who came from the very basic level of life in Nigeria in the early sixties. I remember as a child in primary school, I used to farm for my food, not just to sell, but I used to go to the farm with another more senior boy, and as it came out, I virtually toiled for everything that we ate. Apart from that after school I used to hawk, I used to sell things for my mother, so how more basic can you get? I was used to the life of hardship and that saw me through virtually the whole of my education to the medical school.
Introduction of fertility treatment into Gwagwalada Teaching Hospital
I look back at how everything was against me and against this new idea that I had brough in this part of the country. I faced challenges from every side, even from the people themselves. I paid a heavy price, but I thank God it was not with my life; although three times, I remember, my life was on the line.
But I knew if I had taken one more step forward I'd be gone, Almighty God brought me back to life and success is now the story.
I never knew I'd live to see the first test-tube baby. The storm around me was so much I thought maybe just before that day like the biblical Moses, I may not see the promised land. But God preserved me to even see her grow.
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There were serious challenges. I joined the National Hospital in 1999, the first test-tube baby in that hospital was born in 2007; about eight year's journey! I fought that and I didn't give up. So, the success of my actual return to Nigeria was the birth of the first test-tube baby at the National Hospital, a public institution because that's what I came for!
In all honesty, I didn't board the plane from England to come and open a hospital in Nigeria; my background does not allow that. I am the last business man in the whole country because if I can treat everybody free, I'll do it. Ask any staff I am the non-business man amongst them, I am the one who'll say let them go, or give discount, I don't use business sense to run this place. Mine is success.
Technology transfer
Technology has many facets; one man does not make it alone. Everybody has a portion to fill; so, when I came back, I knew I still needed complementary assistance. It took me the best part of three, four years to break all the difficulties that our system posses against high-tech medicine. Now I have learnt enough of how to conquer the problems of bringing high-tech medicines into the country that I started to teach other Nigerians what I knew even though, it wasn't easy.
Success of IVF in Nigeria
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Today's IVF treatment is high tech. I think we've broken it down to its simple state that Nigeria is at world class level, other entrants have confidence to come in.
I mean yes, there were a few units in Lagos then, but now its spreading like wild fire. I think its not just what I have done, but what the knock-on effect of my life and achievements have brought on the entire country.
So, in our own Centre here, I cannot recall the exact count, but I stopped counting when 1,000 families were affected, because it was my mission after the first child was born to let her life touch 1,000 lives. Everyday we record successes, I am not doing daily count, but I am aware we are well above 1,000 successful births.
Cost and access
Relevant Links
West Africa
Nigeria
Health
One nagging problem that may not just be wished away by those of us who are engaged in this business is the run away exchange rates and the fact that we are producing nothing among the high-tech medicine we use in this country and we are going to live with this problem for so many more decades. No group is working on it now! The materials are here but nobody is developing the market, thereby, the major things we need, scanners, incubators, medications, are all imported. That means we are subject to variations in value of naira to foreign currencies.
I think that's a key issue; the other key issue of course is that we have to pay heavy import duties to bring these things in. Most countries have exempted Medicare items from import duties, but it is not so in Nigeria.
Regulation of the practice
We are working on an Association and basically, it is concerned about the ethics in this kind of medical practice. We are trying to get a charity funded IVF project for the poor to come up at Garki; We've started on a small scale but I can see a future for it too because there may be good-hearted Nigerians who would say okay, I want to donate this huge amount towards what you are doing so that poor people could enjoy IVF services. So, we are hoping that far, so people could get to access this technology.