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When IVF Fails, Other Therapies Can Help

Tuesday, December 28, 2010

Many Nigerians Wrongly Believe IVF Babies Are Not Normal

Dr. Abayomi Ajayi is the Managing Director of Nordica Fertility Centre in Lagos. The fertility expert tells ADEOLA BALOGUN why it is necessary to take the campaign against infertility to the grass roots as it is being done in the case of the Human Immunodeficiency Virus scourge After about 17 years of marriage, a lady of about 43 years just had a baby. How did this happen? It is possible for even older people to have babies with the new technology around. She probably must have gone through assisted reproduction.

Many of us are familiar with IVF, but I can read something up here called ICSI. What is it about?

When we talk about IVF, from the name, In vitro fertilisation means fertilisation takes place outside the body. What IVF is all about is bringing the sperm and the egg together outside the body. Of course, the first baby was delivered in 1978 for which Robert Edwards was awarded the Nobel Prize (in medicine) this year. But we also discovered after IVF that a particular group of people, even if we bring together their sperm and egg, the sperm just cannot fertilise the egg. This went on for quite a while until 1992 when a gentleman in Belgium discovered a technique called Intracytopalsmic Sperm Injection, whereby we can pick one single sperm and actually inject it into one egg and after that, fertilisation takes place. it is just like IVF as well. So, it is just the laboratory procedure that is different from IVF because every other thing is the same.

But is it more expensive than IVF?

Well, in our own clinic, it is not more expensive because we want it to be a clinical decision, not a monetary decision. Money does not come into whether you need ICSI or not. it is the sperm that you give us on the day of treatment that determines whether you need ICSI or you need just IVF.

But in Nigeria, people who seek the fruit of the womb often throng houses of worship instead of the hospital. What is your opinion on this?

I believe there is nothing you can do without God. So, I am not against people going to church or mosque or wherever. But what I am also after is that they should do the thing that God also has made us to know about because without God, there is no inspiration. And all these discoveries are highly inspirational; it is just like saying you still want to be using typewriters today when you know that things would be faster using computers. IVF is another invention. I guess that people should continue to believe in facilities of the 21st century and pray to God to make it successful. Just as people don‘t take appendicitis to the church, I want them to take infertility to the hospital, but keep praying in the church for the success.

Is it true that women are the only ones affected in infertility cases?

It is not true; that is the cultural backlog that we still have. People used to think that men could not be infertile, but we know that men contribute the same percentage, if not more, to infertility than women. For whatever reason, the sperm count continues to be decreasing worldwide and Nigeria is not an exception. I don‘t want to sound like an alarmist, but the human race might seem to be going into extinction because it is becoming more difficult to reproduce. It is not only a women affair; it is fairly shared between the sexes.

What are the possible reasons for that?

There are many factors. Environmental factors are involved; some things that we are born with called congenital factors, and other reasons. But definitely, the more we get away from nature, the more we encounter some problems.

There are cases of childless couples who, after 10 years of marriage, a woman outside is said to be pregnant for the man. Is it always true that the man is actually the father of the child outside?

Well, we know that very often, people play on the need of other people. When a man is successful and people see that the only thing he needs in his life is a baby, it is so easy to conjure things up. I have seen where friends organise what you just said: one of them impregnates the woman, gives it to this other guy and everybody is happy and they get money from this woman who lives in affluence. But all this is short-lived because technology is also catching up with that. DNA is there; so even now you don‘t need to take blood samples to do it. But the bad thing about it is that most men don‘t even want to do DNA because everyone is happy as I said. The man knows that this child might not be his, but they really don‘t want to find out. But all those heartaches should not be because now it is possible with technology for almost everybody to have children. Technology has taken care of the large chunk of the male factor; in fact things are even getting better with ICSI. There is even a new one which we are bringing up very soon called Intracytopalsmic Morphologically Sperm Injection. It is the newest in the world and it is more sophisticated than ICSI, which addresses male infertility especially. Technology is actually catching up with male factor infertility and it may get to a point that almost every man will be able to father a child.

Why are men running away from taking the blame, leaving the woman to face the stress?

Culturally, the man is egocentric and he is not supposed to fail. Again, the fact that another woman can have a baby for the man is another reason; and since it is the woman that carries a pregnancy, he can afford not to bother. That way, men have not been exposed to the ridicule and the stress. so, it makes them to not to want to admit, but the picture is changing now because awareness is catching up and people are beginning to see the light.

Would you say we have enough awareness?

No, we can never have enough awareness yet, but today is different from yesterday.

Maybe some people are aware, but do not have the wherewithal to fight it.

Maybe that is the reason for the limited access, but the biggest I think is awareness. The second one is the wherewithal, but this is where I think the government needs to come in because there is a limit to which private organisations can cater for those suffering from the scourge of infertility.

In terms of infertility, who is more vulnerable to environmental hazards and infections, the man or woman?

As for the environment, I think the man is more vulnerable. But to infection, the woman is more vulnerable. Don‘t forget that the sperm making machine in man is hanging out; it is exposed to the vagaries of the environment, it is not protected at all, unlike the woman‘s, which is inside. But of course, there is an opening that leads to everything and if there is any infection there, it gets inside.

When can we say a couple is suffering from infertility?

Well, the World Health Organisation says when they have been trying to conceive for one year but there is more clarification based on the age of the woman. We now say that one year if she is less than 35 and six months when she is over 35.

What would you want to advise prospective couples to do medically before getting married?

Of course, you would want them to undergo screening for communicable diseases, infectious diseases like HIV and the rest. But when it comes to fertility, you discover you cannot begin to tell them to do semen analysis before they get married. Even now with technology, it is just for you to find out what the problem is and it can be treated. So, I don‘t think that should disturb marriage relationships.

There are still some infertile couples that have been cleared of any medical defects or problems. What happens here?

There is a problem called unexplained infertility and it is recognised all over the world. This happens when you have done your common investigations and you cannot still identify why this couple are not able to conceive and the incident rate from one environment to another varies. In Nigeria, it is about 10 per cent. But the wonderful thing is that it can be treated. There are ways to treat unexplained infertility.

We recently had a 56-year old woman who was delivered of triplets after IVF. It is like multiple births are very common with IVF. how can that be reduced to just one baby at a time?

Nigeria has the highest twinning rate, even without IVF, in the world. We share it with the Republic of Ireland and our women tend to do well with multiple pregnancies more than Caucasians for reasons nobody knows. There is a place called Igbo-Ora, where we have a lot of triplets and their mothers are never admitted in any hospital.

Where would you advise a couple, who have remained childless for three or four years to go for counselling; church or hospital?

The truth is that both medical and religious counselling are okay. But while one is based on facts, the other one is based on emotion. The two are okay, but the man of God can never be wrong. I will tell you a story. There was a woman who wanted to get married and she said, ‘Pastor, I saw you in my dream, you told me to marry Dayo.’ The man of God said, “Okay, if I said so, then it must be right.’ Then three years down the line, they started fighting, the woman came and reported and said, ‘Pastor, you are the one that told me to marry him’ and the pastor said, ‘When did I tell you?’ The lady said, ‘But I told you I saw you in my dream telling me to marry him.’ Then the pastor said, ‘Well, maybe some witches must have worn my image to tell you that.’

Apart from funds, how would you convince someone who had failed to have a baby after two failed attempts at IVF to try more?

It is important for people to prepare their minds when they want to go for IVF. It is not that we put a baby somewhere for picking. Some people would need to do it two times. Some would need to do it three times, while some people will do it once. The most important thing is that if you don‘t give IVF enough chance to work, you call a good technology a bad name. If at the beginning you have a mindset that you might need to do it more than once, the chances of success are very high. Even in countries where the government is responsible for the bills, so many people do it once and then run away, but we know why this is so. The psychological toll that the treatment of infertility takes on couples is enormous and that is why some centres have trained counsellors, who can meet the emotional needs of these couples when the treatment is going on because we know that the treatment of infertility is emotive. But we also know that infertility itself is also a terrible thing, so one needs to be mentally prepared for the worst but if you do it once and it works, fine.

It is understood that someone with a low sperm count can be helped out. But what of someone who does not even have any count at all?

No-sperm count can also be helped. We know that there are two types of no-sperm counts. It is either the testes have failed or they are working, but the conveyor belt has been blocked. If the testes are working, we can go to the testes to bring out sperm cells and we can use that to do ICSI. And we have achieved so many pregnancies through that here.

I thought you would have studied in the US, Britain that we all know; why did you choose Denmark?

Well, when we wanted to start, I tried to look at successes all over the world because we wanted to bring in something fantastic to Nigeria. That is why our name is Nordica. It is not a Nigerian name; we are a franchise. The Nordic countries generally have the highest success rates in IVF. Apart from that, IVF there is just like a routine. For instance, about six per cent of babies born in Denmark are from IVF, so it is like it is part of their culture. And that was what I was looking for and that was why I went there.

After your training in Nigeria, a medical doctor would want to set up a hospital and practise. Why going for extra training in assisted reproduction?

I think the plight of infertile couples pushed me into that. When I was doing my residency in UCH to become a gynaecologist, that was when I saw that there was a special need for people with infertility. I saw that after attending to them, it was like we were telling them to go home and pray. When the two tubes are blocked, the gynaecologist would try to do tubal surgery; the success of tubal surgery is about five, 10 per cent. So, essentially, what you are doing is telling them I leave you in the hand of God. When I got to urology, the success rate was worse. And I said to myself, there must be a way out and I started to find out why IVF was not happening much in Nigeria. I discovered that it was lack of infrastructural support. That was what made me to finally go into it. Even one of my friends, a doctor, had a problem with his marriage and ended up with another lady who had had three children for different men. Of course, it didn‘t last a year because the lady said she had a baby for him. Meanwhile, his wife, who got separated from him, got pregnant instantly after meeting a new man and we all knew that the other lady‘s baby was not for him. So we knew that it was a male factor.

But the impression we have is that all these facilities are not here and that is why people go abroad to have IVF.

I don‘t think it is so. Some are worried about their identities; they want to protect their confidentialities. There is nothing wrong since they can afford it. Even in the US, there is what we call cross-border fertility treatment. But the thing I tell people is that IVF is best done in your own environment. For instance, we have seen people who go to the UK in their late 40s and they need donor eggs. The waiting period for donor eggs in Britain is about three to five years. Even those that go there are referred back to us. Inasmuch as we cannot stop that, we want people to know that the facilities are here and their confidentialities are assured. But people need to go to good centres and people also need to get information; they should go on the Internet and read. I keep telling my patients that if they read about IVF and the doctor is telling them something else, they should speak out. Because we know of some doctors even in Lagos who don‘t do IVF, but they claim to be doing IVF. They give patients all kinds of stupid prescriptions, telling them that they import bottles to keep babies, which is ridiculous and they collect a lot of money from patients.

Why is it that some people, after achieving success with IVF, feel reluctant to share it with people?

I have had many experiences in that regard. It is because of this stigmatisation: some people believe that IVF babies are not normal babies, so they don‘t want people to know that they have IVF babies and that is not right. There are about four million babies from IVF worldwide and they are all normal babies; even some doctors think IVF babies are not normal. One doctor called me one day and said, ‘Oh, my wife has just been delivered’ and I said where? He said UCH, and I said I am actually on my way to Ibadan, I will see your wife shortly. Later, he called back and said, ‘Doctor don‘t come oh, everybody will know that he is IVF baby.’ It is that bad.

Why is infertility still being discussed in hushed tones?

It shouldn‘t be, but it is because in fertility discussion has not been taken to the community yet. Now people can discuss freely about HIV to a large extent because it has been taken to the community. That is what we tell all the support groups that IVF and fertility should be discussed at the community level; so that it is no longer hidden. You know you can be working with someone with infertility challenge in the office for years and you would not know. You ask her how the children are and she says they are fine, and she even gives you a smile. And the day you don‘t ask her about the children, she takes offence. This pretence that we put on is not helpful, but again you need to understand why people put on the pretence because the people who are supposed to help them do not know how to.