•Popular LAGOS Fertility Doctor, Dr TUNDE OKEWALE
The problem of Infertility has been on the rise for very many years, not only in Nigeria, but globally. What explains this? What causes it? Whats the way out. The founder of St. Ives Hospital, Dr. Tunde Okewale who is also a fertility doctor last week explained why. Below are his explanations to City People Publisher, SEYE KEHINDE.
Looking at the challenge of Infertility today, at what stage are we at?
I think we are getting there. His definitely much more better than 5 years, 10 years ago. I remember there was a time in Lagos we can actually count the number of Fertility clinics on your fingers. In the whole of Nigeria, there was a time, about the time we started off, there was only about 10 in the whole country.
I remember saying at that time that India had about 500 fertility clinics. The ideal thing really is every state capital should have their own Integrated fertility clinic that can cater to IVF patients because fertility issue has become a big social issue. But it has improved tremendously. There is now a lot of IVF Fertility Clinics all over Nigeria but the issue is that they are still concentrated in the major cities. Lagos is more or less saturated. There is Port Harcourt and Abuja. Apart from those 3 you have to travel long distance to get access to clinics.
Why is the problem of Infertility still high in Nigeria?
It is a worldwide problem. It is not even a Nigerian issue now. Generally, fertility issue is on the rise now for various reasons, mostly all over the world because of environmental issues. With the level of development its going up. Infertility increased for obvious reasons. Pollution is making the sperm count of men to gradually decrease over the years.
Pollution from specific industries like Plastic industries, Led Industries, all pollute the atmosphere and do have an effect on fertility, especially in Nigeria where there is virtually no control. A lot of the waste products in there industries are thrown into the streams that find their way back into the water system.
So we’ve generally seen a decrease in sperm count over the years.
The 2nd problem we have noticed in this environment over the years is Infection. The Kind of Sexually Transmitted Infection people had in the past is different now. In the past if you had Gonorrhea it will be obvious within a week. And you will go and seek treatment. But the kind of Sexually Transmitted Disease that is prevalent now is the groups of Chlamydia do not give any warming or symptoms. You will be infected and you wouldn’t know. And by the time you realize it, they would have damaged the tubes of the woman or they have damaged the tastes of the man interns of sperm production.
The other thing is Late marriage. Again, because of developments generally, women are following their career paths, more women don’t get married at the right time.
They are getting married in their late 30s. And again, Fertility in a woman is age-dependent. The further you grow in age, (especially after the age of 35) the more difficult it is to achieve pregnancy. So late settlement in life, infection, pollution, industrialization, etc. All those things coming together has made Infertility to be more and more prevalent and for the incidence to be on the rise.
How do you define Infertility?
Infertility is defined as the inability to conceive despite regular and unprotected intercourse for one year. Approximately 90% of normal couples in the reproductive age group conceive within a year of attempting conception. Approximate conception rates with regular unprotected intercourse in normal fertile couples: 1 month 25%, 6 months 75%, 9 month 85%, 12 month 90%, 24 month 95%.
Although infertility by itself may not threaten physical health, it does have a serious impact on the mental and social well being of the affected couples. Infertility is divided into 2 types. Primary infertility means there has been no previous pregnancy (40% of infertile couple) and secondary infertility if there was a previous pregnancy whatever the outcome (60% of infertile couples).
Infertility affects million of couples in Nigeria leading to untold misery and frustration. One in 4 couples is having difficulty in conceiving, and the number of couples seeking medical help has risen dramatically in recent times. Infertility has always been with man even, from the biblical time. Couples finding it difficult to conceive were however far and in between in those days.
The incidence has suddenly been on the increase for various reasons ranging from urbanisation, pollutions, stress, chemical exposures, career orientation and late settlement in life.
How serious is this issue of low sperm count?
It is serious. There are now many observational studies that have shown that the average sperm counts of Nigerians in the urban centres are gradually falling. Many of the causes of the falling sperm count can be traced to environmental pollutions and exposure to certain pesticides, metals and solvents in many industries and especially in the plastic and printing industries.
There is also suspicion that many of these pollutants with oestrogenic contents from the industrial wastes may have contaminated the public water systems including the indiscriminate borehole water supplies.
Not only are the average sperm counts falling, men are also producing large numbers of abnormal sperms due to the environmental pollutions. Smoke either from cigarettes or environmental smoke from industries and generating sets affect fertility, by reducing the functions of eggs and sperms.
What role does stress play in Infertility?
It is not rocket science to know that the stress level of Nigerians have increased many fold since the early eighties when the economy suffered major turbulence from which it is yet to recover from the structural adjustment programme (SAP) of the government of that time.
Stress affects relationship. Stress is a major cause of reduced Libido (sexual desire) among couples, thus reducing the frequency of sexual intercourse. To get pregnant fast, couple must have sex at least three times a week. Having sex regularly is the best way to get pregnant quickly. Many couples try for pregnancy only during their fertile or ovulation period because of their day to day stressful lives. Severe stress can also affect female ovulation and can limit sperm production.
How about the issue of Infection?
Unlike the obvious sexually transmitted diseases of times past such as Gonorrhea which are now easily treated with the increasing sophistication in Antibiotics, there is now an increasing incidence of CHLAMYDIA infection which has little or no symptoms and causes damage in the reproductive system that are not detected until too late. Because it has little or no symptoms, Chlamydia has become one of the commonest infections causing infertility. It damages the fallopian tubes in women and causes swelling and tenderness in the scrotum of men.
How about the issue of Weight?
Being overweight reduces male and female fertility. In women, being overweight and severely underweight may impair the production of mature eggs. Obesity predisposes to polycystic ovarian syndrome which in turn affects ovulation.
Tell us more about the effect of Age and late marriage in infertility?
Men can maintain fertility to ripe old age. The same cannot be said of women. Women’s fertility starts decreasing from age 30 and at a faster rate from 35 years onward. The older a woman gets, the older her eggs get also. The Quality and the Quantity of egg also decrease with age. Age is one of the fixed factors in life. A woman can be forty but feel or claim to be 30 years old, but unfortunately her eggs would remain forty and behave like a forty years old egg.
More women work than ever before and many are increasingly becoming the bread winners in the family due to the socioeconomic problems unleashed on Nigerian from the early eighties till date.
Many women and men are involuntarily delaying marriage and child bearing till very late resulting in increased incidences of infertility. The peak of a woman’s fertility is between age 20 and 30 years. Unfortunately, many are getting married in their thirties and forties.
Why is advanced fertility treatment expensive?
Advanced fertility treatment such as Invitro fertilisation (IVF) helps more patients to alleviate infertility problem. Problems of low sperm count and total tubal blockage which would have led to adoption are now easily treated with fertilisation. It is however unfortunate that only a few patients can access Invitro fertilisation because of the cost of this procedure.
Until the governments see Infertility as a social problem and subsidize its cost, many otherwise treatable infertility problem would remain, hence contributing to the rise of infertility and its attendant social problems.
How about the issue of Religious dogmatism?
Religious dogmatism affects many couples approach to infertility. There has been an increase in different religious fundamentalism with their plethora of dogma and doctrines since the early eighties coinciding with the conomic downturn in Nigeria.
Many couples find comfort in religion and spirituality, when it comes to coping with the pain of infertility. But there is a difference between finding comfort and taking direction on which treatment to alleviate infertility. To many couples, seeking medical help early for their infertility problems, negate their religious belief and faith system. Seeking medical help and prayers should not be mutually exclusive. Prayers and seeking medical help should work side by side. Religious Dogmatism limits the hand of God to act only in a certain way.
Many of the couples in these groups finally present themselves for medical intervention in their forties when it is more difficult to treat what could have been simple problems in their late twenties or early thirties. There is a real danger that infertility could become an epidemic problem due to a combination of the many socio economic, environmental and lifestyle issues.