The name Dr Abayomi Ajayi is synonymous to solving Infertility problems in Nigeria. He has over 17 years of experience and heads the Nordica Fertility Centre in Lagos, Abuja and Asaba. He holds many media talks where he talks about why Infertility has been so prevalent in Nigeria and how it can be reduced.
Dr Abayomi was our guest on City People’s Instagram Live Chat on Friday, August 14, 2020, where the Publisher, DR SEYE KEHINDE took him on several infertility issues and possible solutions.
DAMILARE SALAMI brings you excerpts from the exclusive Live Chat. Have fun while reading.
How has it been since March… Has the pandemic affected the issues that you deal with on a daily basis?
Oh yes, it has. It has been a learning period for all of us. Initially, we were asked to stop the treatment of fertility cases because we did not know exactly how COVID will affect what we are doing but after a while, we were also instructed to resume treatments. We know the pandemic has affected every part of the economy, so it’s everywhere. I said initially, we didn’t know whether it was going to affect or not so we stopped treatment out of fear but later on, we became more comfortable with it. A few weeks ago, there was a report that COVID-19 could cross to the unborn child but we are not so sure how common that is, so we are not so sure yet. You know this problem is just with us for about six months ago so we are learning every day about it.
What are the strategies in place to get more clients in this harsh economy?
That’s where every one of us has to be ingenious. What we try to do at my place is that we came up with a plan where it is possible for people to pay in installment. That is what we call the flex pay where you can spread your payment over one year. And if there are fluctuations in the prices, it will not affect you. That is the kind of programme we have in place because we know that the economy is shrinking. Some people are bound to lose their jobs, while some people’s income will decrease, so we need to place ourselves at a level where they will still be able to afford our treatments.
Ok sir. What is the state of affairs on the option of IVF to battle infertility?
The truth about IVF for those of us who have been in it for a long time is that Today is better than yesterday. Because the awareness is getting much more wider beyond where we were a few years ago and the stigma is reducing. People are getting to agree more and more that IVF babies are normal babies, so it’s great.
Talking about Infertility sir, what stage would you say we are at now if you look back at where you are coming from?
If we look at it from the point of view of Awareness, we are probably at mid-stage. If you say from a number of 1-5, we will probably be at number 2 or 3 in terms of awareness. But when you talk of access, we will probably be at number one. Because the number of people who need the service in Nigeria is still very little compared to the number of cycles we do across the country. Access is still an issue and cost is another major issue that many people still have to battle. Awareness has overtaken access.
When we talk about Surrogacy and other available options, are they fallouts from IVF or new discoveries?
They are all fallouts from IVF. ‘Necessity’ they say ‘is the mother of inventions’. As we were able to cross the bridge of extending IVF treatments to men, it also got to the people who cannot bear the child on their own for whatever reasons, that’s where surrogacy came in and right now the more practised surrogacy is gestational or IVF surrogacy. Most of the time now, nobody does IUI surrogacy except when you are doing it at home or yourself. To prevent controversies in IVF surrogacy, what we avoid is using the eggs of the carrier, so that she is not genetically related to the baby because that was one of the problems that arose with the first case.
I’ll like you to also talk about the role of men in all these. What should we know sir?
This is actually a million-dollar question because day-in-day-out, this is what we are asked. Men contribute equally to infertility as women, but when you are doing IVF, the concentration is on the women even when you are treating low sperm count, the woman will get the treatment most of the times in other for her to be able to carry your baby. That is one part, the man is ignored. But another part where I get very worried most of the time is the psychological impacts on the man most of the time is also ignored. Men don’t help matters by trying to be macho sometimes, but the truth is that they feel the pain as much as the women too. That is one of the things I try to discuss with some of my patients when they come to complain that their husbands are not so supportive. I try to let them understand that majority of men support, but the way they do this is different from the way the women do theirs. And sometimes they cannot communicate well because the reaction of a man to stress is different from the reaction of a woman to stress especially when the cycle fails. The woman cries and cries which is better, but the man tries to console her; which is good, but he represses most of his feelings and nobody is concerned about that. I am trying to work on it now. In the first place, we need to get the men to talk about how we can help them. You hear how some men misbehave at “open and close” but it’s not as if they want to misbehave, it is because they don’t know how to deal with this stress. Infertility is one of the most stressful cases you will ever encounter as a couple. And women get more support than the men. So, men really need to talk more so that we can be able to help them. I think we also need to lower this macho life, so that they can get the appropriate helps.
Sir, there are those who also complain that the problem they have with IVF is that they have to do it over and over again before they get it right. How come it’s still a 50-50 chance before you get it right?
I wish it was 50-50, I think it is about 40-60 and that is what we talk about all the time that there are some things you need to understand about what the technology can do and cannot do. IVF has not placed a baby somewhere that you are going to pluck. What people don’t understand is that when about 100 couples who do not have any problem decide to have a baby, only about 20-26 percent will be able to achieve that in one month. That is what nature has to offer. What IVF does is to replicate nature with the use of technology when there is a problem. So, the success rate of IVF is in the range of 40 per cent per cycle. And that is why when we counsel people we tell them to prepare for more than one cycle. Even the World Health Organisation (WHO) says that if you are less than 35, prepare for 2 cycles and if you are more than 25, prepare for 35 cycles because the success rate in IVF is cumulative.
What do you mean by the success rate being cumulative?
It simply means if you do 3 cycles, you have a 75 per cent chance of taking a baby home, and what I tell patients is that a positive pregnancy test is not what we are looking for, what we are looking for is that you carry a baby home.
I was also going to ask sir, how you respond to women who go for a sperm donor or something. I don’t really know what is involved, but a lot of people talk about it these days. How do you respond to that sir?
I guess it’s great, it’s part of the awareness that people like you are talking about it. One thing that we are saying is that sperm count is declining all over the world. And some people, because of the nature of their job, they have to store sperm. In some countries when you are a pilot or in the military, you have to store your sperm but in Nigeria, we are not caught up with that, but it’s getting better by the day. So, I think it’s a good thing that people are getting to know that the facility is now available in Nigeria.
What are the other facilities available? You’ve mentioned just a few.
What I’m happy about in the field of medicine is that IVF is one of the areas where we can beat our chest in Nigeria and say we can compete with anybody all over the world. Any facility you can get anywhere in the world is available in Nigeria. Either by collaboration or otherwise, it’s available in Nigeria. So, we can do egg freezing and that is one technology we should embrace much more in Nigeria. Somebody said it is a gift a father should give to his daughter when she turns 30 and there is no serious relationship in the horizon because we know that egg quality decreases with age, so when you store your egg at 30 and you turn 40, the age of the egg remains 30 and it can be very useful. That’s one of the things we should encourage our people to embrace and I know some centres that are very good with the facility. Not all centres have it but some do and are very good at it.
I’ve always asked you this question about infertility. Would it be right to say that it is on the increase in Nigeria?
I guess you are right to say that. You know one thing about Nigeria is that we are not so strict with data that you can fall on, but one thing that is so certain is that male infertility has increased all over the world. There was a research that says that male infertility has climbed to about 40 per cent increase all over the world. And the one we did in my clinic, we saw that sperm quality has depreciated by 30 per cent in 10 years that is about 3 per cent every year and so many things are responsible for it; majorly our lifestyle and the environment, but the good thing again is that it is possible to treat most of these things. However, it is better we prevent them and that’s why it’s always good to have this kind of talk where people can learn before things get out of hand because lifestyle is a very important component in infertility either for the man or the woman. So, if you know that you are yet to complete your family, you need to check your lifestyle. I see that a lot of recreational drugs are available in the market in Nigeria and that is a no-no with fertility. Cigarette smoking declines fertility in both the man and the woman and the sedentary lifestyles that we live. You need to exercise not strenuously, but mildly and consistently to keep good body weight and eat healthy too, those are some of the things that we need to do. And for the men also, if you can avoid excessive heat around your testes, that’s also good for you. Avoid long-distance truck driving, avoid putting laptops on your laps and the kinds of underwear you put on also matter. Lifestyle is the only component of infertility that we can handle. Age is also part of the lifestyle. If it is possible, start your family on time, if it is not, store your gametes either your sperm or eggs.
What is your message for the male folk?
What I tell the men is that when you have infertility, please do not leave your wives alone, please go with them to the hospital. You know we men, the way we are wired is different. We are logical beings and women are emotional beings; the two balance each other. If you allow all the decisions to be made from the emotional point of view, you might be missing a lot and if you also allow all the decisions to be made from the logical point of view as well, you might be missing a lot. That’s why God made us differently and put us together. So, it’s important for the men to follow their wives to know exactly what they are doing, so that you can make decisions together because the most important aspect of IVF is decision making.
So, how do you now deal with the ego aspect of the male folk?
The men have ego, but we need to have reality checks all the time. Some of the things I say about the men all the time is because they are logical beings, if you are not logical to them, you tend not to make sense but once you are logical to them, they tend to corporate with you and that is my experience with them. Once they see that what you are doing make sense to them, they tend to relax and that’s why I keep saying that they should always be there with their wives.
But sir, if you compare our lifestyle now with those of our forefathers, is it that theirs was better for fertility?
In dealing with any disease, reporting matters a lot. The more you find a cure to a disease, the common it becomes because many more people are going to come for the solution. I am not sure that infertility was not with our forefathers, but I’m sure that in those days, they have so many ways of dealing with infertility, some of which nobody would want to try in this time and age. In some parts of Nigeria, some young men are allowed to sleep with women, who are not their wives in order to reproduce their family lines and those things are unheard of now because of technology. Infertility has always been with us, it was there in the time of Abraham.
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