Infertility is a big problem globally and in Nigeria, it has become a big issue. So bad has it become that it has broken many homes and shattered many marriages. However, it is not a problem without a solution. Infertility has been with us since time immemorial and different ages have solved the problem differently. In this era of digital technology, Infertility is gradually becoming easier to solve, however, not without some cost.
Below Fertility Expert, Dr Abayomi Ajayi opens us up to the many solutions available to battle this threat to marriage and family. City People’s Publisher, Dr SEYE KEHINDE hosted him few weeks ago on the popular City People Instagram Live Chat and DAMILARE SALAMI brings you the excerpts, enjoy.
Before a couple can say they have infertility challenge, how far would they have gone for them to say we have a challenge on our hands?
Thank you. We are going to look at this statistically. When 100 couples decide to have a child in a month and they don’t have any problem, about 25 per cent of them will be successful. If in six months, about 55 per cent of them will be successful and in one year about 85 per cent of them will have a child. So for us to say that a couple has infertility challenge, they must have tried for at least one year before subjecting them to various tests. But we have had to modify that definition of infertility because of women who are over 35 years because we know that there is something called the physiological clock that ticks for women of over 35 years. For them we say after six months we must begin to investigate why they are not pregnant but if you are less than 35, after one year will be appropriate for investigations.
So sir, what will be the most appropriate definition of infertility now since it’s been reviewed over and over again?
Well it’s still the same that is, the ability of a couple not to have a child after one year of unprotected regular sex. Regular means they have sex 2-3 times in a week and unprotected means they have sex without the use of any contraceptives. But the modification is the age of 35. If she’s 35 and above, after six months you can start ringing the alarm bell.
Sir, is it possible for a 55-year-old woman to have a child?
Sure, it is possible for a 55-year-old woman to conceive especially if she’s using IVF. The good thing is that you use any technology but you can as well abuse it. For a woman if you are healthy and have a uterus, you can use IVF. There was a couple that hold the record of being the oldest to produce an IVF baby in India, the woman was about 70 years when she had her babies. While they were celebrating the birth of the babies, the husband who was 72 had a heart attack and was taking to the ICU, two days after, the wife also joined him at the ICU. The technology can be used even if you are 80 years and healthy but the question is in whose interest? When a woman is going to have a child at 70 and she probably lives till she’s 90, the problem is the quality of life that she has produced. When you are 50 and you have a toddler with you, you understand the amount of energy you need to train a child but when you are 70, it is a lot of hard work. People talk about the quality of lifestyle of a child being trained by a woman of 70 years.
What will be your message and advice for the women reading this right now?
Well, my message is always simple and that is that there is hope if you want to have a child. The time when infertility used to be a big problem is gone. All you need to do now is follow your doctor’s advice, do the right thing and God will be with you.
Are we also making progress with IVF technology in terms of bringing down the cost because a lot of women are actually scared of how much they are going to spend on IVF so I want to know if we are making progress in that regard?
Thank you. That’s also a very good question but I will say to you Dr Seye without being tricky that is there a way we can bring down the cost of iPhone in Nigeria? We don’t manufacture it so we are not really in control. Most of the things we use for IVF, if we do it properly are imported. You want to have good quality like what is obtainable in the UK or US and you want it cheap, somebody must be paying for it. It’s either there is a subsidy or insurance. The dollar has a big bearing on the kind of service we render. An IVF clinic is not a place that light can go off for two minutes and we know what electricity is like in Nigeria. There are some clinics like mine where we have three generators. We also have a transformer dedicated to the clinic and we have inverters too and these are some of the facilities people don’t bother about in the UK or US. We are also at the mercy of foreign exchange and it’s not easy for people who want to measure up to the standard you have all over the world. What I tell people is that if you have a business that the success rate is about 40 per cent if you cut corners, your success rate becomes 20 per cent and somebody who can get pregnant once will now have to do it three times before getting pregnant. So it’s like penny wise pound foolish. It was a better business for me when a dollar was N165 than what it is right now.
Sir, I don’t know how to define this but these days people tend to have just one or two children unlike in those days when they have as many as they want. Is there a medical reason for this?
I guess it’s the reality check. I’m sure you know how much it costs to send children to primary and secondary schools now unlike when we were going to school when our fathers could afford to send 10 of us to school at the same time. You must be very wealthy to have four children in a private secondary school now. That is one of the things that is affecting the number of children that we are having these days. There are different groups, some don’t want to have many children because of the quality of life they intend to give those children while some cannot have many children because of a medical challenge.
Sir how do you cope with a lot of women who are supposed to fulfil the tips that you roll out but cannot meet up because of the conditions of the society. What advice do you have for them?
Yes, thank you so much, that’s why we talked about other options. For example, if Mr Right is not forthcoming, you can freeze your egg. We know that that’s the ideal world but sometimes things happen so you just have to be aware of the options that are available
And the older women, how do they also cope?
Yea, the older women are an interesting group because they pay out of pocket. Majority of the women who can afford IVF are probably past 35-38 years so they are a large group in Nigeria and all over the world. And sometimes we have to ask some of them to use donor eggs and that’s where the problem always lies because it is not an easy pill for any of them to swallow initially and that’s why we have counsellors to help them through this stage because it is always very difficult to go through this. We also have a very important group people; when I say that, they marvel that people can do this in Nigeria, there are some people who have gone through this and are always willing to hold the hands of others and help them go through this stormy period; so we have this support group sometimes speak with couples over the phone when it’s difficult for a couple to make the decision and sometimes they don’t meet and they later become very good friends. Just as I said earlier, the most important thing to do in IVF treatment is the quality of decisions that a couple make.
Sir, is it possible for you to mention the options that are available again, a lot of people are interested in it?
For the majority of the people who are older, they might have to use donor eggs especially if you are above 43. The 2018 IVF result in the UK was released a few weeks ago and it showed that if you are above 43, the chance of having your own baby using your own eggs is less than 5 per cent and you see some people who are 45 and they say they want to use their eggs, most of the time this will fail and we just have to tell them that they have to use donor eggs. But we also know that this is not what we will tell them and they do immediately. We still have to talk to them and make them understand why they have to use donor eggs and some of them will only agree have they have had a series of failed cycles. And one thing the people are always afraid of is what the baby will look like when they use donor eggs and that is one interesting question I really cannot answer. But what I usually tell them is that there is a nurturing part of rearing children and there is a nature part. The nature part is what the woman might probably not be contributing to in the process because we are going to be using the sperm of the husband and donor eggs. The truth is that children tend to look after the people that take care of them; how that happens I don’t know but what I realise is that when a man marries a woman, they begin to look alike after a while and they were never related. So, this ‘look’ thing, I don’t have all the answers to it and that is what I tell my patients but I can tell you from experience that some children from donor eggs look like their parents and I have been doing this for more than 17 years. So it’s the fear of the unknown and a worthy fear indeed but that’s why clinics have counsellors to help them and as I said earlier, support groups also. And sometimes it’s the sperm, and that is even more difficult when you have to use the donor sperm because sometimes even when you have succeeded, you see some men reacting negatively to their wives because they used donor sperm. They are dear to the child but to the wife, they start behaving funnily. What we try to do in my clinic is that we try to form a large family so we don’t leave our patients alone and that’s why you see that we have a lot of pictures because when you have a problem, we try to see how we can come in. It’s a phase and we try to see how we can make the husband come around and understand that the child is his and nobody is ever going to take it away from him. It’s easier when you put it into words but some people will just never say it but it’s always a problem when you don’t just express it. We’ve talked about surrogacy as well where a woman carries the baby for you. Then we can also do sex selection where we determine the sex of the child for the couple depending on their choice. For people who have AS Genotype and married to another person who has AS Genotype, we can help them do the genotype selection so that their baby will not be SS. There are so many things that are fictions many years ago but are now realities with the help of technology and that was why I mentioned iPhone earlier because anything that has to do with technology is usually pricey until after sometimes when it becomes commonplace and then it probably becomes cheaper. So those are some of the things that we can do.