Dr Babatunde Wale Okewale is the UK trained Consultant Obstetrician-Gynecologist with over 30 years of active practice in the United Kingdom and Nigeria, as well as a leading Fertility expert in Nigeria. He is a Fellow of the Royal College of Obstetrics and Gynecology, UK.
He qualified as a medical doctor in 1985, at the University College Hospital, in Ibadan, Oyo State. He then proceeded to the United Kingdom where he trained and practised as an obstetrician and gynaecologist at Leeds, Manchester and Oxford, before returning home after 10 years to set up St. Ives Specialist Hospital in 1996. His sub-speciality is in all matters of infertility.
A few days ago he spoke with City People Publisher, SEYE KEHINDE, in an Instagram live chat and he reveals what people who are waiting on the Lord should do that can boost their chances to get pregnant. Below are excerpts of the interview
Dr Okewale is a family man with four kids, a renowned management consultant, media entrepreneur and broadcaster. He is a strong advocate of preventative healthcare practice and women development
Talking about infertility which is your field, what are the things we need to talk about in this period to help our viewers at home?
Well, what I think we need to talk about is what is infertility? A couple is said to be infertile if they have had unprotected regular sexual intercourse in the past year. When a couple comes to the clinic, the first question we ask is “how long have you been trying?”. So if they have been having regular unprotected intercourse for 1 year, we could say that they are infertile or have infertility issues.
The next thing you need to do at that point in time is to try and find out what could be responsible for it. There are basically five requirements that have to be met for someone who wants to get pregnant that must be fulfilled. The first thing is the sperm of the husband must be of good quality and quantity.
The second requirement is that the woman herself has to be seeing her period regularly. She has to so that she can calculate a fertile period and also know when she is ovulating. there is a very narrow gap between the woman’s fertile period in a month. It is only during her fertile period when they make love that pregnancy will occur. The womb of the woman must be able to accept a pregnancy. There shouldn’t be anything inside the womb that would disrupt the pregnancy. The fourth requirement is that the woman’s fallopian tube must be open so that the egg and semen can meet there. That is where fertilization occurs.
Finally, the woman must be producing quality eggs every month. So those are the five requirements to get pregnant naturally. So if you see any couple that has gotten pregnant naturally, all those requirements have been met and it worked for them. So if you’ve been trying for some time to get pregnant and you haven’t been able to we check for those 5 things.
So if I could give people tips on how to get pregnant naturally, what I’d say is as far as the man is concerned, he must ensure that his sperm is in good condition. and as far as the woman is concerned she must be sure she understands her body in this season that we are. So if they have done that for one year and they are still not getting pregnant. They need to see a fertility expert
Talking about a season like this, what another thing should they look out for.?
Well, another tip for people trying to get pregnant is that having a pregnancy is just one aspect of it. You also have to ensure that your pregnancy is healthy and you have to have a healthy delivery. So it’s very important that people are in good physical health even before they try and get pregnant.
So if there are any health challenges especially in this period of staying at home that we are, for example, weight gain and pregnancy do not go together. So the woman should ensure that she doesn’t unnecessarily put on weight during this lockdown that we are in, so exercises must be done. Constant checking of blood pressure and other health issues should be faced squarely and dealt with. Ensure you are in the best physical condition before attempting to get pregnant.
If after doing all of this, the couple still is not getting pregnant, what should be done next?
After trying, go and see a fertility doctor. And what he would do is to quickly check those 5 requirements to locate what the problem is. In 90% of the time, we find what the problem is from there while In the other 10% we say the couple has unexplained infertility. So there are specific solutions to each problem and the reason for the investigation is to know what solution to use for that specific couple.
There are times where simple counselling can help like educating the woman more about her body and ovulation periods. If the problem is a tubal blockage, there is no time to waste, what the couple would need is In-vitro fertilisation (IVF). If the woman is not ovulating, there are ovulation drugs that can help with that to make her start ovulating. If it is a case of Polycystic ovarian syndrome which about 20-30% of the women who are trying to get pregnant have, you might just have to change your lifestyle like losing weight and exercising that would restore the ovulation. So whatever the problem is, there is a solution for it.
Is it true that men have increasingly been part of the problem of infertility?
Yes, that is very true. It is known that 50% of the cases of infertility are from the malefactor. Unfortunately, most men don’t believe they have a problem because they believe the problem would be from the woman. Some men equate having a good erection and being very good in bed with fertility. They are two different things.
Over 50$ of the problem come from men and it has been increasing over the years. There have been a stust that over the last 30 yrs, the man sperm count has been gradually decreasing due to some reasons like industrialisation, environmental factors etc that affect the men’s sperm especially men who work in some certain industries like plastics, pesticides, and some chemical that are toxic and harmful to the sperm. Stress is an environmental issue which affects the libido. These things have been making the sperm count lower and lower over the past 30 years.
What are you advise to women who looks at other areas like churches for solutions?
Well, faith is good. Having faith or going to church should not be in competition with getting a solution. The challenge is for people not to try and find out the problem and to solely rely on faith. We have women with problems who would have been treated in their early 20s or 30s now coming to fertility clinics in their 40s. When you ask why now, they tell you they were believing God for a child. God uses doctors to help people so I believe they are complementary. They are not mutually exclusive. Coming to the doctor does not mitigate your faith.
Can we say scientifically that there is an increase in the rate of infertility over the years?
Yes, we can say that. This is due to most of the factors I mentioned earlier. Looking at it from the women’s part, we have ladies getting married later in life than they used to do in the past like in the days of our parents where they get married in their 20s and by their 30s, they have completed their families. That has happened for various reasons. Some pursue their career or for education. But the problem is, as a woman gets older, age catches up with her and fertility decreasing.
The most fertile years are between 20 to 30. At age 35 the fertility starts to decrease rapidly. At age 40, it becomes extremely difficult for the lady to conceive a child. Like it’s happening in the society right now where it’s hard to get married, people tend to marry late and that has increased the numbers of infertility for the ladies.
Environmental pollution like I mentioned earlier on that is affecting the men’s sperm has also contributed to the increase. I’m sure if you compare the rate of infertility in Lagos state to a remote area like IgboOra, there would be a huge difference. Environmental pollution has affected both male and females in various ways. All those things combine together to increase the rate over the years.
Talking about Women’s health, what are the things women need to know as they grow older in their 40s?
Well, women and men as they grow older need to know that their organs are not as they use to be. There are some diseases that are common that affects women as they grow older. Women are more prone to cancers of the reproductive system like the cancer of the cervix which is very preventable by doing regular smear tests and is detected and treated 10 years before it starts growing. The women as they grow older should be doing regular smear tests for themselves.
Ideally, every woman above a certain age should have a gynaecologist. There are some areas of the body that needs to be checked like the breast. The incident of breast cancer increases as the woman gets older but they are prevented if detected on time. A mammogram should be done every 3-4 years which is an x-ray of the mammary gland and they should be doing other check-ups that every normal person does about 40 regularly like blood sugar, blood pressure etc.
In terms of specific cancer cells, check the cervix, breasts and the ovaries. These are the types of cancer that tend to rear those eggs at the ages of 40 and above. The job of a gynaecologist is to check extensively every woman if they have any health issues.
Going by the achievements of people getting pregnant in their late 40s and 50s. What does this say to those that are still looking up to God for a child?
Yes, over the years, especially since 1978 when the first IVF baby came, and tremendous improvements and discovery In reproductive Medicine. Most times back then when people are older or younger but have a tubal blockage, it was unlikely that they would get pregnant naturally, so we advise them to adopt a child. But since the tremendous improvements and discovery In reproductive Medicine, even those who have reach menopause can have a baby by having the option of a donor egg.
The truth of the things is every woman that has a womb can get pregnant irrespective of whether you have reached menopause or not. The only barrier might be money or going to a fertility clinic. That’s why we have recorded cases of people in their 50s or 60s getting pregnant and having their own babies. They might be using a donor egg that is fertilized by their husbands. A perfect example is the 68yrs old woman who had twins using assisted techniques that went viral on social media and the conception was done in our clinic.
So IVF technology has opened up a door for women to have their own babies at any age.
Is IVF technology the only solution to those facing fertility challenges?
No, there are numerous solutions to infertility, IVF technology just happens to be part of them. Until you see a fertility doctor, you might not know the solution that would pertain to you. Sometimes, IVF can be the last solution and it can also be the first solution. For example for someone who has a bilateral tubal blockage, IVF becomes the first option but there are other options apart from IVF technology. Sometimes, ordinary counselling of the couple results in pregnancies.
So What’s your message or advice to women out there regarding what to do about infertility?
I think the number one advice would be to understand that age plays a big role in fertility unlike for men. They should understand that as they get older, the quality and quantity of their eggs start to decrease and it decreases at a very fast rate at age 35 upwards. So The most fertile time is from age 20 to 30. So try and achieve getting pregnant at that age. I know it might be quite difficult especially in Nigeria right now for a woman.
There are quite a sizeable number of women who know for a specific reason that they probably would not be ready for children till probably in their 30s. IVF technology has opened up another pathway where they freeze their eggs in their 20s so that it would still be fresh whenever they are ready to use it probably in their 30s. So age is very important for a woman. Even if one gets pregnant at old age, the incidents of miscarriages start to rise because the quality of the eggs has started to decrease.