IVF is a solution to infertility among couples. But, it comes with some issues. Lately, some women who conceived through IVF have been talking about these issues. They include developing Ovarian Hyper Stimulation Syndrome, having IVF failures, suffering from miscarriages, having mental issues, etc. To get an expert view on the matter, City People’s Contributing Editor, IYABO OYAWALE approached Dr Abayomi Ajayi, the MD/CEO of Nordica Fertility Centre. He shed light on these issues and more below.
Why do women have to go through several cycles of IVF in trying to conceive?
Let’s put it in context and say that not all women go through several cycles but the majority of people need to go through several cycles because the success rate of IVF is not 100%. The technology doesn’t work that way if you know that about 70 to 75 per cent of embryos formed in the Lab cannot become babies. What we’re trying to do is to force nature to do what it does not do normally. Every month a woman produces, it’s only one egg that ovulates but when we’re doing IVF, you bring about 10, 15 or 20 eggs out but it’s not the eggs that can become, babies. So, sometimes, in the course of the processes that happen, sometimes, the embryos you have cannot become babies. Apart from that, there are a lot of steps involved. Apart from fertilization, you have the big one, which is implantation. So, sometimes the embryos that make it to that point cannot become babies. There are so many IFs. That explains why we say that if you’re starting, don’t plan to have one cycle. If you succeed after one cycle, that’s great. And of course, we know that the chances that you succeed with one cycle are dependent on your age. The age of the woman is one of the main determinants of success. There are so many things involved in IVF and it’s always better for your psyche to prepare for more than one. We know that when some people fail, it takes them a long time to come back to do the cycle and unfortunately, it’s the best time of their reproductive career when they’re waiting to gather enough courage and confidence to do another one. That’s why it’s always better to prepare them upfront that they might need more than one cycle. If you get pregnant after one cycle, that’s great but if you don’t, you should be mentally prepared to go for another one. People do IVF to have a baby or babies, until you have done that, then you’re not successful. That’s why we prepare them for multiple cycles.
So, what’s the success rate of IVF?
I just said now that it’s dependent on your age and it’s not that everybody has the same success rate. That’s why we say each couple carries their success rate. It depends on the age of the woman. It depends on the reason you’re doing IVF so, there are so many things involved. We know that the final thing is getting a baby but there are many steps involved in getting you a baby. That’s why we’re always talking about people understanding the process. So, that it’s easier for them whether they succeed or not the first time. Back to your question, if we want to put figures to it if you’re less than 35, which is the prime of your reproductive career, then success would be about 40 -50 per cent.
Some women have several miscarriages before they conceive full term. One of the daughters of Chief Okoya said she had 14 miscarriages before she had her twins. Why is this so sir?
Are we talking about IVF or natural pregnancy?
It was through IVF sir.
I asked that question, it’s still the same thing, whether it’s IVF or natural pregnancy, the genes of the husband and wife, if they’re not using donor eggs, are still what you’re going to combine. If the husband is an older man, the chances that there would be a miscarriage are even higher. If there’s a family history of congenital problems, the chances that there would be a miscarriage are even higher. Of course, there are some things that we can do to reduce miscarriage. We can do what we call Pre-implantation genetic diagnosis to be able to see that the embryos we’re going to transfer are normal embryos because like I told you earlier, about 70-75 per cent of embryos we form in the Lab cannot become babies and there are so many factors responsible for this, including the age of the 2 of them, particularly the woman but also the man. So, there are so many complex issues and therefore it’s always important to listen to your doctor, ask questions, and the most important thing, you know the Bible says knowledge is the principal thing, in all your getting, get understanding. Even in IVF, even in reproduction, it’s important for us to understand the technology, what it can do and what it cannot do.
Why do some women suffer from Ovarian Hyper Stimulation Syndrome? I read the story of Stephanie Coker-Aderinokun. She went through IVF and was successful on her first attempt but she said she had the syndrome and it was almost life-threatening for her.
Yes, Ovarian Hyper Stimulation Syndrome is one of the common, well not common because it’s less than 1 per cent of patients who go through IVF that have it. It’s even rarer now because we now have different types of protocols that can almost prevent Ovarian Hyper Stimulation Syndrome but a few years ago, it was almost about 2 per cent of patients that have Ovarian Hyper Stimulation Syndrome. So, the experience of the clinic and who you are also matter a lot in some of these happenings but like I said, it’s not very common, it’s still possible but it’s not a very common complication anymore. It’s becoming rarer and rarer that now, we’re even talking about having an OHSS-free IVF clinic. I can’t remember the last time we had Ovarian Hyper Stimulation now. Maybe 8, or 10 years so it’s a rarer complication now. But, it’s known that anytime you give a drug that can simulate the ovaries, you run the risk of Ovarian Hyper Stimulation Syndrome and that’s why like I said there are regiments that almost avoid OHSS. I’m sorry if somebody has suffered from it, those can happen, but now, I think our experience with IVF is much better and we can almost say that the chances of Hyper Stimulation are 0.000 something per cent because now we also do what we call Freezol where we can freeze your embryos, instead of transferring and we have good freezing programs now. So, these are some of the things that help us prevent hyperstimulation.
IVF is touted as the best solution for infertility in couples but like most medical solutions in life, it comes with side effects. Now, what are the potential side effects of undergoing IVF?
I thought that’s what we’ve been talking about. The commonest one used to be Ovarian Hyper Stimulation Syndrome. And then one in 1000, it’s possible that the needle goes into the wrong place because we don’t operate to take out the eggs. Then, of course, you could have multiple births. That we’re reducing by sometimes not transferring more than one singular embryo or 2 embryos at the maximum. These are some of the complications that can arise. And of course, very rare complications that some people could have, blood clots but there are some people who’re already predisposed to that. It’s not the IVF that causes it. So, yea, those are some side effects we could have from IVF.
How long is the IVF process from start to finish?
There’re different kinds of IVF procedures. It might be different if you’re using donor eggs, and it might be different if you’re using your own eggs. It might be different if you’re using a Pre-implantation genetic diagnosis but the average cycle takes about 6 weeks from start to when you’ll do your pregnancy test.
Is IVF painful?
Well, I don’t think so but the pain is a subjective thing. It’s not painful but maybe discomforting. But, if a patient says I have pain, you’ve got to respect that.
How do you handle the mental issues that arise out of IVF I read another story where the woman said she failed severally and almost didn’t want to go for another cycle but she had to push herself. How do you handle these mental issues that come with doing IVF at your centre sir?
Yes, there are counsellors at the centres. We know that going through this procedure is always emotionally tasking and we have staff that would hand-hold them. We know it’s probably the toughest period that tests their relationship so we try to as much as possible handhold them through this period, not just pure knowledge but also somebody you can lean on. But the first thing is to understand what you’re going through because even the Bible says “Jesus for the joy that was set before Him endured the cross.” So, it’s easier for you to go through the process when you understand what it entails. But, no matter how strong you are, there are some times that you definitely would need support and that’s what we are here for. So, we have quite a number of people, counsellors, nurses, and doctors, who can offer that.
What are the different types of IVF?
IVF is still IVF but it depends on if you’re using your eggs, your sperm, or are you the one carrying. So, we have different offshoots of IVF depending on your situation. We call one third-party reproduction. This is a situation where we have somebody else involved, apart from the couple. It’s either the person is donating sperm or somebody is carrying the baby or babies for the couple. So, these are just spin-offs of IVF technology. IVF itself is the umbrella body for technologies that involve mixing sperm and eggs together in the laboratory. But, we have spin-offs of the processes like ICSI. ICSI is still IVF. We use ICSI when the sperm count is not very good. We use that method to select the sperm and fertilize the egg with the sperm. We have so many spin-offs. That’s why we say most of the time that your treatment is tailor-made for you. It’s customized for the couple, depending on what their problem or problems are.
You mentioned low-sperm count. What do you think causes it sir?
We cannot say it’s one particular thing. There are so many causes. Some people inherit it. Other people have it because of their lifestyle. Yet some other people have it because of injury. For some people, it’s because they have a growth in their testes that needs to be attended to. Some people have had a fall. Some people have infections, there are so many reasons you would have a low sperm count. Now, what we look at is the solution. The only cause that’s reversible is that of lifestyle. For those who smoke, or use recreational drugs, we probably would appeal to them to stop. The use of cell phones is also being touted as a possible cause of low sperm count. Some people even say climate change because we feel sperm count might be reducing globally. We’re concentrating more on how to treat, rather than the cause. Because most of the time you never get to the root cause. So, we eliminate the ones we have control of, such as lifestyle and concentrate on treating the patient to be able to achieve our goal of having a baby.
So, ICSI is the solution for people who have low sperm count?
It‘s one of the solutions.
Why is it necessary to have so many eggs when doing IVF?
Because we want to have as many embryos as possible. The more eggs we have, the more the productivity of success. Like I told you, about 70-75 per cent of embryos we form in the Lab cannot become babies. While looking out for eggs, we are also careful to avoid a situation where the woman develops Ovarian Hyper Stimulation Syndrome. It’s always a balancing act between having enough eggs and making sure the woman doesn’t have Ovarian Hyper Stimulation Syndrome.