Dr Abayomi Ajayi

For couples who are unsuccessful with natural conception, advancing infertility research has provided successful treatments for men and women alike.In so many ways, fertility specialists all over the world are creating methods to make initiatives that will restore or boost fertility. One of such techniques that consistently bring life-altering joy to infertile couples is in vitro fertilisation.

In Nigeria and perhaps much of Africa, the common thought regarding infertility is that the problem lies within the woman’s physiology. This is because a woman’s reproductive organs can be more easily damaged than a man’s. However, regular readers of this column are by now familiar with the fact that infertility is a shared problem between men and women. About 40 per cent of the time, infertility is either due to a male factor or a female factor. Some couples may both have factors that interfere with conception.

All around the world, pockets of the population face a high risk of infertility. The problem rests mostly with populations where women have contracted sexually transmitted diseases in the past or have delay in childbearing for certain reasons. Physical causes for infertility in women include scarring on the cervix, uterus, or tubes; blocked tubes; and problems with ovulation or the menstrual cycle.

Male organs are much more easily damaged by mumps, swelling of the testicles, or a varicocele (a large varicose vein on the testicle), that can cause lower sperm count. For couples desperately trying to conceive, any additional help they can receive is a relief.

Couples going through any number of infertility treatments are more likely going to try a procedure, such as IVF or Intrauterine insemination, also known as artificial insemination. Giving couples even the slightest chance of improving the probability of conceiving is a boost. Couples seeking assisted reproduction techniques are often urged to choose the treatment option which maximises their chances of conceiving quickly. This is so because traditional treatment for infertility usually involves a logical step or wise approach.

First, a diagnosis is made to find out what the problem is. Next, an attempt is made to try to fix it using a progressively escalating approach. Medications are tried first. If this fails, surgery is tried and if this also fails, then it may be on to IUI. If this still does not work, then we try HMG (human menopausal gonadotropin) superovulation plus IUI; and if this ultimately fails, and the patient is up to it, IVF is the ultimate.

Today, IVF is practically a household word. But not so long ago, it was a mysterious procedure for infertility that produced what were then known as “test-tube babies.” Louise Brown, born in England in 1978, was the first baby to be conceived outside her mother’s womb.

IVF is sophisticated unlike the simpler process of artificial insemination — in which sperm is placed in the uterus and conception happens, otherwise normally — IVF involves combining eggs and sperm outside the body in a laboratory to form embryos. Once an embryo or embryos form, they are then placed in the uterus. IVF is a successful procedure; but less than 5 per cent of couples with infertility seek it out.

When it comes to infertility, IVF may be an option if you or your partner has been diagnosed with problems including endometriosis, low sperm count, ovulation challenges or an unexplained fertility problem, among others.

IVF may not be the first step in the treatment of infertility except in cases of complete tubal blockage and very low sperm count.

Traditionally, IVF has been used for treating infertile couples. However, it would be equally valid to use IVF to help couples to achieve their personal reproductive goals, as long as they make a well-informed decision, and are aware of the pros and cons.

Actually, if most fertility experts had a choice, the only treatment they would offer would be IVF – after all, the bottom line is to get pregnant as soon as possible. If couples can get pregnant with IVF, then why not use it first rather than as a fallback option when all else fails?

While all this is logical, it often does not work out clockwork in real life. Some couples complain that the IVF approach is time consuming, and may even drop out of treatment rather than move on to the next step. This can be tragic however because there are scores of patients who could have got pregnant with IVF but didn’t because they were not patient enough.

The first step in IVF involves injecting hormones so the woman can produce multiple eggs instead of only one. She will then be tested to determine whether she’s ready for egg retrieval. Prior to the retrieval procedure, she’s given injections that start the process of ovulation. Timing is important; the eggs must be retrieved at the right time. It is important to state that women are not cut open to retrieve the eggs.

Most women are given pain medication with the choice of being mildly sedated or going under full anesthesia. For egg retrieval following this, the eggs are mixed in the laboratory with the partner’s sperm, donated on the same day. The fertilised eggs are kept in the clinic under observation to ensure optimal growth.

Once the embryos are ready, the woman returns to the IVF facility so doctors can transfer one or more embryos into her uterus. A pregnancy test is performed about two weeks after the embryo transfer.

Success rates for IVF depend on a number of factors, including the reason for infertility, where the procedure is done, and the couple’s age. Any embryo that is not used in the first IVF attempt can be frozen for later use. This will save money if the couple undergoes IVF a second or third time.

It has been extensively explained in the past that a woman’s age is a major factor in the success of IVF for any couple. For instance, a woman who is under age 35 and undergoes IVF has a 40 to 50 per cent chance of having a baby, while a woman over age 40 has an 11.5 per cent chance.

Is IVF affordable?  The answer is yes. The average cost of an IVF cycle in Nigeria will vary depending on factors like the amount of medications required, the number of IVF cycles, and where it is performed.

It’s well known that pregnancy rates with IVF are much better for younger women than for older women, so it’s much more cost effective to do it when you are younger. It is true that doing IVF means spending considerable money. On the other hand, not getting pregnant has a considerable cost attached to it too – the drainage of emotional energy and the time spent waiting and hoping. IVF may be more cost effective and time effective for many patients.

Equally importantly, IVF gives infertile couples peace of mind that they tried their best – that they gave infertility treatment their best shot. This peace of mind can be priceless! In the past, IVF was considered to be the treatment of ‘last resort’ – and was reserved for patients who had failed all other treatment methods. Today, it is often the treatment of first choice because it maximises the couple’s chance of conceiving quickly, no matter what their medical problem is.

Ideally, the best option would be to allow couples make informed choices. Where there are options, the responsibility for deciding depends on them with the guidance of fertility specialists.

 

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