Patients Need Education on IUI, IVF

Dr.Ajayi

As some Nigerians continue to fall prey to substandard and fake fertility treatments across the country, a renowned fertility expert and the Managing Director of Nordica Fertility Centre, Dr. Abayomi Ajayi in an interview with journalists recently, called on patients to learn about invitro fertilisation, intra uterine insemination, who should use IVF, and when assisted reproductive techniques must be considered. Martins Ifijeh brings excerpts

Most Nigerian couples have issues differentiating IUI from IVF. Could you elaborate on the differences?

Let’s put it this way, IUI, which is Intra Uterine Insemination and IVF, which is Invitro Fertilisation are cousins but they are not interchangeable; they both belong to the group that we call Assisted Reproductive Techniques (ART) but the most basic form of that family or the least developed is IUI which any doctor can do. You seriously don’t need any particular equipment to do that except to prepare sperm because we know that when the semen comes, there is sperm, there is seminal fluid so all you just need to do is to separate them from each other, concentrate the sperm, and then you are able to introduce it back into the woman. And for a woman to be able to do IUI, her tubes must be opened, while the sperm must be good.
But when you look at our environment, the commonest problems are blocked tubes on the part of the woman and bad sperm on the man’s part. This makes the IUI of limited use in this environment.

You look at it in this environment where the commonest problems we have are those two things, blocked tubes and bad sperm quality, it has very limited use in this environment.
But there are some people who will still benefit from it but you need to be sure that those two things- the sperm parameters are good, and tubes are open so it is useless for anybody who has blocked tubes to be doing IUI, if you do one million, you can’t get pregnant.

But the common happening now is that people are mixing up the two and the patients are not any wiser. Someone who is ideally supposed to be doing IVF, is rather recommended for IUI which is not the ideal solution. For IVF, you need to bring out the sperm, egg, then combine them to form an embryo before you can transfer back into the patient. And for this to happen, you have to start with the use of drugs, which makes the woman to produce eggs, and that is why it is called IVF and Embryo transfer.

It is important, especially now that it is hard to get money for patients not to waste their resources and even their productive life in the hands of charlatans who give IUI in place of IVF just because they want to exploit the patient.

I was talking to a 50 years old woman who said she went to store her eggs in one clinic. This made me wonder, how can she store her eggs when she wont be needing it, because she can’t use her eggs, what she needs are donor eggs. So what is she storing? And she will continue to pay money for this kind of thing. It is so important the media educate the public on IVF, so they can make informed choices and also know from knowledge which doctor is telling them the right thing.

Have there been any regulation recently to tackle quackery and monitor fertility clinics in the country?

Regulation is slow even though we are making efforts at it. If you are waiting for legislation or regulation, a lot of people will still continue to be misinformed and misled. The fastest thing is for the citizens to be equipped with information. Once a buyer of a treatment plan knows what he or she is buying, the person will most likely not waste any money on quacks.

Though our associations is working on regulation, but I tell you, how many clinics can you police a day. In a year how many? If they know you are coming, they will put up their best behaviour, when you leave, they continue with what they are doing. So the easiest thing to do is educate the people who are investing their time and money in these clinics so that they know and can ask their doctors questions. They can tell their doctor what you are giving me is IUI and not IVF. Imagine a doctor in a teaching hospital doing IUI for a 43-year-old, that is criminal, you don’t do IUI for a 43-year-old, because you wouldn’t achieve the needed result.

Don’t you think these lapses are from the professionals themselves?

The problem is that most of them don’t know, you just assume that they know because this is a different branch of medicine. The fact that you are a gynaecologist just doesn’t make you a fertility specialist.

So who are the right people to practise it?

Someone who has been trained as a fertility expert is qualified to practise, because you need to know the indications. The fact that you can do surgery or you are a gynaecologist doesn’t mean you can practise as a fertility specialist.

Like I told you, IUI is the most basic form of assisted conception, once you are trained, you can do it because you don’t need big equipment to do that, all you need is a functioning lab, but the fact that you can do it doesn’t mean the patient needs it. Your job is to be able to identify the patient who really need it. Unfortunately in this country, not many patients will benefit from IUI  because our biggest problems are tube blockage and sperm quality issues. These two are contraindications when it comes to age (above 38). Once the person is above 38, it is relative contraindication to IUI because the success rate goes down dramatically not to talk of when the person is 43 years old. At that age if you do one million IUI, it wouldn’t work even when the tubes are open.

Why I think all we need is patient education is because that’s how endometriosis started, but when people started getting education on it, they started asking doctors questions, and this makes doctors uncomfortable and sit up. At that point the doctors will be forced to learn more about the health issue so they don’t get embarrassed. So the same step I think we need to take here, educate our patients correctly.

Also one of the problems that patients are having now is comparing oranges with apples. They are comparing IUI with IVF because they don’t know the difference between the two. So when somebody says, I am going to do it for N10, they run there but what is the person doing, is it IUI or IVF? But if you know what it is, you will ask questions. I keep telling patients that it is their body. You shouldn’t let any body insert anything into you without you knowing what they are doing.

But most times when patients become inquisitive, doctors become defensive and harsh. What should the patient do?
The patient should walk away from such a doctor. Don’t forget that infertility treatment in Nigeria is paid out-of-pocket. That’s the more reason you should ask questions because you sweated for the treatment money.

Who should use IVF?

Patients whose tubes are blocked, patients who we don’t even know why they should not have children (this category is called unexplained infertility because they have done the entire test and they are normal). For those people, if they are less than 38, they could first start with IUI. But for those who can afford IVF straight away, they can take IVF, but the expert must lay everything on the table so they can make their choices themselves. If sperm count is just likely not very good, just likely, not that it is severely bad, they can try IVF. Someone suffering from endometriosis can also try IVF.

But one thing we can also know now is that IVF can be used for some people who don’t have infertility like in cases of sex selection, if you want to prevent diseases, because now, we are able to do the gene analysis of the embryo we can use that to prevent genetic diseases, so now the scope of IVF is expanding beyond just infertility treatment and it is ethical.

There have been accusation lately that many doctors coax their patients to do caesarean sections, now again it seems we are also going the same root with IVF?

That is why I said IVF can be used for unexplained infertility. Let’s look at a couple that have been married for eight to 10 years and they have not had children and let’s say theoretically that the woman is about 36, or say 34 and they come in front of you and you know the pressure that family will be going through, and they have the means and as a responsible doctor, you present the two options to them, say; you can do IUI or IVF, the success rate of IUI is 10 – 15 per cent.

The success rate of IVF is 25 – 30 per cent and they have the money, tell me which one they are likely to choose. Of course, it is IVF so that is not doctor now. I told you that a responsible doctor must give them all the options because some of them might say, why don’t I try IUI once or twice and if it doesn’t work I will do IVF. There are controversies over success rate of IVF. Some experts are saying one per cent, some say 46 per cent, while some even claim 100 per cent.

What is the success rate?

Don’t let us quote things out of context. Is this person talking about a particular age range because there are some age range you can have forty something per cent, those are the cream of IVF, less than 35 years old and you can have very lower percentage when talking about over 40 years of age.

So what is the average success rate of IVF?

That is why we always say 25-30 per cent when taking everybody together.

With your experience, what has been the success rate for you?

For women below 35, it is 40 to 50 per cent. For 35 years upward upwards it is 25 to 35 per cent.

What are the factors you will see in a woman that will make you recommend IUI for her?

The woman’s tubes must be open, at least one, but if the two are open, the chances are better but at least one must be open, if the two are blocked, it is criminal to do IUI for such a person. Another thing is that the sperm count must be good as well as sperm mortality. If the sperm count is good but motility is bad, you are not going to get anything. But for some people, you explain to them that we are not going to get anything here because of this sperm and if she says why don’t you try, I don’t have any money for any other thing, you try but you have told her that this is not your preferred form of treatment.

In terms of cost, is IUI cheaper than IVF?

Of course, it is like buying Volkswagen and Mercedes Benz. But some doctors are not telling their patients the truth, they say I am doing IVF for you but actually what they are doing is IUI. And so they don’t collect the money for Volks but actually collect money for Mercedes.

At what point would you advise couples to go for treatment?

When there is no problem at all, what we define as infertility is when you have tried for one year. For example, if the man knows that even before he got married that one of his testicles is missing, he knows that there is a problem, such a person should seek help faster. He doesn’t need to wait for one year. If the woman is less than 35 years, you can wait for one year, if she is over 35, after six months, you should be going to do your test. If for example the woman also has irregular cycles, then she doesn’t need to wait for one year before seeking help, she will be advised to start almost immediately. Another category will be women who do not menstruate regularly.

If she is not ovulating, she cannot conceive. There are some women who only menstruate four to six times a year, such a patient should see the doctor early so that she can be able to get pregnant but if everything is okay, we say wait for one year before you start your investigations. Again, it also depends on the woman’s age. If she is less than 32, she can stay one more year with her gynaecologist. But for the man, if there is a problem of low sperm count or tubes are blocked, he is required to start treatment immediately because the earlier you start your treatment, the better the success rate. And that is why we say that once you need IVF, you better start on time.

IVF: No law yet in Nigeria on pregnancy with dead man’s sperm

Conceiving a baby with sperm extracted from a dead man (post humously) is an IVF innovation that is gradually gaining popularity elsewhere in the world. Through this procedure, young men, who died suddenly without fathering a baby, have a chance to conceive, from 0-48 hours after being dead.

A recent case was that of a healthy baby boy born after doctors in Australia used sperm taken two days after the father had died from a fatal motor bike injury for In-vitro Fertilization (IVF) procedure. The wife of the deceased had opted for the procedure after her husband died without a chance to father a child. Doctors had described it as a ‘most extraordinary case’, due to the length of time the sperm survived after the man’s death. Previously the longest time recorded for sperm taken posthumously that produced a healthy baby was 30 hours – 18 hours less than in this case.

IVF expert Steve Robson, an associate professor at the Australian National University medical school, said there had been fears sperm taken after death could have its DNA damaged, but this case had shown this did not occur. In fact, the woman had become pregnant at the first attempt, and now has a healthy baby boy. A similar case is that of a Texan mother, Missy Evans, who gained media attention in 2009 for her attempts to use her deceased son Nikolas’s sperm to create a child. She later won permission to harvest Nikolas’s sperm, and sought and found willing surrogates in several countries. According to Robson, the sperm extraction could be done through a process known as postmortem sperm retrieval. “There are several main ways that sperm are harvested, including needle extraction. As the name suggests, this method involves inserting a needle into the testis and drawing out some sperm. It’s often used in live patients but because minimizing invasiveness does not matter in dead people, doctors tend to use other methods in post-mortem.

One of these approaches is to extract the testis or epididymis surgically. As the epididymis is where sperm go to mature, this tissue is a popular target. The doctor surgically removes the epididymis and milks it or otherwise separates the sperm from the tissue. Alternatively, the epididymis or a piece of testicular tissue can be frozen whole. A fourth option is rectal probe ejaculation, also known as electroejaculation. The doctor inserts a conductive probe into the man’s anus until it is next to the prostate. A jolt of electricity causes a muscle contraction that stimulates ejaculation of sperm through the usual channels”, he said. However, there are varying controversies regarding the ethics of post mortem sperm retrieval. For instance, The American Society for Reproductive Medicine’s position is that post-mortem sperm requests should be granted only to surviving spouses or life partners and that there must be a grief period prior to the sperm’s use. Other opinions and legal rulings vary, according to countries. In Israel, implied consent suffices — a deceased man need not have left a written document but his widow just has to say that she believes he would give consent were he alive to do so. The government may even provide financial assistance: state health insurance will pay for as many IVF cycles as needed to produce two babies. As for the rights of posthumously created children, after a 2007 court battle any child produced is considered the deceased man’s legal heir.

Some fertility clinics in the U.S. and elsewhere refuse to perform a post-mortem extraction if the person requesting is anyone other than the man’s wife or committed partner, unless he has left written instructions that state otherwise. France, Germany, Sweden and Canada are among the countries that prohibit posthumous sperm retrieval. In the United Kingdom, it is not allowed unless the man has given prior written consent. In the mid-1990s, the case of Diane Blood brought the issue into the public eye there. Diane and her husband Stephen had already begun trying for a family when Stephen died suddenly from meningitis. At first the courts in UK denied Diane’s request to have children using Stephen’s sperm, saying its collection had been illegal. But after appeal, she won the right to send the sperm outside the UK so she could undergo insemination in a more permissive country. Diane eventually gave birth to two boys with her husband’s sperm. Here in Nigeria, investigation reveals that this procedure has never been done. According to Prof. OladapoAshiru, a renowned IVF expert, such procedures can only be done with legal approval and consent. “However, a more acceptable procedure is extracting the sperm while the man is alive and using it to make babies after the man is dead”, he said.

 

By Frank Osakwe

5 FACTS ABOUT IVF EVERY COUPLE SHOULD KNOW

According to research, Nigerian Yoruba women have one of the highest incidence rates of having twins in the world- every 45 of every 1,000 births? Because of this, however, Yoruba women are also at higher risk of developing polycystic ovarian syndrome (PCOS) or Ovarian Hyper-stimulation Syndrome (OHSS).

Around 10-15% of couples experience the heartbreak of being unable to conceive naturally. IVF is an assisted reproduction technology (ART), giving new hope to couples who cannot conceive naturally. Louise Brown, born in 1978, was the first IVF baby. Over the years, technological advancements and innovative techniques have further improved IVF treatment, with around 3.5 million babies born through fertility treatments. Here’s a list of the essentials you need to know regarding IVF:

CAUSES OF INFERTILITY

Couples who have been unable to conceive naturally for over one year should seek advice from a fertility specialist to assess and determine the possible cause/s. The cause of infertility can relate to factors in both men and women. The most common cause of infertility in women (accounting for 40% of cases) relates to the ovarian cycle, where women may not be releasing enough or viable eggs; or physical abnormalities such as blockages in the fallopian tubes, uterine abnormalities, endometriosis (growth of uterine wall tissue outside the uterus), or PCOS

Infertility in men (accounting for 30% of cases) usually relates to sperm production, in both quality and quantity. There may also be anatomical obstacles to ejaculation or sperm production. Hormonal irregularities and genetics may also influence fertility in both men and women; but 30% of infertility actually relates to unexplained factors in both genders.

 

2. Be ready

The IVF procedure does not come without its challenges. Mentally you should feel that this is the best option for you both. You should be prepared to undergo a series of physical and invasive tests to establish your eligibility for IVF, as well as making the necessary lifestyle changes as recommended by your specialist. These include both partners being tested for HIV/Aids and Hepatitis B and C, as well as undergoing genetic screening. For women, the exam also includes a hysterosalpingography, Pap smear and ovarian function test, among other tests. Men are required to provide a sperm sample to test the quality and quantity of sperm.

Once a couple is considered eligible, they should understand what is involved in the entire IVF procedure, including the numerous hormonal drugs that will be administered and the risks involved. They should also consider the possible financial restraints of the procedure, if for example they require a second cycle of treatment after the first was unsuccessful. IVF can be an emotional rollercoaster of highs and lows, influenced by hormonal therapies and the overall treatment process, thus it’s important to receive full support and guidance throughout your treatment. Added attention to stress relief and self-care, a balanced, supplemented diet with gentle exercise and alternative therapies, like acupuncture, can be beneficial.

 

3. Risk Awareness

As with any medical procedure, your thorough knowledge and understanding of all risks associated with ART should play a crucial role in your decision of whether or not to proceed with treatment. Always consult your physician and receive a full diagnostic examination before accepting any new medical procedures.

Aside from the emotional and financial stress that stems from the fertility process, ART drugs may cause further irritability, stress, headaches, hot flushes, mood-swings, and nausea. These reactions are common and manageable. It is highly recommended to contact your physician if you experience any discomfort or concern.

IVF treatment can result in multiple pregnancies as a product of multiple embryonic implantation and over-stimulation of the ovaries. While the prospect of having multiple children may be appealing to couples struggling to conceive, a multizygotic pregnancy poses an increased health risk to the mother and may threaten the success of the pregnancies in reaching full term. Certain demographics of women, such as Yoruba women, are naturally more prone to multizygotic pregnancies, and should take further consideration with their physician when determining their eligibility for treatment.

Ovarian Hyper-stimulation Syndrome (OHSS), although very rare, is a result of the ovulatory stimulating hormones taken during IVF. OHSS results in bloating and abdominal pain. Patients experiencing such discomfort should consult a health professional immediately before further complications occur. Physicians assess each woman for this risk, and are capable of managing it effectively. Women who are more prone to multizygotic pregnancies, such as Yoruba women, also tend to be more prone to OHSS and should be mindful of this risk when considering IVF treatments. Ectopic pregnancy (embryo outside the uterus), although rare, is more likely to occur with IVF than with natural conception.

 4. Age influences Success Rates

Success rates are influenced by many factors and can differ case-by-case depending on the unique cause of infertility and lifestyle choices or the patient. But the success of IVF treatment in all candidates is largely age-dependent. A woman is at her peak fertility in her 20’s, with egg quantity and quality declining after the age of 35. For women under 35, assisted reproduction is successful around 40% of the time. It is recommended for women older than 35, who are still trying to conceive after 6 months, to seek advice from a fertility specialist. In men, particularly over the age of 50, the viability of their sperm also declines with age. One should not be discouraged, however, as over 25% of couples are still successful with IVF.
 

5. IVF procedures

There are various different ART approaches depending on the cause of your infertility. In most cases of IVF, the egg is extracted and then washed with a large quantity of motile sperm (~100,000 cells) and left to incubate and fertilize naturally. In cases where the sperm count is low, intracytoplasmic sperm injection (ICSI) is employed, injecting a viable sperm cell directly into the extracted egg. The fertilized embryo (or in some cases multiple embryos) is then inserted back into the uterus.

Extra embryos can be frozen (cryopreservation) for future pregnancies, or to be used if the previous treatment is not successful. Women undergoing chemo or radiation therapy may also undergo cryopreservation in order to protect their eggs during cancer treatment. Since a woman is most fertile in her 20s, and it is best to freeze eggs before age 35.

In cases where a partner’s gametes are not viable, or there is no partner (or no partner of the opposite gender), IVF can also be conducted using donated eggs or sperm. There also exist several other less common, but viable approaches to ART, which may be suggested by your specialist depending on your specific case.

 

Source: Nicole the fertile chick

NATURE CURES FOR INFERTILITY

The principles are:
1. The more water you drink, the better for you.
2. The more fruits and vegetables you eat, the better for you.
3. The more natural your diet, the better for you.

Learn to drink at least four glasses of water first thing on rising daily. This is extremely important for infertile couples. If you cannot have your supper before 7.00 p.m. simply forget about it, and take plenty of water. Make sure you take not less than five cups of water daily. Men who suffer from low sperm count should avoid alcohol and sugar. They should take plenty of lime, lemon and honey. Women should avoid sugar and all sugar products like ice cream, soft drinks or glucose. Remember that a ball of orange is better than a bottle of coca-cola drink.
Rev. Fr. Anselm Adodo...Nature Power

FERTILITY CRISIS

Fertility Crisis!
•40% men suffer low sperm count •Late marriage in women big factor •Couples now queue at orphanages to adopt babies•15 fertility clinics to the rescue •IVF costs N1.2

By the accounts of Nigerian medics, there is an upsurge in the number of couples seeking fruits of the womb in the country, a trend experts attribute to a number of reasons ranging from late marriages, environmental factors and decline in the quality of sperm.
Indeed the situation has given rise, in some instances, to the dislocation of some otherwise ideal families founded originally on love.Worse still, evil merchants, taking advantage of the situation, have set up shops and are surreptitiously trading in babies of indigent mothers like stocks on the floor of the Stock Exchange. Quite a few have been nabbed in the process. Those that bother to do the right thing run accredited orphanages, now with unprecedented patronage. At the spiritual level, some self-professed miracle workers have been at their very best, all in an attempt to convince baby seekers to look into their places of religious worship, and be glad that they did.
Yet, the problem remains that Nigerian men are by the day losing their virility to empirical reasons. On that score, medical personnel are of the opinion that stress alters the reproductive system by impairing hypothalamic function responsible for reproduction in both sexes, fertility declines with age.
They also fingered environmental pollution, substance abuse, obesity in women, and multiple sexual partners that lead to sexually transmitted infections, resulting in tube blockage, as key factors fuelling infertility.Hear Professor Oladapo Ashiru, Medical Director of Medical Art Centre in Lagos: “The number of infertile couples is on the increase and more worrisome is that the number of men presenting with low sperm count is on the increase.”Sunday Sun gathered that the statistics has shot up from 15 per cent in men to 40 per cent.The development has led to the proliferation of fertility centres, churches with bogus claims of miracles and spiritual homes, making couples desperate and even gullible in the hands of opportunists.
Over 15 fertility centres have sprang up in four cities - Lagos, Port Harcourt, Benin City and Abuja.More worrisome is the fact that it has, in some instance, led to the breakage of many homes. Sperm donation and surrogate motherhood, hitherto perceived as abomination, have become rampant in the country.However, few genuine Assisted Reproduction and Fertility Centres offer solution to infertile couples, but at exorbitant prices.
On the average, it costs Six hundred and fifty thousand Naira (N650, 000) for a procedure of Assisted Reproduction.
It was gathered from orphanages in Lagos that the demand for adoption far outstrips supply, so couples now queue for months on waiting list, further affirming that all is not well with procreation process.
Prof Ashiru speaks:Yes, infertility is on the increase in Nigeria. The population that is involved with regard to infertility is as high as 20-25 per cent of married couples. One in five couples have fertility problem and the trend is on the increase for two reasons. One, there is increased awareness about the problem. Secondly, there are more problems that are occurring within the system, that are technological-related that are creating fertility problems.StressFor both men and women, the first is emotional stress. Our society is a highly stressed society. From home to work, and the kind of things that go on, are all stress-related. There is stress in getting on the traffic on the road; there is stress in achieving what you want to do. Even, when you go to the store to buy something, there is stress. There is fear from armed robbery. Economic, financial stress is there, because we live in a society that place a lot of emphasis on money as opposed to value of professionalism. The level of stress that goes into marriage planning and the money spent by the couple is high stress-related. All these have far reaching consequences on a centre in the brain called the Hypothalamus, the centre that controls some of the reproductive functions.Stress is a condition that triggers the adrenal gland. This is known as the stress gland. When there is too much pressure on the adrenal gland, it will control the ovary and the sperm cell, and the brain. Under normal circumstances, when it is stable, it balances these two hormones, the brain and the hypothalamus and the ovary, so they circulate like an orchestra in symphony, to bring out this tune and at the end of each month, it will clock at 28 days to produce an egg. Stress, either from the environment or your thought, goes straight to the adrenal gland. If you can’t handle it, it releases some hormones, and could lead to high blood pressure. If you can’t handle it, it releases some hormones that create problems for the ovary and metabolic process, so the person may start to eat too much. It may release something that affects mood, leading sometimes to depression. When that occurs, it may affect the ovaries and the woman may no longer ovulate every 28 days. Sometimes it may be 19 days or it could be delayed. Sometimes, it could lead to early miscarriages.Effect on menIn men, stress is known to reduce sperm production by 15 per cent. It destroys the spermatozoa.AgeMany people now marry at late. Twenty years ago, people married at the age of 25 or even earlier. Today, people are getting married at the age of 32 or older. I am referring to the women or ladies. And for the men, it is even slightly higher. At this age, reproductive function is already declining. From basic raw statistics, for somebody that is between 16 and 21, fertility is almost 75 per cent. By the time you get to age 40, it has declined to eight per cent.Environmental hazards: generators and allThere are too many things in our environment leading to infertility. There is no electricity. Excessive use of alternative energy leads to the release of hydrocarbons and they are definitely having far reaching consequences on the sperm production process in men and the ovulation process in women. Smoke release is also a major factor. If you look at our society, the level of pollution that we are witnessing now cannot be compared to what we saw in the 70s and 60s. Almost every other house has a generating plant and when there is no light (public power supply), they all release fumes and pollute the air.Poor water sourceWe don’t have enough regulation to control our water system and there are a lot of poisons being released into the water system. In some cases, petrol stations are sited near the river. We site soap and dry cleaning industries in the various places. These have serious consequences on fertility.Bad urban planningPrevious governments made use of area planning by strictly reserving some areas as residential and some for commercial purposes. In developed societies, residential areas are strictly residential, maybe with one or two corner shops but here, areas reserved for residential are converted for commercial use. All these emit serious toxins into the air.Men firing blankMen are having very low sperm count. The percentage of men with low sperm count is higher than that in the US. From my experience in Chicago in the US, the male problem is about 30-35 per cent, but in our country, the male factor is rising. The uses of hard substance, smoking, alcohol and marijuana have far reaching effects on sperm count and sperm production.Occupational hazardsOccupational hazards, like those who work with heavy metals and those who work in hydro and petrochemical industries are at risk. Men working in plastic and paint industries are also at risk, because these are occupations that are known to drastically damage the sperm.Sperm count hithertoFrom raw information, when you have 10 couples with infertility, ten years ago, the problem was predominantly tube blockage, and those who are unable to ovulate and may be 15-20 per cent with low sperm count. Then, you could help them if you concentrate the sperm and inseminate it into the woman. But today, you are having as high as 35 per cent of men with low sperm, if not 40 per cent and a substantial per cent, say 15-20 per cent of them, you will have to get the sperm and inject it into the wife, through the procedure we call intracytospemic sperm injection (ICSI), because the sperm on their own cannot do anything. A low percentage of them have obstruction to the sperm, which are genetical factors whereby the sperm are blocked on the pathway, so you have to do a special procedure called testicular extraction to extract the sperm from the testis and then use it by ICSI to achieve fertilization and get them pregnant.Sperm countSperm count is the amount of sperm that is produced in semen. When a man ejaculates, he comes up with a fluid, either grey or yellowish in colour. The semen contains very small cells known as spermatozoon for one and spermatozoa for many. Normally, it should be 60 million in one ml and a man should be able to produce about 2-3mls per ejaculate. So you will be expecting about 120-200 million sperms in that ejacula.You could have oligospermia, in which case the sperm is there, but in small quantity and anything below 40 per cent or 40 million per ml is oligospermia. However, a man that has 10 million sperm cells can get a young lady that is very fertile pregnant. Whereas a man that has 40 million sperm cells and has a woman that is old and not so fertile may find it difficult to impregnate the woman. The next one is Exospermia in which there is no sperm cell at all, or Dispermia, that is abnormal sperm cells or Aspermia, which means there is no sperm produced at all in the ejaculate.There is also low motility. The sperms are there, but they are not very motile; they can’t move all the way to the tube from the vagina where they are deposited. By the time they get to the uterus, most of them are dead, because they are slow moving.CausesArtificial sweetners like saccharine can cause low sperm count. Wearing very tight pants can cause testicular overheating. It creates a very high temperature around the scrotum and that burns the sperm cells. Sperms thrive when the temperature is low, slightly below the body temperature.Female factorIn the US, 10 per cent of women between the ages of 44 have impaired fertility and about 25 per cent of these women will have infertility problem when they get married. On a general level, we are looking at 37 per cent of infertile women between age 35 and 44 have infertility.AgeAs age progresses, the problem of fertility also progresses. A higher percentage of women are having fertility problem because we are not marrying early. If they marry early, the problem is less. But in our own environment here, some of the causes of infertility in women are attributed to stress.WeightOvebesity is a major factor in our environment. Overweight women have polycystic ovarian syndrome. It is a condition in which the ovary, rather than produce follicles that will make egg, they produce empty follicles known as cyst, and these follicles will line the ovary and they are not be able to ovulate. This is a condition that creates infertility because the excess fat that is there does not allow the ovary to have proper hormone functions, so rather than have those hormones going to the ovaries, they are working on the fat cells. This is an easily treatable condition if early detected. Women who are also underweight and those suffering from nutritional deficiency and low vitamins also have problems with fertility, just like marathon and long distance runners.Caffeine and alcohol can also cause infertility. Perpetual habit in terms of multiple sexual partners. It can lead to infection and sexually transmitted diseases which is the core of blocked tubes.
What couples should do while waitingWhen couples are newly married, they should begin to be aware of the anatomical and physiological processes that control conception. If you are a man, make sure that you preserve your reproductive processes. Stay away from pesticides, smoke inhalation and the same for the woman. If you notice any infection or discharge in the penis, make sure you give it immediate attention. Same for the woman, because these are things that could lead to chronic infection that could block the tube, or blow up the passage of the testis (Urethra).
Irregular mensesIf the woman notices that her period is irregular or unusually painful, she should seek medical attention. If the flow is excessive or little, she should see the doctor to ensure everything is okay immediately they get pregnant. Before, we used to say that infertility is when the couple is married for one year and they have tried without conception, but because our people are getting married late, they should seek medical consult immediately within three months, not to wait for one year. Those parameters of one year is when they were getting married at 21-24, because you can delay for one year and you still have a lot of time. But now, a lady that gets married at the age of 32, and has ovarian shut down at age 35, the time available for her is not much.
Treatment/OptionsThe options are quite many. You could seek medical attention from your doctor. If that doesn’t work, you need to take further investigation.
Fraudulent fertility centresI have to warn that there are some people out there that are not really practising advanced technology, but they are telling people that it is what they do. In the last two months, I have seen four women coming to my clinic to complain. One said that she went to a doctor, got pregnant, and she had a surocal suture. We did a scan and there was nothing in the uterine cavity. And we looked at the cervix, there was no suture. Another one had said she was going to have her baby in June and we did a scan and her uterus was empty. People have to be careful.

PATRICK ASONYE & AGAPTUS ANAELE