The prevalence of infertility in Nigeria is becoming alarming. According to statistics, 45 to 50 per cent of all consultations in gynecological clinics are infertility-related and over 80 per cent of laparoscopic investigations are for management of infertility. As the growing incidence of infertility in the country continues to stare victims in the face, exploring other options aside from natural fertilization has become an object of discussion but how open is the average Nigerian to scientific techniques that could aid reproduction? This monthly special for waiting mothers is aimed at debunking the myths surrounding assisted fertility while exposing its benefits and viability.
Last month, I introduced fertility clinic with the situation of Mr and Mrs TK and how they were finding it hard to conceive. Their story didn’t end there… Somewhere in the middle of consultations with an expert, Mrs TK remembered that assisted fertility had been recommended to her before but she didn’t tell her husband. Why didn’t she tell Mr TK, her reason was this “I thought it could only be done abroad and that asides from being very expensive, it is rarely successful.”
I adjusted my seat as I proceeded to enlighten Mrs TK on the subject of assisted fertility and clear her misconceptions, which are in most instances, general. I began by saying, “IVF is not new in Nigeria. As a matter of fact, the procedures have been carried out in this country as far back as 20 years ago. The cost is not as expensive as you think and honestly if all the money you spent on womb washing, womb massage, HSG and fertility medications to bring period after menopause was put together, it would be almost enough to afford IVF. In any case, any couple that can afford a tokunbo car can afford IVF.”
Really? They wondered and exchanged glances. After a lot of education and walking Mr and Mrs TK through the rudiments of assisted fertility techniques, in their case, IVF treatment, they decided to have the procedure.
I remember Mr TK telling me on the day of the embryo transfer that “if this doesn’t work, heaven knows that we have tried our best!”
However, it was a very excited Mrs TK that called me 12 days later, crying and laughing and screaming all at once. After 17 years of childlessness, her pregnancy test was positive. When I delivered her prince nine months later, she looked at him with tears in her eyes and asked “where have you been all my life?”and she broke down crying. There were, of course, tears of joy.
Is this not enough reason for anyone to try Assisted Reproductive Techniques (ARTs) when natural conception delays? Today, I would like to walk my readers through ARTs and some important steps involved.
Egg stimulation
At this stage, the woman takes some injections to stimulate the growth of eggs in the ovary and eight-12 matured eggs, when achieved, is usually a good number. This process takes about two to four weeks depending on the drug protocol that is being used. During the stimulation process, the response of the ovary to the stimulating drugs is monitored and when the eggs are close to maturity, a final maturation injection named Human Chorionic Gonadotropin (HCG) is administered and 34-36 hours later, the eggs are collected.
Egg collection and fertilization
The process of egg collection takes about 15 minutes and the woman’s partner is required to donate sperm that same day so that the eggs can be fertilized. After administration of anaesthesia, the eggs are collected through the vagina under guidance by an ultrasound scan. It is a very safe procedure and complications are very rare. There may be some blood stained discharge for a few hours after the egg collection. The eggs are then fertilized in the laboratory and incubated for 3-5days before it is transferred back into the womb.
There are many ways of fertilizing eggs but perhaps the most commonly performed is the conventional In Vitro Fertilization (IVF) in which the eggs obtained from the woman are kept in the same Petri dish as the man’s sperms and natural fertilization of the eggs by the sperms is allowed to occur. However, in situations whereby the man’s sperm count is low, the rate of natural fertilization is affected and it becomes slow. So, the fertilization of eggs by sperm is therefore assisted by injecting a healthy sperm into an egg.
However, when the sperm count is really poor, a stricter criteria is required in selecting the sperms that will be injected and this is where the Intracytoplasmic Morphologically Selected sperm Injection (IMSI) technique is employed.
Embryo transfer
Two weeks after embryo transfer, a pregnancy test is done to know the outcome of the treatment so as to know if implantation has occurred. During the two weeks wait for a pregnancy test, women are encouraged to live their normal lives but to abstain from intercourse and avoid any activities that exert them. However, restricting oneself to the bed throughout this period has not been shown to improve pregnancy rates. However, women are advised to delay embarking on long journeys after embryo transfer for at least 48 hours after the procedure.
Outcome of IVF treatment
The outcome of IVF treatment depends on several things including, the number and quality of eggs obtained, the number and quality of embryos transferred, the ease of the transfer and the state of the lining of the womb before embryos were transferred. Of all these variables, the strongest predictor of the outcome of the treatment is the age of the woman because the younger the women, the better the chances of conception.
For a woman less than 30 years of age, there is a 40 to 50 per cent chance of success while for women between 30 to 35 years; there is a 30 to 40 per cent chance. In older women between 35 to 37 years, there is a 20 to 25 per cent chance while women aged between 37 to 40years, have a 15 to 20 per cent chance.
At 40 years of age and above, for a woman making use of her own eggs in the procedure, the chances of success are less than 10 per cent. This is why it may be a wise decision to plan for more than one cycle of IVF treatment. If the first cycle succeeds, a refund can be requested but if not, the next cycle is usually commenced at a decent discount.
Factors such as weight of the woman, life style like smoking habits also affect the outcome of the treatment. Supportive treatment may also be recommended for women who are older than 37 years old such as assisted hatching.
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