Sola Ogundipe
6 May 2008
column
Lagos — THE need to continuously educate the Nigerian populace about the facts of infertility and its treatment has been stressed.
Medical Director, Nordical Fertility Center, Lagos, Dr. Abayomi Ajayi, who made the point pointed out that infertility is like any other medical condition and as a result should not be mystified. Speaking to Good Health Weekly during the facility's 5th anniversary marked recently. Ajayi said every one in society had a stake in helping to demystify the issues surrounding childbirth.
His words: "Everything about childbearing in this environment is surrounded with myth and this is one of the main cahllenges that we as practitioners have to demystify. This is something we need to do so that people will understand that infertilty is just like any other medical condition that is treatable in hospital."
Further, Ajayi argued that the challenge of dealing with the myths surrounding childbearing issues were even more formidable than the problem of infertility itself. "Every day is a challenge but we try to evolve on a daily basis. It is necessary for everybody to get the facts about IVF. We really need to educate the people, so that they constantly get the facts.
I do agree that we have tto look at our literacy level. It might be difficult but it is something we can all achieve. We know that we have to take everyday as it comes so as to advance the frontiers of this important medical practice."
Continuing, Ajayi remarked: When we talk about infertility, it could be male or female factor oriented. It is possible for a virgin to be infertile if she has endometriosis. We have seen cases where a woman who got disvirgined in marriage is unable to get pregnant and traced the cause to endometriosis. It happens quite often and does not require the woman to have been infected.
"As a fertility expert there are things that do with faith and others with your training and there should be no conflict between the two. If a patient comes to me in the clinic it is because I am a doctor and I should be useful to that patient as such. This is where I always draw the line. "Stressing athat a doctor does not always know it all, he said:
"But there are some things as a doctor and as a scientist that one knows one does not have explanation for. We know there are certain things under control of nature or God depending on what you decide to call it. It depends on which side of the divide you want to be, but I believe it is God. There are things that despite all your training, despite everything you know that there is another hand at play here. Every doctor has this kind of experience not just with IVF.
"We usually say that any procedure that the indication is not clear cut is not a good one. What I mean is that if a woman does not need IVF and you go ahead and do it for her, and it.fails, you cannotake away. Fertility drugs have different effects. There are women who even without doing anything apart from taking these drugs, often become pregnant even after they may have stopped treatment."
Also speaking, the Head Nurse, Mrs. Dupe Onafalujo, said fertility nursing should be include as part of the general nursing training. She stated: "Every nurse should be ready to read. More of the principles of IVF should be taught in nursing training schools so that they will not be totally new to the nurses when they come into practice."
Onafalujo said on the average, she encounters 20-25 patients daily, seeking intervention for one infertility ailment or the other. "Usually they want. the personal touch beyond and above the medical treatment. I have come to realise treatment of infertility is just as emotional. I develop personal relationships in an official sort of way.
Nursing generally is about caring. It is even more especially so for those undergoing infertility treatment. It is about caring. A nurse must be loving, caring, trustworthy and dependable. Her shoulders must be there for the patient to cry upon. They confide in you and you build relationships"
The Head Nurse emphasised hopwever that one of the greatest challenges in the profession is often having to break the news to a patient that an attempted cycle has failed, even after such patient has gone to so much trouble gathering the financial resources. "Many will admit that for the next one year. they are just working free, yet at the end of it all it fails. On regular basis you need to keep in touch.
There are many of them. Often you need to keep in touch that they should not lose hope. You need to It is more comfortable to work with the man and woman as a couple even though IVF treatment is very much on the woman and most of the time she is the one you really have to hold."
In his own view, Mr. Remi Ogundepo, the embrologist described the process of reproduction as "very wasteful."
His words: "A woman produces thousands upon thousands of eggs out of which only very few say between 10-20 depending on how fertile she is, get fertilised and become embryos. For the man, he produces millions upon millions of sperms in a tiny drop of semen out of which only one is destined to fertilise an egg.
Why is this so? It is a wasteful process. Nature is selective. The moment it discovers there is an abnormality within a parameter in the reproductive process, it prefers to do away with the entire process. So I must confess there are so many unreported abortions that occur during the reproduction process.
There was this couple that failed to achieve pregnancy after one year of marriage. Series of tests indicated both of them were normal. What was happening was that their bodies were still getting to know each other. They were urged to keep trying. Exactly a year after, the woman became pregnant. What was happening was that their bodies were simply getting to know each other.
He added that the greatest challenge for the embryologist in infertility treatment is that right from the beginning, it is impossible to tell which of the embryos will be successful. "We generate the embryos quite right and the doctor puts them back in the woman. Even if the endometrium is right, the uterus is right, everything is right, but one could still encounter failure.
What causes the failure? It is a puzzle.
"Every embryologist will always put himself in the shoes of the patients. The moment the process fails, you feel it deep down in your heart. It is as if you have not done anything at all. The greatest failure is to generate embryos that fail to implant. Take a woman who is over 37 who insists on using her own eggs, you can know from the word go that 50-50, it may work, or it may not work.
But what about a woman of prime age for who everything goes on fine to the point of embryo transfer. Yet there is failure to get the desired result. It would not be difficult to tell the woman who is over 37 that the problem is with her eggs. But what excuse do you give to the younger woman? You just cannot explain it. It's a big challenge. But there is always hope. Just like natural birth, the more you try IVF, the more it becomes feasible.
There is no hopeless case for IVF. For instance, if a man is a zoospermic, except he so chooses that he does not want donor sperms, it is by no means a hopeless case. However there are limitations. Take a young couple.
The woman is made to undergo controlled super ovulation, that is to produce more than one egg because we want her chances to be maximised, one of the limitations of this is that some women could be prone to ovarian hyperstimulation syndrome. It is always a cascade of events such that you may not even know where to limit the procedure so that it does not get to this stage.
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