21 June 2018

Nigeria: Overcoming Infertility Through Multiple IVF Cycles

Photo: Pixabay
Infertility affects women and men equally, experts say.

While one in every four Nigerian couples experience delay in achieving conception, experts say with multiple IVF the challenge can be addressed. Martins Ifijeh chronicles the lives of couples who through the assisted reproductive technology are now proud parents.

Hope, they say is the pillar of life and theatre where dreams become reality. It is the instrument that makes anything possible even in the face of failure. But what happens when that hope is gone and life becomes gloomy? How then can life stand without the pillar of hope?

This was the situation Rose and her husband, Lanre found themselves in January 2016 after undergoing their first ever In-vitro Fertilization (IVF) without success. It was a time they spent midnights counting their loses and pondering on why life has been unfair to them. They almost lost the only thing that binds them together - hope.

They had believed that 11 years as an infertile couple would come to an end after accessing fertility treatment in one of the centres in Lagos. It was their last hope of having a child of their own.

"When we finally decided we can end our infertility with IVF, I became hopeful that at last I will become pregnant and end the mystery associated with 'barrenness'. It was a time I began to imagine what name my baby was going to have, and how much love I was going to show him or her," says Ruth, during a chat with THISDAY.

"The fertility centre did a series of basic hormonal screenings and other diagnosis on me, which showed I had Polycystic Ovarian Syndrome (PCOS). The quality of Lanre's sperm was also tested, but they found him healthy enough to father a child."

PCOS, according to health experts, is one of the commonest causes of infertility. They say patients with the disorder have multiple small cysts in their ovaries that occur when the regular changes of a normal menstrual cycle are disrupted, leading to enlargement of the ovary and production of excessive amount of androgen and estrogenic hormones.

"I went through treatments, including the correction of hormonal imbalance in my body. After which, egg retrieval was done along with other processes. The fertility specialist certified me okay with the belief that within the next 14 days I may end up being pregnant.

"Of all the explanations he gave me, the part I didn't want to hear was his constant use of 'may', suggesting the possibility of either the pregnancy may be successful or not."

But reality dawned on her two weeks after the treatment, as no sign of pregnancy was noticed. By the time she went back to the centre, the treatment was declared unsuccessful.

She got home and broke down in tears. It was about the darkest periods of the couple's lives, as the only hope they believed they had crumbled like packs of cards. They did not prepare for the eventual outcome.

"During those times, I and Lanre would spend lonely nights wondering why nature and science had suddenly find limits in our homes. We were almost resigning to fate since both the natural and artificial methods have been tried without success. We weren't prepared for the reality that hit us," she said.

No wonder in the recent Failed IVF Cycle Open Forum organised by Nordica Fertility Centre in Lagos, the Managing Director of the centre, Dr Abayomi Ajayi, emphasised that many couples do not prepare for treatment beyond the first IVF, thereby getting disappointed if the cycle is unsuccessful, as the probability of attaining higher successes occurs when a plan for multiple cycles is put in place rather than the one off treatment.

Ruth said few months later, they eventually resorted to undergoing another treatment. This time, they were already armed with information on the various benefits associated with multiple cycles, hence they settled for two more IVF sessions in Nordica Fertility Centre.

Among benefits associated with multiple cycles, according to experts, include high possibility of treatment success, cheaper to pay for multiple cycles than a single IVF, among others.

"By February last year, the first treatment from the multiple cycles commenced. Like the very first one we did, this one was not successful. But knowing that we still had one more try to make since our arrangement was for a multiple cycle of two, I didn't let the failure bother me."

By the time they accessed the last IVF, Ruth became pregnant. It was a dream come-through, as her perseverance eventually paid off. She is currently a proud mother of twin boys.

Mrs. Nkechi Sylvanus did not believe she could ever breastfeed her own child. She got married early in life and the joy of motherhood was all she craved for, but eight years passed without holding her child.

Even though she was not disturbed by her husband and his people, the pressure from the society overwhelmed her, as she was not comfortable being associated with bareness; a title the society place on women who are yet to have their own babies years after marriage.

She made several efforts to get pregnant but unfortunately she was unable, even though doctors constantly told her that nothing was wrong with her womb.

Along the tumultuous journey of uncertainty, she heard about IVF; a process by which a woman's egg is fertilised by a man's sperm outside the body, usually done through a laboratory procedure involving high monitoring and stimulation of the reproductive elements.

Nkechi gave it a thought and decided to approach one of the clinics in Lagos providing such service. "By the year 2010, I approached a fertility expert to know my possibility of getting pregnant through the assisted technology, and how much it was going to cost me."

"The doctor who attended to me explained that it was not a 100 per cent guaranteed process and that all they do is try to enhance chances of couples becoming fertile.

"We were advised to go for the multiple cycle category as it was cheaper with a high probability of success rate than the single IVF cycle. My husband bought into the idea and we settled for three cycles. What this meant was that if we do the first treatment and it didn't work, we will continue to try until we reach the third cycle."

While the first cycle ended in miscarriage, Nkechi was however lucky with the second. "Six months after the first cycle failed, we tried again, and this time it was successful. We didn't have to complete the third cycle," she added.

The happy couple tried again after two years of nursing their two year old daughter, and they had one more addition to the family.

"At this time, I decided to stop IVF since I already had two lovely kids. But one day, I started feeling somehow; it was pregnancy again, but this time, I wasn't assisted through IVF. It came naturally even though I wasn't expecting it. Today, I am a proud mother of three within the space of eight years," she added.

Ruth and Nkechi are among the lucky few who never gave up after the first trial. Their persistence and belief in the assisted reproductive technology eventually paid off, but many Nigerian couples have lost hope in having their own babies after first taking the leap of faith to try IVF.

Research has shown that women who undergo multiple cycles are more likely to have their babies. A study published in the Medical Journal of Australia shows that for women over the age of 40, the success rates for having a live baby rose from 10 per cent at the first cycle of IVF to around 40 per cent at the end of the seventh cycle.

The study confirms that women who are undergoing IVF do have a 'reasonable' chance of getting pregnant, noting that rates of success are higher for younger women. It also added that IVF can never guarantee a 100 per cent chance of success.

At the Failed Cycle Open Forum, Dr. Ajayi explained that couples who have had a failed cycle should not give up, as there usually is a bright light at the end of every tunnel.

"The more couples understand how IVF works, the easier it would be for them to understand what to do when a cycle fails," remarked Ajayi.

"The role of the fertility centres and experts is to lay the foundation for a successful pregnancy, but when the sperm and egg have been fused, what happens within the next two weeks remains a mystery. The implantation at that time is like a black box. That is when pregnancy is determined.

He said in implantation, the embryo is placed like planting a seed and waiting for it to germinate. This is why the two weeks wait after IVF is observed. At this window of time, IVF could fail for several reasons and it is often difficult for couples to understand why.

He said embryo selection methods can contribute to a failed cycle, adding that embryologists select embryos for transfer based on cell stage, embryo grade and the rate of cell division and the surgical procedures themselves. "The egg retrieval and the embryo transfer are very important to the success of an IVF cycle. Despite all the challenges, IVF remains extraordinarily successful."

He said one of the reasons IVF often fail is because couples are unable to make the right decisions that IVF requires, adding that they need to listen to their doctor and try to make right decisions.

He added that the work of a good IVF clinic remains to support couples in making right decisions.

But even when couples make the right decision, all may still not go well. According to the World Health Organisation (WHO), a woman below 35 should be prepared to do at least two IVF cycles.

Dr. Ajayi said for couples above 35, they should be prepared to do multiple treatments, as IVF does not automatically mean there is a baby somewhere kept to be delivered to the couples.

"However, some people are lucky with just one cycle and they are successful. Some have done four cycles and have four babies and there are those that have done five or more cycles and no baby to show. Everybody contributes to their own success rate through the quality of their sperms and eggs. Now, technology can actually help the sperm, unfortunately there is nothing that can be done about the egg. The quality of the egg is number one in determining the success of IVF and conception," Dr Ajayi noted.

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