Dr. Abayomi Ajayi, a Consultant Obstetrician and Gynaecologist is a fertility specialist and Fellow of the West African College of Surgeons. He is also the Medical Director of NORDICA Fertility Centre. In this interview with FRIDAY OLOKOR, he discusses the problem of infertility and the efficacy of In-Vitro Fertilisation
At what point would you advise a couple to undergo IVF?
What the World Health Organisation says is that when you are 35 or below 35 years, you wait for one year before you go for test when there is no obvious reasons for you to go for it. For instance, if the husband has had a fall, or his testes have been compromised, you can do that earlier. If a woman is not menstruating regularly, you don’t need to wait for one year before you do that. Those are the obvious reasons. But if you are below 35, you wait for one year for investigations. If you are above 35, you wait for six months before you go for investigations. It is the investigation that will say whether you need IVF or not. We know that among infertile couples, it’s only about 10-15 per cent who will need IVF.
Considering the high technology involved in IVF procedure, it is still believed that its success rate is still low. What are the reasons?
The reality is that everywhere in the world, IVF is not a 100 per cent success rate. If somebody tells you that IVF success rate is 60 per cent, he or she is lying. You have to know the physiology of pregnancy. It’s like you take an organ from one person and put it in another person. The chances of rejection are high. For instance, when you take someone’s kidney and put it in another person’s body, chances of rejection are very high. That’s why people like that take drugs to suppress their immunity in order to encourage the body to accept it. Now, in pregnancy, you have two people coming together. Whether it’s IVF, whether it’s on the bed, you have two people coming together; they create a new creature and now, it’s in one person. The chances that one person will reject it is higher than for that person to accept it because that is simple immunology. That is the way the body protects itself. Once it sees a foreign body, it tries to kill it. Unlike the kidney transplant where you can give the patients drugs to reduce or suppress their immunity, however, you dare not try it in IVF. That is why we can brag and say that IVF babies are normal babies because they go through the same quality control system in the body. However, it’s that same quality control system that makes our success rate not to be 100 per cent, 60 or 70. But there is a lot of work because when IVF first started, the success rate was very poor, with about 10-15 per cent. But now, it’s going to 30-35 per cent and sometimes 40 per cent, without compromising the quality control system in the body. Probably in the future, with some things now being worked out, maybe we might be able to improve, but I don’t see us getting a 100 per cent.
How do you convince overly religious patients to undergo IVF?
It’s purely science. When people are resistant to things, most of the time, it is because they don’t have the knowledge. So, one of the things we need to do is to educate people; to make them know that IVF is natural because the only thing we do is to mix sperm and egg. Every other step is natural. Apart from educating clients, which is the most important thing, we can’t force anybody to accept the explanation. We equip people with the knowledge and allow them to make up their mind. We want people to know that there’s nothing diabolical about IVF. I’ve had the opportunity of educating a pastor on IVF, after which he said he was going to organise a seminar for me to lecture his congregation on the efficacy of IVF.
How much does it cost to undergo IVF?
It is difficult to put a price because it depends on what the problem is with the couple. Two friends may come and they might have different bills because it depends on what the problems are. But I can give a range. That is why I am so comfortable saying that if you can buy a second-hand car, you can do IVF.
Would you say that infertility is on the increase in Nigeria?
It looks like it’s on the increase, but one needs to be careful. We can only rely on figures from outside Nigeria because we don’t keep figures in Nigeria. The figures we have from outside show that infertility might definitely be on the increase. There was a study that was conducted two years ago in Denmark, which showed that sperm count was decreasing. Those are the things that we can lay claim to; and in Nigeria, there is no doubt that we are seeing more infertility cases. However, that is among those that report because people now know that it is possible to treat infertility. Once you can treat any disease, many more people will come forward because you can help them. That is why I say one must be careful about Nigeria because we don’t have accurate figures. But it definitely seems as if it’s on the increase.
How do you guard against transmittable diseases like HIV/AIDS?
HIV is not a disease that you inherit. We screen for HIV before we start treatment. If any of the partners has HIV, there are things that will be done to reduce transmission to the baby. But if there are genetic diseases, IVF has gone a little beyond that and we can even detect genetic diseases, which we can now prevent by not using the embryos that are affected by such genetic diseases. That is what we call pre-implantation genetic diagnosis.
How do you check abuse of the procedure among IVF practitioners?
We always advise couples to go to reputable fertility centres because we know a lot of things that happen when a woman is infertile. But those acts have their consequences and in a short while, quack IVF clinics will be in debt and consequently go out of business. In any case, we are regulated by quality control.
What is the life span of sperm in storage?
It does not have time limit; you can store it for a long period of time as long as the condition is maintained. The same thing with egg storage, which is a new thing.