Effective treatment options for infertile couples
Dr. Faye Iketubosin is the president of the Association for Fertility and Reproductive Health in Nigeria. In this exclusive interview, Iketubosin who is also the Medical Director, George’s Memorial Medical Centre, Lekki, Lagos State reminisces on the global infertility scourge and treatment options among other salient issues.
What is the Association for Fertility and Reproductive Health in Nigeria (AFRH) all about?
The Association for Fertility and Reproductive Health (AFRH), started as the Nigerian Fertility Society in the 1980s.It was a platform for fertility practitioners to come together to share scientific ideas as regards their service delivery agenda. Currently, it is trying to enact guidelines, which will govern the practice of assisted conception in Nigeria in terms of infrastructure, personnel and the actual practice of the specialty.
At what point is infertility said to have occurred?
Infertility is said to have occurred if a couple that have been married for one year, and have been living together for this length of time, and having regular and unprotected sex without pregnancy occurring.
What is the link between a female’s age and infertility?
Women have a finite time in which they are expected to reproduce. Female children are born with eggs in them for life. The eggs only last for a certain period of time. Usually, by the time a woman reaches 40 years of age, her reproductive potential is significantly reduced. At 45, you will hardly find women getting pregnant naturally. Now, there is a difference between couples in their 20s and couples in their 30s. The former has a long time as regards their reproductive future unlike the later, who do not have such luxury of time. Therefore, younger couple who have been leaving together for one year, having regular and unprotected sex, and yet pregnancy does not occur should see a fertility doctor. But for older couples, it is six months.
What are the major causes of infertility?
There are female and male factors and in some situations, a combination of both. For the male factor, it could be as a result of problem with the number of sperm motility (active sperm) and morphology (structural make up of the sperm). For females, it can be a problem of ovulation (women who do not ovulate). It could also be blocked fallopian tubes, fibroid in certain locations such as submucus fibroid, which causes infertility by mechanism of interfering with implantation, among other causes. There is also an unexplained infertility; the sperm is normal, the fallopian tube and womb are in order and yet, the woman does not get pregnant.
What are the available treatment options?
The treatment option is dependent on the cause. The normal sperm count is 50 million. For instance, a man whose sperm count is 10 million is different from a man whose own is two million. From these low sperm counts, one is severe than the other. However, there are medications to stimulate the testicles to produce more sperm counts. In severe cases, chances of increasing it from a severe case to a normal position are very low. Such men would benefit from assisted conception, precisely In-Vitro Fertilization (IVF).
For women who do not release eggs on a regular basis, medications would be administered to increase the chances of ovulation. For blocked fallopian tubes, in the past, tubal surgeries to reconstruct the tubes were done, but the success rates were not very good. Certainly, IVF is the way to treating women with fallopian tubes problems. However, Intra Uterine Insemination (IUI) can be applicable to couples that have unexplainable infertility. Certainly, IVF success rate is higher. In IVF, you have confirmed that the eggs are fertilised and divided unlike in IUI where you are putting the sperm in the uterus and the sperm in turn looks for the eggs.
Who determines how many embryos are to be transferred during the IVF process?
It should be decided alongside with the patient. There should be transparency in the entire process of IVF. This informs the patients on their chances of a good result. But again, the success rate is dependent on the professional know-how of the fertility medical team.
How long is it medically safe to store/freeze embryos for future purposes?
They can be frozen as long as possible and even up to 10 years. If a couple wants to reuse their stored embryos in future, the number they want to use at that particular time will be thawed. However, an embryo cannot be refreeze after it has been thawed. This is where the fertility clinic will have to apply its discretion.
What are the possible complications that may arise from IVF?
The major one is Ovarian Hyper-Stimulation Syndrome and could be life threatening. Anybody can have complication. There is a standardised dosage of treatment based on age. Fertility clinics must have facilities to deal with any complication that may arise. Once a complication is preempted, there is need to start treating it right away. It is important for women to report back to the fertility clinic where they were registered, should complications arise, rather than going to any hospital because a general gynecologist with no experience in IVF cannot handle the situation, hence, he/she may take a decision, which may be harmful to the patient.
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