‘We discovered a lot of women don’t want to get pregnant in time because they want to build their career’
The issue of infertility has led to a lot of broken marriages, especially in the African society where women, regardless of cause, are mostly held responsible for their inability to conceive after a given period in marriage, thereby absolving men of what might equally be their failure.
While it may be difficult to determine the causes of infertility, which may include inadequate levels of certain hormones in both men and women, and challenges with ovulation in women, a number of treatments significantly improve the chances of getting pregnant if properly followed up by couples. In this interview with The Guardian, Dr. Babatunde Ogunniran, a consultant gynaecologist with the Bridge Clinic talks about infertility in men and women, causes and treatment. By Maria Diamond
What is the gender-based statistics of infertility?
Infertility generally is the inability of a couple to achieve a conception after one-year of unprotected sexual intercourse, and of course that has to do with regular sexual intercourse. Infertility is a very common challenge in marriages, but in this part of the world, a lot of people find it difficult to deal with it, as it should. Looking at the gender based aspect of infertility, there is the male infertility and the female infertility. About 30 per cent cases of infertility are due to female factors, while 30 per cent are also from male factors, and a combined factor of both male and female has another 30 per cent, while 5 per cent to 10 per cent causes may be unexplained.
Tell us about female infertility what are the causes, and solution?
Majority of female infertility is related to what we call the tubal factor, in which the tubes are affected by a lot of pathologies. For conception to take place, you need the womb and the tube to be functional, also, the ovaries, cervix and all the female anatomy, which is part of the reproductive system. For conception to take place, there should be fertilisation of both the eggs and the sperm within at a particular part of the tube, but if the tube is diseased due to defects or infections that were not properly treated, it would then develop into tubal blockage or having fluid in the tube, which we call hydro saplings. All these can reduce the chance of conception. So tubal factor is a major cause of female infertility and it is very common amongst patients. We have women with cases of bilateral blockage after having gone through the hysterosalpingogram (HSG) procedure in the past and found out that their tubes are blocked, they have also done laparoscopic procedures and discovered that their tubes are actually blocked. These set of women need In Vitro Fertilisation (IVF). Also, women who have problems with the ovaries need IVF. Some women also have irregular menstruation with so many follicles on their ovaries, which lead to ovulation problem, we proffer what we call ovulation induction drugs. However, some of these cases will still go through the reproductive technology, which is now the IVF. However, there are other factors that affect the ovaries, if a woman is also not ovulating and the man’s sperm is good, fertilisation cannot take place. Also, there is a condition called endometriosis. Endometriosis is something that is actually common and 10 per cent of women are actually affected by endometriosis, which means that they are having cells that are meant to be in the inner lining of the womb, but now occurring outside the womb. This is what we call cyst and can occur at any part of the womb, it can occur on the ovaries or even caesarian sections, and could also lead to infertility in women. We also have women coming up with what we call premature ovarian failure whereby the ovaries show signs of menopause in younger women who are less than 45 years. Of course the range of menopause is between 45 to 55 years, but you see cases of women that are less than 45-year who have stopped menstruating or the ovaries have completely failed when we look at their hormonal test. These set of women definitely need IVF.
Another factor of female infertility is fibroid. Although fibroid itself does not prevent a woman from getting pregnant, but there are a lot of other associated factors. We have a lot of women who have fibroids and they carry their babies normally and deliver normally. But we have also found out that there are also a percentage of people that are having fibroids that distort the inner lining of the womb, hereby reducing the chances of conception. This kind of fibroid blocks a particular section of the tubes. We also have cases of women with recurrent heavy menstrual flow, which also reduces their sexual intercourse with their husband.
What is your definition of heavy menstrual flow?
Heavy menstrual flow is what we call menorrhagia. Menorrhagia is when we have women who are having prolonged or heavy menstrual flow different from the regular or normal flow. For example a normal flow should be about 2 to 7 days, but when you’re having your flow for more than 7days with clots, that is what makes it abnormal. Also, when you menstruate for the normal days but have exaggerated flow and need to seek medical intervention.
Tell us about male infertility, what causes the sperm to be infertile?
In this part of the world, a lot of castigation goes to the woman. When a woman gets married, if she is not pregnant within a period of 6-months, people begin to ask questions, with assumptions that the woman is infertile, but science has proven that 30 per cent of infertility cases are also due to the male factor, so basically for the male, we would be looking at the sperm count, the motility and the appearance which is the morphology. According to the World Health Organisation (WHO) standard, it is expected that a normal and productive sperm count should be at least 15million per milliliter (ml) of semen, so if we are getting less than 15 million, we are already talking about oligospermia which is low sperm count. Then we look at the motility, which is the movement. The sperm during sexual intercourse swims all the way to the tube to meet with the egg in order to cause fertilisation. Now if you’re having low sperm count, it means you are having poor motility. When we are looking at the motility, we need to see at least 40 per cent motility, anything less is poor motility, which is also a major cause of infertility. Also, we need to see at least 4% of normal and healthy sperm morphology range for fertility, anything less is abnormal.
There are some men that will come in to do their analyses and we won’t even find sperm cells at all. So a lot of factors come in to play, such as unhealthy and imbalanced diet, exposure to radiation, chemicals, petrochemicals, poor and unsafe sexual habits, which leads to Sexually Transmitted Diseases (STDs), others, cause male infertility.
Also our diet has changed over time, smoking and alcohol intake also impact negatively on the sperm count. So a lot of lifestyle modification is actually necessary and this is predisposed to the issue of low sperm count.
Which of the gender based factors is more detrimental to fertility?
Both factors are detrimental to fertility as there is no conception if either the man, or woman has issues with their reproductive organs. Which is why we insist that people come in for evaluation because there is nothing that does not have a solution, whether male or female factor, there is always a treatment to go ahead with.
Tell us about IVF, how comfortable is the treatment for women?
IVF started way back in 1970 when the first baby Louis Brown, was born in the UK. Her mother had tubal problems, which is a delicate issue. So she had Louis via IVF, which gave rise to controversies, litigation and castigation. A lot of people wondered if the baby was normal. Louis who is now over 40 years old has also given birth to her baby normally. So with IVF, there’s always an atom of doubt and resistance amongst couples at the initial stage, but, over time, people have come to accept it. Even Obama’s wife went through IVF and a lot of people now go for the treatment. IVF makes it possible for women with broken tubes and fibroid to conceive. It also goes for men with low sperm count or zero sperm cell.
At what stage does a woman or man decide that IVF is the way to go?
Basically, at Bridge Clinic, we do evaluation before we decide on treatment. After evaluation, if we discover that your tubes are blocked, or your ovarian is reduced, you definitely need IVF. If you have low sperm parameters, problems with ovulation or you’re appearing with menopause despite being below the age range, you need IVF.
What’s your advice on fertility check for women?
In terms of fertility, you need to have a check. Most of the time you feel everything is fine, but when you get married, you discover there are problems. So we have facilities for women who can just come in to check their reproductive function. We conduct a scan for you, we check your hormonal balance and advice you on treatment or what to do, because infertility in this part of the world is mostly blamed on women, neglecting the fact that men are equally liable to infertility. You can also do routine check-ups to ensure everything is fine even before marriage.
Another aspect is the career and lifestyle. We discovered a lot of women don’t want to get pregnant in time because they want to build their career, so it’s important to have an evaluation and know what is happening. Then for such women, we advice the IVF egg freezing method which helps them save their eggs for a period of time. The process of egg freezing is what we call oocyte cryopreservation, this involves stimulating the ovaries with hormones to produce multiple eggs. We retrieve the eggs from the ovaries and take them to the lab, where they’re frozen and defrost when the woman is ready to be pregnant. The eggs can be frozen for a period of 5-10-years and the women can come in within this period of time for cycle treatment. We also freeze the eggs of women who are going through strong medication like chemotherapy, because they take strong drugs and are exposed to radiation. Egg freezing process for women is like saving for the future.
How expensive is the IVF treatment?
The price is relative. I don’t want to use the word expensive but I believe a lot of people can still afford it. Though there are some people who cannot afford IVF, but we always advice that people look at the bigger picture of what they want to achieve at the end of the day.
Due to the African belief system some people tend to attach infertility to supernatural distortion, what’s your take on this?
We are scientists, we work with science, but if a patient feels the need to pray about the situation, he or she is entitled to do so.