‘How infertility drove me into reproductive medicine’
Tunika Cleopatra Adonor is a clinical embryologist with 17 years experience in Assisted Reproductive Technology (ART), commonly known as In Vitro Fertilisation (IVF). Though catering services was her first love, she’s today Clinical and Managing Director of TuniCleo Fertility Centre Asokoro Abuja.
In this interview with RALPH OMOLOLU AGBANA, she spoke on how her experience with infertility led her into reproductive medicine.
I spent almost all of my life, including growing up, in Benin City for primary and secondary education. Then, I went to Ambrose Alli University and later University of Benin College of Medical Sciences. I also hold a bachelor’s degree in Assisted Reproductive Technology (ART) from University of Schleswig- Holstein, Germany; University College, London for Pregenetic Diagnosis for those looking for gender selection; and also, University College of Leeds, where I had a Clinical Master’s of Science in Embryology; Fellows of In Vitro Fertilisation and Reproductive Medicine, Fellows in Managerial Consultancy, Nigeria; Certified Managerial Consultant (CMC); Associate in Medical Laboratory Sciences (AIMLS); Master’s in Medical Laboratory Sciences (MMLS).
We’re eight in the family; four boys, four girls; I am number five and the second daughter. Growing up from primary school level at age seven, I discovered that I loved cooking and baking. I actually do it alongside this job that I do; I have a registered catering organisation. I discharge duties, you know you have to just trust people, so, coping with the two won’t be a problem.
When I was growing up in 1983, I used to watch Mackie Kitchen on Nigerian Television Authority (NTA). I was keen on it; I followed it up. Then, my elder brother will have to say ‘you have to learn, you have to go into sciences, not enough to just know how to cook, you must go to school, that’s why they pay your school fees.’ And I would say, ‘no, I think I can mix it up.’ At the same time, I realised my mother was always reading All Woman, a text book that tells you how pregnancy comes up, what to expect in pregnancy, symptoms, and then if you cannot have a simultaneous vaginal delivery, you can also end up in a cesarean section.
Imagine me as a very young girl as at that time, I was reading and I had so much interest in reproductive medicine, integrated science; I was very good in chemistry and physics. In secondary school, we were like 38 in class; I would always come like second, first and sometimes third if I played too much. From secondary school, I proceeded to learning how to make hair and I also learned sewing before my results could come out. I did that for three months before I got admission in University of Benin and Ambrose Alli University.
I had two admissions and I didn’t know which one to go to. At a point, my parents and my brothers were confused; I just had to pray to God about it. I actually went to Ambrose Alli University, I started with Microbiology; I did that for a year, but I was not satisfied. I just had to go back to University of Benin School of Medical Sciences where I specialised in Dermatology, Immunology and Blood Group Serology; I did that for five years.
After graduating, not actually working with my degree, I went ahead to start cooking and catering for people in Benin City; I live all my life almost in Benin City.
How Infertility Challenge Drove Her Into Reproductive Medicine
Now, what drives me most in reproductive medicine or people suffering from infertility is that about 22 years ago; I suffered from infertility. I could see what women suffer when they can’t bear children. I was born October 15, 1975, soon I will be 47. If you minus 22 from 47, you’ll see how young I was to have experienced infertility.
It was so traumatic. You have so much shame; you don’t want to go out. I was driven out of my husband’s home, because I couldn’t bear children for a year. That’s where I specialise now for the past 17 years. I am a reproductive expert, a certified clinical embryologist. I am founder, managing director, TuniCleo Medical Fertility Centres, Asaba, Abuja and Benin.
Infertility And Causes
When you talk about infertility, it is both male infertility and female infertility. I want people to understand that education actually will not cure infertility. No matter how knowledgeable you are, whenever your family or peers or environmental factors pressure you, you begin to act accordingly; that the problem is coming from the woman.
When I channelled into infertility, like I said, I went to University College in London, University of Leeds, London, we got to know so much that we have male factor, which is 40 per cent, women factor which is 40 per cent also. Then, 20 per cent unknown (that’s like ignorance, from men and from women/incompatibility or we call it idiopathic). I discovered while growing up that I suffered from what we call Polycystic Ovary Syndrome (PCOS). It is a very significant factor when it comes to infertility.
Why? Under it, you have anovulation, you have scanty menses, prolonged menses for like six months, three months, and they come in clogs. The types of reproductive ovaries we have is different from the normal women that have up to four to eight ovaries in the follicles, that’s on the left and on the right. For Polycystic patients, you have up to like 10 to 12, which do not make you to ovulate, because the follicles there are so small that you cannot be able to actually release an egg every month as a sign of ovulation. I discovered that in school, at University of Benin, with one of my doctor friends, who is a consultant right now on oncology. I had it. Some of my sisters also were suffering from it.
Immediately I realised that, I had to advise them quickly to get married. It is a genetic factor; it’s not environmental factor. The way you were born to be. The way our parents lived those days and what they eat, is also different. They knew how to use herbs to control this. But you know, as they too were also growing, they have to travel and start changing from taking leaves to cure headache, to taking paracetamol that has to go through a lot of processes and they are releasing a lot of toxins into your system. They will forget about the way they knew they used to miss their periods or they’re periods wasn’t flowing at all. And we were not told, because they don’t know.
When I was in school, being among your friends, you see them menstruating every month and I wasn’t doing it; I knew there was a problem. I went home, I told my mum, she didn’t understand. So, immediately I got married, I had to follow up with my younger ones, because I had the experience and my younger sisters were also experiencing scanty menses. So, I said, ‘you know what, before you get to 25, marry.’
Now, they have their children. But it took me a while, up to 38 years of age, before I could have my own child and I had to use In Vitro Fertilisation (IVF) in having my kids. People with polycystic ovary, once they crossed the age of 25 to 26, they are going to suffer it.
Wrong Views About IVF By The Society
Let me correct the society. Assisted Reproductive Technology is just to help people to conceive. Under it, you have what we call IUI (Intrauterine insemination). Then In Vitro Fertilisation, which is commonly known as test tube baby in the society. After that, there’s what we call ICSI (Intracytoplasmic sperm injection). After that, you have IMSI (Intracytoplasmic Morphologically Selected Sperm Injection), then there’s what we call TESA (Testicular Sperm Aspiration), PESA (Percutaneous Epididymal Sperm Aspiration).
Now, let me analyse it; when a man and woman being together for a year, you tried unprotected sex for a year and you are not pregnant, the best thing to do is for you to go for investigation as a couple. When you get to your infertility center, it will be discovered if the fault is from the woman or the man. In the society we live in Nigeria, when a man and a woman live together between the first and fifth year without the woman being pregnant, everybody’s eyes will be on the woman, that she is the factor. Whereas the man, because of his ego, he will not be able to tell his family or friends that he is the factor. And we put the blame on the woman.
When you go for investigation, you are told that, ‘okay madam, your ovary, your hormonal profile is okay.’ In some cases when they tell the man and the woman that their hormones are okay, it is because of ignorance and the money. Money is a factor, because IVF is very expensive. But before we go into IVF, you know I started with IUI. If the woman’s tubes are good and she ovulates and the man’s count is very good (his count is from 20 million above, that’s what World Health Organisation requires), once that count is good and the woman’s tubes are opened and she ovulates every month, but she’s not getting pregnant, we’ve done all the hormonal profile, everything is okay and that of the man is okay and pregnancy is not taking place, first and foremost we, do polycular tracking to see if she’s going to produce an egg; the process starts from the second day of her cycle when she menstruates, then we continue to scan to see a dominant follicle. If we are able to see it, then we try to plan for the IUI.
The IUI on its own take the man’s sperm, wash it to remove the normal seminal fluid out and we’re left with the sperm cells. We introduce it into the woman before ovulation takes place within 48 hours. If we try this for three months and she’s not pregnant, then we go to the higher form, which is IVF. When a woman is on a normal cycle, releases egg every month sometimes two eggs, during IVF, we give you fertility injectable so we can get a lot of follicles and have a lot of eggs; we do this from the second day of the circle of a woman to the day 12.
On this issue, we begin to scan the woman to see that the eggs grow by every two millimetres everyday and as you know, we have a dominant follicle for between 18 to 20 days. We do a trigger; that is resources ovulation. What In Vitro means is that we are taking child outside the body. In Vivo is what happens naturally with a man and a woman when they have intercourse, but in IVF, In Vitro means outside. We do the trigger for full maturation of the eggs and once this is done, 36 hours to 38 hours, we take the woman to the theatre and retrieve the eggs.
We bring them out to actually see may be she’s not having good eggs or why is she not getting pregnant. The man’s sperms are good but fertilisation is not taking place? When you do this outside the body, you will see that you develop a lot of embryos, that’s a lot of babies, and after about three to five days, you transfer the baby back into the woman; there is no operation. People say it’s painful, it is not painful; I did it. The risk is multiple babies.
In this part of the world, we generate a lot of embryos. As a specialist, that’s what I do. When you fertilise with a man’s sperm, you just need one sperm, but for women, we can’t produce millions of sperms or oocytes (we call it eggs). But for the men, a little drop is thousands, millions, but just one is enough to fertilise a whole lot of numbers of eggs from the woman. Let’s say 10 eggs from the woman, they all get fertilised. The 10 eggs may not get to maturation. You may end up with four or five; that’s why you have the chance of multiple babies.
When There Are Multiple Babies
We transfer more babies in Nigeria, but outside here, it’s being regulated. In the United Kingdom, there’s something we call S.E.T (Single Embryo Transfer). The best embryo is what you’re going to transfer and then you freeze the remaining embryos. When I talk about freezing, it is not like you are going to put it in the freezer. There’s something we use to freeze these embryos for like 10 to 15 years or more. Anytime you’re ready to come back again, when you feel like having more babies, we go back to where we freeze the embryos and then we return it back into the woman. Nothing will happen to it as long as you’re paying. You continue to pay every year; it is done everywhere in the world. We are capable; we do the same.
In The Event Of Power Failure
It does not involve electricity. In Africa, because of (power) issues, there’s what we call vitrification procedures. There’s what we call liquid nitrogen tank; that one doesn’t need any electricity. It comes in a cooler form minus 195 degree, you can’t even hold it; it will burn your hand if you’re not careful. It won’t even destroy the psycho skeletal structure of the embryo. It kills germ cells like men with HIV, women with HIV and hepatitis; this can destroy it. It’s not transferable to the embryo.
Effectiveness Of The IVF Procedures
Everyday, we have new technologies coming up to help improve on In Vitro Fertility in the society. Let’s say a man that surfers from low sperm count, there’s hope for you. On male infertility, we have what is called Normospermia, Teratospermia, Azoospermia, Cryptozoospermia and Oligozoopermia (that’s normal, scanty, low sperm count or can’t move fast). With an IVF, even if you have a low sperm count like I said before, we have World Health Organisation that says from 20 million, in In Vitro Fertilisation, you have 10 to 15 million by the time we remove the seminal fluid and used the medium that actually separates the debris from the seminal fluid, separate from the sperm cells, the sperm cells become very active and we can use it for a normal conventional In Vitro Fertilisation.
But if you have Oligozoopermia, you know that there’s a problem. You go back to what I told you earlier, under Assistant Reproductive Technology, which is Intracytoplasmic injection. What we do with this one now is enforce the manual machine method, where we have to take a single sperm to invade an egg, that’s the oocyte. We have to force fertilisation into a woman that can produce a lot of eggs.
But when the man’s count is so low, it can’t move fast, you have head defect, you have tail defect. You see that woman has been covering that man for 10 to 20 years, she can’t speak out, the family will say, ‘oh, she’s using something to cover our brother’s eyes,’ not knowing that she’s covering the shame of that man.
Causes Of Low Sperm Count
A man’s lifestyle; taking a lot of alcohol, illicit drug use, exposure to toxic environment, you’re expose to radiation, smokin, having present or past infections, being overweight or significantly underweight. Some women when taking care of there child, may be they are sick, they use hot water on the testis thinking she’s actually healing the child whereas not knowing that she’s fueling it. Some men are so used to their laptops and then wearing only boxers; these are factors.
How To Detect Infertility
They won’t even know. As a man, you will know that you’re having premature ejaculation and as a woman also, you will know that it is not every month that you’re seeing your period. This also goes for a woman that goes about having a lot of abortions.
Importance Of Early Awareness
A lot of awareness is important. We use to go to schools; university, even secondary schools, it is good for them to know from the very beginning. And age is a factor in women. You hear people say that from 18 to 40 years, if you don’t get pregnant that something has gone wrong. Yes, those days because of what you eat, lifestyle and all that. Things have changed, you have ovarian decline.
When we were growing up, we used to see women with a lot of hair, grow beards. They will say this woman is a witch. No, she has more of men’s androgen (testosterone) and she can’t ovulate; that’s a factor. It affects ovulation, as you grow older. Some of them are just lucky that they get pregnant. That’s why I said earlier that Polycystic Syndrome Awareness is important.
A lot of girls out there have a lot of follicles, which then don’t even know. Immediately I see that, I used to tell them ‘you’re going to suffer infertility later in life, but if you get pregnant along the way, please don’t abort it.’ You will hear that a woman that gets fibroid cannot get pregnant, no. It depends on where the fibroid is located. Women with fibroid can get pregnant and women with fibroid cannot get pregnant. Why? The location of where the fibroid is matters. There are women with fibroid that get pregnant, but there are women with fibroid that you actually need to remove it before you proceed. A woman that continue to do abortions, not taking into cognizance that when she gets to settle down she may not know that she has to correct the rectum.
When you’re pregnant the first time, second time, third time, you will need to take what we call RhoGAM injection, but as a young girl, you don’t know. You don’t even have an idea of what your blood group is. Lecturing is important; you need to let them know from the beginning that the rhesus factor will threaten your life, threaten your fertility in the future.