By Chukwuma Muanya
The most typical cause of infertility in men, and women are sexually transmitted diseases, especially gonorrhoea, followed by chlamydia
Oladapo Ashiru is a professor of Anatomy and Consultant Reproductive Endocrinologist as well as Associated Reproductive Technique (ART)/Joint Pioneer of In Vitro Fertilisation (IVF)/Test Tube Baby in Nigeria.
Ashiru, who is also the Chief Executive Officer and Medical Director of Medical Art Centre (MART) and Mart-Life Detox Clinic Maryland Ikeja, Lagos, in a chat with The Guardian to mark the World Fertility Awareness Month, June, spoke on why more Nigerians are becoming infertile just as he proffered solution.
The fertility expert, who is also the President, of the African Fertility Society (AFS), identified technology, especially the use of laptops by men, toxins in food and from the environment, bleaching creams, artificial sweeteners, chlamydia infection, obesity among others to decrease sperm count in men and fuel the growth of fibroids in women.
To address the situation, Ashiru recommends medically monitored detoxification, weight loss, treatment of infections and other lifestyle modifications. He said there is a 100 per cent chance of having a child via ART/IVF. CHUKWUMA MUANYA (Deputy Editor) writes. Excerpts:
There are reports that fertility rates are dropping in males and females. How true is this? What are the figures?
IT is not bizarre information that the fertility rate in males and females is declining. Regarding the female gender, it is said that the level of fertility begins to drop from the age of 35 years and approximately 40 years in the Male Gender. These normal physiological body functions are inevitable as the body’s cellular components begin to age and die off at some point. However, with the help of ART, conception can still be achieved.
In recent years, male infertility has been chiefly the cause of why some families can’t achieve a spontaneous conception. As a result, they constitute about 42 per cent and 26 per cent of Nigeria’s female factors. In general 50 per cent of infertility is now due to male factors while the other 50 per cent is a female factor. Hence, it is the responsibility of every couple with infertility challenges to face it jointly.
Other factors that have led to a further decline in infertility are the increased incidence of sexually transmitted diseases, followed by the severe effects of environmental, occupational, and climate change on fertility.
Why are fertility rates dropping?
There are myriad reasons why these rates are dropping. The major ones would be mentioned as follows: The most typical cause of infertility in men and women is sexually transmitted disease, especially gonorrhoea, followed by chlamydia. These two infection scars the tubes that carry the eggs and the sperm (resulting in blockage of the fallopian tubes in women and stricture of the urethra in males).
Unfortunately, the chlamydia does not show signs early enough; hence by the time the person shows signs of discharge on the urinal passage lot of irreversible damage has been done.
Age is one of the significant factors, especially in females, and it affects men as well. We focused on age at our last retreat of experts reviewing global fertility demographics in Amsterdam. We observed that men and women now delay marriage and childbearing. We, therefore, warned that fertility declines with age; hence people need to be aware that delaying marriage or childbirth may drastically affect their ability to have children.
Environmental factors: This has also contributed immensely to the world of infertility. These factors cause ongoing damage to the body organs, especially the reproductive organs. They include industrial hazards like paint, plastic wares, petrochemicals, oil and gas pollution, diesel and aviation fuel, pesticides, and aerosol fumigations. Many of these affect the reproductive system and go up to the following two generations.
Dietary factors: Any foods that will increase the Body Mass Index (BMI) should be avoided. Adequate exercise is recommended to allow the body’s reproductive system to function at an expected rate. Other dietary factors are heavy metals from a diet like large fish and stockfish. The use of artificial sweeteners has been shown to cause a reduction in sperm. For these reasons that it is now recommended that couples ensure they get rid of years of accumulated toxins in their bodies before attempting conception.
Occupational factor: People who work in the chemical industry, long-distance drivers, Refineries, driving bear footed, and others have been linked with a decline in fertility rate.
Behavioral factors: Genders that engage in substance and alcohol abuse are also extensively linked with a decreased rate of fertility.
Biological factors: couples with co-morbidities like hypertension and diabetes majorly also experience a decline.
What are the implications?
The only implication is the inability to have a child, which can result in so many complications like depression, grief, mood swing, social pressure, divorce among couples, and in extreme cases, suicide.
What are the solutions? How can fertility rates be improved?
Educational awareness is a primary solution. It is done to provide fertility education right from an early age in school. Students need to be educated on the consequences of unprotected intercourse, the damage done by the sexually transmitted disease, damages to infertility from diet and environment, and more. There should also be an orientation for couples to seek the help of a specialist once they have had unprotected sexual intercourse for a year with no pregnancy.
The option of exploring ART for older couples or those who have attempted medical help with no success is one of the best solutions.
We can improve fertility rates if couples refrain from those factors mentioned earlier and quickly seek the help of a specialist when appropriate.
Unfortunately, babies born through ART and IVF have been associated with adverse side effects. Some reports suggest that they are more prone to many other diseases, allergies, etc. How true is this?
I don’t agree that is a true statement. Several studies in the past have shown that the rate of congenital anomalies in babies born via IVF is not statistically different from that of their background populations.
Speaking for myself, I’ve not seen any so far, especially in my line of practice in the last 40 years.
Besides, we do anomaly scans for our pregnant patients between 18-21 weeks gestation. With this scan, any form of malformations would be detected and noted. I’ve also seen babies born reporting to the clinic for just a courtesy visit, and they still look healthy and intelligent. What is known is that the chances of abnormalities in ART are the same as it is in the general population.
How many children have been born through IVF in Nigeria?
Nigeria started a data registry in 2014. Before then, we participated in the International Federation of Fertility Societies (IFFS) surveillance and the international monitoring team.
The total number of babies born worldwide from ART interventions is about 12 million. It is still challenging for us to know the exact number of babies born through IVF in Nigeria to date. There are several factors responsible for this.
For example, the total number of IVF cycles reported in Nigeria is about 7000 per year from about 15 reporting IVF clinics. However, today the number of clinics in Nigeria is over 100. I would estimate the actual number of cycles in Nigeria to be 10,000 per year. The estimated number of babies in Nigeria should be about 12,000.
What is the future of these children considering the challenges they face?
They probably won’t have to face any challenges because they are as bright and healthy as those conceived naturally. The oldest test-tube baby Louise Joy Brown is about 44 years and has her baby.
What are the chances of having a child through IVF? How much does it cost for a session of IVF?
There is a 100 per cent chance of having a child via IVF. The statistical chance of conceiving naturally is about 20 per cent in a given cycle, this increases to about 22 per cent in Intrauterine insemination (IUI) and to about 27 per cent in IVF. When we control for things like egg quality, and sperm quality using treatment of the patient or third party options, this can get as high as 35-45 per cent. The implication is that a couple might have a 110 per cent chance at the first attempt while some might have a 100 per cent chance after two or three attempts.
The fact is that treatment of infertility at all levels is costly. Starting from the drugs used to cause ovulation, improving sperm count for low technology treatment, and buying the media, In Vitro Fertilisation and Embryo Transfer (IVF-ET) infrastructure, and supplies. Unfortunately, none of these items is produced in Nigeria. Hence they are always affected by the devaluation of the Naira. When we started IVF-ET in the 1980s, it cost about $5000 for one IVF cycle, about N3000. Today average cost of IVF is in low-middle income countries is about $4000, which about N2 million. It is far above the average income of the population. That is why many organisations come to the aid of those who have difficulties in meeting their financial obligations to ensure they are blessed with babies in their families. In Nigeria, we have Parah Foundation, Ibidunni Ighodalo Foundation, OARS Foundation, and recently the Aneden Gives. They all support needy couples with grants for their IVF treatment, and we collaborate with them in realising that objective.
In 2005 we started the OARS Foundation in Collaboration with Medical Art Center to get the less privileged the opportunity to carry their babies. We are happy to say that we have been able to have several such babies annually. All the foundations have reported the same success stories. In the final analysis, the Federal Government needs to ensure that ART treatment is covered by insurance. Currently, IVF is not covered by insurance. Since having a baby is a human right, Government should support the realization of the objective.
June is now celebrated as World Infertility Awareness month. World Infertility Awareness Month is celebrated every June to increase awareness regarding numerous infertility issues faced by couples across the globe. It includes problems related to female as well as male fertility. Several myths regarding infertility are debunked during this month, and many options are brought forward to those who may want to conceive.
The purpose of the month? To improve the lives of millions of people who fail to conceive due to a lack of scientific knowledge, more so, in Africa to de-stigmatise infertility myths. Yes, some causes of infertility can be overcome! All you need is a good doctor, a supportive family, and an open mind. Fertility education focusing on preventable causes such as sexually transmitted diseases, occupational hazards, environmental and climate changes, and nutritional and dietary causes would be highlighted.
The International Federation of Fertility Societies, in partnership with the MERCK Foundation, will celebrate the month with a World infertility Summit on Friday, June 24, at 3 pm for all who have an interest in fertility. To celebrate the month OARS Foundation will be giving out several grants to needy infertile couples that require IVF-ET to help them achieve their dreams.
Many centres are now springing up, promising to enhance fertility and ensure conception. How are these claims and practices regulated?
We have a body that regulates the practice called the AFRH (Association for Fertility and Reproductive Health), which oversees and ensures good practices across the nation. In Nigeria, like in many other countries in the world, doctors are guided by their fertility societies’ regulations and direct fertility clinics.
The Association for Fertility and Reproductive Health of Nigeria has had very robust guidelines for the practice of Assisted Reproductive Technology since 2012. The Guidelines are comparable to those used by the America Society for Reproductive Medicine, the European Societies for Human Reproduction and Embryology, and the International Federation of Fertility Societies.
Furthermore, the discipline of doctors in all medical specialities, such as organ transplants, surgeries, infertility, cancer, and others, is within the Medical and Dental Council of Nigeria. What is needed further is that many countries provide a broad enabling law to empower the professional to affect the operation of their guidelines.
I heard MART Center now has an all-inclusive centre where a couple can be taken through the whole process- pre to post-conception and delivery. How is that? How does it work? What technology does it use?
Medical Art Center is a world-class reproductive center that puts a premium on providing cutting-edge technology with highly skilled and trained specialists in rendering the state of the art management of reproductive health, a fertility centre where couples are evaluated thoroughly before embarking on treatments.
For instance, couples are evaluated before doctors decide on which line of treatment protocol is best for management. The patient always loves to continue with our mother and child care centre, where high-risk antenatal care and delivery are provided with a neonatal intensive care unit equipped with incubators, CPAP (continuous positive airway pressure), respirators, and ventilators. All to ensure babies born prematurely as early as 24 weeks can survive. For a patient that needs a thorough body cleansing to get rid of dietary, occupational, and environmental toxins, we recommend detoxification before treatment starts. They are sent for Modern Mayr Medicine therapy (Precision Medicine) at our Mart life Detox Clinic.