Intimately Yours with Dr. Aihmaku; All you need to know about infertility and more
Is it true that being sexually active at an early age aids conception?
I will say No and Yes, we only find out that women who get sexually active at an early age, tend to get pregnant earlier, that is why people often say it aids conception. Those who delay sexual activities till later in life, tend to experience a delay. Those who get sexually active early tend to have experienced pregnancy in life earlier than those who delay till late. According to National demographics, women are sexually active from the age of 15.
During pregnancy what discharge is safe and which is not?
In pregnancy, there is physiological discharge which is normal during pregnancy, a woman has the entrance of her virginal which will normally discharge to protect the woman, there is natural organism that protects the woman from infection. When it becomes abnormal, you need to check for the quantity, is it more than usual? what does it look like? is it clear? If it is whitish or yellowish there is a concern and if it starts to smell. If you have problems with any of these then you should see the doctor.
What are the things that increase a woman’s risk of infertility?
There are many courses, but two major courses are infections and fibroid. Infections could result from abortions and miscarriages not properly taken care of and not given antibiotics, delivery also not taken good care of has also led to an upsurge in infertility. fibroid too can also lead to infertility but generally, fibroid do not contribute as much as infection, most people would have had a history of infection. Another silent cause is an irregular menstrual cycle, most people who have an irregular cycle do not know when they ovulate. Ovulation problem is a leading cause too when women don’t know when their eggs are released.
What are the things that increase a man’s risk of infertility?
Infection too, a lot of men have infections and they do not know, men and women do not use barriers (condom ) I’m so scared there has been an upsurge in men with infections. Men coming with discharge, itching on the penis , STI, if not treated well can lead to infertility. The penis which is a pathway for urinating is the same tract in the penis where the sperm will go through (urethra in the penis ), you can have the urinary infection as a man; STI is greatest form of infertility problems.
How does age affect a woman’s ability to have children?
There is what we call productive age which is between 20 and 45 when a woman should ideally get pregnant. What is the cause? A lot of women who get married early have good quality eggs; every woman has eggs needed in her body when born when she starts ovulating she releases an egg every month until when she gets to 48,49 when the egg gets bad or go. Good quality eggs, when married at an early age, can result in brilliant and bright children. As age advances, women tend to have reduced chances of getting pregnant.
Are there are signs and symptoms associated with infertility?
No, infertility is the ability of a couple (man and woman ) not being able to conceive at least for a year. There are usually no symptoms when the woman comes to a Doctor, questions are asked, examinations are carried out and test. On a scale of 100, 40% of women have problems with infertility, 40% of men, 10% both the man and woman, 10% are those who after all test, examinations, treatment they are still not getting pregnant.
.Q: How is Infertility treated?
A: Infertility is usually treated mostly in women, when women come for consultation on infertility I ask them series of questions like; What’s your age? What’s your menstrual cycle? What symptoms do you have? What does your discharge look like? Then I examine them, if she is hairy, that means she has some male hormones in her, then you check if there’s any abnormality in her womb, we carry out an abdominal examination, order some test to check if there is a problem with the man or woman. Check the woman if it’s the vagina, check for ovulation if she is producing eggs.
About 90% would ovulate, even those that ovulate sometimes don’t know when they do, there is sample test that can test for ovulation, we have ovulation kits where you can actually use the urine to test for ovulation.
Then we would also want to look at the tubal patency, where the egg is produced i.e. the vagina, you would want to know if the tubes are patent. When the sperms go into the womb, the woman releases an egg, then the egg enters the tube so you would want to know if there is tube patency. You would also want to do a hormonal profile like I said earlier about women with male hormones. There are some hormones that are responsible for releasing eggs, so you would want to know if the women have enough of such hormones. Basically, those are the investigation we do in most women.
For the man, we do what is called the Seminal fluid analysis, they release sperms into the container and we look at different parameters with a volume of 2-5ml of sperm. In terms of consideration, we should have about 20 millions of sperm in each ml so we look at how many of them are moving forward, usually, we should have about 50% of them. You may be able to find out the problem through that.
Q: What are some of the medications used for Infertility?
A: Infertility generally, what you do depends on the cause. I think most women may not need any medication because they don’t know their cycle. Everybody assumes they have a 28 days cycle but that is the average, anyone who has 21-35 days cycle is normal. After each menstruation and the egg is wiped off, another one starts to grow. A woman needs to monitor herself, You ask a woman when she saw her last menstrual period, she would bring out her phone to check.
A lot of them need to monitor their ovulation, like I said earlier we have some nice kits that can be used to monitor ovulation. So those kits tell you two things; if she is ovulating, it then tells you when? When you sort that out, you find out that few women get pregnant. Also when we are talking about adequate sexual intercourse, it means having sex at least 3 times a week with your spouse; the fertile period is that period when ovulation should occur. Then when a woman comes to you that she doesn’t think she’s ovulating, that’s when she has to use the ovulation drugs which help to stimulate the woman to produce eggs. Other tests are carried out depending on what your results are, then you know what to do next. For example, if you find out she has an infection then you treat.
Q: Do all patients receive the same treatment for Infertility?
A: No, it depends on the cause.
Q: Have heard that having IVF is very expensive, is that the only treatment you offer for Infertility?
A: IVF is like almost getting to the end of your options, there are still more options after it, it’s expensive because, in an IVF center, a lot of money is spent on generation (power). The eggs need to be constantly in the fridge at a particular temperature and we all know power is terrible here in Nigeria.
The eggs are harvested for the patients, we have donor eggs, sperms and all other things, the procedure itself is expensive, a lot of tests are done and they are microscopic.
We are talking about aspirating the woman’s egg mixing with the husband’s sperm, IVF stands for In-vitro Fertilization.
Fertilization is the coming together of man’s sperm and women’s egg and we are talking about in-vitro which is outside the body, it’s done outside, and it is technical you have to do manipulation on many of these things and know how to transfer it back to the woman.
We have a lot of drugs that the woman has to take to maintain pregnancy; nobody wants to spend a lot of money.
There are 2 types of IVF; low-cost IVF and high-cost IVF, when you are talking about low cost, you are using different drugs maybe not as effective as the other one. For example, when you are buying a car and you don’t have much money, you have to buy the one that’s not too expensive
. Those are the ones we tend to offer patients who don’t have a lot of money, it works but it just that the chances of it working is not as high as the quality drugs/high medications of the other ones
. An average low-cost IVF goes for about 350,000 and of course the one that does work goes for about 1.2million or 750,000-1.2million.
There’s no amount of money a couple can pay for a child. But I think if the government does subsidize, doing such procedures in teaching hospitals will drive the cost down. You find out that most IVF centres are privately owned, we have just very few teaching hospital (Federal government facilities) that are doing IVF apart from Kano, Benin, Abuja (National hospital), when you have government-owned facilities, the salaries are paid by the government and then the gynecologist and all those that take part in IVF all get paid, but when you do IVF in private hospitals, you have to pay your staffs to do most of the things that are what drives the cost. The success rate is similar in most places, it’s still about 40%. Have seen a woman who has done IVF in Lagos. Abuja, India and U.K 4 times over a period of about 9 years, and got pregnant naturally, so it’s not the end but it would be more affordable if the government put its finals into it.
Q: Why does it fail, having someone do the IVF 4 times?
A: I think it’s more of patient assessment, we are talking about IVF. When I tell a 42-year-old woman that you are going to do IVF and I tell her I think your eggs are of poor quality, you need to get somebody to donate egg for you, I need to get her a donor then she would tell me ‘No’ that why do I need to get a donor for her, that means the child would not be mine and all that, then it can fail if she insists. When the man also says you mean you can’t use my sperm because it has a low count, It can also fail.
Proliferation of IVF centers in Nigeria are too many, In Lagos alone, we have almost 50 centers, there’s no quality control and only about half of them are run by a gynecologist and others are run by medical officers or doctors who go to India to train for just a month and they have money to buy the equipment and they do it .
I am privileged to be the assistant secretary general of all gynecologist in Nigeria when we have conferences I know who have good results, so I can tell my patients where to go because I know what these guys do.
When you get to some IVF centers, very beautiful, three storey buildings, marble everywhere and you think you are just in the right place and then you get there and they give you funny figures, we have 80% success rate, 90% success rate; I once listened to a colleague of mine who was telling me all of a sudden they were having a lot of failure in their IVF centre and he was worried , he called an experienced professor to come and check their IVF centre, immediately the professor entered the building and told him that it was because of the noise from the other building and dust particles.
You need to have a very clean environment and good quality control, and I tell you as soon as they did a lot of cleaning and waited for the other building to complete their structure, the failure rate reduced.
Q: Someone said “ I have a lot of miscarriages, Can you help me?
A: I tell most patients to let your doctor investigate you, find out what the cause is, now we have a lot of drugs that are called Pregnancy support drugs. Pregnancy is 9 months; the first 3 months, the placenta is not well-formed, so you have chemicals in the body that are hormones that usually maintain pregnancy, we found out recently one of the reasons why women have a lot of miscarriages especially in the first 3 months is because the hormonal level to support pregnancy in them naturally is low, so we now have drugs called Progesterone that helps to support pregnancy and then you must find out the causes before you treat.
We have some collagen disorder that has been responsible for current miscarriages in women, they are treatable. You need to get to see a specialist so you can find out what the cause is before treating.
Q: What Impact does Infertility have on the psychological well being of an Individual?
A: It’s a big problem, we have about 4 million Nigerians suffering from Infertility, It’s an expensive disorder to treat because a lot of people do make money from them.
Some men don’t want to get treated because they believe they don’t have a problem, and also going to the right place is very key. A lot of couples compare themselves with people who got married around the same time with them, these things psychologically can cause marital disharmony.
I always stand on my words, you need to marry someone whose patient level is high. There’s no age limit to having a child.
A patient of mine who had infertility for 14 years, had a baby at 49 years, and the couple stuck together.
Dr. Chris O. Aimakhu
Dept. of Obstetrics & Gynaecology,
College of Medicine,
The university of Ibadan.
Chief Medical Director, St. Vincent Medical Centre. (08037184096)