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Dr. Ajayi
A couple is said to be primarily infertile if they haven't conceived after a year of unprotected intercourse and secondarily infertile if they experience delays in having another child.

Causes of infertility may be male factored, female factored, combined factored (male and female) and unspecified.

According to Dr Abayomi Ajayi, Managing Director, Nordica Fertility Centre, research has revealed that the causes of infertility are more male factored and as such, fertility researches are constantly researching and developing technology to combat this scourge. Male factored infertility includes low sperm count, no sperm in ejaculation and low sperm motility

One major way of combating this male factored infertility is ICSI – Intracytoplasmic Sperm Injection. This involves the injecting a single sperm (the most healthy sperm or best sperm quality from the sperm sample from the male partner) directly into the egg of the woman for fertilization.

'With ICSI, the sperm or ejaculate is magnified to almost 200times for easy identification of the healthiest sperm. Research has revealed that this is almost 28 per cent successful and precise in the treatment of male factored infertility.

'Technology advancement has improved the ICSI service and currently produced the IMSI apparatus -Intracytoplasmic Morphologically Sperm Selected Injection (IMSI) where the sperms are magnified to almost 6000 times for easier identification of the heathiest sperm and for precision modalities.

'Hence, couples achieve more accurate results as the chances of conception becomes higher,' he said.

Nordica Fertility Centre, Lagos in this light, has heralded this significant technological advancement in fertility services by acquiring this instrument. Being the first in Nigeria and West Africa (if not Africa) to acquire and offer such tremendous service, it is a milestone achievement for the fertility centre.

Dr Ajayi spoke on this and on Invitro Fertilization (IVF) generally. Excerpts:

IVF is invitro fertilization and as the name implies, we mean fertilization outside the body. And this is a way of treating infertility. Initially, it was designed for treating female infertility because the first patients that had IVF had it because of tubal problem. So, initially when we started, it was only about treating female infertility, but as time went on, so many things came up. And like they say, necessity is the mother of invention. So, for men whose sperm are not good, who cannot fertilize the egg outside the womb, ICSI came on along and recently, we also launched IMSI, which is even more advanced than ICSI.

Now why did it have to come to Nigeria? Nigeria happens to belong to the countries that are regarded as infertility belt, in the sense that there is a high prevalence of infertility in this part of the world.

It is a contradiction in the sense that we have high population in this part of the world. But at this same time, infertility also is predominant. Initially, we thought it was due to infection, because of low hygiene and health care facilities, but now things are improving but infertility is still high. Now it is even massive but the incidence of male factor infertility all over the world and Nigeria is having its own fair share.

Before, because of lack of infrastructure, many people thought it was impossible to do IVF in this part of the world. But now we know better, because we have many IVF centres in Nigeria, some of them are doing very well including Nordica Fertility Centre.

We have just introduced a method of management of male infertility, which is available in some parts of the world. Not every part of the world, which is a little bit better than ICSI. Until about 1990, male infertility was a no go area even with assisted conception. And because of that you get very poor result of IVF. Many people tried to see how to solve male infertility problem until 1990 when a gentleman devised what we call ICSI now. That had gotten many people treated, even up to many people who don't have sperm count at all, what we call oligospermia.

But we have also seen from that, that there are some problems emanating from that. We could not complain at a stage, because it was better than where we are coming from. Because the incidence of spontaneous abortion was a little bit higher, but people did not complain because this was a man who could not have get treated before, but now he can get his wife pregnant, probably he should get his wife pregnant a few more times, one of them will stay.

But in 2004, someone noticed that if you choose the sperm that you want to use for ICSI, you might be able to solve the problem. And he did something now people found out that we have better chances by choosing the sperm, the blastosis rate increased, better implantation rate, better take home baby rate and therefore he started working on this, and this is what form IMSI.

The difference between IMSI and ICSI is that in ICSI you magnify the sperm to times 200, the very best to x 400. But in IMSI, you magnify the sperm to x 6,000, so you are able to actually see everything about the sperm, you can see the different parts of the sperm. So many interesting things came out from there. You see that so many sperms people were using were not normal sperm in the sense that they have problems in their head, especially in the part bearing the DNA. And some were deformed.

Like they say in computer, garbage in, garbage out, if you use bad raw materials, you will end up with bad products. So, you choose the sperm, and people know that, yes, your pregnancy rate is good, that's what IMSI is all about. But the machine is a little bit much much expensive and you are going to train the people who are going to use it as well. Yes the machine will help the people, who are always looking to get the type of result you get in the first world.

IVF awareness
We are doing that because it is our business, but we are going to do that together with the media. It is a joint effort. We have the technology, we want people to know about it. Like you know there are people who are not doing IVF the way it should be done. I don't want to use the word charlattans, but anybody who is in a vulnerable position like infertility, people can call them and tell them all sorts of stories.

That is why we see it more of a responsibility to educate people so that they don't go where they won't get satisfaction.

The same thing, people should not go where they can never get result.

The other area I want to mention is government taking the responsibility to make IVF affordable to people who cannot ordinarily come to an IVF clinic to access IVF, because we know that IVF is not affordable to majority of the populace. But if they are aware, it is a good step because most of the time, the first thing is awareness. Because many people who can never afford it are not even aware that it is possible to do it here. And they can even been looking for airfare, which will be enough to do IVF here in Nigeria. By the time you calculate money for airfare, welfare, accommodation, not to talk of the costs you can't calculate, you find it cheaper to do it here in Nigeria.

If you are working, you will be absent for about three months, if you are a business man, you will be absent for about three months, you can't put a cost to that, that is why it is important for people to be aware about the opportunities they have here before jetting out of the country to do IVF.

IVF and natural conception
IVF has slightly higher rate that natural conception. Especially when you are talking of young women, the prevalence of multiple pregnancy is more in IVF. So when you are talking of number of babies or the success rate or percentage, natural conception has about 20 percent, IVF has about 25-30 per cent. It is not something we make noise about. When you are talking of number of babies, IVF has the upper hand and this is because we present more embryos to the body than nature would normally do. So if it is successful, it is likely to take more than one.

You know something about IVF is sometimes you are making someone who ordinarily would not get pregnant on her own or his own to be able to father a child. And you are also making that person to be able to have the same percentage with somebody whom nothing is wrong with at all.

IVF babies
It's not true to say IVF babies are not normal, because the only thing that takes place outside the body is the fertilization. The implantation and everything, all the knitty-gritty factors of the quality control system in the body are still at play in IVF. So, babies from IVF are normal babies. That is why the success rate is not too high compared to what happens to the body normally, because the quality control system in the body is not suspended. They are still taking place. IVF children are getting to 4 million people worldwide.

Sperm and egg donation
There are criteria we look out for, if you are not up to 40 years yet, if you don't have any infectious diseases, and in your health history, no medical reports that are contrary, yes, these are the things we look out for, it is possible for you to donate, to make sure they are not going to transmit either sexually transmitted infections or even genetic disorder to people who are going to use their sperm.

Egg donation is a little bit more stringent, we do the same thing for them, and also we look at other things, for instance we look at their body mass index, you can't be overweight and donate, infact their age is even lower, if you are above 34 years, you can't donate. Yes, all those are looked at before you donate, and also you must complete your programme before you start. There is counseling involved, we talk to you to make sure you are in the right frame before we admit you to the programme.

There are cultural issues we tackle in this programme, you know our background, and you have to convince donors that their eggs are cultural issues. There are also ethical and legal issues that we look at because it is possible for donors, if they are not well grounded, if by any reason they get to know who used their eggs or sperm to come back a year or two years after to want to claim the baby. We prevent all that.

In fact, there are legal documents that say they cannot have any claim to the baby because they donated sperm or egg. Unlike in some countries, they've gotten to a stage where they have a website, you can go and choose your donor. We are not doing that here. We are protecting the recipients from the donor, at the same time we are protecting the donor from the recipients.

We have a foundation that helps people who cannot pay for IVF, that you must agree with me that it is a drop in the ocean. Because it cannot solve the whole problem of those seeking to do IVF. Probably we do eight or ten circles per year. You also want to remain afloat. So, there is a foundation that handles this, fertility treatment for such group. And like every other thing, we are trying to look for people who can partner with us to be able to give more people opportunity to be able to have access to this treatment.

IVF is not accessible to everybody because the budget of health is not enough. If you have 150 million people, you can't even treat tuberculosis and malaria yet, you try to go for IVF for everybody, it is a far dream, that may not be totally possible. So we need to be realistic. But can government make it cheaper in government hospitals, the answer is yes. Also, one thing we need to be careful about is bringing the standard down and sub-standard service. So while they want it to be accessible, we should also ensure that people who go through the process can have the result in other parts of the world.

Because there is no point going through four cycles, just because it is cheaper, and you don't get any result. And you can go through one cycle and get the result that you want. So we must not loose track of what we want to achieve. The private sector must continue to strive for excellence and development must continue to strive to see how we can provide for everybody, but when at that level we must lose track of quality.

Work hard to achieve your heart desire.