The First Fertility Hospital in Makurdi, North Central Nigeria is a new facility aimed at putting smiles on the faces of these couples...
The youngest woman is 25 while the oldest is 53 years, they are here for 1 reason, to have a child, a chance to experience motherhood...
They've just received their first baby implants, shortly after the procedure, I speak with Dr. Rajesh Koradia who is leading this team:
King James:
Let me start by ASKiNG you your name and where you are from
Dr. Rajesh
I am Dr. Rajesh Koradia from Mumbai, India.
King James:
How long have you been into this practice?
I've been practising general Obstetrics and Gynaecology since last maybe twenty-five years but then I am into field of infertility and IVF since the last five to six years
King James
Is this your first time in Nigeria?
Dr. Rajesh:
Yes, for professional work, I am coming for the second time, in the month of April, I came for the screening the patients then formulation of the batch and then I'm coming for the second time in this country.
King James:
Obviously, as you can see, the issue of difficulty in having a child among couples is a serious one, some have tried and are trying for periods ranging from three to eight years or more, from what I've heard, having seen them, having screened them, and having gone through all this process, what would you say are the commons problem with women especially?
Dr. Rajesh:
The reason for the infertility among women in this country is entirely different than our country, in our country, the polycystic is the most commonest cause of infertility whereas in Nigeria, I observe maximum number of the fibroids, maximum number of the tubal blocks and maximum number of the abnormal semen, responsible for the infertility.
This number of cases I have never seen in any and never heard in any part of the world. The maximum number almost all women either they have some abnormal semen, some fibroid and blockage of the tubes, maybe one tube, two tubes, maybe damaged tubes, maybe some irregular uterine lining, maybe some abnormal semen sample. So, these are very peculiar reasons for infertility in this country, and which requires to be corrected, there are some problem with the lifestyle over here, what I have observed from the history that there is lot of pre-marital sexual activities going on, so because there is lot of abortions; voluntary abortions before marriage, and those abortions must have been conducted in not a very proper way, so which is majorly responsible, the multiple sexual partners, sexual promiscuity, I believe is the responsible reason for such a high number of tubal blockage and the endometrey lining irregularities, so, I believe you need to pay attention to and you need educate the person to take care of themselves and avoid having multiple sex partners.
King James:
That's on the side of the women, for the men, what seems to be the commonest problem?
Dr. Rajesh:
For men, I have noted (as compared to the other countries), the high number of the abnormal low sperm count, although physically, they are very well built and very masculine but then looking at the sperm, the count is quite low and the motility is disturbed I do not know what is the reason, some stress factor responsible, maybe some irregular lifestyle may be responsible, I need to go into details because I'm not very with the social aspect of this country, so really, I need to go into the details why there is abnormal low sperm count.
King James:
Now, IVF seems to be the final bus stop (as we say here) when women or couples have gone through different other methods and then they resort to doing IVF, obviously, the ovum and the sperm are fertilised outside the womb but what are the chances of introducing the embryo and then it is able to find its roots in the womb?
Dr. Rajesh:
That depends on what is the reason for not conceiving, but if you ask me to answer broadly, the success rate is something around forty to fifty percent (40-50%), the take home baby, what is important is how many percentage of the patient take their baby home is somewhere around thirty percent (30%).
King James:
Anxiety is one thing (from what I hear) which leads to (if you like) infertility or prolonged absence of a child among couples, now, with IVF, do you think anxiety can lead to its failure?
Dr. Rajesh
In any case, anxiety has got direct relation with the hormonal secretion from the hypothalamus which is the master gland which governs the fertility cycle, so, any patient who is too much anxious, has put on certain weight, lost certain weight or work, they are going to be disturbed because of the abnormal hormonal secretion from the hypothalamus which is going to affect the regularity of their cycles, so indirect way, yes, anxiety definitely affects.
King James:
Now, another factor that is responsible for the delay in seeking medical attention in Nigeria is religion, people are busy going to Churches, Pastors are promising them miracle babies through prayers because many rather believe it is witchcraft rather than lifestyle.
Where do you suggest couples should go first, Church or hospital?
Dr. Rajesh
See, any woman who is married for a year and having regular relationship with her husband, what I mean regular relationship is, at least they should meet at least three times in a week, and the woman should have a regular menstrual cycle and the husband has a normal sperm count, such type of the 100 couples if you take the 50 couples should conceive within 3 months, some 25% more couples may take 6 months, 10% couple may take 3 moths more, so at the end of the 1 year, one should expect 85% of the normal couples should conceive, those who are not able to conceive, they definitely require medical attention and investigation rather than going to Church of course God is great and no Doctor can take the place of God, but then definitely they should seek the Infertility Specialist and the Specialist should commence the basic investigations.
Suppose the patient is of advanced age, maybe 35 years, then only 6 months, they don't need to wait till 1 year, if in 6 months she is unable to conceive then she should be thoroughly investigated and accordingly and treatment should start.
King James:
Now, talKiNG about age which you just raised concern about, in IVF, we are looKiNG at success rate given the woman's age as well. At what age is the success rate quite low for a woman?
Dr. Rajesh
Very good question you asked. You know as part of the International Standard for Foreign Studies based in Western Countries, the approximately years of the woman's age the egg quality starts declining from 34, from 34 to 37 years there is a sharp declines and from 37 up to 40 years, there is a steep decline, and then after 40 years, there is almost impossible for that woman to conceive with her own eggs, mind you this is a Western data, I am from India, in India, what is there is 4 years earlier than the Western data, so what is happening with that egg at 30 years Western country, in India, it is happening at 26 years. So, after 26 years in India, the girl's egg quality starts declining. I need to check what the Nigerian study says, I will have to talk to the Nigerian Gynaecologists about their quality status over here. But this is the fact, and I'm so much worried because of the career oriented woman, they are trying to postpone their marriage, late marriage, they are trying to postpone the child birth , by the time they discover they decide to go for the child, they reach up to 36 or 37 years of age which is not good, the they start to run from one fertility clinic to another fertility clinic to conceive and this problem has been created by them so, definitely, there is age for everything, so any woman they should marry by age of maybe 25 and they should try to finish childbearing before 32 or 33 years of their age.
King James:
Is there any difference between the woman who is pregnant naturally and that woman using someone else's fertilised egg?
Dr. Rajesh:
Absolutely, normally when we feel that the eggs are not of good quality then we recruit the donor and obviously the donors are very young patients and usually around 24 to 25 years, so naturally their quality of eggs has to be good, the results are fantastic,but if the eggs do not belong to that particular woman in whom we are going to transfer, genetically, the child is not hers 100%. 50% genetic material is from the husband because we take the sperm of the husband, so it is not completely resembling the couple, it may be 50% resemblance by all means.
King James:
Now, in the last few months that you've been coming here and you have monitored women, you have screened them, and one of the women got pregnant after the initial treatments just before the IVF, before this process, she wasn't able to conceive for 2 years, what could have led to her pregnancy?
Dr. Rajesh:
Very interesting question, many times what happens is something called Expectant Treatment. If the patients are thoroughly examined, counselled properly. If they are psychologically absolutely satisfied, then automatically hormonal imbalance gets corrected and they conceive.
King James:
The women who underwent the IVF are returning in two weeks for confirmatory scanning, within this period are they going to experience changes in their system?
Dr. Rajesh:
That depends on the sensitivity of the woman. There are few women who start feeling something within 10 days of embryo transfer maybe breast heaviness, nausea feeling, maybe blotting sensation, maybe discomfort in the abdomen na day this they also come to know that they are pregnant and their tests turn out to be positive.
King James:
Is there any difference in the system of a woman who has conceived naturally and that whose conception is assisted through IVF?
Dr. Rajesh:
Yes! Absolutely, those who have conceived through IVF, they are likely to have multiple pregnancy because we transferred multiple embryos, chances of prematurity, the chances of growth retarded foetus, the chances of placenta separation. So in that cell, the obstetric complications are likely to be later on high side when the woman has conceived because of IVF as compared to natural conception, yes, I can not deny that.
King James:
So, what do they need to do within these 9 months?
Dr. Rajesh:
They need extra medical attention by the Gynaecologist.
King James:
What kind of foods should women eat or avoid to naturally increases their chances of hormonal balance which will likely lead to high level of fertility
Dr. Rajesh:
They should try to avoid junk food, they should avoid foods produced with lots of fertilisers and all those things. They should eat more natural foods, high protein foods and avoid high carbohydrate foods.
King James:
What else do you want to say generally to Nigeria women and other Nigerians?
Dr. Rajesh:
I will advise them to have a protected relationship 100% because most of the problems are tubal blockage problems and endometrey chaotic problems because of the sexually transmitted diseases which are incompletely treated, so if at all they have some sexually transmitted diseases, it should be treated thoroughly so that it doesn't leave behind any damage. First of all they should try to avoid pre-marital sex number 1.
Number 2: they should have minimum sexual partner, they should do monogamy; only one sexual partner
Third: if at all they have developed sexually transmitted disease, it should be properly treated, properly treated.
Four: they should try to marry before they are 25
Fifth: they should try to complete childbearing before 32/33 years.
King James
Thank you very much Dr. Rajesh
Dr. Rajesh:
Thank you King James
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