IVF is not the solution to Infertility - Gynaecologist

In Vitro Fertilization is an assisted reproductive technology (ART) commonly referred to as IVF. IVF is the process of fertilization by extracting eggs, retrieving a sperm sample, and then manually combining an egg and sperm in a laboratory dish. The embryo(s) is then transferred to the uterus. 
Dr Babatunde Okewale, an Obstetrician and Gynaecologist (O&G) and a fertility expert is the Chairman and Chief Medical Director of St Ives Specialist Hospital
Is IVF the only solution to infertility?

No. In fact, IVF is just one of the solutions in infertility. It is not all the infertility causes that you need IVF for. If you have menstrual disorder, all you just need is an ovulation drug that would correct the problem, or if the problem is fibroid that is blocking some passage ways that will allow sperm to meet with eggs; if you remove the fibroid that should sort out the problem. IVF is however the first treatment option in women that have blocked tube. What it does is that it bypasses the tube and makes fertilization occur outside of the womb.



Some women have done IVF four, five times without it resulting in pregnancy and some of them later conceive naturally. What is responsible for that?

The truth of the matter is; before you embark on IVF you must be sure that that is what is needed. It is not a situation of let me try IVF then try other things. There are some indications for IVF that lent themselves into the fact that after having an IVF, you can still conceive naturally. For example in cases of unexplained infertility (when all examination had been done and there is no reason for why pregnancy has not occurred), we advice IVF because what it does is to ensure that both the egg and the sperm meet. In such couples, they had IVF, got pregnant and have a baby. Subsequent conception does not have to be IVF. The drugs used in the IVF have made some correction in their reproductive hormones. It does happen but it is very rare. So, the reason IVF fails is that people don’t go for test to find out whether that is what they really need. Another reason IVF fails is either because the quality of the woman’s egg is low or the quality of the womb is not fertile or okay. But if the womb is very fertile, if you put an embryo there, it will grow. The problem in women is that as a woman grows older, the quality of the egg and the quality of the womb start deteriorating. IVF is usually very successful in women below the age of thirty. As a woman grows older, the failure rate of IVF starts increasing. In fact, let me give you some statistics; if a woman is below 30, her chances of getting pregnant in a cycle of IVF is 60 per cent, while in a woman who is 40 years old, her chances of getting pregnant in more than one cycle is not more than 25 per cent. What have made the differences are the age and the quality of the egg and the inside of the womb. The best time for pregnancy in women either naturally or IVF is below the age of 35. Most failures in IVF are in women who are using their own eggs above 35 years old. The converse again is if a woman is 60 and wants to get pregnant by IVF and decides to use the egg of a younger person, the chance that she will get pregnant with the egg of a 3o-year-old is high.



Talking about pregnancies, why do women have miscarriages?

Generally speaking, the incidence of miscarriages in natural conception is about one in four. Most people might not know that. In fact, most people have miscarriages even before they missed their periods. What causes miscarriage in the early stage of pregnancy mostly is abnormality in the formation of the embryo. Again, if people get married late, the incidence of abnormality increases. Any woman who gets pregnant above the age of 35 should ideally be screened for Down syndrome. For most abnormal pregnancies, the way the body deals with them is to let them go (miscarriage) before 12 weeks.



IVF is on the high side for many Nigerians, especially in the rural areas. What are you doing to ensure that they too can benefit from this procedure?

What we have been doing for the past 10 years is that we work closely with a Non-Governmental Organisation (NGO) that twice in a year our patients pay only 50 per cent while it pays us the balance. So, we do a promo twice a year courtesy the NGO. Ideally, the government should step in, in such situation. In UK and some other socially responsible societies, the government steps in. In UK for instance, the government ensures that you have free IVF for the first three cycles it is only if nothing happens after three cycles, that you start paying. And people that can’t afford it, it is highly subsidised because infertility is a social problem. Although our governments don’t see it that way, they are more interested in population control so more money is being put into contraception. But for a couple trying to conceive, infertility is a social problem and government should be able to help. Having said that, IVF is an expensive procedure all over the world not only in Nigeria. Part of the reason is that an IVF laboratory is a high tech lab. There must be light 24 hours and there is a level of sanitation that must be present in the lab. Though it is not as expensive as heart or kidney transplant. The only problem is that people don’t see infertility as a diseased process, they only see it as a lifestyle issue.