Saturday, 8 September 2018

REPRODUCTIVE HEALTH CARE

THEME -  RHYTHM OF HOPE
SUB- THEME: -   MANAGING INFERTILITY
“Be Fruitful and Multiply
BY


                              DR. MICHAEL GBENGA OGUNKOYA
(MB, BS, D.A, M.D, F.H.C.O.G, F.W.A.C.S, F.I.C.S)

MD.   THE HOPE VALLEY FERTILITY CLINIC LTD
FREEDOM WAY – BY V.F.S
LEKKI PHASE I,
LAGOS.
  
    INTRODUCTION
The problem of infertility is so prevalent in our society today that almost everyone knows of someone who is so affected. i.e. 1 in 6 to 7 couples are so affected.

OBJECTIVE AND AIMS OF TALK – The DERA formula
§  To provide practical principles based on the word of God on how to approach the issues.
§  To provide information on the scientific basis of infertility i.e. causes, effects, associations etc.
§  To provide facts and information on clinical approaches to investigations and treatments.
§  To provide facts on key points that needs emphasis.
§  Some titbits on medical alternatives.
§  All the above under the guidance of the HOLY SPIRIT.

Definitions

Infertility -: Inability of a couple to achieve pregnancy after timeline months of unprotected sexual intercourse.
ü Primary infertility
ü Secondary infertility
ü Voluntary infertility
It appears that there is a higher prevalence rate of infertility in Nigeria. Ours, is a society where undue importance is attached to child bearing and sex selection with the consequent emotional and social stigma associated with infertility.

Modification of Definition: i.e. Start investigation before 12 months as in
ü Due to female age > 35years.
ü Presence of obvious personal circumstances i.e. irregular periods / presence of Fibroids.               

What is God’s promise on reproduction

·       Those couple experiencing delay in this area are in God’s waiting room
·       You are expected to survive the waiting room with certain weapons ALREADY provided by God.
·       After all, the Bible says the kingdom of God suffereth violence and

 What are these weapons:
·       Faith
·       The word
·       Prayer/fasting
·       Praise
·       Sowing
·       Fellowship
·       Patience
·       Fight fear
·       Adoption
·       Doctors
·       Mercy and plead for compassion
·       Spiritual Confession
  
FAITH:
Definition:
·       Substance of things hoped for, the evidence of things not seen.
Hence TRUST in God; have CONFIDENCE in GOD to do things for you. Heb. 11
·       It is God’s will as married women to bear children.
·       Heb.11-6, without faith it is impossible to please God.
·       Because he has promised, he will do it even without evidence.
·       Without faith, you cannot please G=od. Without pleasing God, you cannot receive His blessing.
·       So, go to God’s waiting room and exercise your faith.
·       Faith must be constant
·       Faith must be ACTED i.e. Buying baby things.
·       Faith must be SPOKEN i.e. Do not say “If I get Pregnant”
·       Roman 10-7, faith comes by hearing; hearing by the words of God.
·       Hebrew 11-11, it was by faith that Sarah conceived.
  
THE WORD:
·       “He sent his word and healed them and delivered them from their destructions”.
·       The word is life, powerful, sharpen than two- edged sword, piercing, discerning of the thoughts.
·       The word is right, gives light.
It is lamp to our feet and light to our path.
·       It has healing power.
·       The word is pure and it is a shield.
·       God’s word is like fire, like hammer that breaks the rock into pieces.
·       It endures forever.

·       THE WORD BECAME FLESH & SO CAN and WILL BRING LIFE TO YOUR WOMB IJN.
ü by destroying whatever name by which your delay is presumed due to.
ü The Kingdom of God suffereth VIOLENCE and VIOLENCE taketh it by the FORCE of the WORD.
·       Other verses- to counter NEGATIVE REPORTS
ü Luke 1:37, for with God, nothing shall be impossible.
ü Isaiah 61:7, for your shame, you will receive double honour.
ü Psalm 113:9, you are a joyful mother of children especially if looking for more children.
ü Psalm 128:3, your children will surround your table like olive plant (for those looking for more children).
ü Deuter. 7(13-14), None shall be barrier in the land.
ü Gen 30:23, Like Rachel, you too will declare that the lord has taken away your reproach if being mocked by people
ü For MISCARRIAGE, stand on Exodus 23:26 i.e. “no one will suffer miscarriage or be barren in the land”.
ü 1 Corr. 2:5, Declare that your wisdom is not in the wisdom of men but the power of God.
Summary Rom 10:10, It is by believing in your heart that you are made right with God, and it is by confessing with our mouth that we are saved.
i.e. BELIEVE and CONFESS LOUD over your situation. Hebrew 10:23, reiterates “let us hold fast”. The confession of our hope WITHOUT wavering DERA for he (God) who promised us is faithful.
RECEIVE IT, BELIEVE IT; CDONFESS IT & AQUIRE IT.
Mark 4(13-14), illustrates the parable of the solver as explained by our lord, Jesus.
·       Psalm 119(8-9), “His word is settled forever”. He honours them more than his name. He is faithful.
·       Isaiah 55(10-11), for as the rain……… it shall not return to me void.
·       Jeremiah 1:12 (KJ) He says he will HASTEN his word to perform it.
  
PRAYER/FASTING:
·       God answers prayer.
·       Am too little to instruct you how to pray your way through this issues especially as our senior pastor is available for you.
·       However, some facts are true irrespective i.e. if three women believe God for the fruit of the womb, the Lord can bring about their miracles in different ways i.e. through prayer or covenant vow, prophetic word or even medical intervention.
See Biblical examples:
a)    Rebecca: God had mercy and remember her.
b)    Hannah: Received her miracle through prayer and a covenant vow
c)     Leah: Conceived because God saw how her husband despised her.
d)    Sarah: Conceived through a prophetic word.
We are enjoined to pray:
·       Fervently-  James 5:16.
·       Steadfastly- Roman 12:13.
·       With belief- Matthew 21:22
·       In the name of Jesus.
·       Without ceasing.

PRAISE:
·       Exodus 15:11…... Fearful in Praises, doing wonders.
·       Psalm 22:3…… He inhabits the praises of Israel(we).
·       Hebrew 13:15.
·       Psalm 22:3-5.
  
SOWING:
·       Psalm 126:5-6…... Those who sow in tears shall reap in Joy
·       2 Corinthians 9:6…. Those who sow sparingly will reap sparingly vis.a.vis bountifully. ALSO, not grudgingly or of necessity.

FELLOWSHIP:
·       1 Corinthians 1:9…... God is faithful.
·       Followership with brethren, pastor and people of like mind is a powerful tool or antidote for internalizing childlessness. A problem shared is a problem halved.
·       Followership with other women can help bring some scientific and medical facts to the ignorant.

PATIENCE:
·       Habb 2:3…... But these things I plan--won’t happen straightaway -- will surely come to pass.
·       Proverbs 13:12…. Hope deferred makes the heart sick but a dream fulfilled is a tree of life.
NOTE:
·       Rejoice in HOPE.
·       BE PATIENT in TRIBULATION.
·       Continue steadfastly in prayer.
     IT SHALL SURELY COME TO PASS.

FIGHT FEAR:
·       Fear is of the devil.
·       Walk confidently in the promises of God and not in other people experience.
·       Fear is shutting God out of your situation.
·       Fear is bondage (Roman 8:15).
·       Fear is torment (1 John4:18).
·       Fear is snare (Proverbs 29:25).
·       Psalm 27:1…… The Lord is my light and my salvation…... of whom shall I be afraid [ OF WHAT SHALL I BE AFRAID].
·       2 Timothy 1:7…. For God has not given us the spirit of fear but power and of love and of sound mind.
·       Isaiah 21:10-13…… Fear not, for I am with you. Release your fears unto the Lord and keep your Peace.
Why you should not entertain FEAR
1)    You are his creation- Isaiah 44:2.
2)    He fights for you- Exodus 14:13
3)    You are loved- 1 John 4:9
4)    He is your helper- Hebrew 13:6
5)    He is with you always- Genesis 26:24

ADOPTION:
·       Is adoption an option for you? YES, a valid one for that matter.
·       This is another method God can decide to use to complete or compliment your family.
·       Galatians 4:7, Roman 8:15-17- After all God adopted us spiritually.
·       Joseph adopted Jesus in a way.
·       Matthew 1:1-25- Gene ology of Jesus to Davidic throne via Joseph established Jesus legal inheritance rights.
·       Ephesian 1:3-6
·       Adopted children are acceptable to God:
v Esther 2:15- Mordecai adopted Esther.
v Exodus 2:10- Pharaohs daughter adopted Moses.
v God adopted us as HIS children irrevocably.
·       You may still look forward to having other children.
OUR SOCIETY IS SLOWLY ACCEPTING THIS OPTION.

DOCTORS:
·       This is an interesting segment especially because of some belief.
·       Does attending the Doctors for treatment constitute lack of faith and trust in GOD. NO!!!
Why?
·       Because GOD cheated the doctors and the plants, herbs that are synthesized to make drug.
·       God gave doctors wisdom to treat infertility cases.
·       1 Corinthians 2:5 “That your faith should not be in the wisdom of men but the power of God”.
·       Despite all the wisdom in men with mind- blowing scientific feats, the power to heal and deliver still ultimately belong to God.
·       God deals with everyone differently at the level of our faith. Some differed, some immediately i.e. “He will show mercy to whom He will show mercy”
·       If you decide to see a doctor for your issues (and there is nothing wrong with that) do so in faith. If you decide to wait for God to do a miracle without medics, do so in faith. Roman 14:23…. whatever is not from faith is SIN.
·       Pray to God to give your doctor wisdom to give a correct diagnosis of your issues and to direct him in the treatment he will recommend.
Finally, SEEK GOD’S FACE and be LED BY THE SPIRIT in whatever decision you take.

MERCY&PLEAD FOR COMPASSION:
·       Roman 9:15-16- For he says to Moses, I will have mercy on whomever I will have mercy, and I will have compassion. So, then it is…………. Show mercy.
   You PLEAD for MERCY
·       Psalm 102:13……. He will arise and have MERCY on Zion for the time to favour her, yes the set time has come.

SCRIPTURAL CONFESSIONS:
1)    My father, I thank you because your word is settled in heaven and your faithfulness endures forever. Psalm 119:89
2)    You have blessed me and commanded me to be fruitful and multiply. These words assure me that you bless the fruit of my womb and not barren. Genesis 1:28; Deut. 7:13-14
3)    You said sickness shall be taken away from me. Deut. 7:15
4)    I thank you therefore father that I am a joyful mother of children. Psalm 113:9. I rejoice because my children will surround my table like the olive plants. Psalm 128:3
5)    Creator of Heaven and Earth, I praise you because my body is fearfully and wonderfully made.
6)    Quote Number 23:19, Matthew 21:22
7)    You said whatever things I ask in prayers, believing, I will receive.
v Like Hannah, Lord, I prayed and Lord has granted me my petition which I asked of him. 1 Samuel 1:27
v Like Rachael, I can say with Joy that God has taken away my reproach. Genesis 30:23.
v Like Sarah, I receive strength to conceive seeds IJN and considered you faithful to your promise. Hebrew 11:11
8)    Heavenly father, as Abraham did not waiver at your promise through unbelief, but strengthened in faith giving you glory… so shall I not waiver Lord and by your grace it will count for me in righteousness. Roman 4:20-22.
9)    Your word says that after I have done your will, I will receive the promise.
10)                      I thank you, for all the advances in medicine regarding infertility. Am not perturbed by my doctors negative report because my faith is not in the wisdom of men but in your power. 1 Corinthians 12:5.
11)                      2 Cor 10:4 The weapon of my Warfare are ….
Thank you lord.
·       I come against Satan, his cohorts IJN.
·       I pull down all strongholds of the enemy IJN
·       I nullify all curses and covenants IJN
·       I PLEAD THE BLOOD OF JESUS OVER MY WOMB.
12)   MY BODY/ MY HUSBANDS BODY, I speak to you IJN. You will   come in line and agreement with the word of God. You will function   normally IJN.
13) Isaiah 49:25… Lord, you promised that they shall not be ashamed who wait for you. I will hold fast to this for I know that He who promised is faithful. Hebrew 10:23.

WHAT HAS THE DOCTOR GOT TO DO WITH THESE?

Some Psychosomatic consequences of infertility
·       Anger.
·       Guilt.
·       Anxiety- A natural contraception (Proverbs 12:25)
-         Anxiety in the heart causes depression.
·       Depression
·       Grief: If is a devastating calamity to most couples.
   
CLINICAL ASSESSMENT OF THE INFERTILE.
History
Female:
·       Past obstetrics history
·       Surgical procedures
·       T.O.P & Complications
·       Galactorrhea
·       Coital activities
·       Age
Male:
·       Genitourinary infections
·       Surgical operations i.e. herniorrhaphy, erchidopexy
·       Drug history (of libido and erectile dysfunction)
Physical Examination
To reveal:
·       Galactorrhoea
·       Phenotype- physique
·       Weight
·       Laparotomy/Laparoscopy scars
·       Identify fibroid/ovarian cysts
·       P.I.D
·       Pelvic masses
Investigations
Basic
·       Seminal fluid analysis for:
v Oligospermia
v Azoospermia
v Asthenospermia etc.
·       Hysterosalpingography- submucous fibroid
·       Hysteroscopy- polyps
·       Hystercontrassonography- uterine synechiae(Ashermans)
·        Laparoscopy & dye test- Tubal occlusion.
·       Ovulation tests:
v Basal temperature(outdated)
v Self-assessment
v Hormone assays- p4 & LH
v Ultrasound scan
v Endometrial biopsy

Treatment of infertility in Nigeria.
Goal: - To achieve pregnancy economically and quickly.
Male factor treatment:
·       General advise- Behavioural modifications i.e. Avoid tight nylon pants, decrease smoking, alcohol, psychotropic drugs & steroids.
·       Treat infections of prostate or epididymis.
·       Operate varicocele
·       Anecdotal treatment with drugs. FSH for hypogonadotropic hypogonadism.
Female factors treatment:
·       Tubal……… Surgery - Peritubal adhesiolysis
                    -cuff salpingostomy
                    -tubal anastomosis
                    -tubal reimplantation
                     -tubal micro surgery
                     -fibroid surgery
                     -I.V. F
·       Ovulation
i.e. –Hyperprolactinemia-Bromocriptine
       -P.C. O
       -Unexplained- Clomiphene
                               -Gonadotrophin

Contemporary approach to infertility management.
The role of IVF.