In Nigeria and
perhaps much of Africa, the common thought regarding infertility is that the
problem lies within the woman’s physiology. This is because women’s
reproductive organs can be more easily damaged than men’s. However regular
readers of our publications are by now familiar with the fact that infertility
is a shared problem between men and women. About 40 per cent of the time,
infertility is either due to a male factor or a female factor. Some couples may
both have factors that interfere with conception.
All around the
world, pockets of the population are at high-risk for infertility. The problem
rests mostly with populations where women have contracted a sexually
transmitted infection in the past or have delayed childbearing for certain
reasons. Physical causes for infertility in women include scarring on the
cervix, uterus, or tubes; blocked tubes; and problems with ovulation or the
menstrual cycle.
Male organs are
much more easily damaged by mumps, swelling of the testicles, or a varicocele
(a large varicose vein on the testicle), that all can cause lower sperm count.
For couples desperately trying to conceive, any additional help they can
receive is a relief.
Couples going
through any number of infertility treatments are more likely going to try a
procedure, such as IVF or Intrauterine Insemination (IUI) also known as Artificial Insemination. Giving couples even the slightest chance of
improving the probability of conceiving is a boost. Couples seeking assisted
reproduction techniques are often urged to choose the treatment option which
maximizes their chances of conceiving quickly. This is so because traditional
treatment for infertility usually involves a logical stepwise approach.
First, a
diagnosis is made to find out what the problem is. Next, an attempt is made to
try to fix it using a progressively escalating approach. Medications are tried
first. If this fails, surgery is tried and if this too fails, then it may be on
to Intrauterine Insemination (IUI). If this still does not work, then we try
HMG superovulation plus IUI; and if this ultimately fails, and the patient is
up to it, IVF is the ultimate.
Today, IVF is
practically a household word. But not so long ago, it was a mysterious
procedure for infertility that produced what were then known as “test-tube
babies.” Louise Brown, born in England in 1978, was the first baby to be
conceived outside her mother’s womb.
IVF is
sophisticated unlike the simpler process of artificial insemination — in which
sperm is placed in the uterus and conception happens otherwise normally — IVF
involves combining eggs and sperm outside the body in a laboratory to form
embryos. Once an embryo or embryos form, they are then placed in the uterus.
IVF is a successful procedure, but less than 5% of couples with infertility
seek it out.
When it comes to
infertility, IVF may be an option if you or your partner has been diagnosed
with problems including endometriosis, low sperm counts, ovulation challenges
or an unexplained fertility problem among others.
IVF may not be
the first step in the treatment of infertility except in cases of complete
tubal blockage and very low sperm counts. Traditionally, IVF has been used for
treating infertile couples. However, it would be equally valid to use IVF to
help couples to achieve their personal reproductive goals, as long as they make
a well-informed decision, and are aware of the pros and cons.
Actually, if
most fertility experts had a choice, the only treatment they would offer would
be IVF – after all the bottom line is to get pregnant as soon as possible. If
couples can get pregnant with IVF, then why not use it first rather than as a
fallback option when all else fails?
While all this
is logical, it often does not work out clockwork in real life. Some couples
complain that the IVF approach is time consuming, and may even drop out of
treatment rather than move on to the next step. This can be tragic however
because there are scores of patients who could have got pregnant with IVF but
didn’t because they were not patient enough.
The first step
in IVF involves injecting hormones so the woman can produce multiple eggs
instead of only one. She will then be tested to determine whether she’s ready
for egg retrieval. Prior to the retrieval procedure, she’s given injections
that start the process of ovulation. Timing is important; the eggs must be
retrieved at the right time. It is important to state that women are not cut
open to retrieve the eggs.
Most women are
given pain medication and the choice of being mildly sedated or going under
full anesthesia. For egg retrieval following this, the eggs are mixed in the
laboratory with the partner’s sperm, donated on the same day. The fertilized
eggs are kept in the clinic under observation to ensure optimal growth.
Once the embryos
are ready, the woman returns to the IVF facility so doctors can transfer one or
more embryos into her uterus. A pregnancy test is performed about two weeks after
the embryo transfer.
Success rates
for IVF depend on a number of factors, including the reason for infertility,
where the procedure is done, and the couple’s age. Any embryos that are not
used in the first IVF attempt can be frozen for later use. This will save money
if the couple undergoes IVF a second or third time.
It has been
extensively explained in the past that a woman’s age is a major factor in the
success of IVF for any couple. For instance, a woman who is under age 35 and
undergoes IVF has a 40-50% chance of having a baby, while a woman over age 40
has an 11.5% chance.
Is IVF
affordable? The answer is yes. The
average cost of an IVF cycle in Nigeria will vary depending on factors like the
amount of medications required, the number of IVF cycles, and where it is
performed.
It’s well known
that pregnancy rates with IVF are much better for younger women than for older
women, so it’s much more cost effective to do it when you are younger. It is
true that doing IVF means spending considerable money. On the other hand, not
getting pregnant has a considerable cost attached to it too – the drainage of
emotional energy and the time spent waiting and hoping. IVF may be more cost
effective and time effective for many patients.
Equally
importantly, IVF gives infertile couples peace of mind that they tried their
best – that they gave infertility treatment their best shot. This peace of mind
can be priceless! In the past, IVF was considered to be the treatment of “last
resort” – and was reserved for patients who had failed all other treatment
methods. Today, it is often the treatment of first choice, because it maximizes
the couple’s chance of conceiving quickly, no matter what their medical
problem.
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