Managing Director of Nordica Fertility and Fibroid Centre, Dr Abayomi Ajayi, speaks with DEBORAH ONYOFUFEKE on issues of infertility, its treatment, and availability of facilities in Nigeria, among other sundry matters.
How did you get to become a fertility doctor?
For you to be a fertility doctor, you need to be a gynaecologist. I was a gynaecologist for a few years and I took interest in fertility and then became a fertility specialist
What has it been like running a fertility hospital in Nigeria?
It’s been 19 years so, we are going to be 20 years in April next year, so of course, the patronage has improved over the years, when we first started, IVF was like they are doing something there but now, even bus conductors talk about IVF. So, I think we’ve grown and the number of circles has grown, and the number of clinics has grown.
Is fertility treatment about IVF or there’s more to it?
There’s more to it. You see, fertility treatment is tailor-made for the couple, what’s wrong with couple A might not be the same thing wrong with couple B, we call everything IVF but it’s like you are drinking coke and I might see that what’s in your hand is another cola brand. I think everybody calls it IVF but there are so many variants of IVF, for example, if the woman is the main issue, the treatment is different from when the man is the main issue at least have a pick because IVF boils down to picking the egg and the sperm. The dilemma is how to pick the best egg and best sperm. Most of the time maybe you are condemned to whatever eggs the woman gives you because they are not many. Maybe she has 20 or 30 but the man is going to give you millions of sperm cells so you have to be able to choose which ones to use to fertilise these 20 or 30 eggs out of the millions. So, where the dilemma usually comes is choosing the sperm because if you choose the wrong sperm, you get the wrong stuff at the end of the day. That’s what I say if everything is working well, your result is determined by you. The quality of the sperm and the quality of the eggs that we are using and that’s why we sometimes tell women when they are older, they are not likely to get anything great from the union of the sperm and eggs, why don’t you try double eggs but we know that’s an emotive thing so, sometimes the counselling has to be stronger, your ability to let them see, but we know that it’s emotion. Once it is emotion, logic does not play so much but that’s the work that a fertility doctor needs to do.
What has been the success rate so far since you started the IVF clinic in Nigeria?
What we’ve tried to do, year in and year out is to make sure that we meet up to international standards. That’s what we set up to do from the get-go. To make sure that Nigerians here in Nigeria, can have the same treatment and that’s why we try to move abreast with technology. That we are here in Nigeria, we are not sub-humans, Europeans don’t have two heads, because we believe in VAT, we also try to give Nigerians what they will get if they go to Paris or London and that’s has been our goal all along. So Year in and year out, that’s what we try to match ourselves with and I can say proudly that everybody is beginning to see that and that’s why we are getting many more people coming in from Abroad to come to Nigeria for IVF treatment. So, it’s common now for people in England, for people in the U.S to say look, if you want to do IVF, go to Nigeria. We get a lot of people from Australia, and America, coming to Nigeria for IVF. Nigerians who live there, come home for IVF treatment
What about foreigners?
The only people who are confident in coming to Nigeria are Nigerians. Even Ghanaians are afraid to come to Nigeria. I think we just have this larger-than-life cult image with the people that if you come to Nigeria, once you land in Lagos, you will disappear. Something like that, but Nigerians are willing to come though we are beginning to see a lot of Ghanaians come now especially with the fibroid treatment because it’s not available in their own country. We are seeing people from serial Sierra Leone coming in. I think over time because we use to be a health hub in West Africa and that’s what we lost with our security situation. If our security situation improves, I’m sure that we are going to have a lot more people wanting to come. The problem is, that the average Ghanaian is scared to come to Nigeria unlike the Nigerian who is always willing to go to Accra but they don’t want to come and that’s affecting some of the things we should be offering them
What are the major causes of infertility in men and women?
We cannot pinpoint most of the time with men the major causes but infection is still a big player also, some men were born like that. They’ve inherited the infertility gene. There was a study that showed that men who are conceived through male factor infertility treatment tend to also need the same treatment to father their children so, one can inherit some of these things. Also, a man’s lifestyle is probably the greatest contributor to male infertility. The work we do is becoming more sedentary. People are becoming overweight, people are drinking and smoking as if life is coming to an end, hard drugs, are also a big player, putting laptops on your laps, things that heat the testis, long distance Okada drivers, truck drivers, those things are detrimental to the testis and there’s a study that showed that if you put your cell phone in your pocket and it’s near the testis, that might just be one of the things that could lead to male factor infertility. Also, accidents, and traumas, fall on your manhood, when you are born with one testis and it wasn’t fixed on time. Most of the time, we cannot pinpoint one major reason for the male factor infertility but the female, it is much easier either infection because the tubes being blocked in an environment is the greatest problem. It’s either you have an infection that was badly treated or you have endometriosis, or you have appendicitis that ruptured or you are not ovulating regularly, fibroid is also associated with infertility in this environment
I have read that age can also be a contributing factor to infertility. At what age does one need to start getting bothered if one is interested in having kids for men and women?
For women, 35 is the age where fertility tends to curb down. Once you start crossing 35, you either store your eggs or get married. For men, 45 is the age. It’s also significant for men because we’ve seen where even when everything is okay, the time for pregnancy to their partners, no matter the age of their partner even if they are 45 or a 50, the man goes to marry a 25-year-old, the time to pregnancy is not the same as if she’s married to a 30-year-old. So, we know that so many things happen even with the sperm when a man clocks 45.
How does fibroid contribute to infertility?
The funny thing is that it’s not cut out. We cannot say when you have fibroid then you have infertility, but it’s associated. We don’t know why exactly, but we are seeing also that a lot of people with fibroid have endometriosis which might be one of the reasons why there’s infertility but women who have the sub-mucus fibroid where the fibroid is located where the pregnancy should be can be prone to infertility or miscarriages
What is premature menopause all about?
Premature menopause is said to occur when a woman reaches menopause before the age of 40. There are a few women in their 20s that have reached menopause. The youngest is 13
Tell us about the HIFU method of treating fibroid against the old method where one had to go under surgery
The high-intensity focus ultrasound (HIFU) and it’s a non-invasive technology in that it converts ultrasound into heat energy. I will use the word burn but it is not burning. To burn the organs whereby killing them because we know that our organs are made up of protein and proteins, if you heat them to a certain extent, they will de-nature and that means it’s like dice, so it’s the same technology that we are using for fibroid. It’s like killing the fibroid without really touching it. We heat the cells to a particular temperature and they de-natures. Thereby killing the fibroid.
With HIFU treatment, does the fibroid grow again?
The one you kill cannot grow but other ones can grow the good thing about HIFU is that because you are not cutting, it can be repeated but I doubt if somebody will repeat it three times unlike surgery because sometimes, one of the problems with surgery is that it’s not fibroid they are dealing with. They are dealing with endometriosis
Is there any other thing you may wish to add?
I have a word for the women, the first thing is that fibroid is not a death sentence, fibroid does not mean you need surgery because I have seen many women who will come back from maybe a medical and start weeping. “Doctor said I have fibroid” and I will need surgery. It’s not true. It’s not every fibroid that needs to be treated to start with, it’s not every fibroid that you want to treat that you need to operate on. So, there are many options now available for women to choose from. If I were a woman and I have a fibroid, I will do HIFU or something non-invasive. I would probably prefer it to go under the knife.