State of art of infertility treatment by Prof. Oladapo Ashiru
Louise Brown, the first baby born through IVF technology clocked 40 years in July, 2020. I am, therefore, writing this article to focus on this extraordinary technique that has saved many lives and has been used to birth almost seven million babies. IVF has also saved several broken homes and brought happiness to many families. In Nigeria, our journey into IVF started almost 40 years ago through landmark scientific research by Ashiru followed by applied clinical research and skill by Ashiru and Giwa-Osagie, leading to the first test-tube baby in Nigeria and Western Africa in 1989. Others join the race and as of today, there are over 60 clinics that are members of the Association of Fertility and Reproductive Health in Nigeria.
The IVF of 40 years ago has evolved significantly
At a recent meeting in Copenhagen, the World Health Organisation had experts from different regions to consider the formation of a multinational registry on Assisted Reproductive Technology. One of the issues that came out of this meeting and that of an earlier one in Geneva at the WHO headquarters was ‘‘infertility is a human right issue.’’ Hence, everything must be done to allow everyone have access to fertility care.
Infertility is the inability to get pregnant after a year of unprotected intercourse. About 10 per cent of couples in the United States of America are affected by infertility. Both men and women can be infertile. According to the Centers for Disease Control, one-third of the time the diagnosis is due to female infertility, one-third of the time it is linked to male infertility, and the remaining cases of infertility are due to a combination of factors from both partners. For approximately 20 per cent of couples, the cause cannot be determined (unexplained infertility). Consequently, the WHO meeting has now made clear definitions for male infertility and female infertility distinct from each other.
There is a worldwide emotional epidemic of infertility. As of today, twenty-five percent of couples are infertile. Even in India which has severe overpopulation, the most common reason for a visit to the doctor is infertility. In Nigeria, infertility which used to be a small area of gynaecology practice has now become a huge discipline with several doctors devoting their clinic solely to the practice of infertility. During the conference of the Nigerian Association of Fertility and Reproductive Health and the African Fertility Society on September 24, 2015, the number of IVF clinics in Nigeria was close to 50. The number of IVF clinics in Africa is near 150, and in comparison, the number of clinics in Chicago city alone is over 60! It is clear that Nigeria is now recognised worldwide as part of Assisted Reproductive Technology providers. It is noteworthy that many countries still do not have the ability to provide ART services.
The human ability to get pregnant decreases with age, which explains why only one per cent of teenagers are infertile while a large majority of infertile couples are in their thirties. It is well documented that from our teen years when the last thing we want is a child, to our mid-thirties when we are finally secure enough to start our family, our ability to conceive decreases almost by twenty-five per cent.
Research shows that in the past 30 years, infertility has increased and those over the age of 30 have the most problems.
If you are in your thirties and have been working to establish yourself in your profession, and are now just casually reading this column because you are thinking maybe in a few years I might like to start a family, you should realise that there is a 25 per cent chance you will not be able to do so without medical intervention. It is for this reason that the definition of infertility was made to include a person of age 35 years who has not been able to achieve pregnancy within six months of attempt at conception.
Other factors that may make it difficult for you to get pregnant include abnormal organs, immunological factors and other malfunctioning of the body system. The dramatic increases in infertility over the last 30 years has been blamed on various factors including the increases in sexually transmitted diseases, environmental toxins in our food such as heavy metals in fish, environmental pollution particularly in the oil-producing geographical zones, declining sperm counts from absorption of toxic substances and even the increased tension and anxiety of the modern life.
In all other animals except humans, the desire to have sexual intercourse is timed to correspond exactly to that moment when the female is ovulating or producing eggs that can be fertilised. Take, for instance, a dog or a rabbit, once the female is ovulating she seeks out the male and after intercourse, the female is usually pregnant with multiple pregnancies. Humans, however, desire to have sex at any time regardless of whether there is an egg that can be fertilised in the woman and it makes us reproductively more inefficient than other animals.