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By Ngozi Nwoke
The high rate of infertility among couples in Nigeria has proved that the perception of in vitro fertilization (IVF) is not well understood by most couples seeking conception.
Infertility remains a huge challenge for most married couples but the solution proffered by science, which is the IVF, is adversely hindered by many people’s religious and socio-cultural perceptions of the phenomenon.
Despite efforts by health experts to create awareness on the immense benefits of IVF treatment among married couples, a survey by Professor. Peter Perebiri Erigbali from the Department of Human Physiology, Niger Delta University, still records the existence of high infertility in women.
The survey showed that out of 200 cases of infertility which was carried out in four hospitals with a total of 50 cases of infertility evaluated in each of the centers between 2020 – 2022, showed that high infertility in women was established in all the hospitals; (Obafemi Awolowo University Teaching Hospital, Ile-Ife), 59.4 per cent (Obafemi Awolowo University Teaching Hospital, Ilesa), 47.7 per cent, (Ladoke Akintola University Teaching Hospital, Oshogbo), 54.8 per cent and (General Hospital, Ikire), 44.2 per cent. 77.5 per cent was recorded for a high rate of secondary Infertility, while Primary Infertility was 22.5 per cent.
It stated: “The commonest causes of infertility in this environment were, the tubal factor, uterine factor, and ovarian factor representing 39.5 per cent, 30 per cent and 13 per cent respectively. The least common cause was cervical factor, Pelvic Infection Disease (PID), and endometriosis which was seen in 3 per cent, 5.5 per cent and 2.5 per cent of the subjects respectively. There was also prevalence of infertility between the ages: 15 – 25 years at the rate of 17 per cent, while 26 – 35 years at the rate of 31.5 per cent. The majority of the cases occurred between the ages of 36 – 45 at the rate of 50.5 per cent and between 46 – 55 years at the rate 1 per cent.
Senior Fertility Doctor, Dr Ayo Olayinka, explained that some of the major challenges to IVF was lack of power supply and importation of the consumables used in the laboratory, adding that they were not readily available locally.
He said: “A lot of our consumables are sourced outside this country; we don’t get to buy the most sophisticated consumables locally and you can imagine that exposes us to a lot of forex variation. We know that in Nigeria, any business that wants to thrive must solve that power equation that we have thankfully been able to overcome. The other challenge is lack of information. The relative difficulty in getting prospective donors to donate eggs to couples that are incapable of using their own for treatment, so there’s still a lack of education, awareness and general information about the process.”
He also enlightened that IVF was not a process to be ashamed of, rather it helped to end barrenness.
“My message is that the world has evolved and our ideas have to evolve as well. The world no longer sees IVF as anything that should be frowned upon. I’ll tell the couples who are struggling to achieve conception that it is nothing to be ashamed of, this is just like seeking treatment for malaria or typhoid, you come in, the doctor assesses you, determines the best treatment option and then deploys a solution.”
Lagos-based medical doctor, Tunji Olaleye, from the Mother and Child Fertility Clinic, Yaba, opined that for conception to occur, the sperms, eggs and hormones must be in the right condition.
While highlighting causes of infertility in women, Olaleye explained that infertility can only occur in a woman if there is a failure in the process or if there are inadequacies in the requirements.
“Hormonal causes of female infertility are too voracious to explain all. Polycystic ovary syndrome is one condition that is characterised by infrequent ovulations or complete absence of ovulation, which is known as anovulatory cycles. This is caused by a disorder in the hypothalamus, pituitary (these are organs in the brain) and ovary, from where the egg grows and gets released. PCOS is also linked to obesity, insulin resistance, acne and excess hair growth on the body.
“Another cause of infertility in women is Hypothalamic dysfunction. Two of the four hormones responsible for ovulation each month are follicle stimulating hormone and luteinizing hormone. These hormones, together with the others are released at specifically set times during the menstrual cycle. Conditions that affect the release of these hormones may cause infertility. These conditions include obesity, sudden or substantial weight loss or increase in weight, emotional stress etc. The menstrual period can be so severely affected as to render the woman infertile.
“Gluteal phase deficiency is another actor of infertility. The hormone, progesterone initially produced in the ovaries and carried on by the corpus luteum (the hollow left after an egg has been released from the ovary) may become deficient. Insufficient progesterone will not be able to sustain the pregnancy. Known as luteal phase deficiency, this condition strictly speaking leads to abortion of the pregnancy.
“The next hindrance to fertility is Hyperprolactinaemia. Prolactin is the hormone secreted when a woman is lactating and breast-feeding. On the other hand, this hormone blocks oestrogen production and release, thereby effectively preventing ovulation. Indeed, breast-feeding is a known contraceptive method used especially by rural women to space their children.
“Tubal infertility. The fallopian tubes can be damaged and blocked. When this happens, sperms can no longer pass through to meet with and fertilize the eggs. In some cases, the blockage may be partial allowing the smaller sperm cells to pass and blocking the fertilized egg from passing. Infections from the vagina and the uterus are major causes of fallopian tube blockage.
“These may infect and multiply in a location in the tube where the blockage could occur. Gonorrhea and Tuberculosis are likely infections that can cause this. A previous surgery in the pelvis or directly involving the fallopian tube after an ectopic pregnancy is another cause of tubal blockage. Cervical stenosis, which is narrowing of the cervix during excessive instrumental abortion can also cause infertility in a woman.”
