Dr. Adayomi Ajayi is a consultant obstetrician and gynaecologist and Managing Director, Nordica Fertility Centre, Lagos. In this interview with CHIJIOKE IREMEKA, he discusses the impact of flushing blocked fallopian tubes and strategies to sanitise Nigerian healthcare system.
As a long as standing medical practitioner in Nigeria, what changes would you like to see in the health sector?
Things that characterise Nigerian health sector are now changing. For example, we have one of the highest mortality in the world. Until this mortality changes, when we have proper facility to manage everybody, take care of our health care, then, those of us who are doctors can’t really appreciate ourselves to say that we have done nice work in the hospital. So, I foresee Nigeria installing world class facilities in Nigeria so that the healthcare system would be remedied.
What does fertility medicine entail?
It is about getting the people who are facing the challenges of fertility and trying to help them achieve their dreams of becoming parents. So, everything that is involved in this, starts from using drugs to surgery to IVF. Continue...
Previously, you mentioned that people should take decision that would not give them babies. So, who will not go for IVF treatment?
No, I do not mean that some cannot go for it. What I meant when I said that is when you are doing your IVF, you will be taking decisions that would suit the treatment for you in order to have babies. For instance, if you are supposed to be using donor’s eggs for IVF and you insist on using your own eggs, you might not have a baby. Sometimes, no matter how many cycle you have done, you might not likely achieve pregnancy because the changes of eggs giving babies decreases with age.
Even when you get pregnant, the chances of losing the pregnancy through miscarriage are there. That is what I meant. Sometimes you need to use donor sperm because your own sperm is very bad. So, in decision making, you need to understand that the outcome you get is dependent on the raw materials used. Sometimes, the raw materials are to be changed, if not, it might be difficult for you to achieve pregnancy.
Is there any person who would not achieve pregnancy after these treatments?
There are different kinds of them. IVF is not a shelf item. It depends on what the problem is. Now in 2015, there are different methods of achieving pregnancy. So, you just have to use the one most suitable for you. For instance, if awoman’s uterus has been damaged, then, surrogacy will be there.
But if such person doesn’t want to take surrogacy, because of third party reproduction, she may use another person’s sperm, egg or uterus of another person. These are very emotive decisions. Sometimes, the couples involved feel that they have failed to achieve babies on their own.
This is an emotive decision, it takes a lot of courage from couples to come to terms with the reality. So, it’s not as if they can’t do it, probably, using a method that will not give them result. So, they have to go back and seek the help of a professional counselor, who would counsel them to take make right decisions.
Is there is any of these methods that guarantee 80 per cent success?
I wish but there is none. May be, about 60 per cent, if screening of the embryo is done. If the patient is young and we choose the embryos that would be suitable for her, looking at the genes of the embryo to discover that the embryo is normal and you could have about 60 per cent possibilities, but not 80 yet.
Multiple births have been the greatest risk of IVF, how does it apply and could there be a way out of this situation?
Well, because we are not God, the human body is structured in a way that it would naturally release only one egg in a month but because doctors are not God, they cannot play with one egg. They tend to have many eggs and that is why we give drugs to the patient to produce more egg than would normally be produced. And this also means that we will end up with more than one embryo. In many parts of the world, they transfer more than one embryo. To do this, it means you have more than one baby and that is why the rate of having more babies is high in IVF but we know that usually, there is one baby in the uterus and therefore, when there are more babies in the uterus there is likely to be problems.
What are the likely problems?
There are a number of them. The mother could develop hypertension and the babies come prematurely because of overcrowding in the uterus. Prematurity is one of the biggest problems one could encounter in the case of such IVF babies. They come very early and the cost of taking care of those children in the developed countries is very high. Then, think of Nigeria, where some of these facilities are not there, many of them will die, if they come too early.
Ovarian hyper stimulation syndrome (OHSS) is one of the deadliest problems resulting from IVF treatment. How do ensure that your patients don’t get to this stage?
First of all, the condition means that the ovary is over reacting to your drugs. The first thing to observe is whether the risk factors are there. Usually, the young women are more at risk, especially those with polycentric ovaries, which produce many eggs normally.
The most important thing is for the doctors to be aware of these risk factors. Those are the things to look out for when you have such people. Recently, there are some drugs you can use to stop OHSS. But sometimes, when you have them, you know how to prevent it. You can do coasting in which you give the drugs and monitor the hormones and how fast it’s rising.
Then, you can trigger it without the normal drug we use in doing that. That’s why I said there are protocol to prevent it for the people, who are at risk of OHSS and alternative drugs. Sometimes, you can harvest but don’t transfer, because if you don’t transfer, it will die a natural death because of progesterone. You can do the transfer in the next cycle. That was why it is high in pregnancy.
I learnt it kills fast, what is the survival rate of the OHSS?
Yes, it can kill. Like I said, don’t let your patient go into it. Prevent it because when your patients go into it, you really cannot predict the outcome of it. The best is to prevent it. Blockage of fallopian tube is another situation that prevents pregnancy and in some cases, doctors flush.
Is the procedure still necessary in this current time? We don’t flush. It is barbaric in this century because flushing is a dangerous procedure. It was stopped 20-30 years ago. This means that you are putting a liquid in a blocked tube, sometimes, it balloons and it can even burst.
This also implies that there is the possibility of one introducing disease into internal parts of the patient because when there is blockage, it means there is an infection. So, if the tube is blocked and there is accumulation of fluid in it, and you put your fluid in it, if you succeeded in puncturing the tube you are going to splash the contaminated water to the abdomen. I don’t think anybody flushes again.
What method is predominantly in use now?
When there is IVF, why do you flush? Nobody flushes anymore.
What is your take on flushing which would allow the couples to have the baby naturally?
But that is silly because the tube is diseased and that’s why it’s blocked. Why do you want to flush if is blocked? It islike having a sink that is blocked at home and you continue to put water into it. It depends on what blocks it, if it is oil, you can put hot water and it goes out. But if it is bone, put all the water in the world, it will not open
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