10th January, 2014
Dr. Felix Agu is a Consultant Gynaecologist and Obstetrician and Fertility Specialist, Federal Medical Centre, Umuahia. He speaks with NKRUMAH BANKONG-OBI on the relationship between infertility and child trafficking
Tell me a little about what gave rise to the concept of fertility clinic?
After several attempts, the first invitro-fertilisation baby was born in the name of baby Louis. And since that time, the use of assisted contraceptives technology to couples who, otherwise on their own would not have had children, has been a fast developing field. It has given smiles to a lot of couples. There are millions of children today that have been born through that procedure – through assisted conception.
Before, fertility problems were classified, based on the cause or the source of the problem. Generally, we can say that infertility is not a one-person affair, it is a couple’s affair – inability of a couple to achieve pregnancy after one year of unprotected sex. So, we may have to investigate, to find out what’s causing the problem and to find what the solution will be. We know that there is an age-related decline; the fertility protential of women, after the age of 35, declines. After 40 years, it further declines because the number of eggs in the ovary is reducing with age. Normally, it starts reducing from the time of puberty and after the age of 35, the decline is much more drastic. So it is quite optimal for a woman to have children at certain ages.
But you know there have been some changes in recent years, whereby some women may have to postpone child bearing to sort out their career issues. So all these things contribute to couples coming down with fertility challenges. The essence of assisted-conception technique is to assist couples who otherwise would not have had children of their own.
For example, when the tubes are blocked, conception might take place, the egg might break down, she will ovulate. If it is the husband, the sperm could travel from the vagina up and they would meet at the angle of the tube where fertilisation takes place. Now, if the tube is blocked, conception will not take place. So, the first attempt at assisted reproductive technique was aimed at overcoming this blockage. That is why you have what you now call test tube babies.
Can you give me the data of the fertility level of the cases you handle in your clinic here?
Conception or fertility rate? The number of people coming in with fertility challenges is higher than what it used to be in recent years. The reason may be that there is increased awareness that this challenge can be treated. Another reason is that people now marry late because they have to face their education, unlike before, when people married at a much younger age.
Besides blockage of the tubes, what are other illnesses you treat here that can also pose challenge to conception?
As I said earlier, conception is not a one-person affair. The husband and wife must meet before it results to pregnancy. But when the sperm count is low, there is a problem. We say in simple language that the woman contributes 40 per cent, the man brings 40 per cent to the conception process while both of them combine to produce 20 per cent.
How do you link infertility to the illegal baby market out there?
The issues concerning the booming baby market can be better managed by people who have been trying to track down the cause. But the way it relates to infertility is that when there is so much pressure on the woman, she can resort to other means to purchase babies without being aware that there is nothing like hopeless situation when it comes to fertility challenges. No matter the age, fertility challenges can be managed successfully. Those who may resort to either baby buying or selling, I don’t really have any interaction with them so as to know why they do it.
Are there figures you can give me on Abia or south-east specifically, showing the rate of infertility in the state or region?
There are published data in journals that put the prevalence of infertility at different ranges. Some put it at 50 per cent up. This relates to attendance at the hospital, not the general population. In terms of the population, sometimes depending on the population, in our own environment, it is different. It is different in the UK, America.
So, are there local data here that one can find?
The cases that come to our gynaecological out-patient clinic with fertility related matters form about 60 per cent.
Is that for Umuahia or …
No, it is for people who come to our gynecological out-patient clinic. I think that data was for 2012.
If we compare that to 2011 and 2013, what do we get?
Data for 2013 is not available but for 2011 it formed 53 per cent, which means there is an increase of 7 per cent.
How many patients can you say you attend to in a month or, say, a year, so that we can work out the percentage for ourselves?
You may have to go back to the data I referred you to earlier because I am not the only one involved in this; there are other consultant gynecologists involved here.
Are there diseases that could hamper the reproductive process? And if they do, are such cases reported here?
The major thing that affects fertility is chlamydia. Another one is gonococal infection. Sometimes because we don’t culture the organisms, so we don’t know. But recently, we have procured a reagent to be able to test for the organisms.
What does it cost to have assisted conception in your clinic? For example, the security people say from confessions of those caught, illegal babies go for N450,000-N1 million. If for example, I have a fertility issue and I come here with N450,000, can that give me a result?
When we talk about the cost of a cycle of assisted conception, you take into consideration the technical cost, the drugs. It may not be easy to arrive at a particular figure, to say this is how much it is going to cost. But I know that the treatment cost varies from one centre to the other. On the average, even though some clinics don’t like to disclose their cost, N700,000 should be able to take care of it.
What can medical doctors do, to curb child trafficking?
These patients are not really sick, they only have a challenge. They come to us, as well as they go to other people. Sometimes they go to churches, some go to prayer houses and other places. Sometimes somebody will come, knowing that he has tried this orthodox treatment and it failed, it may just be because the cost dissuaded the person. So doctors and hospitals should make the cost as pocket-friendly as possible.
Mind you, there are some areas you cannot compromise, you have to use a standard drug. Some people have proposed what they call “low cost IVF”. We use cheaper drugs to stimulate the process of birth. Most of the drugs we use are quite expensive. Some are also proposing that we also use natural cycle, where you don’t need to give these expensive drugs. The first In Vitrio Fertilisation, IVF, was done through a natural cycle, so if you use a natural cycle, you are not going to spend money on drugs and you will make it far more cheaper. Doctors should work together to enhance the success ratio of IVF.
You can’t always have 100 per cent success. Some of the drugs may be resistant. It is this awareness that can be handy in seeking solution to fertility challenges. The solution should be sought early enough because some people begin to seek fertility treatment when they are already in their 40s. Maybe if you offer them a donor programme, they will say they want to use their own egg. And as at that time, their success rate has declined. If somebody comes here at 44/45, that time the success rate was only like 5 per cent, compared to somebody that is coming at 25 years, the success rate is more than 40 per cent or even more.
When you are talking about prevention, it does not affect the person that has infertility challenge. It is for the other people, it is for the future. You can’t be talking about prevention to a couple who are already having fertility challenges.
You just said something about lifestyles. Now, what can people do to improve their fertility health?
For the women, the things to do are: avoid infectious life, chlamydia, gonorrhea. It is such infections that can lead to tubal blockage. The other is a fibroid infection. A fibroid must not be operated because it is there. Some people go to hospital to remove the fibroid. In that premise, sometimes it might compromise the reproductive organs. So, it is better an expert examines you to find out whether that fibroid is contributing to your inability to get pregnant. They occur in relation to termination of pregnancy. People who have unwanted pregnancy and then go to just anyone to terminate it, in the process, they might get an infection.
I’ll tell you a story about someone who got pregnant because she just wanted to find out if she can get pregnant, only for her to come back later and was appealing to the doctor to help her terminate the pregnancy even if it would cost her life. This is the type of person that can have a tubal blockage because she could come down with infection. Abortion must be done in safe places, where the person won’t go and contract infection that can lead to tubal blockage.
On the side of the man, the major problem is low sperm count. The health of the sperm is dependant on the temperature. If the temperature is too low, it is a problem; if it is too high, it is also a problem. Avoid any operation around the scrotal region where an injury can affect the organs. If a baby is born, it is good to make sure that the testis is in the scrotum. Check very well, because if the testis is allowed to stay outside the sac beyond two years, it can lead to problem of sperm count later.
So why do you think people still indulge in baby theft and illegal adoptions?
I don’t know if it is that the times have changed or that human beings have decided to change. Mind you, there are solutions now that were not there before. For example, there are many fertility centres in Nigeria now, although cost of treatment may be their own reason for doing what they do. These centres may not be affordable for everybody but at least the average person can afford it. Reporting early too can help. You don’t wait until after 20 years of marriage to start looking for fertility treatment. Sometimes, you see people who are coming after 20 years of getting married to seek fertility treatment. Elsewhere, once people get married, as soon as they find out they have fertility issues, they won’t even wait for a year before coming. The doctor would even be the one to push them back, that they still have that chance of natural conception. This problem is traceable, especially if detected early, but if you wait for two long, the chances may not be as bright as the person who began early enough.
These young girls who are put in confined areas to produce babies, are there health challenges they are likely to face later in life?
Remember, these people are teenagers, some school leavers, who are just brought up from anywhere and they start having children. Now, experiencing pregnancy with all the associated challenges is a problem. If somebody has taken up a job of producing babies, for example, he is likely to be having too many. And the risk of maternal death is also there. In this country, we take things to the extreme. We are becoming pacesetters in baby factories. One of the ways to dissuade people is, for example, if they don’t have somebody who will buy the children, is to give couples with infertility challenges hope that this thing can be done legitimately.
For this part of the country, what is the prevalent lifestyles that can encourage infertility?
Smoking is rampant here; it can reduce fertility. Chronic alcoholism has the potential of increasing infertility. We encourage women who are obese to lose weight, the weight-height ratio that is optimal for fertility.
What can we say is the overriding factor that inhibits fertility in the patients that come here?
Generally, in our environment, we find that the problem of tubal blockage is common because of infections. Tubal blockage can be found in somebody who has had an abortion that was not properly handled or who had infection that was poorly treated. Some people come here who had been pregnant before. We call that secondary infertility. Then, subsequently, pregnancy refuses to come because the tubes are blocked.