Frequently Asked Questions About Infertility
Frequently Asked Questions About Infertility
In this video, Dr Abayomi Ajayi, MD/CEO Nordica Fertility Centre, answers fertility-related questions in an interactive question and answer session on the Dr. Abayomi Ajayi Live Video Series.
1. Q: What can one do to maximize the chances of IVF success?
A: Let’s look at it this way. Each couple carries their own success rates. But at the same time, there are some things you can do in order to maximize your success rate. The first thing is to start early because we know that success rate is dependent on age, especially for the woman. So if you need IVF, you need to start early. You need to choose the right clinic. Let’s look at it and say that the success rate of IVF is cumulative and therefore most of the time when you want to do IVF, please know it is not guaranteed. So don’t go with the mind that you are just going to do only one cycle and succeed. If you succeed with only one cycle it is great but that is not the norm. The typical success rate is between say 20 to 35% with one cycle depending on the age of the woman. If you do about three cycles, that increases your chances to about 50/60% and therefore, that is what is recommended. If you are less than 35 and you want to do IVF plan for two cycles. If you are over 35 and you want to do IVF, please plan for three Cycles. I said plan, I don’t mean that you have to, you will need to do that, but it is better to plan first so you won’t get disappointed at the middle of the road and feel IVF doesn’t work. IVF works and that is proven all over the world, there are over 8 million babies all over the world from IVF.
2. Q: What can be done to improve egg quality in a 37 years old woman and what is responsible for failed Implantation in IVF?
A: Wow. Okay, I will take the second question first. What is responsible for failed implantation? Okay, we know IVF means in vitro fertilization. It means that fertilization that takes place outside the body. So the only thing that happens in the body is implantation, which means the embryo that has been deposited into the woman now burrows into her and becomes a baby. Now, what makes them able to talk to one another? So we can say three things, the embryo, the endometrium of the uterus and the hormones. Now, most of the time when implantation fails in about 70 to 80% it is from the embryo and we have seen that there are some things that can go wrong in the embryo. We talked about what we call an abnormal number of chromosomes in the embryo. Someone will be asking me what chromosomes are? Every living thing has a nucleus, that is where life is. And as human beings, we have a nucleus. In this nucleus, they are things that are arranged in 23 pairs which we call chromosomes. These chromosomes are responsible for our genetic material. I like using this example that you have a bookshelf that has 23 layers. Okay, those are the chromosomes. The book that you have inside the shelf when you open the book those are like the genes. So that is the difference when we talk about chromosomes, and when we talk about genes. The chromosomes are 23 pairs and inside the chromosomes are the genes. We have seen that it is the chromosomal problems that are responsible for many failed implantations. This problem with the chromosomes is directly linked to the age of the woman. That is why we always talk about age and success rate in IVF. So chromosomal problems are the commonest problem in the embryo. Meanwhile, scars and abnormalities are also possible in the uterus especially in an environment like Nigeria where there are a lot of fibroids cases. Either fibroid themselves could distort the endometrium or the treatment of fibroids when doctors do myomectomy. We reviewed about 3000 patients here. We saw that 61% of our patients actually have one form of problem or the other in the uterus and we were able to see that out of these people 50% of them have done myomectomy.
3. Q: Can a diabetic patient of 50 have a baby through IVF
A: Yes, but diabetes needs to be controlled and once the diabetes is controlled you are as normal as anybody. It is important that the diabetes is controlled before IVF is done.
4. Q: Can someone at the age of 50 years conceive through IVF
A: Yes but you would need to make some decisions, just like the first question that was answered. Once you are 50 you are likely to be menopausal or premenopausal. At this stage, you would be running out of eggs or almost running out of eggs. At the age of 50, most of your eggs, if you still have them left, are like a 4th position team. They are unlikely to win the premier league in that case you might need donor eggs. Once you can make that decision then it is possible for you to do IVF.
5. Q: Can you assist the less privileged to benefit from IVF
A: We try what we can do, we have so many NGOs that give free IVF, we also collaborate with people. We just gave a free IVF cycle to some groups from a fertility Hub so we try as much as possible. That is a drop in the ocean and a lot needs to be done. We can only try as much as we can do
6. Q: If one has had a failed IVF cycle is it possible for the same person to have a successful one
A: The success rate in IVF is cumulative so the fact that you had a failed cycle doesn’t mean you can’t have a successful one. Unfortunately, you didn’t tell us your age so that would have been able to give us more information. So the take-home is that when doing IVF listen to your doctors, ask questions, know what you want and what you don’t want and bring this to the table so that you can agree on the best way for you to be able to achieve your dreams. I pray that you would also be lucky, God would shine his favour upon you as you undergo this journey.
7. Q: I want to do IUI and I need guidance.
A: Just be sure that the indications are right. Talk to your doctor because if you are doing anything that the indications are not there you are not likely to succeed. Just have a good chat with your doctor. Sometimes I see some people who don’t qualify for IUI and they come and say that is the only thing I can afford. When the doctor is saying that your husband’s sperm parameters do not qualify for IUI and you have blocked tubes and you say IUI is the only thing that you can afford, that is a different thing. That is why I said you should have a good chat with your doctor and then you will see how this goes.
8. Q: What could be the cause of several miscarriages? I have had no child in seven years after CS for my first child that I lost.
A: Sorry to hear that you lost a child. If the miscarriages are likened to implantation failure, it means the pregnancy has started developing and then it fails. The quality of the embryo, the quality of the uterus and this time the hormones. Don’t forget I talked about hormones but I was a little bit silent about them because you see here that in the first trimester of pregnancy, you know miscarriage happens in the first thirteen weeks of pregnancy majority of these are from chromosomal problems. The chromosomes in the baby are not just right sometimes that is nature’s way of getting rid of babies that are not fit. That is why the age of the woman is so important in this, what you need mainly is to have a good chat with someone who can help and I wish you luck in the journey that you are going to take.
9. Q: What can be the cause of having stillbirth and miscarriage for over five years?
A: Stillbirth can be from a myriad of problems. It could also be that the baby has some abnormalities. It could also be how labour is managed so it is difficult for me to have a go at this. You also spoke about the miscarriages which I just treated in the last question so what we need most of the time is to have a chat with the doctor that can help you to navigate this pathway.
10. Q: Is it possible for a woman who has gotten to menopause to have a baby?
A: Yes, but IVF needs to be done
11. Q: Can a menopause woman conceive through IVF?
A: Yes, it is possible.
12. Q: Is infertility hereditary and can someone be infertile after giving birth to a child?
A: I will take the second question one first. The answer is yes you can, but don’t forget what we mean by infertility. It is when you have been trying for one year and it is not happening that is what we call secondary infertility. Infertility can also be hereditary and there are some that are acquired so it depends, for example, male factor infertility. Some could be inherited of course females PCOS could run in the family. Endometriosis could run in the families, some autoimmune diseases could also run in the families. It is possible there are some things that can run in families.
13. Q: What can cause a delay in pregnancy after 8 months of unprotected sex and one is not up to 30 years of age?
A: Well don’t forget that when we talk about this. Unprotected intercourse must be regular, to be regular it has to be up to 2 to 3 times in a week. We know that each month there is a probability of pregnancy, that is why we say when you are not up to 35 you can wait for one year. We know at that time about 75%-85% of people who don’t have any problems should have been able to conceive, but if you have not conceived after one year see a doctor that can help.
14. Q: Does stress cause infertility and can infertility be prevented?
A: Well that is a million-dollar question. Stress can cause infertility, infertility can cause stress so sometimes people ask which is causing which. Is it the stress that is causing infertility or infertility causing stress and we know that stress can affect your ovulation and if you don’t ovulate regularly that could lead to infertility. Can infertility be prevented? Well yes, there are some causes of infertility especially those linked to a lifestyle that can be prevented, that is the low hanging fruit in infertility are the ones that can be prevented. The ones that we can help so we don’t even have to treat them. They are about eating balanced food, doing regular exercises so that your BMI is good, not having multiple sexual partners, using barrier contraception if you don’t want to get pregnant. Avoid alcohol, smoking and hard drugs, these are some things that you can do to prevent infertility.
15. Q: After chemical pregnancy how soon can one get pregnant in their late 30s?
A: Chemical pregnancy means that you had a pregnancy with early miscarriage and there is nothing seen on the scan. This usually comes with IVF but sometimes it can also happen as an accident in pregnancy. You can get pregnant as soon as you want to, you might need to talk to a health practitioner because sometimes there are so many theories concerning this. Some people get pregnant frequently but the quality control in the body is not very good, so they can get pregnant so easily and lose them easily. Because of the quality control system in the body that is not very good, they might end up with something like chemical pregnancy that we talk about. The more you get pregnant the more you get the one that is going to be okay.
16. Q: What are the major causes for infertility?
A: Well we have the male factor, female factor, combined factor and unexplained. These are the four main causes of infertility. Some other days we would go into details about them.
17. Q: What causes prolactin not to stop and ovarian cyst not to dissolve because I have prolactin and I have used so many drugs and still everything is still the same. Please sir what can I do to dissolve ovarian cyst and high prolactin?
A: This is a question I get so many times and let me say something about prolactin so many people waste a lot of time trying to treat something that should not be treated. Prolactin is non-specific, there are so many things that can make it go up. If you take it after taking food it can go up, if you take it when you come back from work or terrible traffic stress can make it go up. If your prolactin is significantly high your menstruation is not going to be regular because the way prolactin acts is that it interrupts the secretion of FSH and therefore your menstruation is not going to be regular. It is a hormone that goes up and down and therefore I see some people worrying about their hormone level. They say prolactin is 40 and they are running around the whole place and that is not what is affecting them. It is important for you to have a proper evaluation and please talk to the right people.
Talking about ovarian cyst also there are two types of ovarian cyst there is the physiological ovarian cyst which is normal and there is a pathological ovarian cyst. If your cyst is less than 5cm and it is on scan we see that it is regular and it doesn’t seem to contain anything apart from fluid, what the doctor just needs to do is to monitor and that would go away overtime because it is likely to be physiological so you don’t need to treat that. If the report shows that your ovarian cyst is either more than 5cm in diameter or it has some things that make it a suspect then there might be some things in it. That is when you might need to do something about it.
18. Q: Can prolactin cause infertility?
A: Yes, very high prolactin can cause infertility. I have told you about the figures of the high prolactin that can cause infertility because that way it would suppress the FSH and then it would obstruct ovulation.
19. Q: Good day sir, what is the cause of delay in pregnancy after 3 years in marriage? My manhood is strong and I am 28 years old and my wife is 27 years old.
A: Well you need to see a doctor to do a proper assessment. 3 years is a lot of time so you need to see a doctor.
20. Q: Can most of the tests be done in a laboratory in your centre and in the diaspora?
A: If you are in the diaspora what we will say is that you should go to a standard laboratory and that is it. But there are some tests that we would want you to do here because sometimes we have some people that have done some tests since 2 years ago and they come with such tests. We want you to do a test that is as near to the time of your treatment as possible.
21. Q: Is there hope from a PCOS patient that her period is seized due to that?
A: If you have stopped seeing your menses because of PCOS then it shows that your hormones are not at peace. You need to see a doctor and that can be treated. Sometimes what amazes me is that some people talk about PCOS and their husband has not done any test. You might be running about for PCOS when there is no sperm, so it is better that the both of you do tests together. What I will say is that proper evaluation is needed.
22. Q: Can I still do IVF after three open fibroid surgeries?
A: Of course you can. But fibroid surgery can affect the lining of your endometrium, don’t forget we have been saying that implantation is the interaction between the embryo and the endometrium. The more regular the surface of the endometrium is the more likely the success rate is when IVF is done. So if you have done three open fibroid surgeries, it is very likely that your endometrium might be affected so what we need to do is a hysteroscopy. To look inside your uterus and see whether it has been affected if it has been it can probably be rectified so that your chances can become much better.
23. Q: What are the odds of conceiving if one’s partner has Parkinson’s disease?
A: Parkinson’s disease is a disease of the brain, it does not directly affect your fertility. It can reduce your urge for sex but it doesn’t greatly affect the sperm, so it is possible for you to conceive. Then again one cannot guarantee that it won’t be transmitted to a child because the causes of Parkinson’s disease are so many, some of them are not in the genes.
24. Q: Good day doctor I noticed I don’t ovulate like before, what could be wrong?
A: When your cycles are regular it is assumed that you are ovulating regularly, so many people are going about with diagnoses they make up by themselves. Or even a ridiculous diagnosis, they go to the diagnostic lab and the technician is the one making the diagnosis for them. Please stop this habit.
25. Q: How long does it take to boost low progesterone?
A: Well when you have low progesterone there must be a reason for that. Most of the time it might be age-related, the quality of your eggs might have started declining so see the doctor. The doctor will tell you what to do.
I am trying to get to male factor infertility because there are so many men who asked me a lot of questions about male infertility. I think that men are neglected in fertility and we need to talk more to them because we know that men contribute equally to infertility.
26. Q: What can we do for a guy with a low sperm count after many drugs?
A: If you are a regular listener you would have heard that drugs do not boost sperm count. Once you have a low sperm count you need to go and see a fertility doctor.
27. Q: Which drugs can I use to cure low sperm count?
A: We don’t prescribe drugs on this program and by the way, there is no drug right now that can improve sperm count.
28. Q: Is it possible for no sperm when TESA is done?
A: Of course it is possible. TESA is when you go to the testis to go and bring out sperm when there is no sperm in the ejaculate. For some men they are not even producing at all so it is possible that there is no sperm from TESA and at such times you might have to resort to the use of donor sperm.
29. Q: We have been married for 10 years and I understand now that I have low sperm count and infection. What can I do?
A: Go and see a fertility doctor.
30. Q: What are the chances of having kids for someone having irregular menstruation and heavy bleeding for months before stopping?
A: You see when we talk about irregular menses sometimes we need to also clarify what it could mean by irregular menses. The average cycle is about 28 days but the normal period is between 21 and 35 in order words 28+ or -7 so if you fall within this range between 21 and 35 days your cycles are regular so don’t bother yourself. But if you have heavy bleeding let us know how that can be tackled because sometimes when you are not ovulating regularly, one of the ways it would come is that you would bleed heavily and you wouldn’t menstruate within these 35 days. Usually, you would have prolonged menses, your cycles would become prolonged and then when it comes it is usually very heavy. You have to see the doctor if this is the case.
31. Q: Is all severe menstrual pain always the symptom of endometriosis?
A: It cannot be, but severe menstrual pain is usually one of the reasons why we should suspect endometriosis. You should not rest until you are sure that you have endometriosis or not. Because, early diagnosis prevents all the problems that can come from it including the fact that you can store your eggs early. It can prevent you from having infertility or you can have treatment early enough.
There are so many questions on fibroid now but at this point, we just have to stop. Other questions would be answered. Thanks for being part of this today.