Tunde Okewale was writing his school certificate when the first test-tube baby was born. So it seemed fitting he would aspire to be a gynaecologist. There is an equally-compelling tale about Okewale, medical director of Lagos-based St. Ives Specialist Hospital. He runs a programme that makes the otherwise expensive fertility treatment accessible to couples for whom that alternative may have been shut. Lanre Odukoya writes
Speaking on the vision that has kept him in business, the chief medical director of Ives Hospital, Okewale said: “First of all, I’m an obstetrician and a gynaecologist. The job of a gynaecologist is basically into women’s health; that’s what I was trained for. I was trained at the Royal College of Obstetrics and Gynaecology in the United Kingdom before I came to Nigeria. When I returned to Nigeria, I had a choice of floating a general clinic but I decided to focus on the area of my strength.
So, we started the hospital by just being a women’s hospital. Over time, the women started bringing their children, so we brought in the pediatricians and it became a women and children hospital and that’s our core area of practice. But along the line, the women would also bring their husbands; that’s where the family healthcare side of it evolved. Over the years, we found out that reproduction is a very big part of a family survival. We saw so many couples coming to the hospital for cases of reproduction, so it became a charity part of our practice. We treat women with fertility problems up to the stage of IVF at present.”
He recounted the story of a 53-year-old woman who recently benefitted from his intervention at no cost at all. “Fortunately for the woman, at the time she came here, we were doing our annual half-discounted price promo for IVF. We have an NGO arm, Ives Medicare Foundation. At a specific month of the year, our partner would subsidize the cost of IVF for those who want to do it in that particular month. The reason for that is that quite a sizeable number of women who require IVF cannot access it because of the cost. So, increasingly in our environment it was becoming an elitist kind of intervention. I guess it’s quite expensive to do IVF and that’s the reason for this intervention once a year. But in participating in the promo, they still pay us our money, but as far as the patients are concerned, they’re paying half price.
“Basically, what the foundation is telling us is that, treat this people and come to us for the bills. So, there’s that program in place and last September when that particular one was being done, a woman came along but couldn’t even come up with the half price that was advertised for IVF then. In a practice like this, most of the times, you rarely come on a one-on-one contact with the chief medical director until the last minute; you would have probably seen the other doctors or nurses. She was very fortunate that I was the first person to see her when she came that fateful day. When I listened to her story and after proper counseling because of her age - she was 53 - we decided that the foundation should pay half of the price and we as an organization will pay the rest. That was what kind of intervention we gave to her. IVF is not hundred percent certain but I think God just honoured her by making success of that story.”
Like many fertility experts, Okewale offers a grim prognosis on the gynaecological situation in Nigeria. “About 50 percent of all gynaecological consultations in Nigeria now have to do with infertility. There are other issues like fibroids and the rest of them, but even the bottom line of the fibroid, what people are saying in effect is that they cannot have children. So, infertility has suddenly assumed big proportion of all gynaecological consultations for obvious reasons. The society starts counting the months for every couple that gets married and when pregnancy is not seen after a short while, they put the couple under tremendous pressure. The pressures come from the family members, friends, acquaintances and so on.”
But he adds that many causes of infertility which inadvertently give rise to the need for IVF are preventable. “The first thing is that if you understand why infertility occurred, then it’s easy to prevent those causes. Generally speaking, there are five basic requirements for women to get pregnant: the first requirement is that the man must have adequate sperm of good quality and quantity. At least the cells in the sperm must be a minimum of twenty million. The second requirement is for a couple to know when their fertile period is, that is the time the woman is ovulating. The third is that the inside of the woman’s womb must be able to accept and keep the pregnancy. So, there must not be any problem inside the womb that will disturb the pregnancy. This is where the issue of fibroids comes in. The fourth is that the woman’s fallopian tubes must be open so that the eggs can enter it and meet with the sperm. It’s like a conduit pipe that connects the woman’s eggs and the sperm. Finally, the woman must produce quality eggs every month.”
About how long a woman should monitor these developments before she comes for consultations, the demure physician said: “Ideally, if a woman comes for any gynaecological consultation within a one month cycle, all those five requirements could be known. From the day she begins her period till when the period ends, the test to check out those five things would have shown results. And a solution would be proffered straight away. The mistake in Nigeria is that people think the same solution applies to all cases of infertility. But if you look at those five requirements, you’d realize that they’re different. At the end of every investigation of infertility, the treatment you give to a woman who is not producing eggs is different from the one for the woman whose tubes are blocked. So, IVF is not suitable for every woman who is trying to get pregnant.
There are indications specifically in the history that will say, your own best solution is IVF, like the case where the two tubes are blocked, IVF is the perfect solution. If the sperm count is low and it’s about five million, IVF is the best. The minimum sperm count here is twenty million, but if you have about eighteen to nineteen million, drugs can work at that level.”
As promising as it always seems though, there are reported failures in IVF procedures. In the event that all these conditions are met and a woman still cannot conceive, he explained: “In about 10 percent of women who come for fertility test, at the end of the month when you check those five things, there may be nothing wrong.
In such situations, we’d say they have what we call unexplained infertility and there’s a treatment for that. Basically, what unexplained infertility means is that the sperm and the eggs are not meeting for some reasons. It could be that the mucus in the cervix is blocking the sperm and so on. And there are specific treatments for that. Unexplained infertility is a well recognized situation which affects up to about 10 percent of the married couple. Another problem in our environment is stress. A lot of couples are not even making love at the right time to even allow for pregnancy because of their work schedule. Maybe they had been living in Nigeria and it’s been all work; they would go on holidays for a few weeks and when they return, they are pregnant. So, change of environment especially if there’s no problem, can aid the healing process.”
In-Vitro Fertilization essentially is fertilization that occurs outside as opposed to the more traditional In-Vivo Fertilization which occurs inside. “What we do is that we bring out the woman’s eggs into a separate dish in the lab. We treat the eggs and when the man produces the sperm, we treat the sperm by separating the good from the bad ones. And we use that sperm to fertilize the eggs in the lab when the fertilized eggs have started growing in the lab. Then we place the embryo back into the woman’s womb. When this is done, you bypass the tubes totally because you don’t need them now,” he said.
“In IVF, the last frontier that has not been cracked is that if you interview some people, they would tell you their IVF failed and that it never worked until the third attempt. You can place four embryos that look equally good inside a woman’s body while the body would accept one and reject the three or accept two and reject two sometimes or accept all the four and sometimes not accept any. It’s still a mystery. And this is what everyone is working on the world over. Any doctor who predicts a hundred percent success of any IVF procedure is obviously lying.”
Okewale grew up at a time when, as he recalls, “people were complaining of austerity in the late 1970s”. But he notes nonetheless that things were more organized. “My father was a broadcaster with WNTV then Ogun Radio in those days and I have a sister, Toun Okewale, who’s into broadcasting too. My mother was a teacher and a trader and life was good. I’m the second child. Growing up, the only thing I thought about was becoming a broadcaster because it was the earliest influence over my life”
He may be a fertility expert, but he’s not at sea on matters of fashion and style. “Sometimes I wear my tie, suit and the white coat to the office, but today is more or less not a very busy one for me. I use the gym to stay fit. I patronize local designers but mostly wear ready-made stuff because I don’t trust people cutting and measuring me before they go and sew. I’d rather enter a shop, see what I like, if I put it on and it’s my size, I’d just buy it. What I’m wearing today is a product of Vans Kere. I love the good things of life, I socialize, I go on holidays and do regular things men do. I drink occasionally. I would only take a Cabernet Sauvignon, I’m normally not a beer person,” he said on this sunny Wednesday.