While millions of Nigerian couples with fertility issues wallow in silence, self pity and are resigned to their fate, the decision by a lucky few to seek proper help has resulted in solutions to their infertility problems. Martins Ifijeh chronicles the steps taken by couples who underwent IVF treatment and are blessed with children of their own 
 
During Veronica’s hey days as a young university Law student, she had dreamt of a happily-ever-after kind of life. She hoped to work in a prestigious Law firm, earn money, marry her dream man, and surround herself with four lovely kids; two boys and two girls. She was 19 years, and was going to stop making babies before her 30th birthday.
While working towards her wishes, life served her the deserved desserts for her hard work and focus. But it also served her lemons. She graduated at 21, was called to Bar at 22 and married her husband at 23. He was 28 at the time and a budding engineer with so much robust career ahead of him. Everything (almost) worked in Veronica’s favour.
But her dream of having her children surround the matrimonial home began to deem every passing month into the marriage. The possibility that she may miss her period every other month became the pillar of hope for the young couple at the time. Yet each month turned out to be without pregnancy. Veronica and her husband couldn’t make lemonades from the lemons life served them.
“While being anxious from the very first month after my wedding, because I had wanted everything to work as planned, I didn’t think anything was wrong with me or my husband, because every experienced adult we met at the time often tell us not to worry that it might take a couple of months before conception starts.
“Doctors also told us the possibility of getting pregnant per month generally for a woman was only 25 per cent, and that with regular sexual intercourse of say three times per week, there was the high possibility of pregnancy within one year. We made it a duty to have regular sexual intercourse, yet there was no desired result,” Veronica explained.
But the truth dawned on the young couple like a twilight of a shuttered room when a full year passed without Veronica missing her period for one month. It was obvious. They were infertile couple.
Realising this, Veronica’s apprehension and anxiety increased, and then it turned into frustration. She started to feel she was going to grow old without a child of her own, and then the society would label her barren.Two years ago, the couple celebrated their 13th wedding anniversary without the cry of a baby.
 
“Just about the second year of my marriage, I and my husband went to see an obstetrician and gynaecologist, who examined us and said everything was fine, and that in a matter of time I will get pregnant. He recommended some drugs for both of us. My husband’s own were more of sperm boosters and supplements. Mine, according to him were drugs to relax the womb and make it flourish. He also advised me not to be too anxious, that it may come sooner than expected.
“We took the drugs exactly as prescribed. It was a renewed hope for both of us, as we looked towards the good news which never came. I became ashamed to visit my in-laws, attend parties with my friends and age groups who most times come to such gatherings with their children. Baby showers and naming ceremonies were no go areas. Not that I hated the celebrants or their babies, I just couldn’t come to terms with the idea that I was praying so badly to have something every other person was getting at ease.
“All my younger ones got married and started making babies. Every news that any of my two sisters had given birth gave me mixed feelings. In one breathe I will be happy for them, and in another I will be shredded in pieces,” she said.
At 36, Veronica and her husband, who was already 41, knew if no drastic step was taken immediately, they may miss the window of ever having babies of their own. This was significant for them because fertility experts had told them that as a woman approaches 40 years, her egg production slows down and the possibility of conception diminishes.
They were advised to take a shot at In Vitro Fertilisation (IVF); a process by which a woman’s egg is fertilised by a man’s sperm outside the body, usually done through a laboratory procedure involving high monitoring and stimulation of the reproductive elements. It is an assisted reproduction technology (ART) that has given new hope to couples who cannot conceive naturally.
“That was how the task of finding a good IVF centre started, and then we finally settled for one in Lagos where I did some basic hormonal screening and other diagnosis which showed I had multiple issues including tubal factor infertility. First, I was told I needed to gain weight, as my hormones were affecting my metabolism.And in few months, I was ready for the IVF.”
While reflecting on the verdict of the first gynaecologist they met years ago that said there was nothing wrong with them, the couples decided to ask a lot of questions in order not to make mistakes.
“I and my husband asked all the questions, surfed the internet for information on the likely causes of infertility, the chances, the processes of IVF, among others. Despite repeated warnings by both the fertility experts and information from the internet that it was not a 100 per cent guaranteed process. We believed it was the miracle we needed and there was no going back on it. After all, we had no choice.
“I was told about the possibility of using a donor egg, but when we considered the cost of everything, I asked for the viability of my own eggs, and I was told it would be fine as well, but may not be as good as that of a younger woman. That was how the process started with the stimulation of my ovaries. I was on injection for a couple of days to be able to excite simultaneous multiple ovarian follicle. On the 8th day, I was given a high dose of the drug,” she added.
The doctor, according to her, said he gave the specific high dose because it will trigger ovulation to occur approximately 36 hours later. Experts believed the process had to be perfectly timed since a woman’s eggs will not fertilise appropriately if they are premature or too old. If the patient ovulates before the final injection, the cycle will unfortunately be cancelled.Records suggest up to one in five women have had to cancel their cycles due to too early ovulation.
“The process was successful and at 37, I was carrying my first pregnancy. I couldn’t wait to hear the cry of a baby in the house. I cherished and savoured the moment. Despite the pain and discomfort I felt, I knew deeply that it was worth it.
“On February 16th last year, I gave birth to two boys, who we named Marcus and Marvin. Any time I hear my babies scream or laugh, I feel the real joy of a mother. That was the treatment that took me out of barrenness. I wonder how I would have ended up if I didn’t take this step,” she joyfully said.
Veronica still believed her dream babies of two boys and two girls will be a reality. “I know my next pregnancy will result in two girls to complete the wishes I asked from God over a decade ago as a university student,” she happily explained.
Over 25 per cent of Nigerian couples are infertile
Eight years of uncertainty
Just like Veronica and her husband, the journey to living a fruitful married life did not come immediately after Bolanle’s marriage to her husband. It took eight years of pain,uncertainty and determination. They moved from pillar to post, while hoping they could get lucky at it.
Bolanle, who got married at 30, wasn’t a happy woman all through the period because pressure was on her to complete the dream of every married woman – to breast feed her own babies and have them run around the home.The joy of a mother was all she craved for.
Even though she was not disturbed by her husband and his people, as it is generally the norm in Nigeria, where women suffer the brunt of infertility among couples, the pressure from the society overwhelmed her. She was not comfortable being associated with bareness; a title the society places on women who are yet to have their own babies years after marriage.
Along the tumultuous journey of uncertainty, she heard about IVF and then gave it a thought. “I didn’t want to wait longer than eight years for a normal conception, so I approached Nordica Fertility Centre in Lagos, where I got a lot of explanations on the processes and the need for us to use a donor egg. I was also told the chances and possibilities of pregnancy. I knew it was not 100 guaranteed, but IVF is said to be the climax of any reproductive treatment, so I was optimistic.
“I and my husband then prepared for it financially and psychologically. And within a year, we were back to commence the treatment. The process was successful and by 2003, I had my first child after eight years. It was like a dream come through. I couldn’t believe I could birth a child of my own,” she added.
Like a booster, two years after, she decided to give it a try again. “I went back to the hospital again and repeated the process for the second time, and it worked. I had my second child. I went back to repeat the process again for the third time but unfortunately it failed.
“With two children within three years, there was nothing more I could ask for. I then decided to stop the process, because at least, the evidence at hand had taken the toga of barrenness out of me. God used that to show me that He could use science to provide answers for fertility issues,” she narrated.
Bolanle, who believed she had stopped making babies, one day discovered she missed her period. It was pregnancy again. But this time, it wasn’t through any assisted reproductive process. It came naturally. “Today, I am a proud mother of three children,” she added.
Early presentation increases chances of conception
Providing solution to a dead case
But the case of Mrs. Ebizimo (not real name) from Bayelsa State presented a more difficult scenario. After trying several methods and assistance to get pregnant for 13 years, including attending religious homes and other unconventional places, she finally settled for IVF. It was her last hope, as every other methods and places she attended failed her.
“After doing the necessary tests and we were ready to commence the process, the doctor who examined me said the hospital management has rejected to render any assistance because my chances of having children was far too slim considering the fact that I only had three follicles, and that they wouldn’t want to collect money from me even when they know I may be unable to conceive.
But Mrs. Ebizimo wasn’t deterred. Like the biblical Zacchaeus with a petite stature who went all out despite the odds, climbed a sycamore tree just to see Jesus, she refused to give up. She told the hospital management that she was unwilling to accept the refund, as she believed the three follicles in her would be enough to have the children. She just wanted to stay happy in her family.
She explained that upon her insistence, the hospital management decided to continue with the process. “I went through the process and as God would have it, I became pregnant and I didn’t just have one baby. I gave birth to twins; a boy and a girl, and they are six months old already,” she added.
The grim picture
Veronica, Bolanle and Ebizimo are among millions of couples in Nigeria who have gone through or still going through the challenges of fertility. While few have been lucky to get treatment and are now enjoying parenthood, millions of others have either continued to live in denial, lack the information on where best to get IVF, or are too financially down to access IVF treatment.
The IVF lucky three are some of the lucky Nigerian couples with fertility issues that are finally enjoying parenthood.
According to the Managing Director, Nordica Fertility Centre, Dr. Abayomi Ajayi, over 25 per cent (one in every four) of Nigerian couples are suffering from one form of fertility issue or the other, with majority of them still either living in denial, seeking help from unconventional means, or are still skeptical about IVF because they believed babies from the treatment are not normal babies.
Records from hospitals show that 40 to 45 per cent of all consultations in gynaecological clinics are infertility-related in Nigeria, a statistic that brings to bare the burden of infertility in the country.
 
infertility causes 30 per cent of marriage breakups
Breeding unhappy relationships
The plight of the IVF-lucky-three before they got help illustrates the pain over 25 per cent of Nigerian couples go through. By its magnitude, it is a major public health/social problem which is silently killing the joy of homes.
“Apart from the impact infertility has on the psychology of husbands and wives, it has caused the breakup of several marriages,” says a marriage counsellor and social health worker, Mrs. Blessing Nwaneri-Obi.
She says over 30 per cent of marriage breakups have been linked to fertility related issues, adding that Nigeria should give fertility treatment a priority in the country.
“Often times these marriages breakup because the partners do not see any other solution to the problem, as they may have gone for help in odd places without results, thereby fueling frustration. Some are not even aware fertility clinics can help them if they present their issues early before the woman’s reproductive clock closes,” she said.
Why do couples experience infertility?
The World Health Organisation (WHO) believed infection, genetics, environmental, and health challenges like adrenal and thyroid diseases were major causes of infertility globally.
On specifics, the world health body says infertility in Africa is caused by infection in over 85 per cent women compared to 33 per cent worldwide.
Dr. Ajayi, who is an obstetrician and a gynaecologist, says apart from infection, which is a leading cause of the health challenge, excessive intake of alcohol, coffee, smoking, appendix, low sperm count, use of steroids, among others could also be causal factors.
Infertility is treatable
Infertility without any medical condition
While couples visit fertility clinics to get proper diagnosis and know exactly what to do to be able to conceive, there exist category of women whose fertility problems has no medical explanation. Experts believed such women may have been suffering from endometriosis; a disorder in which tissues forming the lining of the uterus grows outside the uterine cavity.
Dr. Abayomi, who has assisted infertile couples to birth over 2000 babies through IVF, said this was because endometriosis happens to be the cause of half of all unexplained infertility, affecting 1 in 10 women of reproductive age.
“The endometrial tissue can grow in the ovaries,  bowel, and tissues lining the pelvis, causing irritation, scar formation, severe pain during periods and of course fertility problems.
He mentioned that most women suffering from this condition often go through symptoms such as “painful periods, pain in the lower abdomen before and during menstruation, cramps one or two weeks around menstruation, heavy menstrual bleeding or bleeding between periods, pain following sexual intercourse, discomfort with bowel movements and lower back pain that may occur at any time during menstrual cycle,” he added.
Men could also be reason for infertility
The lie told against women by the society
It is no longer news that women are often the sacrificial lamb during fertility fights, especially in Nigeria. But what has refused to be a front burner is that men contribute a lot to infertility.
“Worldwide, sperm count has reduced by more than 30 per cent,” said Dr. Ajayi, adding that when comparing the sperm count of men who used Nordica’s service 10 years ago and now, “the decline in counts have reduced by more than 30 per cent, and they are increasingly contributing to infertility.”
He said while women have been known to take first steps towards addressing their fertility issues, men should not shy away from doing same, adding that there exist technologies to assist men with very low sperm to be able to fertilise an egg. “Intra-cytoplasmic Morphologically-selected Sperm (IMSI) is helpful in this regards,” he added.
The fertility experts advised men to take foods high in antioxidants, as they have been proven to boost the quality of sperm. Such foods, he said were beans, apples, carrots and a host of others. He said foods high in vitamins, magnesium, potassium were important for men.
    
Dr. Ajayi says infertility is treatable
Way forward
A Professor of Medical Microbiology, Prof. Folasade Ogunsola, believes one of the ways of tackling infertility was a sustained research into the causes and cures of the health and social condition in Nigeria.
She said when causes, management and treatment of  infertility are demystified, couples would come out more to get help. “Many years ago, there was no treatment for infertility, but now there is treatment, so people need to be aware of this, so they can get help,” she added.
Recently, the House of Representatives called on the Federal Government to subsidise the treatment of IVF in the country, as this will motivate more couples to access treatment. It further urged the government to establish fertility centres and equip same with state-of-the-art facilities in at least one federal institution in each of the six geo-political zones.
The call followed a motion by Hon. Anayo Edwin (APGA-Ebonyi), which was unanimously adopted by the House members through a voice vote.
Dr. Ajayi said on his part, Nordica Fertility Centre, in collaboration with the Fertility Support Foundation (FTSF) provides free treatment for couples who are unable to afford treatment, yearly. It also provides a support platform for couples who are fertility challenged, so they can interact and share their problem.