Introduction

Thank you for visiting our IVF and Fertility Unit page.

Infertility affects millions of couples leading to untold misery and frustration. In Nigeria, about 25% of couples in theirfertlie age group are the sufferers and the incidence is on the increase because of urbanisation, pollution, stress, chemical exposure, career, orientation, late settlement in life etc.

Whilst about 40% of infertile couples will get pregnant by themselves, by changing their lifestyles and by the standard gynecological treatments, up to 60% will however require some form of assisted conception technoques such as Intrauterine Insemination (IUI), Invitro Fertilization (IVF) or Intracytoplasmic Sperm Injection (ICSI) etc. to achieve pregnancy.

St. Ives IVF and Fertility Unit is commited to providing state-of-the-art assisted reproductive techniques (ART) such as IVF, ICSI, IUI, Sperm & Embryo Freezing etc. at an “AFFORDABLE” cost with a resultant high pregnancy rate, in a comfortable informal atmosphere.

We would strive to provide adequate moral, emotional, ethical and spiritual support to couples trying to find solution totheir infertility problems.

About the Fertility Unit

St Ives, IVF & Fertility Unit adopts a success-oriented approach towards infertility. We focus on solutions (getting babies for infertile couples) rather than the problems (doing endless investigations and tests) We do not waste time, money and effort by concentrating on a long list of useless and fanciful tests and investigations that do not affect the treatment or the outcome of the IVF procedures.

Apart from the basic infertility tests which are necessary in the initial evaluation, extended investigations and tests do not get women pregnant and usually do not help much in deciding the best treatment for couples. Couples that come to infertility doctors for help want to have babies, not extended investigations and having to wait too long in achieving their objective. It is bad enough being infertile but going through tests that add no value to the outcome of the procedure drains the couples emotionally and financially. Keeping the treatment complex however helps some clinics to justify the abnormally high fees they charge.

At St Ives, IVF & Fertility Unit, we focus on IVF treatment protocols that are easy, simple, safe, less stressful and produce a high pregnancy rate because we are confident of the fact that IVF technology is better at solving infertility problems rather than a long list of unnecessary diagnostic tests.

Mission Statement

TO PROVIDE ADVANCED AND COMPETITIVE IVF AND FERTILITY SERVICES OF INTERNATIONAL STANDARD WITH A HIGH PREGNANCY RATE AND AT AN AFFORDABLE COST TO THE COUPLES.

In Vitro Fetilization

invitroIn order for pregnancy to occur, an egg has to be released from the ovary and unite with a sperm. Normally this union called fertilization occurs within the fallopian tube, which joins the uterus (womb) to the ovary. However, in IVF, the union occurs in a laboratory after eggs and sperm have been collected. Embryos are then transferred to the uterus to continue growth.

Candidates for IVF

couple

      • Endometriosis
      • Both fallopian tubes absent or blocked due to surgery, ectopic pregnancy or infections.
      • Reduced sperm count and motility.
      • When all other treatment such as ovulation induction and intra uterine insemination has proven unsuccessful.
      • Patients with unexplained infertility
      • Patients who have failed to get pregnant in spite of all routines treatment for infertility
      • Patients who want to get pregnant by the procedures of embryo and egg donation.
      • Advanced female age > 38 years.

IVF procedures

IVF treatment involves the administration of fertility drugs, monitoring of the circle, collection of eggs, mixing egg and sperm together outside the woman’s body in a culture dish or test tube. Any resulting embryos are left to grow and the best embryos 2 – 3 are then transferred into the woman’s womb. Any remaining embryo of good quality may be frozen for future use.

Prelimenary Testing

testing
When attending our IVF clinic, for the first time, the Doctor will conduct a consultation. He or she will review in depth your history. The basic initial investigation before treatment will include;

      • Semen analysis
      • Blood Hormonal assay FSH, LH, PRL, TSH
      • Sonohysterogram, Hysterectomy OR HSG to confirm your uterine cavity is normal.
      • Vaginal ultrasound scan to confirm your uterus is normal

If these tests have been done in the past one year we might not need to repeat them. If there is a problem we can treat it prior to starting the IVF.

Consent Forms

Before the couple starts IVF treatment they would be issued a consent form and information sheet about their treatment.

Super Ovulation

ovula

This involves the use of fertility drugs to stimulate the ovaries. The aim is to grow several mature eggs rather than a single eggs that normally develops each month… With the introduction of cryo preservation, excess embryos can be stored so that women do not have to go through stimulation and egg collection each cycle.

A number of different drugs and protocols are used in IVF treatment. Because the treatment is individualized, a couple may find out that their drugs and protocols differs from other couples.

For further information concerning super ovulation protocol discus with your infertility specialist.

Monitoring the treatment circle

The aim of monitoring the cycle is to check the development of the follicles and the lining of the uterus to adjust the dose of the drugs and to time the HCG injection. Each patient is different. On the average you need to attend the clinic 2 or 3 times to assess how you are responding to the injections and to adjust the dose of the injection accordingly. The development of the follicle is routinely monitored using several vaginal ultrasound scan.

Egg Collection

egg

This is usually performed in the morning or early afternoon approximately 36 HRS after the HCG injection.
Vaginal ultra sound guided eggs collection is the technique we use. It is a minor and safe procedure.

A vaginal ultra sound probe with a fine hollow attached is inserted into the vagina under ultrasound guidance, the needle is then advanced from the vagina wall into the ovary to suck out the fluid from the follicle which contains the egg.

Follicle flushing is not associated with improvement in pregnancy rate or the number of eggs collected, but increases the duration and pain of the procedure.

After the egg collection, the patient might experience slight pain, and a painkiller is often helpful. Bleeding should be minimal if at all.

Fertilization

fertilize

The term fertilization is derived from the Latin word in-vitro meaning glass, because the eggs are fertilized in laboratory glassware. On the day of egg collection, the male partner is asked to provide a semen sample.

The sperm is washed in a culture medium and prepared in order to separate the sperm from the seminal plasma. The eggs are collected into a specially prepared culture medium and examined under microscopes and graded for maturity. The eggs are then placed in the incubator for about 3 – 8 HR before it is mixed with sperm.

Between 20,000 and 30, 000 sperms are mixed with each egg in the specially prepared culture medium and kept in incubator to allow fertilization to occur. The first sign of fertilization is the presence of two small dots inside the egg, so called “two pro nucleate” and the fertilized egg is called Zygote, of the 2 pronucles, one is from the egg and the other from the sperm.

It takes 18hrs for the egg to be fertilized and about 12 hours later the fertilized egg starts to divide into 2 cells and subsequently into 4 and so on. After about 48 to 72 hours from egg collection the embryo will usually consist of 4 – 8 cells each and ready for replacement into the woman’s uterus.

Embryo Transfer

embryo

The embryo transfer procedure is quite simple and usually pain free. The cervix is cleaned and embryo or suspended in drop of culture medium are loaded in a fine plastic catheter with a syringe on one end. The procedure is guided by ultrasound scan. The use of ultrasound scan during embryo transfer appear to increase pregnancy rate:

General Adviser after Embryo Transfer

    • Take it easy for a few days avoid any strenuous exercises such as aerobic and horse riding
    • Avoid douching, tampons and swimming in order to avoid undue contamination of the vagina.
    • Avoid unnecessary exposure to solvents and paints containing lead.
    • Avoid carrying or lifting heavy objects.
    • Eat healthy and sensibly, avoid alcohol, avoid non-pasteurized milk and soft cheese, blue cheese
    • Avoid cat litter and soil
    • Stop smoking
    • Continue taking folic acid tablet
    • Refrain from oven
    • Avoid intercourse for 2 weeks
    • Do not stop lutheal phase support until pregnancy test result.

Lutheal Phase Support

lutheal

Once the egg has been removed the follicles start to produce a hormone called progesterone to stimulate endometriuml and prepare it for implantation. The amount produced by the follicles is usually not enough to support the uterine lining. Hormone supplements are usually given for 2 weeks or longer to assist implantation.

The choice of luteal support will be discussed by the infertility specialist.

Treatment Options

treatment

    • Ovulation induction / controlled ovarian stimulation
    • Intrauterine insemination (IUI) Husband / Donor
    • In-vitro fertilization (IVF) and Embryo transfer
    • Intra-cytoplasm ic sperm injection (ICSI)
    • Gamete intra fallopian transfer (GIFT)
    • Sperm Retrieval technique
    • Sperm Bank Embryo Freezing
    • Endoscope surgery
    • Donor Embryo programme
    • Endoscope Surgery

WHY INFERTILITY IS A RISING PROBLEM

Infertility is defined as the inability to conceive despite regular and unprotected intercourse for one year.

Although infertility by itself may not threaten physical health, it does have a serious impact on the mental and social well being of the affected couples.
Infertility is divided into 2 types. Primarily infertility means there has been no previous pregnancy (40% of infertile couple) and secondary infertility if there was a previous pregnancy whatever the outcome (60% of infertile couples)
Infertility affects million of couples in Nigeria leading to untold misery and frustration.
One in four couples is having difficulty in conceiving, and the number of couples seeking medical help to have family has rising dramatically in recent times.
Infertility has always been with man even, from the biblical time. Couples finding it difficult to conceive were far and in between in those days.
The incidence has suddenly been on the increase for various reasons ranging from urbanisation pollutions, stress, chemical exposures, career orientation and late settlement in life. I will discuss a few of these factors.

Environmental Issues.

There are now many observational studies that have shown that the average sperm counts of Nigerians in the urban centres are gradually falling. Many of the causes of the falling sperm count can be traced to environmental pollutions and exposure to certain pesticides, metals and solvents in many industries and especially in the plastic and printing industries. There is also suspicion that many of these pollutants with oestrogenic contents from the industrial wastes may have contaminated the public water systems including the indiscriminate borehole water supplies.
Not only are the average sperm counts falling, men are also producing large numbers of abnormal sperms due to the environmental pollutions. Smokes either from cigarettes or environmental smoke from industries and generators affect fertility by reducing the functions of eggs and sperms.

Stress

It is not rocket science to know that the stress level of Nigerians have increased many folds since the early eighties when the economy suffered major turbulence from which we are yet to recover from the structural adjustment programme (SAP) of the government of that time.
Stress affects relationship. Stress is a major cause of Libido (sexual desire) among couples, thus reducing the frequency of sexual intercourse. To get pregnant fast, couple must have sex at least three times a week. Having sex regularly is the best way to get pregnant quickly.  Many couples leave trying for pregnancy to only their fertile or ovulation period because of their day to day stressful lives.
Severe stress can also affect female ovulation and can limit sperm production.

Infections

Unlike the obvious sexually transmitted diseases of times past such as gonorrhoea which are now easily treated with increasing sophistications in Antibiotics. There is an increasing incidence of CHLAMYDIA infection which has no symptoms and causes damages and not detected until too late.
Because it has little or no symptoms, it has become one of the commonest infections causing infertility.
It damages the fallopian tubes in women and causes swelling and tenderness in the scrotum of men.

Weight

Being over weight reduces male and female fertility. In women, being over weight and severely under weight may impaire the production of mature eggs. Obesity predisposes to polycystic ovarian syndrome which in turn affects ovulation.

Age and Late Marriage

Men can maintain fertility to ripe old age. The same cannot be said in women.
Women’s fertility starts decreasing from age 30 and at a faster rate from 35 years onward. The older a woman gets, the older her eggs get also. The quality and the quantity of egg decrease with age.
Age is one of the fixed factors in life. A woman can be forty but feel or claim to be 30 years old, but unfortunately her eggs would remain forty and behave like a forty years old egg.
More women work than ever before and many are increasingly becoming the bread winners due to the socioeconomic problems, unleashed on Nigerian from the early eights till date.
Many women and men are involuntarily delaying marriage and child bearing till very late resulting in increased incidences of infertility.
The peak of a woman’s fertility is between age 20 and 30 years. Unfortunately, many are getting married in their thirties and forties.

Cost of Advanced Fertility Treatment

Advanced fertility treatment such as Invitro fertilisation (IVF) helps more patients to alleviate infertility problem. Problems of No sperm count and total tubal blockage which would have warranted counselling about adoption are now easily treated with Invitro fertilisation. It is however unfortunate that only a few patients can asses Invitro fertilisation because of the cost of this procedures.
Until our governments see infertility as a social problem and subsidize its cost many otherwise treatable infertility problems would remain with us, hence contributing to the rise of infertility and its attendant social problems.

Religious Dogmatism

Religious dogmatism affects many couples approach to infertility. There has been an increase in different religious fundamentalism with their plethora of dogma and doctrines since the early eighties coinciding with the economic downturn in Nigeria.
Many couples find comfort in religion and spirituality when it comes to coping with the pain of infertility. But there is a difference between finding comfort and taking direction on which treatment to alleviate infertility.
To many couples, seeking medical help early for their infertility problems, negate their religious belief and faith system.
Seeking medical help and prayers should not be mutually exclusive. Prayers and seeking medical help should work side by side. In any case it is only a foolish and inexperienced doctor that would take any glory for helping couples to achieve pregnancy. Religious Dogmatism limits the hand of God to act only in a certain way.

Many of the couples in these groups finally present themselves for medical intervention in their forties when is more difficult to treat what could have been a simple problem in their late twenties or early thirties.
In conclusion, there is a real danger that infertility could become an epidemic problem in our society due to a combination of many socio economic, environmental and life style issues afflicting our societies from the early eighties.