•And the two women, one baby option

By Chioma Obinna

In the days of our grandparents, a woman in her 20s would have given birth to  her second or third child. It was quite common then for  women to have had all their children before age 30. But things have changed. Women are readily postponing marriage and by extension child bearing.

There are several reasons for this development. Women are acquiring more educational qualifications in order to get better paying jobs before settling down to get married and start their families. Meanwhile, their biological clock is steadily ticking away.  By the time many achieve this goal, they are already well into their mid  or late-30s.

Even  men are not making matters easier.  In the face of the current economic situation, many eligible young men are reluctant to settle down in marriage until they are financially stable.

All these and more combined, today, many women are  having their first babies in their late 30s. It is therefore no surprise why the country is witnessing associated infertility problems.  Experts say a woman’s eggs are as old as the woman, unlike the man whose sperm  is  renewed every few weeks.

It’s a fact that age is the number one factor that determines fertility especially for the woman.  A woman does not only have to battle with age but the stressors in the environment:  Stress as a single mother, stress of coping with everyday life, being a bread winner, with addition to family’s income. And this stress multiplies  after marriage. The woman is under a lot of pressure from all angles.

This was exactly what happened to Ekaette John, a brilliant and pretty accountant. At 20, she had already graduated from the university. But for her, it was just the beginning of her career.  As the best graduating student that year, she was given scholarship for further study abroad.

Ekaette stayed abroad for another four years. Back to Nigeria, she became a  chartered accountant.  She was really engrossed in her academic pursuit.  As years passed, Ekaette never thought of marriage.  Her dream was to take a course in Harvard School of Business.  Ekaette could not make it to Harvard but made it to a prestigious university in the United Kingdom.

Despite the fact many men were seeking her hand in marriage , she put her educational  pursuit first.  Finally at 32, with series of degrees and as Managing Director of a big accounting firm, she was ready for marriage.

But it was not easy finding Mr Right. Two years into the search, no even looked her way or approached her for friendship not to talk of marriage.   Many of her contemporaries in the family were already married with children. Ekaette was now feeling too old.

At  36, she was under pressure to settle down with a widower, who showed interest in her.  But the problem was not over. One year into the marriage,  there was no pregnancy. They went from one hospital to another without  positive result. She was told they should keep trying.  Another year passed. She finally faced up to their childlessness.   Ekaette attended so many baby showers and naming ceremonies. This  added to her stress. She became a bit of an introvert. But she did not give up. The years passed and, in the process of searching for solution, she visited a fertility clinic in Lagos.  Ekaette was close to 40.  After series of tests, it was found that her eggs were  weak and no longer viable.  Her prolactin levels were sky-high. So she was put on  drugs to bring the levels  down.

The fertility experts recommended IVF with donor eggs.  They noted that it would have been more helpful if Ekaette had frozen some of her eggs when she was younger as such eggs could have been used in place of donor eggs.  Although  IVF is said to be expensive, anyone who can afford a secondhand (tokunbo) car, can afford it.

According to experts, IVF with donor eggs or embroyos  are usually for old women from age 40 or women unable to become pregnant with their own eggs like Ekaette.    It is also recommended for women and their partners that have fertility problems, or if the woman had repeated miscarriages because of embryo issues, donor embryos may be an option (two women, one baby).

Also, single women with fertility problems can  conceive using donor eggs or embryos, and men without a female partner can become fathers by using donor eggs or embryos and a gestational carrier.  However, there may be laws restricting unmarried people from using gestational carriers.

Although  IVF with egg donation is similar to standard IVF, there are  key differences. For instance, to synchronize the menstrual cycle of the donor with the recipient, a medication must be used to suppress the recipient’s natural cycle and prepare her uterus for implantation of the embryo. During this time, the donor receives fertility medications to stimulate the maturation of multiple eggs. Once the eggs have been collected from the donor, they undergo fertilisation with sperm from the recipient’s partner. Embryo transfer occurs several days later, once the new embryos have been examined and the healthiest ones are selected.

IVF with donor eggs

During the procedure, a small catheter is inserted into the uterine cavity, through which the selected embryos are deposited. After the transfer is complete, which takes approximately 10 to 15 minutes, the patient rests for an hour and is released. She should also rest at home for the next day or two. To optimize the chances of a successful pregnancy and reduce the possibility of a multiple birth, only two or three embryos are transferred.

Ekaette’s  case was not different.   Her doctor advised her to get an ideal egg donor who would be between  23 and 33 with no medical or genetic conditions.

According to her doctors, the donor must be prepared to discuss her medical history, and provide details about her lifestyle and physical descriptions with  a  fertility specialist.

Ekaette was able to get a  donor who was 23 with no medical or genetic conditions.  She and her egg donor, who happens to her sister inlaw however, underwent the process.

Ekaette’s case may not be unconnected with the fact that, medically, a woman’s fertility starts to measurably decline around age 27, due to the depletion and ageing of the eggs. It is also said that if a woman is under 30, the chance of getting pregnant in any one cycle is 20 – 30 per cent. By age 40, it falls to five  per cent.

But it is not just the woman who needs to pay attention to the clock ticking. Men over 35 are twice as likely to be infertile as those under 25.

Ekaette’s husband, who was 55, was found to have problems with the quality of his sperm. Thanks to advanced technology, Ekaette and her husband were helped through IVF and Intracytoplasmic Sperm Injection (ICSI).  One of the advantages of ICSI is that the sperm doesn’t have to travel to the egg or penetrate the outer layers of the egg. According to experts, this process can help couples where the man’s sperm can’t get to the egg at all. It can also be recommended when sperm can get to the egg, but, for some reasons, can’t fertilise it.  It can also be recommended when you have a high percentage of abnormally shaped sperm and can result in poor motility, which means the sperm can’t swim well.

Despite all these efforts, Ekaette had a miscarriage.  Her world came crashing.  She was heartbroken  Her husband may not have been bordered so much as he had two grown up children before they got married.

Again, Ekaette’s fate is not unconnected with the fact that it has been established that, with age, it takes longer for a woman to conceive and the risk of not being able to get pregnant increases; miscarriage  and complications in pregnancy and childbirth  also increase.  Studies have shown that the rate of miscarriages rises from 40 percent to 50 percent in women above 40.

But her doctors advised her to try again.  She went through the same process the second time.  This time it worked.  Due to her age, she underwent some complications all through the pregnancy.  Her doctor had already classified her as high risk case.  She was advised to stay away from stress which she  did.

Meanwhile,  Ekaette had to contend  with the consequences of age again.  At almost 45, she was not expected to have her baby through the normal birth canal since she had  never had a child in her life.   Miraculously, nine months after, she was delivered of a baby boy.  Ekaette is, today, a proud mother, courtesy of IVF but experts say if she had frozen her eggs earlier she would have had  the opportunity of having her own offspring without donor eggs.

It is no longer news in the medical world that diminished fertility, also called diminished ovarian reserve, often reflects a decrease in number of eggs quality.

Studies have shown that women’s fertility runs in cycles, unlike that of men. As a woman ages, her fertility decreases and this usually occurs slowly up until about 35 years of age, when fertility falls even faster. Chances of getting pregnant diminish gradually but significantly from about the age of 35.

Drop in fertility

A woman that is over 35 is nearly 2.5 times more likely than a younger woman to have a stillbirth. By age 40, she is more than five times more likely to have a stillbirth than a woman under 35. For a woman aged 40 and above, the risk of miscarriage is greater than the chance of a live birth.

The drop in fertility is seen even in women with perfectly normal, regular menstrual cycles. For some women, fertility may no longer be possible  five  to 10 years before menopause. As the woman ages, a natural loss of eggs occurs as well as a decrease in the quality of those eggs.

According to experts, the average age of menopause is roughly from the late 40s to early 50s, by then, ovaries stop functioning and there are few or no eggs left.

Factors such as smoking cigarettes, chemotherapy or radiation from cancer treatment and diseases of the ovaries could cause a decrease in the lifespan of the ovaries, making fertility after 40 even more difficult.

A  fertility expert and consultant, Dr. Ifeoluwa Oyetunji of Nordica Fertility Centre, Lagos, said: “Once a woman is 24 to 26 years, she has 86 percent chances of conceiving within a year of marriage.   But from 35 to 45 years, it is about  five  percent.

“It decreases even naturally. When there is infertility problem, the rate it decreases is  worse; even with treatment it is about 10 percent.”

Advising women to marry early, she said there is need for such women to freeze their eggs.  “Instead of rushing to find husband, women can begin to rush to freeze their eggs and have their lives in their hands and plan it the way they want”.

She explained that egg freezing is a method of storing a woman’s unfertilised eggs to allow her to try to conceive at a later date, when natural conception would be unlikely.

It may been seen as a way of preserving the possibility of fertility for women who are not in a position to becoming pregnant straight away, or whose fertility is at risk for medical reasons such as cancer treatment.

Frozen eggs may be stored for many years without significant deterioration. When the woman is ready to use her eggs, they are warmed, and then fertilised with sperm. The aim is for the fertilised egg to develop into an embryo, which can then be transferred to the woman’s uterus giving a chance of pregnancy.

Men, Age and Infertility

Just like women, contrary to the age long belief that a man can impregnate a woman at any age, studies have shown that a man’s age can reduce the chances of fathering a healthy child.

While a man can have a child at any age, male fertility starts to decline after 40 when sperm quality decreases. This means it takes longer for the man’s partner to conceive and there’s also an increased risk of not conceiving at all. If conception occurs, there’s an increased risk of miscarriage regardless of the age of the mother if the father is over 45.

For couples having IVF, the risk of not having a baby is more than five times higher if the male partner is above 40. The volume of semen and sperm motility (the ability of sperm to move towards an egg) decrease continually between as from the 20s.

It is also known that risk of miscarriage is twice as high for women whose male partner is aged over 45 than for those whose partners are under 25.

Age and egg freezing Biological clock of a woman can be reversed through egg freezing —Dr Abayomi Ajayi, MD, Nordica Fertility Centre, Lagos

Medical Director, Nordica Fertility Centre, Lagos, Dr. Abayomi Ajayi, explained that the biological clock of a woman can  be reversed through egg freezing.

Ajayi, who noted that, until 10 years ago, the result from freezing eggs were not very good, explained that  the results are now guaranteed, thanks to Japanese vitrification method of freezing.

“The problem with freezing years back was that human beings are made up of 80 percent of water; so the eggs are also made up of 80 percent of water.  Then, the things we are using to store the embryos do not do very well with the eggs because water in the eggs used to turn into ice and could not maintain the original structure”, he said.

“But since the advent of what we call vitrificationusually used by the Japanese, we have been able to adapt it to IVF in the last 10 years; we can now store eggs and the water does not become ice and the eggs also retain their original composition and that method is  available  in Nigeria now.”

On reasons why people freeze eggs,  the Managing Director  stated that there are two main indications of egg freezing, the social and  medical indications.

“For the social, some people  may want to postpone having children which they describe  as ‘reversing the biological clock’.   One of the ways the biological clock in women can be reversed is by freezing the eggs.

“For example, if you are 30 and you see you are not likely to get married in the next couple of years, you can freeze you eggs because, whenever you want to use them, they will still retain the potency of that age of which you have stored it.  If you store your eggs at the age of 30, after 10years when you want to use them  at age 40, you are using your eggs like you are using them at 30 years old”.

On medical reason, Ajayi stressed that if, for example, a woman has either breast or ovarian cancer, she may have to freeze her eggs as  some of the treatment may affect her reproductive capacity.

“When a woman has cancer of the breasts and ovary, and she needs to have treatment which might affect her reproductive capability, she can store her eggs and, if she achieves a cure later on, she can come back for the eggs.”

Cost and success rates of IVF

Ajayi went on: “IVF success is 35 to 40 per cent. The best time to have IVF success is at the age of 35, but some time you can get success  in 50 or 60-year-old  persons. When you are above 40, the chances of success are about 10 per cent using your own eggs. But at the age of 50 or 60, you can use donor’s eggs.

“The patient must be aware of using donor’s eggs; if she can afford it, the doctor goes ahead. There is no age limit in IVF treatment but it is very important to start the treatment early. If you are 35 years, you start after six months of not getting pregnant, but if above 35 years or below, you start after one year. In my clinic, age limit is 55 because we believe one thing is to have a child and another is to raise the child up. By the time you are above 55 and your child is still very young, it is a challenge.  Sometimes, the husband would not get erection, which results into infertility.

But when we treat the patient, he gets erected. For instance, there was a couple we treated and the husband could not produce sperm”.

Subscribe to our youtube channel


Comments expressed here do not reflect the opinions of vanguard newspapers or any employee thereof.