Tuesday, August 23, 2011

Exercise and Diet important for Successful IVF Treatment

The chance of conception occurring in a single cycle of IVF treatment is 25 percent on average with marked variations based on the female partner’s age. It would, therefore, be prudent to do whatever one can to improve the chances of a positive outcome. The importance of a good diet and exercise as part of a daily routine cannot be overestimated. Good exercise and diet habits are an integral part of any lifestyle but have also been found to be beneficial for both men and women trying to conceive.

Studies have shown that women who are overweight often have problems with ovulation, menstruation and conception. Obese women have also been found not to respond as well as their slimmer counterparts to the fertility injections. On the other hand women who are underweight may have anovulatory (no ovulation and no menstruation) cycles which in themselves present other problems.

Thus, attaining and maintaining the ideal weight will improve the chances of achieving a pregnancy.
According to Dr Richardson Ajayi, Medical Director, The Bridge Clinic, a healthy and balanced diet can be defined as a diet in which nutrient intake (carbohydrates, protein, fats and oils, minerals, vitamins) is maintained, and cholesterol, salt, sugar and fats is reduced. The idea of a healthy diet is often used to ensure that people are well protected against common illnesses, as well as conditions which stem from poor diet; to which many problems such as headaches, lethargy, reduced. libido, heart disease, alcohol poisoning, and obesity may be attributed. In addition to this, a well balanced diet is essential to any form of exercise, as without a good diet, the body will not have the fuel to recover from the stress of exercise.

“Following a healthy fertility diet is not about deprivation, nor is it about loading up on so-called miracle foods” that are reported to increase fertility. It is about giving the body what it needs, in the right amounts. The key ingredient is balance. Women going through fertility treatment are advised to cut back on fats.

“However it is well known that fat is necessary for proper body functioning. Without it, the body’s systems will not operate normally. Some sources of fat are better than others and too much fat has adverse effects on the body. The same holds true for carbohydrates and protein. A balanced fertility diet will incorporate each of these in the appropriate amounts, along with other key nutrients. Because even the healthiest and most diverse diet won’t necessarily provide all of the vitamins and minerals that the body needs, a multivitamin is recommended as well.

“Women who are overweight tend to have more fat in their bodies and, because 30 percent of oestrogen comes from fat cells, this means they usually have more oestrogen. This can affect ovulation, menstruation and conception negatively. Women who are overweight also tend to be more resistant to insulin. Insulin resistance can force the body to produce excess levels of insulin, which can inhibit ovulation.

“For obese women who have underlying fertility problems, weight loss can improve the chances of success because excess body fat makes patients resistant to the effects of fertility medications and increases the risk of complications during treatment with assisted reproductive technologies (ART). By following a fertility diet and exercise plan for a period of time prior to undergoing treatment, most women can significantly improve their chances of conceiving.
“Obese women are at risk for miscarriage, gestational diabetes, gestational hypertension, preterm delivery, macrosomia, low birth weight, stillbirth, delivery via operative route, and postoperative complications. Underweight women are also at risk for miscarriage, low birth weight, preterm delivery, and stillbirth. It is therefore important to have and maintain the right body weight before and during IYF treatment to optimize the chances of conceiving and delivering a healthy baby.

“Advice for a healthy fertility diet would be to eat foods that are as natural .as possible. Avoid chocolate, sugary foods, salty snacks, processed foods, coffee, tea, and cola. Fizzy drinks and alcohol add to the bloated feeling many women complain about during ovarian stimulation. Drinking a minimum of 2 litres of water a day is highly recommended.

“PCOS, also known as Anovulation Androgen Excess (AAE), is a key cause of obesity in women undergoing fertility treatment. It is a condition in which women have high levels of male hormones (androgens). These hormones playa role in blocking the release of the egg from the follicle and in the overproduction of the female hormone, oestrogen. As a result the ovaries fill with cysts or create immature follicles that are unable to generate eggs.
“Insulin seems to be a key factor in PCOS. Many women with PCOS have increased insulin resistance. High levels of insulin in the blood lead to the ovaries producing too much androgen. Excess insulin also leads to excess glucose in the blood, and sets the conditions for prediabetes, and weight gain. If untreated, PCOS can lead to obesity, heart disease, diabetes and some cancers.
“Clinically, if you have two out of three of the following symptoms you will most likely be diagnosed with PCOS. irregular, few, or absent menstrual periods, androgen excess – clinical or biochemical (excessive body hair, acne, loss of head hair, increased testosterone in the blood) and polycystic ovaries (ovaries with 10 or more follicles)

“Insulin is a hormone that regulates the change of sugar, starches, and other food into energy for the body’s use or for storage. Excess insulin causes a rise in male hormones, which can lead to acne, excessive hair growth, weight gain, and ovulation problems.
“Insulin insensitivity contributes to weight gain, especially around the abdomen and makes it harder to lose the weight. This excess fat sets up a negative feed back system where high blood levels of the fat derived hormone, leptin, increases the appetite and inhibits the production of female fertility hormones.
Continuing, he said, just losing 5 to 10 percentage of your body weight can be enough to bring on monthly ovulatory cycles. A combination of weight loss, diet, exercise, and mind body techniques can be extremely effective in eliminating peas symptoms, getting ovulation on track, and reversing the negative effects of stress.

“The benefits of exercise are numerous and enhance the overall health status of the individual. Studies have shown that regular exercise: improves the chances of living longer improves quality of life, reduces the risk of heart disease helps lower high blood pressure, helps prevent or control type 2 diabete, reduces the risk of arthritis and alleviates associated symptoms, alleviates symptoms of depression and anxiety
“By exercising on a regular basis, women can help reduce their body fat and oestrogen levels. Low impact exercises are best. Some examples of these include walking, swimming, cycling and yoga. These exercises have low impact on the muscles and the joints and are good cardiovascular workouts. Gradually increase the exercise to 30minutes, 3 to 4 times a week so as not to cause any injuries.

“Men can also make adjustments to maximize their reproductive potential and ensure a happy, healthy baby. Proper diet, exercise, reduced stress and a healthy lifestyle not only improve personal wellbeing but can boost reproductive success as well!
“Do not start any new exercise, sport or event training within 3 months of starting IVF and ensure that jogging is kept below 20 miles per week. Over exercise can affect male fertility by causing the internal temperature of a man’s testicles to rise, which kills sperm cells.

“Another issue couples getting ready for IVF treatment face is stress. The stress of taking daily injections, the side effects the drugs cause, the stress of having been without a child for so long, and stress from family and in-laws. The distress caused by stress can really take its toll on fertility. Stress can make it difficult to be intimate with your partner. Stress can also trigger a variety of health problems, including cardiovascular problems and depression. Stress can also interfere with ovulation and menstruation, as well as sperm health and motility.

“One of the single biggest stumbling blocks that fertility patients face when trying to lose weight is relying on food to cope with stress and other emotional issues. Struggling with infertility can be a very intense experience and, in order to have success with a fertility diet and exercise program, it is necessary to acknowledge and address the impulse to eat in response to emotional upheaval.
“Exercise can also help to relieve stress. Deep meditation exercises go a long way in releasing stress and tension. Yoga and pilates are particularly effective,” he said.


Wednesday, August 17, 2011


Couples trying to achieve pregnancy for more than three years without success may need to consider and investigate In-Vitro Fertilisation (IVF) as an option.

Richardson Ajayi, managing director, The Bridge Clinic, Nigeria’s foremost assisted-conception centre, gave this advice at an interactive session with health writers in Lagos, recently.

According to Ajayi, “It is advisable for couples who have tried to achieve pregnancy for three years without success to go for IVF. IVF is a method of creating an artificial condition for a natural process and it enhances an environment similar to that present in the womb to achieve pregnancy.”

He noted that various causes of infertility can broadly be classified as ovarian problems, uterine problems, tubal problems and semen abnormalities are cases where IVF offers a solution. “The purpose of IVF is to allow the sperm and egg to meet as this is a challenge with the causes of infertility and IVF is the hallmark of treatment for Infertility,” Ajayi reiterated.

Bridge Clinic’s Scientific Director, Peter Hollands, a renowned embryologist whose appointment was in keeping with the vision of offering global standard IVF services to clients, further explained the processes in which occur in the laboratory to assure quality and sustainable outcomes. Hollands attends to details to reduce to the minimum side effects from the procedure, gametes mix-up amongst others. He also ensures best practice as he brings to the table, a wealth of experience in reproductive medicine.

With regard to standards and regulation in the Clinic, Ajayi stated that the IVF process of The Bridge Clinic is the benchmark in assisted-conception services in Nigeria with an annual certification audit carried out by the accrediting body of TUV Austria, most recently led by Bruno Imthurn, a professor, in the IVF department, Zurich.... “We have a duty and responsibility to provide our clients with the same standard of healthcare that is acceptable in the United Kingdom and other European countries because there is and should be only one standard for healthcare delivery. Our quality assurance and control processes are put to the scrutiny of our Scientific Director.’

Ajayi also used the opportunity to intimate all present of The Bridge Clinic’s activities in the nearest future which included the launch of the LASUTH IVF Facility, a facility which will largely subsidise the cost of IVF treatment. Through this avenue, courses will be drawn up and integrated into Medical students’ curriculum to afford them the first-hand basis to learn more about reproductive health. The Bridge Clinic also has a Foundation called ASPIRE whose main driver is LIHN – Let IT Happen Naturally, a programme designed to reach out to the Nigerian youth and enlighten them on infertility and its causes. The Bridge Clinic is also expected to expand its clinic network across the nation.

Sunday, August 14, 2011


dr. ajayi

We are increasingly seeing young couples these days with various problems of infertility and since we at the Bridge Clinic do not believe in the concept of unexplained infertility, we try as much as we could to assist couples achieve pregnancy using the Invitro Fertilisation (IVF) option and even using the ICSI to a large extent…”

This was the submission of the Medical Director, Bridge Clinic, Lagos, Dr. Richard Ajayi, during the Bridge Clinic IVF Lecture series for media practitioners last week.

According to Dr. Ajayi, a number of times when couples encounter practitioners who declare that the infertility

condition they are experiencing is "unexplainable," it is mostly untrue as there must be some explanations why

either of the couple is infertile.

"For instance on the issue of low sperm count, what we do know is that the vast majority of men who have low sperm count do not have identifiable cause. That is, we really do not know what causes low sperm count but we know staphylococcus does not cause low sperm count.

"Those who are propagating that staph could eat up all the sperm in a man and cause him to be infertile, do not know what they are talking about . "But what we do know is that a high proportion of men with low sperm count have an abnormality of the tip of the Y-chromosome which is also referred to as Teratospermia or teratozoospermia.

"This is a condition characterised by the presence of sperm with abnormal morphology and nature has sort of programmed the low sperm count as a way to block the propagation of the abnormality to the next generation and the truth is that no drug has been scientifically proven to treat or can actually boost low sperm count once it is proven to be so," Ajayi noted.

He said, in a situation where the problem of infertility has been linked to the man's low sperm count, the most probable and best option is for the couple to try without delay, the option of IVF.

"Using the Intracytoplasmic sperm injection (ICSI) procedure, which is also an in vitro fertilisation procedure whereby a single sperm is taken from the man, injected directly into an egg for fertilisation, a man with low sperm count can still achieve pregnancy in his wife, explained Dr. Ajayi.

He identified some other common causes of infertility to include fibroid in women, Polycystic ovary syndrome (PCOS) which is one of the most common female endocrine disorders affecting approximately five per cent-10 per cent of women of reproductive age (12-45 years old) and is thought to be one of the leading causes of female subfertility blocked fallopian tubes among other causes.

He said for all of these problems and others, the important thing is for a couple to understand that there is an option to achieve pregnancy which is IVF, "though it does not guarantee pregnancy as only God gives life, it is an effort to create an enabling environment for conception and then allow God to do His work of giving the breath of life"

Also speaking at the lecture series, the clinic scientific director, renowned Dr. Peter Holland, who alongside Prof. R. G. Edwards and Edward Steptoe, pioneered the birth of Louise Brown - the first baby born through IVF, described as erroneous the believe that IVF is man's invention at playing God through creating life.

Holland, who is a reproductive medicine expert, noted that a woman has only five per cent chance of becoming pregnant every month provided there is no problem and this chance tends towards zero as she ages.

He described In vitro fertilisation (IVF) as a process by which egg cells are fertilised by sperm outside the body in a very conducive laboratory environment devoid of pollutants and irritants that can affect the quality of embryo being formed.

IVF is a major treatment in infertility cases among couples who have had continuous, regular and unprotected sex for upward of two years without achieving pregnancy.

Thursday, August 11, 2011

IVF Is It!

Assisted reproductive technology takes root in Nigeria, as many clinics with facilities for such spring up

At over 50 years of age, half of that as a married woman, Fadekemi Williams (not real names) had given up hope of having a child of her own. She had undergone a variety of orthodox and unorthodox conception procedures, all without a positive result. But about five years ago, Williams, who works with one of the General Hospitals in Lagos, told a friend about the problems she was getting from her in-laws on account of her childessness. The friend suggested Assisted Reproductive Technology. She was not overly excited about the idea. But after much persuasion from her friend, she agreed to give the procedure a shot.

Unfortunately, the first round did not go well. The doctor harvested 10 viable eggs, but none of them fertilised. The second visit two years later was fruitful–a set of triplets at the age 53. Williams’ babies were produced from her eggs and her husband’s sperm and were delivered through Caesarean Section at the Lagos State University Teaching Hospital, Ikeja.

Ngozi Nwueze, a staffer of the Lagos State Teaching Service Commission, also experienced childlessness for many years before considering the same procedure, better known as In-Vitro Fertilisation, IVF. Ngozi had been married for eight years. Fertility specialists discovered that she had scarred tubes, endometriosis-a condition that occurs most commonly within the Fallopian Tubes and ovaries that may lead to painful menstruation-and fibroid tumours. Ngozi and her husband could not afford the cost of IVF, so they opted for less expensive treatments.

As a last throw of the dice, they decided to save up money and try IVF at a clinic in Lagos. After three attempts, Ngozi became pregnant and now has a son. “The first three attempts were so heart-rending. Thanks to my husband, who encouraged me to try again. Although the cost was so high and almost affected his business, he told me not to worry. Now, I am a proud mother of a healthy boy,” she told TheNEWS.

IVF appears to have grown in popularity in Nigeria, where there are no fewer than 14 IVF-focused clinics. Most of the clinics were established in the last six months. The latest entrant is the EkoCorp Fertility Centre, an arm of Eko Hospital plc in Lagos. The most prominent are The Bridge Clinic, St. Ives Clinics, Roding Medical Centre, Medical Art Centre, Hope Valley Fertility Clinic, Nordica Fertility Centre and Omni Advanced Fertility Centre, all in Lagos.

Others are M&M Hospital, Aba, Abia State; Nisa Premier Hospital and National Hospital, both in Abuja.

The clinics offer a wide range of services such as Intra-Cytoplasmic Sperm Injection, ICSI, (a procedure in which a single sperm is injected directly into an egg in an attempt to achieve fertilization); intra-uterine insemination (otherwise called artificial insemination.It is the process by which sperm is placed into the female reproductive tract for the purpose of achieving pregnancy), sperm donation, surgical sperm retrieval (a procedure in which sperm is removed from inside a man’s genitals instead of waiting for the sperm to be ejaculated out), surrogacy, egg donor and intra-fallopian transfer (a method in which eggs are removed from a woman’s ovaries and placed in one of the Fallopian tubes, along with the man’s sperm).

However, the cost and wide error margin of the procedure continue to keep many of those who need it away. Chances of success vary widely for each patient, say experts, depending on the cause of individual infertility problem and age. According to experts, the success rate of 25 to 30 per cent of IVF treatment in Nigeria is the same as obtained anywhere in the world.

Chances of success will depend on many factors, including the cause of the fertility problem and age. The older a woman is, the less her chances. Women above 35 years have far slimmer chances. Women under 30 years are said to have a one in four chance of getting pregnant using the procedure. For those over 40 years, it is one in ten. “Usually the success rate of IVF treatment depends on the number of cycles. One attempt of IVF cannot give you more than 30 per cent chance. So, people have to try it several times. We tell people that the more they do it, the brighter their chances. The success rate of nature is about 18 to 20 per cent every month. If IVF can give you 25 per cent, it is a little bit more than what nature can do,” said Dr. Chidozie Egwuatu, consultant gynaecologist and Medical Director, Lifegate Specialist Hospital, Ogba, Lagos. In Nigeria, many of the clinics claim fantastic results on the successful birth rates in their clinics. Some claim as high as 40 per cent success rate.

Dr. Egwuatu revealed that to increase the chances of success, some clinics abroad ask patients to pay for four, five, six attempts at a go, before they start treatment. The thinking is that a woman’s chances of success are higher in multiple IVF treatment.

Dr. Abayomi Ajayi, medical director, Nordica Fetility Centre, Lagos, said what IVF tries to do is a replication of what happens in a woman in a natural cycle. “IVF babies are normal babies and that is because the quality control system in the body is not tampered with in IVF. That is why we have normal babies. People want to increase success rate without decreasing the quality of the baby. So that is usually the balancing act that is being carried out in researches,” Dr. Ajayi informed.

The cost of IVF in Nigeria, said experts, is also reasonable. This is said to have encouraged a number of Nigerians resident overseas to come home and take advantage of the lower cost for some treatment cycles before returning overseas. In the United States, the average cost is between $10,000 and $12,000, while in the United Kingdom, a cycle costs between £4000 and £8,000. This includes fertility testing and consultation fees. In Nigeria, it costs between N300,000 and N1.5 million for a cycle of treatment, depending on the clinic.

The Bridge Clinic in Lagos is reputed to be the first IVF-focused clinic in Nigeria. It opened in 1999 and has been at the forefront of new developments within the field. Recently, the clinic claimed to have achieved success in gestational surrogacy, the first pregnancy in Nigeria attained through Intra- Cytoplasmic Sperm Injection and testicular sperm procedure. Also, the clinic claimed to have treated over 4,500 clients. It recently celebrated the birth of over 1,000 babies to families that had difficulties conceiving.

“We are committed to providing superior IVF services comparable to international standards. We do not create children; only God has the power to do that. But through our assisted conception services, we have been able to bring succour to thousands of couples experiencing fertility challenges all over the country and beyond,” Dr. Richardson Ajayi, Medical Director of the clinic said at the opening of its fourth facility in Kaduna.

Nordica Centre recently introduced an IVF technique that doubles the procreation chances of men with abnormally low sperm count and poor sperm mobility. The new technique is called Intra-Cytosplasmic Morphologically-selected sperm injection, IMSI. This enables the direct selection of good sperms from the man and then injecting them into the woman’s egg to successfully achieve pregnancy.

Ekocorp Centre claimed it had its first batch of IVF patients in December 2009 and till date, 57 patients have so far obtained treatment at the centre. Out of that figure, 27 pregnancies were recorded, a 36 per cent success rate in less than two years of operation, according to Dr. Sonny Kuku, Chairman, EkoCorp plc. “As at now, we have 10 children delivered from treatment received at the fertility centre and 13 ongoing pregnancies. Our results to date are respectable and compare favourably with what obtains in fertility clinics of similar status in the developing world,” Kuku said at the opening of the clinic in February.

St. Ives Clinic, run by Babatunde Okewale, claimed it has successfully delivered close to 200 IVF babies in its less than a decade existence. Just recently, the clinic announced the delivery of a baby girl by the oldest IVF mother in Nigeria, 57-year-old Mrs. Adeyemi Taiwo.

In Nigeria, unlike in other climes, women still shy away from sharing their experiences after successful IVF treatments. Many women would rather attribute their conception and eventual delivery to spiritual intervention.

—Funsho Arogundade