By Enyeribe Ejiogu
In the more than 40 years since the first test tube baby in the world, Louise Brown, was born on July 25, 1978 in Oldham, Northwest England, major advances in reproductive medicine have continued to give couples the extremely treasured opportunity to experience the indescribable joy of becoming parents, through the intricate and precise science, known as assisted conception, which is facilitated by assisted reproductive technologies (ART).
ART is used to treat infertility, which involves fertility treatments that handle both eggs and sperm. Assisted conception entails extracting eggs from the ovaries of the woman, mixing them with sperm from the husband to produce embryos which are later implanted in the woman’s womb and she then carries the pregnancy to term.
One person who has been engaged in this highly specialised aspect of gynaecology is Dr. Abayomi Ajayi, ever since he established Nordica Fertility Clinic in Lagos, in collaboration with Nordica Denmark. In the course of its existence, the facility has bee true to pay-off line, “We complete families,” resulting in over 3000 babies born into numerous happy families.
In this interview, he explains why men of childbearing age and particularly those that younger must make fundamental lifestyle changes if they really want to become fathers in the near future.
What was the situation of assisted conception in Nigeria before you established Nordica Fertility Clinic?
Nordica Fertility Clinic will be 20 years in April 2023. You could say that assisted conception was at infancy when we first started. There was a lot of hush hush talk about assisted conception, especially from the perspective of the patients. Because of the stigma attached to infertility many people did not want to be associated with assisted conception. Many people did not even believe that it was possible to have assisted conception done in Nigeria. So, at that time, there was this atmosphere of distrust over the specialised practice. In fact, the situation was akin to the biblical account of Nathaniel said: “Can anything good come out of Nazareth (symbolising Nigeria).”
That was the picture then and we saw that there was need for a lot of public education and awareness campaign, to enlighten the populace about assisted conception.
Could it be said that the people did not believe that our health system had the capacity to handle assisted conception?
Yes. They just didn’t believe that assisted conception could be done in the country. For instance, we had and still have an epileptic public power supply system. How could anybody guarantee 24-hour power supply, they wondered? So, people were looking more at the challenges than the potentials. There were very few clinics offering IVF (in-vitro fertilisation) even at the rudimentary stage. Looking back at that time before we started, you could say, “it was without form and void” just like the Bible described the universe before God began to bring out creative order. In a nutshell, that represents what the picture was 20 years ago.
For us, we see every problem as an opportunity to bring about positive change. Along with the other players in this highly specialised field of reproductive medical practice, we went into it to see how we could change the picture and turn the seeming hopelessness of couples, who faced difficulties conceiving into joy. We had a burning desire to use the medical science known as of assisted conception to help couples conceive, give birth to children and thereby obey God’s commandment to “be fruitful and multiply.”
Right now, after 20 years, the picture is totally different. Through the grace of God, we have been using assisted conception to help couples experience the beauty and joy of parenthood. Nothing beats that; every time one of our patients gives birth, there is that sense of fulfillment. One of the things that really get me bemused is the issue everybody is talking about these days. More than 18 years ago, many people could not even pronounce the word, but now everybody can talk about endometriosis. That is one of the small successes that came from the robust public education initiative that we championed, to create awareness about the high incidence of the medical condition, which we were seeing in our assisted conception patients.
What drove our resolve was that we realised the need to deal with the misnomer whereby people thought that endometriosis was not common in blacks. At that time, we had started doing endoscopic surgery. The first set of patients that we had to treat, had a vast spread of endometrial issue. So, we began creating awareness, so that doctors will know that it was very common. That was how we started, but we also knew that we could not be talking to doctors alone. We were convinced that we needed to talk to non-healthcare professionals as well. We had a lot of interactions with media professionals and other people. Eventually, we turned the awareness sessions into an annual programme where we had a week during which we talked about endometriosis. Then the whole world caught up with us and the month of March was dedicated for a month-long programme for endometriosis awareness. Through this effort, people became aware that endometriosis was not a Nigerian or African problem, it was a global problem, and people were missing it. Now in Nigeria it is even over diagnosed.
It used to be that the woman was blamed in all cases of infertility. What role did Nordica play in changing this misconception?
The globally accepted definition of infertility is a situation where a couple is unable to conceive after 12 months of consistent, unprotected sexual intercourse.
I think that one important role that Nordica has played beyond giving fertility services is education. We took up education from the beginning because we know that there is power in knowledge. Just like you said, the idea was that the man would stay back at home and say to the woman, ‘You go and solve your problem.’
Meanwhile, the men were contributing equally to the problem of infertility, if not more. Apart from presenting some of our findings at scientific meetings, we were also talking to the public about this. For example, in 2003 we looked at semen analysis of our patients who came in and we compared that with the data for 2013, that is a 10-year gap, and we saw a significant 30 per cent decline in the parameters for determining sperm quality, in the men that we were seeing. We were very careful to interpret that and comment on it because the figures might not represent the community. The figures were skewed and represented only the men with infertility that came to us. Nonetheless, that finding was significant, and we were not so surprised, when globally there are figures to show that the sperm quality of men was be reducing.
What can possibly account for that?
We really cannot put a finger on one thing; I think there is a plethora of factors responsible. Lifestyle probably plays a major role, and of course the environment can contribute to it.
How can environment contribute to male infertility?
We talk about global warming and everything else we do – from the way we carry our phones and put laptops on our laps to work. Again, with general development there might be industrialisation, which might lead to estrogenisation of the environment, and the male needs testosterone instead of estrogen. So, there are so many factors that are involved in this. Some people have pointed fingers at the cellphone and tendency of some of men to put it in the front pockets of their trousers. But one thing we know that is obvious is that people are using more drugs now, especially recreational drugs. It is almost a pandemic now and also affects the sperm count. So, these are some of the social factors that can cause male infertility.
Please paint a picture of the career path that led up to Nordica.
I have heard it said that life has a way cutting out a path for you even when you don’t know it. When I was in medical school, at the University of Lagos, the only subject or course I knew I could pass, even if I did not attend the classes, was gynaecology. I just had a flair for it. I can’t explain it. I decided very early that if I had to specialise in a medical field it would be gynaecology. That was how gynaecology was programmed for me. All through my gynaecology specialisation training, at the University of Ibadan, all that we could do was tubal surgery. The success rate of tubal surgery was very abysmal (5 to 10 per cent rate). Then one fateful day, I came across a story on the first test tube baby born in 1978. That was it; I was just sucked into it. I found myself following up on it, how they developed the media. I read everything about it. I simply followed up the developments. I worked for eight years at Lagoon Hospital.