In this article, Dr Ashiru speaks about the rise of Infertility in Nigeria. It has been highlighted that there has been an increase in Infertility in men and women in Nigeria and even across the globe. This article sheds some light on the issues and factors that is seen to have an impact on fertility.
Oladapo Ashiru is a professor of Anatomy, consultant in Associated Reproductive Technique (ART) and Joint Pioneer of In Vitro Fertilisation (IVF)/Test Tube Baby in Nigeria. Ashiru who is also the Chief Executive Officer and Medical Director of Medical Art Centre (MART) Clinics Maryland Lagos in a chat with journalists spoke on why more Nigerians are becoming infertile just as he proffered solution. The fertility expert identified technology especially the use of laptop by men, toxins in food and from the environment, bleaching creams, artificial sweeteners, chlamydia infection, obesity among others to decrease sperm count in men and fuel the growth of fibroids in women. To address the situation, Ashiru recommends medically monitored detoxification, weight loss, treatment of infections and other life style modifications. CHUKWUMA MUANYA (Assistant Editor) was there. Excerpts:
It looks as if infertility rate is increasing in Nigeria. You see very young couples going for IVF. Why is that?
From some of my studies a number of them are consequences of technology. Men are putting lab top on our thigh. It is increasing the temperatures for spermatogenesis. So is the same as the cell phone that you put in your pockets. It is sending radiations into that area. The cellphone also generates some electromagnetic waves that creates Reactive Oxygen Species (ROS) that alters the Deoxy ribonucleic Acid (DNA)/genetic material composition of spermatogenesis. So we are by our own selves damaging our fertility. Not to talk of dietary aspect. A lot of foods that we now consume are driving us to extinction. Our food in Nigeria is not regulated by anybody. Apart from the Genetically Modified Organisms (GMOs) foods, there are some foods in Nigeria that are actually toxins. When you take soft drinks for example, they have sweeteners. That artificial sweetener, which is aspartame, they decrease sperm count.
We reliably gathered that you are having challenges with NAFDAC in terms of some of the utilities here. Can you throw more light on that?
That is a bottleneck to cost of IVF. Just now we have been told that our license has expired. We had to go and order, reapply with a new license. Meanwhile, the media we imported is detained in the ports. Luckily due to some petitioning they have been able to be kind enough to put it in a refrigerator in the port. But these are things we need to use as soon as possible. Until we have a pharmaceutical company that will be making media and it is not a difficult thing because indeed and in truth when we started IVF we use to make it in the laboratory at the department of anatomy, College of Medicine University of Lagos (CMUL) Idi Araba. But the complexity of IVF now has been simplified because media is now made by some people, the tubes and pipettes we use to make are now in plastic form so that you can quickly do it and move on and do many more cases at a time. Government needs to as they have done in Egypt, recognize the fact that infertility is a human right issue which the position of United Nations Children Fund (UNICEF) and WHO. If it is a human right issue therefore we must ensure that anybody that wants to have this baby must have opportunity to have it. You must provide the means for them to access that therapy and one of the ways to do so is to allow the cost of operation to be low, ensure duty exemption for health items. There is no duty exemption for health items and yet health is a priority. So if they can allow some of these products that has to do with IVF, with fertility duty exemption, the cost of IVF will go down.
What would you consider the greatest challenge to the practice of IVF in Nigeria?
One of them is electricity and of course the second one is the problem in importing essential items. Because don’t have regular electricity, for us to ensure good blastocyst harvest it means that we are having USP, we are having two or three generators that are burning fuel and then we have to put somebody in the lab any time we are running our cycle two people have to be in the lab. Whereas when I was running IVF in Chicago, I will prepare the thing, put it in the incubator and go home and sleep well because I know that nothing will happen. I know it is not possible that there will be power outage for one minute. The truth is that most of the IVF centres are private based and if you know the amount of money we are saving the country in foreign exchange is substantial.
How about the issues of multiple pregnancies and the amount of embryos transferred?
It also has to do with the uterus of the woman. When see the uterus of a Caucasian it is so smooth and nice, anatomically perfect. But for us here, you will be seeing fibroids hanging all over the place. So if you transfer even just one embryo in a Caucasian woman, she is sure of achieving pregnancy. But in a Nigerian woman you have to transfer at least two embryos to improve the chances of pregnancy.
Why is that? Why is fibroid common in the African woman?
It is associated with our diet, which is rich in estrogen. Fibroids occur from unopposed estrogen action. From my own believe, many people who are in that age begin to use certain things for fertility like these vitamin E, Evening Primrose or some of these things. If you look at these things, if you look at the label, look at the recommended daily allowance; some of them are about 5,000 times more of the recommended daily allowance. That means your going 4,900 above the daily allowance. Can you imagine what the excess is doing to you? So that is the situation. We are using some of these things that are higher than we need in our body and it is creating problem in different part of the organ system.
But African women have higher fertility rates than the Caucasians?
No we don’t. The net fertility rate of the African woman is lower.
There are growing concerns about children born through IVF. It believed that children born through natural means are smarter and healthier. How true is that?
I have a theory and that is that if you have conception naturally, it means that your body has been clean and you are able to have that conception. From my own experience here, if the body is not really clean, you can miscarry. When I mean clean, I mean free of toxins. If you manage to enforce conception, there maybe a lot of genetic mutation in that conception. Most studies are not conclusive that IVF babies are different from normal babies because it is a very difficult study to do because there are so many factors that are variables that are involved in other to know. But what WHO now feels is that to prevent all those things that is better for husband and wife to ensure that the sperm, the egg and the environment are right. A woman exposed to pesticide before, during and after conception, the fertility of the granddaughter will be affected. So the toxins have effect on the third or second generation.
What is causing the rise in infertility in Nigerian women?
The problem for women is cosmetics they apply on the skin especially to bleach the skin. It affects fertility. So is extra and undue use of steroids affects progenesis apart from sexually transmitted diseases especially chlamydia.
How about over load of iron and issues of toxins?
Load of iron maybe an indirect action. But the critical one is the misconception that fruits are good for you. When you take fruits in excess like smoothies and all of that, it alters your insulin metabolism and ones it is altered, in the woman it can lead to polycystic ovarian syndrome (PCOS) and in men, it can affect your steroidogenesis at the level of your sperm so that your erectile desire is low completely. It means there is competition between the enzymes doing spermatogenesis, which is now busy processing glucose in the liver. There is competitive reaction and these are some of the things that make create problem for the sperm. Not to talk of the use of alcohol and occupational hazards like plastic industries, oil fossils in those working in oil industries. All these things are having severe effect on the fertility of Nigerians. A number of patients who come to us for example from the oil producing areas have problems with their sperm.
What is the solution?
What we have now come to realize is that no matter how well you live, there are constant toxins that we produce generally by the way we eat and what we eat and there are also toxins in the environment. It is better for you that if you have some of these toxins or pathogens in your body like Lyme, which can lead to preeclampsia (hypertension in pregnancy). Pathogens like chlamydia have been associated with miscarriage. So if you have all these pathogens, go and clean yourself out and these life style modifications as a pre conception process have been recognized now by International Federation of Gynecology and Obstetrics (FIGO) and World Health Organisation (WHO). It will help those who have PCOS, it will help so many people even male fertility because we carry toxins in our cells that lead us to premature ageing and if we remove these toxins, we get better and we enhance our fertility. This is what basically the MART Life Detox Centre is doing. It meant to help people to cleanse themselves of toxins that have been acquired over the years and the results is so different. When they go and come back here, we see a brighter face and it means better ovaries.