Challenges, options of conception after 40
Daily Trust: Why even talk about conception at 40? Dr. Abayomi Ajayi: There are many new things we know that we didn’t know a few years ago and one of them is something called aneuploidy. Normally, after fertilisation cells should divide into equal parts – two, four, eight cells – and they are supposed […]
Daily Trust: Why even talk about conception at 40?
Dr. Abayomi Ajayi: There are many new things we know that we didn’t know a few years ago and one of them is something called aneuploidy. Normally, after fertilisation cells should divide into equal parts – two, four, eight cells – and they are supposed to be equal parts and that’s what the body wants. But as you grow older the chances are that there could be errors in this division. These chromosomal errors are called aneuploidy. They could lead to miscarriage, women not getting pregnant and defects in babies. By the time a woman is about 35, she is starting her second level, by the time she is about 37, she is starting her third level and by the time she is 40, she is starting her fourth level.
By the time you are 40, 41, 80 percent of the eggs that you have can’t become babies because of the issue of aneuploidy. This is the reason we are discussing getting pregnant in your 40s. It is a major event, especially if the woman hasn’t had any children before. It is possible to get pregnant, but there are things such a woman needs to know.
DT: What category of women does this target?
Ajayi: All over the world women are raising families at a later stage. So I expected not only women above 40, but even those who will get there someday so that they are guided before they get to that stage. Some of the problems we are talking about can be avoided if people know.
DT: Do men experience their own version of aneuploidy or something similar?
Ajayi: Unfortunately, we think men’s fertility is not affected by age but it is not true. By the time a man is over 45, there are some changes in his sperm because the testosterone starts going down naturally and therefore the sperm count decreases and so does the quality. The DNA fragmentation and such are some of the things we are getting to understand more and more. Things like what a man transmits in a production using DNA, it is in the sperm head but it is also like in a capsule, an envelope and then if that envelope is destroyed or fragmented…What happens is that although there will be fertilisation, the embryo that is formed will not be normal and so will burn out easily. It dies easily and leads to a miscarriage at some stage. Definitely, men also are affected by age. The only thing is that the change in a man is different from that of a woman in the sense that men continue to produce sperm. Women bring everything. That’s why they’re better managers. Their bodies are always managing things.
DT: The general belief is that once a woman is 40 or above, it’s impossible to conceive whereas a man in his 80s doesn’t have that problem and can get a woman pregnant.
Ajayi: They are not telling the complete story because even in the man the incidence of congenital abnormalities increases in the babies. It’s one of the reasons for Dawn’s Syndrome which is much more when the man is over 45. Such defects are as a result of the sperm quality which has decreased. But this doesn’t mean he can’t father a child. The quality of the child is what we need to start looking at.
DT: Does lifestyle contribute to infertility?
Ajayi: Yes, definitely it does play a part, but that is infertility. For older women definitely, because, their own fertility is even more precarious. They should know the things to avoid and ways to prevent infertility within their power and should do so. There are habits that you can change, for like a man putting his cell phone in his pocket.
DT: For older women, what are the things you would advise them to be conscious of?
Ajayi: Older women should obey the same tenets of lifestyle changes. They must be healthy, be involved in moderate exercises and eat healthy. They should reduce alcohol, avoid smoking, no drugs – I’m talking about recreational drugs. They also need to maintain a healthy weight and be patient for results to come. However, if they have tried for six months and are not achieving the expected results with regards conception, my advice is that they see a doctor because they don’t have the luxury of one year.
DT: How informed are the women in this age group about the possibilities that exist?
Ajayi: Not many of them are aware or know where to go for treatment. They should be wary of doctors who urge them to freeze their eggs at 45, when they are not fertility experts and don’t have the facilities for such. Also, the level of journalism in this regard needs to be improved upon. Healthcare reportage should be more efficient than it is. On our part, we will try to help to raise the bar but there is a limit to what we can do because people need to show interest in it and see it as their responsibility to inform the populace.
DT: NORDICA Abuja recently turned four. How have you fared?
Ajayi: We are trying our best to offer satisfactory fertility treatment to our clients. Over 100 babies have been delivered in the Abuja centre, inclusive of twins and triplets for the past four years. With branches in Asaba and Lagos, NORDICA which started operation since 2003 has delivered over 2000 babies through safe Assisted Reproductive Technology (ART). In the spirit of the celebration, we gave one free treatment and discount to patients here.
DT: What are the distinctions between ART and IVF and multiple births?
Ajayi: Assisted conception involves multiple ovulations and sometimes even multiple transfers of embryos with sensible success rate. Multiple pregnancies because we know that about 25 or 30 percent of babies born through assisted conception, especially IVF, will be more than one; the more the number of babies, the higher the risk of operative deliveries. They are the attendant risk of this multiple transfer. Nigeria and the Republic of Ireland have the highest twinning rates in the world. But when it gets beyond three, it becomes something else. Unfortunately, the IVF procedure also involves the transfer of more than one embryo except in Europe where they now do what is called single embryo transfer.
We have not started doing that here in Nigeria and I am not sure if we are looking forward to doing it, except in select patients because as I said, we tend to accept multiple births.