•18th Anniversary Interview

Nordica Fertility Center is one of the names that come to mind whenever anyone mentions Assisted Reproductive Technology (ART) in Nigeria. Many don’t know that Nordica Fertility Center has already clocked 18 years. It did on Wednesday, April 14, 2021 and on that day, City People’s DAMILARE SALAMI 08155134152 had a Zoom conference chat with Dr Abayomi Ajayi, the MD of Nordica Fertility Center who opened up on a few fertility issues. Below are excerpts from the interview for your reading pleasure, enjoy.

Sir, what is the relationship between fibroid and infertility, does fibroid cause infertility and must a woman remove the fibroid before she can conceive?

The relationship between fibroid and infertility is a tricky one because fibroid itself doesn’t cause infertility except in two conditions; if it is blocking where the tube and the uterus meet and the second condition is if it is staying where the baby should stay (what we call the sub-mucus fibroid) even that most of the time leads to a miscarriage rather than infertility, except if it is bigger and implantation cannot take place. But we found a relationship between fibroid and infertility that people who have fibroid tend to have infertility, not a causal relationship but an association. Because somebody did research many years ago and found out that people who have fibroid used to have additions in the pelvis. Whether that is causal or not, we don’t know. That is why I said it is an association and not a causal relationship. One thing that is common between the two is age. The older a woman becomes, the more likely that she will have fibroids. If she doesn’t have children, the older a woman becomes, the more the chances of infertility because the eggs also age. So, you will see that the majority of our women who say they have fibroid and infertility are not very young but they’ve come to ascribe it to the fibroid; that’s why they have a lot of problems. You now see people who don’t want surgery, have fibroids and have not done any test and they think that it is by treating the fibroid that their infertility will go away; but that is not true. May be it is the sperm of the man that is the major problem that disallowed the woman from having children for a very long time and then, she started growing fibroids. Now, the sperm issue is still there and the woman wants to get rid of the fibroids to have children; you see that that is not correct. So, that is one of the things we have been battling with and right now, a lot of people don’t want to have surgery and they have seen HIFU as a way out of it, they now want to bring infertility for HIFU. And I keep telling them that it’s not so. HIFU doesn’t treat infertility, it treats fibroids. So if you have infertility and fibroids, the first thing we must do is to investigate why you are not getting pregnant before we start talking about how to treat your fibroid. And that has always been the teaching even before HIFU came on board. Before surgery, we will investigate whether the tubes are open and we will investigate your sperm. Because a lot of doctors who are not really qualified to do some things in Nigeria are doing it, so, you have a situation where they just take the woman and just do the myomectomy and after then the woman doesn’t conceive because you have not treated what the real problem is.

Now to your second question, must a woman remove fibroids before she gets pregnant? The answer is NO. You said so yourself that pregnancy and fibroids can co-exist but the doctor must investigate the kind of fibroid that it is. There are three types of fibroids, the Submucos, the Intramural fibroids and the fibroids Subserosal. The submucous is the one that stays where the baby is supposed to stay. When the fibroid is there, it can be removed and the best process of removing it is hysteroscopy not cutting the woman because you are going to leave scars in the womb if you cut the woman. No matter the size of this fibroid, it is better to remove it but the other two fibroids might not be removed. It is not every fibroid you remove, you will see some women go for surgery and they will go and remove an intramural that is just 3 cm; that’s an unnecessary surgery because there is no way you will not leave a scar. I hope that answers the two questions.

Away from fibroids and infertility, Nordica is 18 and of course, there have been ups and downs. Can you share some of the down times you have had with us?

Thank you Damilare, you see, that’s difficult because there’s something about me, I have learnt that in Nigeria, you only remember only the good things because there are so many bad things such that if you remember them, you will only spend all your energy feeling bad about them and teaching about them. So, what I do just as Paul said is forgetting about the things behind and looking forward to the things ahead. I mean this to my bone marrow, it’s difficult for me to remember the bad times but may be one thing I will probably not forget is the adventures of NEPA when one day we came in many years ago and two of our incubators just blew up because NEPA brought high current. Of course, that can never happen now. We know how to live with NEPA now, we know what we need to have as extra. People who work with me think I am crazy when I say we need to have an extra of everything but it is from experience. I can tell you now that I have an extra scanner that I kept somewhere and I am not using presently. Nigeria has taught me a lot of things on how to know that anything can fail. Even oxygen can fail so you have to get extra oxygen. It is interesting but that is the only way to survive in Nigeria, you must always think of the worst happening ahead of time and be prepared for it.

Doctor do you mind telling us about the institutional gaps that need to be filled in the treatment of IVF in Nigeria?

Thank you so much, I think everyone agrees about the issue of regulation, there is no doubt that we need to regulate the practice in Nigeria and the Association for Fertility and Reproductive Health (AFRH) has started on a good note in Lagos. But no private association has a right to police, it is only the government that has the right to do that so, there’s a gap about that. And then, there was a time they were trying to do something in the Senate which also was a little jack reaction. You cannot shave a man’s head when he is not there. When you hurriedly started talking about how to regulate a set of group when they are not represented, then it is unfair. I think for us to be able to do this, there must be a good handshake between the government and the practitioners; and a honest and sincere handshake at that. What some of them say about the practice of IVF was at best ignorant. I mean if you want to be very lenient with them, you will say they are ignorant; sometimes they are malicious. And that’s because the practitioners were not well represented at some of those meetings. Thank God they didn’t succeed because that would have tamed us. Let’s face it, assisted reproduction is one of the areas Nigeria could raise its head internationally. There are some other places we can now raise our heads but one of the areas we could say that we are practicing to international standard was assisted reproduction. Yes, some people were doing some funny things, but you don’t throw away a baby with the bathwater. If they had succeeded, they would have probably shut down so many things just because they didn’t understand and that would have thrown us back so many years. I can say with all boldness that in West Africa, Nigeria is the leader when you talk of ART. While you want to regulate, we need to be sure that you are doing it properly because regulation can be a two-edged sword. Regulation is the next thing we need to do, there’s no doubt about that but the handshake must be sincere, fair and honest.