Patients Need Education To Understand Difference Between IUI And IVF | Independent Newspapers Limited
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Patients Need Education To Understand Difference Between IUI And IVF

Posted: Jul 20, 2016 at 5:10 pm   /   by   /   comments (0)

Abayomi Ajayi, a consultant obstetrician and gynaecologist, is the CEO of Nordica Fertility Centre, which specializes in In-Vitro Fertilization. Ajayi, in this interview with CHIOMA UMEHA proffers solution to unsuspecting Nigerians who continue to fall prey to substandard and fake fertility treatments across the country.  Excerpts:

Many Nigerian couples seem not to know the difference between Intrauterine insemination (IUI) and Invitro Fertilisation (IVF). Could you elaborate on the differences?

Let’s put it this way, IUI, which is Intra Uterine Insemination and IVF, which is Invitro Fertilisation are cousins but they are not interchangeable; they both belong to the group that we call Assisted Reproductive Techniques (ART) but the most basic form of that family or the least developed is IUI which any doctor can do. You seriously don’t need any particular equipment to do that except to prepare sperm because we know that when the semen comes, there is sperm, there is seminal fluid so all you just need to do is to separate them from each other, concentrate the sperm, and then you are able to introduce it back into the woman. And for a woman to be able to do IUI, her tubes must be opened, while the sperm must be good.
But, when you look at our environment, the commonest problems are blocked tubes on the part of the woman and bad sperm on the man’s part. This makes the IUI of limited use in this environment.
But, there are some people who will still benefit from it, but you need to be sure that those two things- the sperm parameters are good, and tubes are open so it is useless for anybody who has blocked tubes to be doing IUI, if you do one million, you can’t get pregnant.
But, the common happening now is that people are mixing up the two and the patients are not any wiser. Someone who is ideally supposed to be doing IVF is rather recommended for IUI which is not the ideal solution. For IVF, you need to bring out the sperm, egg, and then combine them to form an embryo before you can transfer back into the patient. And for this to happen, you have to start with the use of drugs, which makes the woman to produce eggs, and that is why it is called IVF and Embryo transfer.
It is important, especially now that it is hard to get money for patients not to waste their resources and even their productive life in the hands of charlatans who give IUI in place of IVF just because they want to exploit the patient.
I was talking to a 50-years-old woman who said she went to store her eggs in one clinic. This made me wonder, how can she store her eggs, when she won’t need it, because she can’t use her eggs, what she needs are donor eggs. So what is she storing? And she will continue to pay money for this kind of thing. It is so important the media educate the public on IVF, so they can make informed choices and also know from knowledge which doctor is telling them the right thing.

Is there any regulation to control sharp practices and monitor fertility clinics in the country?
Regulation is slow even though we are making efforts at it. If you are waiting for legislation or regulation, a lot of people will still continue to be misinformed and misled. The fastest thing is for the citizens to be equipped with information. Once a buyer of a treatment plan knows what he or she is buying, the person will most likely not waste any money on quacks.
Though our associations is working on regulation, but I tell you, how many clinics can you police a day. In a year how many? If they know you are coming, they will put up their best behaviour, when you leave, they continue with what they are doing. So the easiest thing to do is educate the people who are investing their time and money in these clinics so that they know and can ask their doctors questions. They can tell their doctor what you are giving me is IUI and not IVF. Imagine a doctor in a teaching hospital doing IUI for a 43-year-old, that is criminal, you don’t do IUI for a 43-year-old, because you wouldn’t achieve the needed result.

Don’t you think these lapses are from the professionals themselves?
The problem is that most of them don’t know, you just assume that they know because this is a different branch of medicine. The fact that you are a gynaecologist just does not make you a fertility specialist.

So who is qualified to be a fertility specialist?
Someone who has been trained as a fertility expert is qualified to practice, because you need to know the indications. The fact that you can do surgery or you are a gynaecologist does not  mean you can practice as a fertility specialist.
Like I told you, IUI is the most basic form of assisted conception, once you are trained, you can do it because you don’t need big equipment to do that, all you need is a functioning lab, but the fact that you can do it doesn’t mean the patient needs it. Your job is to be able to identify the patient who really needs it. Unfortunately in this country, not many patients will benefit from IUI because our biggest problems are tube blockage and sperm quality issues. These two are contraindications when it comes to age (above 38). Once the person is above 38, it is relative contraindication to IUI because the success rate goes down dramatically not to talk of when the person is 43-years-old. At that age, if you do one million IUI, it would not work even when the tubes are open.
Also, one of the problems is that patients are comparing IUI with IVF because they do not know the difference between the two. So when somebody says, I am going to do it for N10, they run there, but, what is the person doing, is it IUI or IVF? But if you know what it is, you will ask questions. I keep telling patients that it is their body. You should not let anybody insert anything into you without you knowing what they are doing.

Doctors often become defensive and harsh when patients become inquisitive. What should the patient do?
The patient should walk away from such a doctor. Do not forget that infertility treatment in Nigeria is paid out-of-pocket. That is the more reason you should ask questions because you sweated for the treatment money.