A chance at life
By CAROL MATROO Sunday, May 20 2012
Many couples in Trinidad and Tobago dream of having a child or children to complete their families, progeny to carry on their bloodline. They look forward to the day they will hear little feet racing across the floor, or voices of siblings squabbling with each other.
For some persons, this is a part of life that occurs quite naturally. For others, however, becoming pregnant requires some ingenuity from experts in the field of fertility.
Worldwide it is estimated that one in six couples have problems getting pregnant. In some countries in Africa it is more like one in four couples because in a developing country there are more issues, such as complications during child birth. Other factors include environmental problems, lack of access to good health care, pap smears, screening for various problems, fibroids, polycystic ovaries, poor diets and people generally not taking care of themselves.
This is where the Trinidad and Tobago IVF (in vitro fertilisation) Fertility Centre (TTIVF) comes in. The centre, located at 18 Rookery Nook, Maraval, once offered those who want to become pregnant holistic, personalised,expert fertility treatment plans and services which include fertility investigations, counseling and treatment. But those services have now been expanded to include sperm and egg donors.
For many years when couples had trouble conceiving, it was always thought that it was a “female” problem. However, medical director at the TTIVF, Dr Catherine Minto-Bain, said one in ten men who come to the clinic had no sperm (azoospermia).
“There is something going on in Trinidad. We’ve known there has been a problem here for some time by seeing what has been coming through the clinic. Dr Cristina Hickman, head of embryology, was dismayed at the quality of sperm specimens that were collected,” Minto-Bain told Sunday Newsday in an interview.
“She (Hickman) said it was the worst set of sperm tests that she had seen in her life. So we quantified, did a big study and one in ten men coming to the clinic have no sperm. That’s four times higher than you get in the United States or Scandinavia. It’s a high, high level and that’s why we have such a need for sperm, but male problems in TT run three times higher than in similar clinics in other countries.”
She said when they began to look at the TT problem, every sperm test sample was taken and plotted on a map to determine whether the problem lay in the geography of where the men lived.
“We were thinking maybe they lived around chemical plants or maybe farming areas that use pesticides, but there was nothing. There was no correlation at all. It is worldwide and like looking for a needle in a haystack because there are so many potential causes, but we want to find the cause,” Minto-Bain said.
“We need to know more because there is obviously something in Trinidad. It could be genetic, it could be environmental, something we are eating, the water supply, geographical ... it could be so many things, but there is something that we’ve quantified that we have a huge problem.”
Sperm samples taken showed that just over half of the samples were normal (51 percent) and 34 percent had a low sperm count, which was significantly higher than the international average of 17 to 18 per cent, she said. “In all countries alcohol plays a part in infertility in men, but not more here than any other country. We think of ourselves as a party nation, Carnival country, but most of the people coming through here are healthy. They’ve been trying hard, doing everything that they can, taking vitamins.
“We talk about all the lifestyle practices, but there is something more than that going on, we really don’t know. There has become a huge need for sperm. It’s more here than I have seen in clinics in London,” Minto-Bain said. The TTIVF has been importing sperm for the past 16 years from the United States, but Minto-Bain said this was an expensive process, and there were not many choices in variety since they imported the sperm in bulk to cut costs. If a person wants to bring in the sperm for themselves, then the cost would be triple the amount because sperm would have to be brought in under special conditions.
“It is expensive and what we would like to do is give people more access to treatment, hence the drive to track down local donors to bring the cost down, or increase the choice for people,” Minto-Bain said.
“For good quality you have to have frozen sperm that has been quarantined and infectious- screened. We are trying to get the costs down, so more people can access the treatment because there are lots of people who can’t afford the treatment.”
The TTIVF is now appealing to healthy men, between the ages of 18 to 39, to be sperm donors.
“Honestly we didn’t expect a lot of response. We started off with a few gentle ads and then ramped it up to more funny ones (Sperm Donation ...We know you have it in you). Now we have lots of people calling for information. A lot of guys who call in don’t fill our criteria sadly. The men must be non-smokers, no infections, nice guy ... they must pass the screening with the blood test, infectious screening, must be educated and understands what he is getting into and willing to commit,” she explained.
“You know, the kind of guy you were looking for if you were a 28-year-old lady wishing to have a baby, her life partner.You’re looking for someone nice, educated, clean, no infections, good fertility, somebody who is happy to be fathering children.”
Minto-Bain said sperm donors may have to come in 30 or 40 times to bank samples, so they are compensated for their time. However, she said they are not enticing people with money.
“We do not have a fixed rate, we are looking at what people may want. The whole point of this is to get the costs down and for Trinis to be able to afford the sample. Infectious screening and blood screening are extremely expensive, but we think it’s only fair that we pay them for their time,” she said.
Office Manager Stacy Maraj-Ellis was quick to point out that the TTIVF, which is not widely known, has been operating for the past 16 years and had many “firsts”. “It seems very new to Trinidad because we were not exposing ourselves to the public. In the Caribbean we had the first IVF baby, first intracytoplasmic baby, first donor baby, first frozen embryo baby and many more, but again we were not a clinic that was out there. Those who knew about us may have known through word of mouth from other patients,” Maraj-Ellis said.
“Local couples tend to think that these centres are only available abroad, but that is not the case at all. At TTIVF a patient can come in here, once they walk in to seek any kind of fertility treatment they are fully assessed, so when you walk in the door we don’t just say ‘yes, IVF is for you.’ No, you are assessed medically, psychologically by a counsellor. Sometimes for one reason or another there are some persons who are refused these services because it was recognised they weren’t fit.
“We do full treatment, from full assessment from the start to the final product, which is conception, so regardless of what medical treatment is needed, we can do it right here. It is also cost effective because patients do not have to incur costs to pay for donors, whether they need donors, so we are providing a very cost effective service.”
Minto-Bain said when a couple comes in for treatment they look at the man’s sperm count to see exactly what is not right with his sperm, because there are some things that could not be changed.
“He fills out a questionnaire about his job or what drugs he’s on, because it could be a simple thing such as a medication. If you’re on a drug given by a pharmacist that you are not supposed to be on that is only going to make it worse. Or, it could be as simple as stop smoking, cutting back on your alcohol intake, taking vitamins and living a healthy lifestyle,” the doctor said.
“This (problem) may have been with you all your life and things may never change, so your way of getting pregnant is getting one of these treatments. In other men the sperm count is very low and that’s where we start looking at insemination or IVF if you know things are never going to change.”
She said quite often couples are told they have to get a donor because there is no sperm, which is not the case.
“We could easily find 50 sperm because our labs are specialised and our people are trained in how to look for sperm, so when people come to us looking for a donor, we repeat the test because 50 percent of the time that is not going to be the case,” she said.
Minto-Bain said couples were screened, examined, tested and presented with all the options before they decide that IVF or artificial insemination is the way to go.
“It’s not like you tell a guy go in and have donor pregnancy and his wife is 51 years old with no eggs. You look at them more as a couple to where the problem really lies and that’s where the big problem is because it is not usually done. Most people come to the clinic without having that done. If the woman has no eggs we talk about adoption, donor eggs, living without children ... we have counsellors to help you figure out what you want to do,” she said.
Maraj-Ellis urged couples who had been trying to get pregnant for at least one year not to wait too long to seek help.
“Come and see us. We are here to help each and every individual, however small. Maybe it’s just to show them how to use an ovulation kit and monitor, and the next month they may call and say they’re pregnant. That’s what we are here for. We are not just an IVF clinic and that is why we need to educate the public and let them know this is a full service unit,” she said.
Minto-Bain said IVF at the clinic had the best success rate of 67 percent, although that may not be the case for a woman 43 or 44 years old.
“Everyone is different. You’ve got a man with ten live sperms of which four are abnormal. His wife is 24, but she has had four operations on her womb, so that couple has got a great struggle to get pregnant,” she explained.
The artificial insemination success, Minto-Bain said, is about ten to 14 percent, but in the last six months it rose 17 to 18 percent, something which she considered “excellent”.
Minto-Bain said the clinic’s ethics committee had agreed that they not get anyone pregnant who was 52 years and over.
“We stop treatment at 51 years and three months. That’s because of the life span for women in Trinidad. We want a child to have a mother and father through until they’re 18. You don’t want to create children if they are not going to have a happy family to look after them,” she said.