Help for TT’s childless couplesBy VERDEL BISHOP Tuesday, February 10 2009
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Dr Catherine Minto-Bain, gynaecologist and medical director of the IVF Centre at Medical Associates....
ACCORDING to international statistics, one of every six couples experiences difficulty achieving pregnancy. For some, conceiving doesn’t come easily. If you, a friend or family member have for more than one year, tried to conceive without success, it may be due to an infertility problem. However, there is hope for infertile couples, through In Vitro Fertilisation (IVF).
More and more couples are turning to fertility treatments as their only hope for parenthood.
IVF is the process used to conceive a child outside the body. A woman’s eggs and a man’s sperm are placed together in a plastic dish for fertilisation. The resulting embryos are placed back in the woman’s uterus in the hope that a successful pregnancy will follow.
The Trinidad and Tobago IVF and Fertility Centre, at Medical Associates, in St Joseph, is the only facility in this country that treats with infertility issues in men and women. The Centre provides infertility diagnosis and treatment to patients and is committed to providing the highest standard of care and the most current infertility treatment options available.
IVF was developed for women with blocked, damaged, or missing fallopian tubes, and is also used to overcome infertility caused by endometriosis, male factor issues, sperm antibodies, ovulatory problems, or other unexplained reasons. While there are a number of assisted reproductive technologies available to infertile couples, IVF is by far the most effective of these methods.
According to Dr Catherine Minto-Bain, gynaecologist, and medical director of the IVF Centre at Medical Associates, infertility remains a major reproductive health problem in TT and the prevalence is high. Minto-Bain said IVF is never the first step in the treatment of infertility, but is reserved for cases in which other methods such as fertility drugs, surgery, and artificial insemination haven’t worked.
Minto-Bain works with specialists Professor Samuel Ramsewak and embryologist Bryan Woodward. Through IVF they successfully assisted several couples who were unable to conceive naturally.
Dr Minto-Bain said blocked fallopian tubes is one of the more prevalent causes of infertility in TT.
“We have thousands of couples on our books for treatment. People have been trying to get pregnant for years . . . sometimes as long as ten years.
“We see a lot of endometriosis cases and male factor issues. There is a large proportion of young men in this country with low sperm count,” she said.
“We treat patients as young as 17 years old. The oldest we’ve seen coming in for treatment is 56.
“There are also common cases where women who already have a baby can’t get pregnant a second time — this is called secondary infertility, we see a lot of these cases too.”
IVF usually increases a woman’s chances of multiple pregnancy, however, Minto-Bain was quick to point out that although most couples are happy to accept a risk of twins, it is important to know that even twins carry significant risks. She said medical staff at her clinic carefully discuss the number of embryos to be replaced with every couple.
“We have a one in five rate of twins and rarely see triplets. In Trinidad our health system doesn’t work well with premature births. Twins and triplets place women in a difficult position in this country because of lack of resources. We help couples in different ways.
“We have to be careful to not give couples twins and triplets because besides health issues, it’s not good for the economic consciousness,” she said.
The United Kingdom is moving towards allowing couples replacement of only one embryo to decrease the possibility of having twins. Minto-Bain noted that in Trinidad, the IVF Centre follows the English rules but vary them to suit the needs of their clients. Minto-Bain said the IVF Centre almost always produces single babies.
“A lot of couples that comes to us want twins. Multiple pregnancies such as triplets carry extremely high risks and we do everything we can to avoid these. Some couples come to us and ask for twins but we explain the complications to them.
“We screen the couples first and try very hard not to get them pregnant with twins. We recommend one pregnancy.
“A lot of the process of IVF is about giving information and making sure couples understand. We spend a lot of time talking about treatment options,” she said.
Minto-Bain explained that the cost of treatment varies. She noted that patients don’t have to pay all up front, and payments are structured to suit each case.
She said the cost of treatment can be cut through egg sharing, where a woman can share eggs with someone else who is not able to afford treatment.
Minto-Bain said the procedure is time consuming but it’s not painful. During IVF you are given medications which manipulate your ovaries and the eggs being produced.
The idea is to try and get several eggs to mature, not just one or two. The follicles where the eggs are developing can be monitored by ultrasound and by measuring estrogen levels.
When the eggs are mature, they are taken from the ovaries — using a fine needle which is passed through the vagina under ultrasound guidance — and handed to the embryologist.
The eggs are then fertilised with your partner’s sperm or, in some instances, donor sperm.
The embryos are then cultured under very strict conditions and examined each day by the embryologist to assess their progress.
On the third day the embryos are assessed by the embryologist and a meeting is then held to discuss them. At this meeting they decide how many to replace inside the uterus by a second procedure called an embryo transfer.
Sometimes more than one embryo will be transferred, and sometimes the other good quality embryos will be suitable for freezing for later use.
“Our job is to enhance the chances of pregnancy but limit the risk of multiple pregnancies,” Minto-Bain said.
The IVF centre can be contacted at 662-8344 or for further information visit info@trinidadIVF.com.
