 You're welcome back. We're glad to know you're still there. It's breakfast on plus TV Africa and Right now we're going to look at the challenges and reality of in vitro fertilization or what is simply known as IVF and We're glad to be joined by Dr. Jean Nassar fatality specialist. Good morning and welcome to the program Yeah Infertility is a problem in our society, especially a society that takes Having babies having procreation very seriously it has ruined marriages and so many other things But not many people know about this IVF intro vitro in vitro fertilization So walk us through what that really means and How can get it? Yeah, okay? So Let me start just by the definition of infertility just for people know well To go and seek help or to see a specialist maybe so the first thing is definition of fertility So if you have more than one year of regular unprotected intercourse, and you don't have a baby Please go and see a specialist in in vitro fertilization. So that's the definition of IVF Okay, so in vitro fertilization, it's a procedure that is very simple It's not complicated. It takes about maybe 10 days on average and depends on the patient But it takes about around 10 days during these 10 days the patient will Have to do some subcutaneous injection just under the skin. It's like insulin injection It's very easy to do and during these 10 days she will come to our clinic to Do an ultrasound a monitoring to see how she's responding to the injections and accordingly According to the size of those follicles and the number of follicles. We will decide on what day we should give her a trigger shot so she can ovulate 36 hours later and under light and seizure or even under local and seizure can get Those eggs from her do the fertilization in our lab. Then we'll have some embryo some will be Freezed and some embryo will be transferred to the uterus of the patient Day two slash day three or day five slash day six after the retriever of the eggs Okay, so that's it results in a pregnancy that is our pregnant. Yes Okay, so which means with IVF. There's nothing like infertility in a woman. I Mean, it's not 100% the pregnancy rate but it depends on the age of the patient and On her ovarian reserve. So there are many factors that can affect the pregnancy after IVF So if we are talking about just one IVF cycle, it will be around 50 to 70 percent pregnancy rate depending on the age and Case of the patient. No, but you have your prime age You below 30 for instance, and you you're trying to get your baby. There's a likelihood more than 70 percent More than 70 percent to have this baby. Yes, sure. Okay, but this is only for the woman, right? Yeah, so we're not talking about the man right now I will not talking about the man But also we should talk about the man because sometimes we are obliged to do in vitro fertilization for The sole cause male factor and which is around 20 percent So 20 percent of the infertility is due to male factor and around 40 percent It's a co factor So the male is very important because depending on the sperm count So if the sperm count is very low Sometimes and the woman is perfect. Sometimes we are obliged to go in to do in vitro fertilization Because of the male so because we have a low number or bad quality sperm and by IVF I didn't explain to you by doing the IVF there is Procedure called XE which is intra cytoplasmic sperm injection where we go we find the perfect sperm We get it and we injected inside the egg So if you have a low number or a bad quality sperm we go and check for the best one and we inject it So yes, male factor is one factor of infertility and to be considered seriously Okay, well, it's good to know that it's not just for the woman. So there is no Fight in that that okay, the woman has this advantage over the man but now you're doing the process of IVF to the the woman and Does the person need to repeat after every cycle, you know You have a baby now after it is being done and then you need to have another baby You're still finding problem You have to come back or is it that when once you do it it give it triggers something in the in the in the system Of the person that gives room for pregnancy it's a very good question because I cannot count how many patients Have a second baby spontaneously after doing one or two or three cycles of IVF So it's not true. So it's not once you do IVF. It's always IVF That's not true at all and we have many many examples of women that Struggle to have the first child and then right after they will They will have spontaneous pregnancy not even one maybe one or two and in my opinion The most common here the most affecting effect is Psychology because the woman now she knows that she can have a baby. So Psychologically, she is prepared and she's more relaxed and that's why She will have her second baby. So psychology is very important I've if you want to look into statistics, you can see that a lot of women have Are pregnant just during vacation when they are not thinking about having a baby So when you do an intercourse not in the aim to have a baby There when you have your pregnancy. Oh, I see. So, how do you prepare these patients? Psychologically, you know after the IVF to to be more Confident in themselves that they can have a baby. Do you do anything on psychology specifically for them? Yes, but I will just correct a little bit. Maybe in pre IVF. It will be a better to do some psychological Consultation so to prepare her psychologically for this journey that could be in some woman difficult. So you should Be prepare her psychologically. How would I prepare her first? I sit with her and a lot of time I take a lot of time as the first visit to explain everything and then there is Psychologist, you know that can support the moment during this journey pre IVF and post IVF and even post partum. So it's when the patient Deliver the baby, you know Sometimes you have postpartum blues and postpartum depression and psychology here play a major role a key role But is it really a thing or you just look at the patients and patients and see who needs psychology? I mean every Style couple need a psychologist. Okay. That's my opinion. Walk us through the processes of IVF from beginning to the end So as the first visit we I insist always to see the couple not just the woman So the male and the female I insist to see them and first visit both of them So they when I explain they know exactly what they are going through and First step I'll do an ultrasound for the woman to see her ovarian reserve What is ovarian reserve is a quantity of eggs that she has inside both ovaries And this can be done by ultrasound and also we have a blood test that should be done a hormonal test To see if there's any hormonal imbalance that can affect the pregnancy rate after So this is for the woman also we can do like a hysterosalpancography To see if her tubes are patent so it's not necessary to go directly into IVF There's another procedure called IOI which is intrauterine insemination Which is which is a very simple compared to IVF and if the tubes are patent The sperm is good and the woman has a good ovarian reserve Sometimes we can do IOI and not to go directly into IVF and also it's less expensive so that's concerning the woman and For the male we always ask for a sperm analysis and a sperm culture to see the sperm quality and the sperm Concentration and the normal percentage of normal form of the sperm and according to all those results. I will Decide if I go into IOI or IVF Okay, so the rate of success. Is it depending on On the age of the patient not only the age but but age as a major major factor Why one of the major factor because age is related directly to the quantity and quality of the egg And every woman you know that after the age of 37 38 her ovarian reserve will decrease and also her quality And so after the age of 40 41 we start to have less eggs and Less quality, okay, and that's statistics. There's this thing. I've observed maybe I'm wrong But people who undertake this IVF process or procedure seem to have more multiple babies than single births Yes, is that a thing do you choose it or it just no that was in the past before having the freezing now we have Ambrio freezing so we can do single embryo transfer or a double embryo transfer So the maximum we can have twins or a single baby and but in the fall in the past We didn't have freezing so what we get from the IVF so if you get four or five embryo We used to return those four and five embryo and that's why you have a higher risk of having a multiple multiple pregnancies but nowadays we have the freezing and We should not Return more than two embryo in the worst case scenario What if is the choice of the person patient? What if she wants? Yeah, I cannot tell her no, okay? all right a Lot of people want this procedure, but the thing is too expensive is that a Is that a right perception of what it should be at this expensive? Yes, but it's not too expensive. Okay. What is expensive also? Don't forget if you want to use the right medication The good ones. That's the most expensive part the injections, but it's not too expensive So it's not that much But now if you are considering going abroad and do the IVF in Europe, maybe Versus don't get here. So no ticket. No hotel. So maybe it will be less expensive Okay, what are the what are the contributions of the person who who undergoes this procedure because you will do the Injecting you will do the sorting of the eggs You'll do everything clinical to make sure that the person gets pregnant But when that person gets home, there must be some things that they need to do for themselves What are these critical things? Yes, the most critical thing is lifestyle modification. So by lifestyle I mean diet and stress. That's psychology. So psychology stress anxiety lifestyle modification obesity how diet and Exercise all of these can affect pregnancy and can affect also the pregnancy rate after an IVF So I will say lifestyle modification. I do left as a Does lifestyle affects after you have done it or both it affects them Even lifestyle also can make you not to get pregnant. Yes, both. What kind of lifestyle? I mean if you are eating a lot of carbs and sugar So it will lead to increase weight increase weight will lead to less response to the injections that we have less Response to lead to less and even before the injections like someone comes to you And he needs or she needs help me or she needs. Yeah, but Was is there a possibility that if that person had a different kind of lifestyle He or she may not have needed you. Yes, and we are talking about spontaneous pregnancy here So what can we do to increase the spontaneous pregnancy and not doing IVF? Yeah, that's what you mean Yes, so yes once again lifestyle modification because obesity or increased weight increased carbs intake can affect the ovulation And the quality of the egg So when we have decreased in weight decrease in carbs and decrease in every sugar intake and Exercise it will increase the quality of the egg and we'll have more regular cycle and so the woman can get a spontaneous pregnancy and In particular we are talking now about Policistic ovarian syndrome, which is very common here also in Nigeria. So PCOS patients Especially needs a lot of lifestyle modification in order for them to have a spontaneous pregnancy And yes, they don't need IVF all the time. You are you are right So lifestyle can affect spontaneous pregnancy without talking about fertility Yeah, but when you when you mention carbs, it's it's very scary to a Nigerian our food I know So if you say a couple of cups will will will affect pregnancy It would be not affect pregnancy local look Excessive carbs can affect weight and weight can affect the equality and it can affect fertility Okay, so if you eat the carbs and you can still stay fit. Yes, you're good. Exactly. Okay, fine So no carbs. I know I don't I'm not gonna say zero carbs. I'm saying the low carbs exercise Or you can eat carbs and exercise so you can make like a balance Okay, so tell us about the technology involved in IVF now it like you said It's it used to be different a little bit different from what it is now How is it easier now? Is it better now? Is it less expensive now than before? What are the things that I bought? Yes, sure. There's a lot of of technologies that we are using even here in Nigeria It's like I talked before about freezing. So that's a new technique This aside from freezing we have a new Technology called PGD Where we go and do a biopsy on the embryo and we can see the DNA of this embryo before Implanting this embryo inside the uterus and by this we are like selecting normal embryo and there's any genetic Abnormality it can be detected before Transfering this embryo to the uterus so by this we are increase when we are transferring a normal embryo We are increasing the pregnancy rate That's true and we are decreasing the abortion After if there's any risk of abortion after the woman is pregnant because of any genetic abnormality So we are decreasing this risk So the number of or if you want the percentage of take-home baby, which is different from a pregnancy rate is Higher due to the PGD, which is very new. Okay, but the medical field now has remote Remedies to a lot of things You can stay in in America and do a surgery or something, you know, does that also work for? No, because you need to retrieve the eggs you need the eggs Okay, well, maybe you have a word for the people who Maybe I okay before we get there. How can the people in the rural areas for instance access this Well, you need yes, of course, you need some some financial help of course and we need more centers maybe close Close to every to every area not just maybe in the cities or in the big centers So we need maybe more centers. We need more Awareness and we need to talk more to people to tell them when to seek help and not when it's too late And that's my message today. Yeah, but but but how will you assess the number of IVF centers? With the people who need these IVF centers is even in the cities Do you think it's enough or do you think it's something government has to look at very deliberately? You think there's something of policy or something. Yes, maybe I don't know much more about politics here I'm just talking medicine. So yes, of course, you need more centers, of course Yeah, I'm not talking about your experience in the number of cases that you get a week or per month There's a lot give you an idea whether the centers are not much are not enough for the people to Sure, it's not enough. We need more we have a lot of fertile couple here If you were to advise the government on things to do in the health sector to make it better, what would you say? maybe more hospitals more hospital more awareness and Not to push people also to go away or doctors away from energia to work outside. So keep them here so they can increase The health system. Okay, let's just access Free consultation talk to the people About IVF about what they need to do about what they need to know in the short space of time that we have right now Just talk to Nigerians. You just said there are very many infertile couples. Yeah, and sometimes it's not really Something that is beyond repair is some it's not something that is beyond Remedy, let me use that word. So please by way of advice to Nigerians So my advice today is not to wait more than one year of One unprotected regular intercourse, please don't wait more than that Because we are seeing a lot of patient Coming to us after 10 and 15 years of infertility. So please please please Don't wait more than one year. Please seek help before so after one year exactly go see a specialist and It will be fine because as I told you age is a very important factor So don't wait until the age of 45 and 46 to go and seek help for the first time But you can still have help. Yes, but also after the age of 41 and 42 We have many technologies including ovarian rejuvenation, which is another chapter Which is ovarian PRP that can generate more eggs and better quality in your ovaries So you can have a baby even at the age of 45, but I'm just telling a general info So seek help after one year of unprotected intercourse. All right. Thank you so much. Dr. Nassar for coming on the show. Thank you. It's been very enlightening and we do hope that people will access this information and not only the information will also go to the hospitals and get IVF and Possibly they are some stigmas. So possibly there are some Some traditional beliefs against that and you did say something about enlightenment We will take it up from there when they come to the hospital. You do your bit. Yeah, okay Thank you for coming on the show. Thank you. Well That's how we're going to wrap it up on the show this morning We've had the pleasure of having Dr. John Nassar here. He's a fertility expert and if you're seeking to have a baby and you think you're having a problem try IVF that just might be your solution and on behalf of the entire Breakfast family or plus TV Africa. I'd like to say thank you to you for being a part of the program Let's do to get tomorrow. My name is Nyamu. I've got you