Dr Abayomi Ajayi Answers Questions On Why IVF Cycles May End In Negative Pregnancy Test, Recommends What Patients Must Do When Such Cases Arise

In vitro fertilization (IVF), is no doubt one of the best and safest ways of solving infertility problems.

It is a method that has been tested over time and has put smiles on the faces of many couples who have lost hopes of having their own children. However, not all fertility cycles end in childbearing.

Doctor Abayomi Ajayi, the Nordica Fertility Center MD has repeatedly said that an IVF circle that only ends in a positive pregnancy test cannot be said to be successful because the purpose of IVF is to have children and not just positive pregnancy test.

A few weeks back, Dr. Abayomi took on Hajia Saratu Kassim, who was once an IVF patient and founder of the Fertility Support Group Africa.

Saratu had an ectopic pregnancy which made her lose one of her tubes and then she had the second tube blocked. This made it quite difficult to get pregnant and she opted for IVF.

Her many experiences made this an interesting read for anyone with similar cases or relations with fertility challenges.

In the conversation, they thrashed out why fertility cycles may fail and what IVF patients must do when such cases arise.

City People followed the conversation on Zoom and Facebook, and he brings us excerpts from the discussion.

Question: I remember when I had my IVF session, it didn’t fail per se because I had a positive pregnancy test for about a week before I started bleeding so there was nothing in the uterus and I kept wondering what went wrong because I was young. There was no issue, I had no fibroid and everything was ok for me. I did the IVF in my early 20s and there was no uterine fibroid or hormonal issues, so for me, it was like what went wrong there. So doctor please help me…

The first question I’m going to ask is why do we do IVF?

We do IVF to have a baby or babies. The moment that is not the result we have, the IVF has failed. So that failed. One good thing that is probably going to help shapen this discussion is around June or July, the HFCA released a list of all the clinics doing IVF in the UK and what they saw was that the baby take-home rate for the whole of UK was about 23 percent, and they saw that for people less than 35, it was 31 percent per embryo transfer and that decreased with the age.

For people over 43, it is less than five percent. We need to understand how the technology works because most of the times, our expectations are not real. Remember that the only time an IVF is successful is when you have a baby. So even at age 25 and a perfect health condition, you still don’t have a 100 percent assurance that you will take a baby home.

We need to understand the technology properly for us to be able to know why it may not work at times. What I say sometimes about what we expect from IVF can be compared to someone who bought a new car and expects the car to be flying.

Of course, the technology was not made for that. So if you are expecting a 100 percent from IVF, it’s like that. If you have an IVF treatment and you do a scan and there is no baby, that is not a success because if there is no baby, it is not a clinical pregnancy, it can only best pass as a biochemical pregnancy.

And let me shock you, I could give you an injection now and when you do a pregnancy test, it will be positive. So that does not count as a positive IVF treatment at all, I hope that explains that first before we go into why IVF circles may fail.

In an instance of ovarian hyper-stimulation when I want to do IVF, should I go ahead with the transfer, or should I freeze the embryo until I am ready?

Well, one good thing about IVF that has happened in the last couple of years and that is this freezing. Now we can freeze eggs and embryos with very good results but what we say sometimes is that in medicine, unless there is an indication for the procedure, you may not need to do it. But not also being psychologically ready.

Freezing also is a science and you need a good laboratory to do that and very few things are in the control of the doctor when it comes to the success of IVF but the most important things that are in the control of the doctor are the qualities of the laboratory and the experiences of the medical staff, the quality of the equipment they have available there and the experience of the doctor who is going to carry out the process.

Those are the only things that we humanly have control over and so you must be able to choose the kind of clinics that can have those things. The doctor must have enough experience, the embryologist must have enough experience, and they must have good technology. Part of what we are talking about is that this freezing also comes with some experience.

So is that to say it’s better for you to go ahead with the freezing and then manage the situations that could arise with it as well?

No! I didn’t say that. With the results that experienced laboratories are getting from freezing, we think the pregnancy rate is even better. In science, you don’t make use of one experience, everybody has to agree that this thing is like this.

The initial experience that we were having with freezing is that very good laboratories even seem to be better in terms of pregnancy rate than even doing fresh transfer.

But I told you, it depends on the experience of the person doing the transfer and that of the laboratory but that’s a discussion you probably have to have with your doctor and that’s why I keep telling people that the most important choice you have to make when doing IVF is the choice of clinic you are going to use.

There are so much emotional roller coaster with the IVF process and anyone who is battling infertility but has not gone through the process may not really understand. So many centers do not carry their patients along with necessary information like how many embryos are gotten, how many are frozen, how many they are transferring so you see people lost. How do you go about it at Nordica Fertility Centre? Do you tell them these things or it’s not important for them to know?

Well, thank you so much, that is a very important question and I am surprised that anybody can go through IVF and not know what they are going through. Up to the drugs that you are using, you must know their side effects not to talk of how you are reacting to the process; let alone how many eggs have been taken away from you.

You don’t know how many embryos you have, then you are not doing IVF. You said the experience of the clinic alone but I added one thing, the doctor is important, likewise the laboratory, the two must go hand in hand… most of the time in Nigeria, may be but not necessarily.

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If I want to do IVF, I will want to enquire about how long the center has been working, how many patients have they treated, etc. I want to know all that not to talk of how many eggs they have had from me. Of course, it’s your right to know, you must know what’s happening.

You’ve been talking about this emotional roller coaster and sometimes it’s difficult doing IVF in Nigeria because the majority of our patients see reproductive medicine just like malaria medicine. Some of the times before they finish the discussion, the doctor has prescribed and they are off. The productive medicine is quite different, you need to know everything.

I am in the IVF process and I am 47, what are my chances of having a baby or a success story?

This is a typical thing in Nigeria. A 47-year-old woman comes to you and says she wants to use her eggs and we have some unscrupulous doctors say that they are pregnant using their eggs. It makes life so difficult because I just told you now that in the UK they said that if you are over 43, the chances that you will have a baby with IVF is five percent.

A 47-year-old using her own eggs is almost zero percent. And that’s why I said how you choose your clinic and what you know about the process is very important. That’s why I like this kind of discussion because it helps you to understand the procedure you are going into and how it works.

If you are 47, YOU CANNOT USE YOUR EGGS! And that’s one of the things we need to get right. If we use your eggs, your chances are almost zero. These are some of the decisions that have to be made. When some people go to the doctor and he starts talking about donor eggs to them, they just leave angrily and go somewhere else where they tell them what they want to ear.

I am interested in this person that you said has had two and has not even gotten to the stage of transfer. That’s why I said at the start of this talk that IVF fails at different levels. That is one level of failure. It is either the lab is wrong or the patient is making a wrong decision; those are things that we also need to look at in Nigeria. If there is any aspect of medicine where the buyer needs to beware, it is reproductive medicine.

What can a woman in her early 40s do to achieve a positive pregnancy result in her IVF?

I’m going back to the HFCA figures again that I told you earlier. They said that if you are above 43, your chances are less than five per cent. If you are 40-42, it is about 11 percent. But they also saw that only 18 percent of the patients of over 40 years in the UK agree to use donor eggs.

In other words, what many people of over 40 need to use for a successful IVF is donor eggs. Some people are lucky, I had a 43-year-old who had done it in many countries including France, UK and the US and it all failed. She was doing her 10th cycle but only the first with me and it was successful.

But that was pure mother luck because some people had sweated and sweated, I just came to reap because the success rate in IVF is cumulative. When you are at that age, you need to do many cycles. If you want to do a few cycles in your 40s, donor eggs are the easiest ways.

But now there are some things we can do for a woman in her 40s. She could do what we call multiple cycles i.e. get eggs together may be two or three cycles, bring them together. We could even do better than that, we could do what we call PGT (Pre-implantation Genetic Testing) for us to be able to identify the embryos that can become babies and save your time and because why IVF fails in about 80 percent of the time is that the embryo is not viable, meaning it cannot become a baby and that is the problem people in their 40s have, they don’t make many embryos.