To Dr. Abayomi Ajayi, a fertility expert and managing director, Nordica Fertility Centre, one’s lifestyle is a big deal in infertility.
Dr. Abayomi Ajayi is very well known for his top-notch reproductive health services with a presence in Lagos, Asokoro in FCT and Asaba in Delta State. Recently, he marked 20 years of his sojourn as the founder of Nordica and had a grand party for children birthed at his clinic. In this interview, he spoke about a wide range of issues that could prevent couples from having children, his early life as a gynaecologist and lots more.
What are the reasons for infertility among couples as the finger is usually pointed at women due to their physiology?
About 40 per cent of the time, infertility is due to a male factor, leaving 60 per cent to women and in 20 per cent, the two parties are responsible. The problem rests mostly with populations where women have contracted a sexually transmitted disease in the past, or have delayed childbearing for reasons known to them. Physical causes for infertility in women include scarring on the cervix, uterus or tubes; blocked tubes and problems with ovulation or the menstrual cycle. For men, the male organs are easily damaged by mumps and swelling of the testicles which can cause lower sperm counts.
Are there rules to strictly adhere to to conceive?
Couples should have a lot of sex, especially during the ovulation window. A lot of women don’t know when they are ovulating. The fertile window of a woman in the 30-day cycle is five days before the day of her ovulation and 24 hours before the last day of her ovulation. After the five-day window, the woman would need to wait for the next month, because even if her husband has the best sperm in the world, she will not be able to get pregnant. You are likely to ovulate 12 to 14 days before your next menstruation. (Use the calendar) There are also different ovulation kits available.
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Also, they must have a balanced diet including the consumption of seafood, fruits, and lots of vegetables and a reduction in the consumption of fatty food. You can also take folic acid even before the pregnancy. Don’t smoke either tobacco or marijuana products, because it can affect, both the sperm and the egg production of the woman. Alcohol is something you must avoid when you are trying to get pregnant. You must also take coffee in moderation if you must take it. As for those who are taking herbs and tea to lose weight, some of the weight-loss herbs can affect your ovulation. If you must use herbs, please talk to your doctor.
Nordica Fertility Centre is 20, a landmark celebrated in a big way. Could you share with us your early beginning as a gynaecologist?
I saw that there were people who had achieved everything in life but because they didn’t have children people considered them to be second rate and they also considered themselves to be second rate. I remember there used to be a bank executive who achieved so many things and she said she was finding it very difficult to travel. Anytime people see her on the plane, they say she is going for treatment.
So, my turning point one day was that I was in UCH, and then there was no IVF. We used to have this urologist. I was doing a urology posting. The man is of blessed memory. He was a renowned urologist; a professor of urology. He used to have this meeting in the office, you see men; pilots, and accomplished people come to his office on Tuesday morning. So, I was at one of these meetings one day. Then they used to do testicular biopsy for men who can’t have children. And the Prof will tell them; ‘You see, we have done everything, so you have to go and start praying. It’s only God that can help you. After one of these meetings one day, that must be about 1990. I called the man and I said, but I heard there was something called IVF and the man laughed. He said; IVF in Nigeria? Nobody should think of IVF in Nigeria. That was how I started thinking of IVF.
When I finished my training, all I just wanted to do was IVF but there was no place I could do it in Nigeria. So, I had to go on with my normal gynaecology until 2001. The internet just came in in Nigeria, I think. So, we used to go to the cybercafé to go and study in 1999/2000. So, in 2001, I just received an email. Somebody was asking me if I was interested in IVF.
And I think the way I replied to that mail, the guy now replied to me that yes, I think I have found the person I’m looking for. What was he looking for? These are Israelis and they have clinics in central Europe, the Czech Republic and Slovak. And they wanted to open a clinic in Africa. So, they were looking for a partner; a gynaecologist. There was a group then; OBGYN.net which was a group of gynaecologists from all over the world.
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I was the one representing Nigeria in that group. So that’s why the guy reached out to me and as they say, the rest is history. The guy invited me to the Czech Republic. Then I worked at Lagoon Hospital. So, I went. And that was the first time I was seeing IVF in my life. I was the only black man. I went to Slovakia. I went from the Netherlands to the Czech Republic which was not bad; maybe about three of us were black on the plane. But between the Czech Republic and Slovak Republic, I was the only black person. I was the only black person in the airport.
They had warned me here in Lagos that if I got to Slovak, I might have problems and that I should call them at the embassy. So, when I got to Slovakia, they said I should come and sit down in one office. And then I sat down. I was there for about two hours. The majority of them could not speak English. I think the boss just came in. That was the only IVF clinic in the Slovak Republic then and so they are very well known in that place. They were already expecting me.
So, they carried my name and they were waiting for me. But I couldn’t go out. I think the guy while he was coming to the office had seen that name. And then he came to the office. He saw my passport and he said oh! Are you the person these people are waiting for? I said yes and that was what bailed me out. I came out and, of course, we went. I stayed with them for a week but after that, we had a meeting and I told them I was not going to come back. The agreement was that I was going to bring my people for them to be trained in Slovak but when one person entered your country, the whole place shook. So, if I should bring in four more people, what will happen?
We agreed that we were not going to do the business. So that’s how I got to meet Carl Eric Nordica. There used to be a clinic called Syncronia, it was one of the best clinics in the world. It was in Denmark. The owner was very sick. He had cancer and was about to die. When he saw my mail, he sent it to Carl Eric. Carl Eric and his friend who was the first professor of reproductive medicine in the Nordic countries. So, they were in partnership. His friend was the scientific director of Syncronia. He was still at the teaching hospital.
So, the man sent this mail to him. Carl Eric said, Oh! He was coming to Nigeria and that was how we met in Nigeria. We had the meeting in Abuja then. That was how we came about forming Nordica with Carl Eric. So that was about 20 years ago. Looking back at what has been done over the last 20 years.
Being in business in Nigeria for 20 years is no joke. A lot of people these days JAPA, what’s your advice to upcoming business owners/doctors?
Patience is number 1. I’m not trying to sound like an old man but social media is a horrible thing. It has changed the way our values are. There are some people I don’t think any young man should be looking up to. Those are whom people call their mentors. I shudder and wonder if you are serious! This person? This is a criminal! There is no shortcut in life.
The earlier people realise that your value is not determined by your location. Your value is determined by the problems that you can solve. Why are they coming to take graduates from Nigeria? It’s because they can do basic things. But because every day you are looking at a man who has worked for 30 years whereas, you who have just started 3 years ago and you want to start comparing yourself to him. Then you are going to end up in the ditch. If you like, you can tell me about Mark Zuckerberg, the owner of Facebook that he has money, and then I will tell you how many of his type there are in the world.
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When you know what you are doing, persist in it. When only Lagos has 20 million people, I see people selling fried plantain. If you sell it and you scale up, you can imagine how many fried plantains they would be eating in Lagos in a day. I think we will need to be patient and also be strategic. If you ask me, I don’t see any reason why anybody is running anywhere. What you are doing is that you are leaving all your rights to a place where you don’t have any rights. A migrant has no right. If you like, spend 30 years there.
Now I hear people talk about no light. But I don’t see how light would be the reason for migration. It’s tough, there is no doubt. People say I talk like this because I’m privileged. Yes, I agree but don’t forget I wasn’t born like this. I have had my own fair share of difficulties and issues. So, I would say just persist in what you are doing.
It was announced that the infertility rate in men also is on the high side.
There’s no doubt that we have seen that male fertility is going down worldwide. We don’t know what is exactly responsible for this. We did a 10-year study here in Nordica. That was between 2004 and 2014 and we saw that the sperm parameters of men who reported here had declined about 30% in 10 years. So, it means a decline of 3% every year. A report was released again last year in America, looking at Europe and America. And they said sperm count has reduced by about 50% in the last 40 years. So, there is no doubt that something is happening to men.
Lifestyle is part of them. The other things we cannot really place a finger on because we are looking at so many things that contain spermicides that we were using at home. So that exposure might be higher but we need to be careful so that we are not seen as alarmists. But the ones we think we can look at like the lifestyle. You don’t need to look far. In Nigeria, you see people smoking weed here and there. This affects sperm count. So, we now see a lot of couples, who come here for fertility treatment and the two of them are smoking. Most of the time the woman will not tell you she is smoking. She would tell you my husband is smoking. So these are some of the things that are affecting sperm count, that are affecting fertility generally.
Is lifestyle really a big deal in infertility?
Absolutely. Many young boys are becoming so obsessed and they don’t give a damn about it. One day I went somewhere and I saw a guy who was very slim and was drinking an energy drink. I looked at him and said; Oga, do you know what you are doing to yourself? Go to the nightclub and see the way they are handling hot drinks as if it’s water. When I was growing up, girls who even drink don’t drink publicly. But now things have changed.
So many things are happening right now. We are becoming westernised. Some of these things affect our fertility. You see boys, they say they are “eating iron”, they are doing six packs and they are taking all kinds of drugs to develop those muscles. And you talk about sperm count. So, there are so many things that are happening to us right now. There is also a study that said that men should not put their cell phones in their pockets and that the nearer it is to your testis, the more radio waves can affect sperm production. Same with men who wear tight pants.
What advice do you have for couples waiting? How soon can they start considering going for IVF?
If you are unable to get pregnant and you are less than 35, please start quickly so that we can see if there is anything wrong. You don’t have to come to an IVF office to start with. Go to the gynaecologist to have a proper assessment and if you need IVF, you better start quickly before we start telling stories that touch the heart. When talking about lifestyle, the age at which you start a family is important. Everybody needs to know, especially women. They have an age range where they are at their reproductive peak. So, women should start childbearing early. By the time you are 30, you have to be careful. From 35 years your fertility starts declining rapidly. So, your best birth is when you are between 25 and 32. This is your peak period.