Nordica Fertility Centre is a reputable and leading Assisted Conception Centre with top class medical facilities in Lagos, Asaba and and now Abuja, Nigeria. The Chief Medical Director, Dr. Abayomi Ajayi and Wife, Mrs. Tola Ajayi hosted guests at the formal commissioning of the Abuja center.
Dr. Abayomi Ajayi
Dignitaries in attendance included; Dr. Titus Ibekwe, chairman NMA FCT, Dr. Mrs. Adeniran representing the Federal Minister of Health and the FCT Commissioner of Police, Adenrele Shinaba.
The cutting of the cake: From left, Dr. Titus Ibekwe, Chairman, NMA, FCT, Clinic Manager, Mrs. Tola Ajayi, The Managing Director, Nordica Fertility Centre, Dr. Abayomi Ajayi, Master Julian, Nordica’s first baby, Dr. (MRS) Adeniran, represented the Minister of Health, Perm Sec., Ministry of Women Affairs, Dr. George Ossi and the FCT Commissioner of Police, Adenrele Shinaba.
The cutting of the tape, by the representative of the Health Minister,Dr. Adeniran, flanked by Dr. Abayomi Ajayi, Dr. Demola Onakomaiya, Secretary, HHSS, FCTA, and Dr. Gearge Osssi, Perm Sec. Ministry of Women Affairs.
Nordica fertility centre specialises in productive techniques like ovulation induction and cycle monitoring, IUI (Intrauterine Insemination), IVF (In-vitro fertilization), ICSI (Intracytoplasmic sperm injection), among others.
The unveiling ceremony by the Perm. Sec, Women Affairs Ministry, Dr. George Ossi, while Dr. Abayomi Ajayi, Managing Director, Nordica Fertility Centre, is behind.
Infertility and Polycystic Ovarian Syndrome
Polycystic Ovarian Syndrome (PCOS) is a clinical condition in which multiple cysts occurs in the ovary, the women with this condition tend to have infrequent menstrual flows and may have evidence of high levels of the male hormone -testosterone. Since ovulation is fundamental to fertilization and conception, PCOS is a leading cause of female infertility.
In addition, some of these women have other factors that contribute to infertility (like a husband with a low sperm count or a uterus scarred by a previous infection), which have nothing to do with PCOS. It is such that if a woman has PCOS, it’s difficult to estimate her chances of having a baby, but a lot can be done to improve the odds.
But do all women with PCOS suffer from infertility? This is the million naira question and the answer to it depends on the criteria used to diagnose PCOS. If a main criterion is infrequent ovulation, then by definition women with PCOS would have fertility problems. It is possible to have the appearance of polycystic ovaries and be fertile, but having the syndrome usually does impact fertility adversely. It is possible that PCOS may reduce egg quality — perhaps because of abnormally high insulin levels, or because of the delayed ovulation.
It would be appropriate to say that between 40-80 per cent of women with PCOS have a problem with fertility and the reason for this wide variation is that the condition is a complex metabolic syndrome, with multiple factors that interfere with fertility. Characterized by irregular or absent menstrual periods and elevated clinical and hormonal changes such as serum testosterone, women with PCOS often complain of abnormal bleeding, infertility, obesity, excess hair growth, hair loss and acne. At least 20 per cent of women in the reproductive age range, experience PCOS while it is estimated to affect about half as many or approximately 6-10 per cent of women generally. The condition appears to have a genetic component and those affected often have both male and female relatives with adult-onset diabetes, obesity, elevated blood triglycerides, high blood pressure and female relatives with infertility, hirsutism and menstrual problems. Because of this association with medical conditions,even if pregnancy is not desired, women with PCOS should be sure to have their blood sugar, insulin, cholesterol and triglycerides checked once per year.
Again, there is little agreement when it comes to how PCOS is diagnosed.
After reviewing your medical history, a physician will determine which tests are necessary. If you woman have irregular or absent menstrual periods, clues from the physical examination will be considered next. Your height and weight will be noted along with any increase facial or body hair or loss of scalp hair, acne and as well as a discoloration of the skin under the arms, breasts and in the groin. Things like elevated androgen levels (male hormones), DHEAS or testosterone help make the diagnosis. A two hour insulin and glucose tolerance test will be obtained.
Nearly all patients with PCOS will have at least some subtle laboratory abnormalities, though the levels may not be outside normal limits. A good number of PCOS patients have under-active thyroid glands. About half of women with PCOS are overweight, which means that the other half is not. So does PCOS cause obesity, or does obesity cause PCOS? In some ways, this question is like asking, “Which came first, the chicken or the egg?” since it isn’t completely understood, but it appears more likely that PCOS comes first. Symptoms of PCOS may be lessened by weight loss, or increased by weight gain, but the syndrome is not caused by weight or body mass. There are lean women with PCOS. Insulin resistance that is common to PCOS may play a role in weight gain and the difficulty in losing any extra weight.
It does appear that many women with PCOS suffer some physical or psychological manifestations of depression. Anyone who feels she is showing signs of depression should consult her doctor as well as consider seeking emotional support. Be sure to find a doctor who is willing to listen to concerns and not dismiss this potential side effect of PCOS.
Despite the many symptoms associated with PCOS, not all women will display the obvious signs of PCOS. In fact, some women may not learn that they have PCOS until they undergo a fertility workup. Other women, though, may already be aware that they have polycystic ovary syndrome and see no reason to undergo fertility testing; they already know why they can’t get pregnant.
Most PCOS patients can see a regular obstetrician. Anyone who is severely insulin resistant, diabetic, or has high blood pressure may need to see a high-risk obstetrician. This is an issue to be decided by doctor and patient together. Fertility testing may still be a good idea, even if you have previously been diagnosed with PCOS, not only for yourself but also your partner. Undergoing an assessment for fertility issues in both partners can bring to light any other factors that may cause problems, such as male infertility, which may also require treatment.
Simply put, many women with PCOS don’t ovulate and thus cannot become pregnant. So the first treatment option for infertility is usually the administration of drugs to induce ovulation. Drugs ranging from Clomiphene citrate, Metformin, hCG (human chorionic gonadotrophin), hMG (human menopausal gonadotrophin), FSH (follicle stimulating hormone), GnRH (gonadotrophin releasing hormone), GnRHa (GnRH analogs) and Prolactin inhibition drugs are commonly utilized.
As of yet, we do not understand why one woman who demonstrates polycystic appearing ovaries on ultrasound has regular menstrual cycles and no signs of excess androgens while another develops PCOS. One of the major biochemical features of PCOS is insulin resistance accompanied by compensatory hyperinsulinemia (elevated fasting blood insulin levels). When clomiphene is unsuccessful, the next step is to use injectable hormones to stimulate the ovary to produce eggs. In cases where there is an additional sperm problem, ovarian stimulation can be combined with introduction of the prepared sperms into the uterus around the time of ovulation(intrauteri9ne insemination) Live birth rates after insemination following ovarian stimulation reach 54 per cent after six months and 62 per cent after 12 cycles in carefully selected patients. But more often than not after two to three attempts at Intrauterine insemination without conception, it will be wise to consider more advanced assisted reproductive techniques.
I have often been asked if pregnancy will cure PCOS. The answer is that there is no cure for PCOS, but some women do have a normalization of cycles after a pregnancy. Those who had fertility problems may find it easier to get pregnant again. There are many medications that can be used to control PCOS symptoms, and some may be used in combination with each other. Corticosteroids are sometimes used as well, though their side effects may be intolerable. Women who are not seeking pregnancy can also make use of a wide variety of blood pressure and cholesterol lowering medications, in addition to insulin-sensitizing medications. The best course of action depends on individual needs.
It is unfortunate that at present, there is no cure for PCOS. The endocrine upset characterized by polycystic ovaries does not go away just because the ovaries are removed. The point is that attention must be focused on why the ovary acted that way, and what signals called it to make so many pellet-sized follicles at the same instant? It is possible that it might lessen symptoms, but it is a rather extreme approach that will not prove to be a cure. It is possible that PCOS will worsen during the prime reproductive years, ages 20-40, especially with weight gain. A healthy lifestyle is probably the best defence. It seems as women approach menopause that the severity of PCOS improves, as judged by hormonal parameters.
A good option for couples dealing with PCOS is to undergo IVF. Just how successful IVF will be, though, can depend very much upon individual characteristics such as age, length of infertility and weight. Additionally, neither IVF nor ovarian stimulation is likely to be successful if a woman is severely overweight (body mass index is greater than 30). This is why most hospitals and fertility clinics restrict these treatments until a woman’s weight is within the normal range.
The bottom line is this. Despite the problems that can present themselves to women suffering from PCOS, they can still look forward to getting pregnant. A successful pregnancy is entirely possible and has been experienced by numerous women with PCOS. In fact, for many women, getting pregnant the second time around is much easier. Furthermore, it is not unusual for women with PCOS to notice that their menstrual cycles begin to regulate themselves after a pregnancy.
By Dr. Abayomi Ajayi; Medical Director, Nordica Fertility Centre, Lagos
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