The ability to have children is never a question until a couple makes the effort and then discovers that it might not be as easy as they thought. God made the reproductive act pleasurable enough that the couple finds themselves enjoying trying over and over to conceive until realisation hits that they might need a bit of help.
Fertility challenges in Jamaica are no different from what couples experience anywhere else in the world. It is however an issue that is not talked about locally as much as it should be and so there are many women who, along with their significant other, will often face this challenge with no assistance. Age is probably the most important factor that affects fertility in women and her chances of conceiving.
At birth a woman usually has the total amount of eggs to last her entire reproductive lifetime but as she ages, her eggs age too and with most things except wine, once age becomes a factor then quantity and quality also become considerations. Over the age of 35, a woman’s chances of getting pregnant decline significantly, not to mention when she gets to age 40. When a woman is in her 20’s the chances of getting pregnant naturally each month is 25 – 30 % and when she gets to 40 that chance is reduced to 10%.
For a woman aged 40 the likelihood of miscarriage is greater than the chance of a live birth. Additionally older women who go the route of In-Vitro Fertilisation (IVF) stand the risk of having children with birth defects or failure in conceiving and that is one of the problems highlighted by the Fertility Management Unit (FMU) here in Jamaica. Women are being referred to the FMU when the chances for them to have a successful procedure have become low.
We interviewed Dr Vernon DaCosta, Director of The Hugh Wynter Fertility Management Unit here in Kingston, Jamaica to get a better understanding of what the unit does specifically as it relates to Managing Fertility/Infertility in our Jamaican women.
TBWM: When was this unit started?
Dr DaCosta: The Hugh Wynter Fertility Management Unit was started in 1978 with the focus being on Family Planning Services. We started out by providing mainly oral contraceptive, intra uterine and permanent sterilisation namely tubal ligation and vasectomy.
TBWM: When did you transition to include in-vitro fertilisation (IVF)?
Dr DaCosta: We started to offer the IVF services in 2000. Initially the unit was funded by the German government. However, after that funding arrangement came to an end, we had to start funding ourselves. So we branched out into doing minimally invasive gynae surgery…i.e. Laparoscopy, hysteroscopy and the IVF program. Some of our doctors went away to the United Kingdom for further training and in 2000 we had our first successful IVF cycle and the rest is history. Our first success was a set of twin boys who would be about 16 years old now.
Generally, we did well in our first cycle which is a huge accomplishment for us here in Jamaica simply because there are other centres outside of Jamaica that did not have the success that we had. In 2000, we started in a very small area and since then we have expanded the Unit significantly. In 2011 we created an entire floor, the third floor specifically for IVF. The first success story for the unit was in 2000 and they are here in high school in Jamaica and doing very well so we know without a doubt that this works … (laugh)
TBWM: Can you put a number to the amount of procedures that your unit has done so far?
Dr DaCosta: We do on average 120-130 cases per year.
TBWM: So a couple tries to conceive unsuccessfully, what happens next?
Dr DaCosta: Most of the couples we see are referred to us by local and foreign doctors and one of the problems we find is that they are not being sent to us as early as we would like, because, they are probably thinking, let us just keep trying on our own. So, one of our problems is that we are seeing too many women in their 40’s and as you know the fertility potential for women is age dependent and declines significantly after age 40. For example, women who are at age 20 – the likelihood of getting pregnant each month is 25%, when you get to age 40 it is approximately 10%. Once they come to the unit, we do the necessary tests to ascertain if there are any indications for IVF. If there is, then we discuss the IVF procedures. If we have uncovered no underlying issues then we may suggest that their timing may be off or recommend intrauterine insemination.
TBWM: You mentioned earlier you do an average of 120 cases per month- how prohibitive is the cost if at all, can the average person come to you?
Dr DaCosta: The cost may be considered high for some…it is roughly USD$7000 for the complete process and covers medication, counselling, ultrasounds, egg recovery and embryo transfer. The only other fee is JMD$3000 for registration and an additional fee for egg and sperm freezing. When you compare this cost to going to the United States it may double, not counting airfare and accommodations et al.
TBWM: Do you see a high case of infertility among women and men here in Jamaica?
Dr Dacosta: The rate here is no different from the rest of the world. In all populations you have about 10 to 15% of the population who suffer from infertility and that is significant. We see patients mainly from Jamaica, but, we also see patients from Europe, the United States and the rest of the Caribbean.
TBWM: Maybe because it is more affordable, perhaps … (laughter)
TBWM: I was talking with a friend who lives in Canada and she mentioned that after a year of trying and being unable to conceive you are considered infertile. Is that the case here too? What if it is just not the right time?
Dr Dacosta: The truth is that if a couple is having unprotected regular intercourse for over 1 year without conceiving they are considered infertile and that is only if they are less than 35 years. If they are between 35 and 40 then we would say 6 months, and over 40 that is reduced to 3 months.
TBWM: I am led to ask this question, having listened…do you think all of this, meaning IVF is playing God?
Dr Dacosta: Playing God…No…look at it, initially when we were placed on the earth, we used to walk to everywhere we had to go to. By creating motor vehicles and aeroplanes, did anyone ask if we were playing God?
TBWM: I agree but, I ask the question because there are some persons out there who will have the opinion that this type of intervention is playing with nature. What is your response to them?
Dr DaCosta: I will tell them- we have no control over the fertilisation process (fertilising the egg) that is up to God. What we do here is help couples overcome the obstacles that are present between the sperm and the egg. Once we get the sperm and fertilise the egg, then God determines the rest. That is why we will never have a 100% success rate because we really have no control beyond a certain level.
We are just helping to overcome a problem. I believe the problem with that question is that people do not look at infertility as a medical problem, they think it is cosmetic surgery and it is not (he states emphatically). Infertility is a medical condition like hypertension or diabetes and once we begin to look at infertility in that light, this idea of playing God will disappear. When a couple cannot get pregnant… (Pause)
TBWM: Tell me about it…
Dr Dacosta. When couples cannot get pregnant, it is a major life crisis for them. It causes anxiety and depression. As a matter of fact studies have shown that the anxiety rate in a couple who cannot get pregnant is 70-75% for the women and in the men it is as much as 60%. Depression is 55% in the women and 33% in men and it does cause a lot of problems in the relationship. At times the men will want to go outside and the women will try to go outside too because they think the problem is with the men and vice versa. So counselling is an integral part of our process once a couple signs on to begin. This in itself is a problem sometimes because not all couples want to do the counselling but most persons who do have, said they found it to be beneficial.
TBWM: When one procedure is done successfully do you recommend the couple doing another?
Dr DaCosta: The good thing with IVF is that once we collect eggs we usually collect enough so that we can freeze some if there are good. So depending on the woman’s age we replace a certain amount of embryos and if they get pregnant successfully and want to do IVF again then we have eggs in reserve. We recommend up to and within a 5 year period for them to try again. On that note, we also offer egg freezing because we find that some women are delaying childbirth for whatever reason.
Sometimes the reason for delaying pregnancy is career or they cannot find the right partner or other reasons but the fact is that while they wait their eggs are getting old. So in that situation we recommend that women come in and freeze the eggs and then when they are ready to get pregnant we thaw them out and fertilise the egg with the man’s sperm.
TBWM: Do you have women come in to see you who are interested in using your facility because they just want to have a child, they don’t have a partner and are not interested in having a partner. Do you facilitate such requests; are there sperm donors readily available in Jamaica?
Dr DaCosta: We import sperm from the Cryo Bank in California (United States) for that purpose; we try not to use local sperms.
TBWM: Why is that?
Dr DaCosta: We do freeze local sperms but (sometimes the men give a bit of problem) mainly for men who have prostate cancer and are undergoing treatment and for some who want to preserve young sperms. We do not use local men as sperm donors, because we are a small island and we do not want to potentially compromise our genetic pool. We do not want (unbeknownst to them) maybe brothers getting married to sisters, that kind of thing.
TBWM: Earlier we talked about the fertility rate. Is there anything that you can say would be pointed towards why one would be infertile?
Dr DaCosta: There are a number of things that can lead to infertility, one of which is an infection which can be associated with one’s lifestyle- multiple partners, unprotected sex etc. Then there is endometriosis (painful periods) which is a complex disorder which can affect every organ in the body.
It can spread to the lungs, liver, brain…and it causes a lot of infertility because over the years every time you have your period, the endometriosis deposits within the pelvis also bleed. The blood is an irritant inside the abdomen and so it causes a lot of inflammation and when it settles down it results in healing with scarring.
TBWM: Okay, let us talk about the process and what it entails for the couple who are considering IVF.
Read the rest of the interview by clicking here
