Victor Ajayi

Are semen parameters worsening? Comparing semen parameters 10 years apart

Background: Semen parameters, especially sperm count and motility have been said to be diminishing over time with implications for fertility and infertility treatment. Objective: The objective of this study was to study semen parameters 10 years apart and describe any observed change. Design: A retrospective study carried out at Nordica Fertility Centre, Lagos, Nigeria. Semen parameters of 100 consecutive men who sought fertility treatment on account of infertility in 2003 and semen parameters of 100 consecutive men who also sought fertility treatment at the center in 2013 on account of infertility were analyzed and compared. A paired t-test was performed to ascertain whether sperm counts have diminished over the last decade. The World Health Organization semen values were used as standard. Main Outcome Measures: They are sperm count, motility, and mean progressive motility. Results: The mean sperm count in the 2003 group was 34.6 × 106/ml (range: 0.1–105.0 106/ml) compared with 21.8 × 106/ml (range: 0.1–80.0 × 106/ml) in the 2013 group. The mean motility was 47.9% in the 2003 group and 45.3% in the 2013 group. The mean progressive motility in the 2003 group was predominantly graded as good (50% good, 44% fair, 2% poor, 4% no motility) while in the 2013 group, the predominant grade of mean progressive motility was fair (15% good, 81% fair, 4% poor). Normal morphology was more commonly seen in the 2013 group compared to the 2003 group. Mean semen volume was 2.7 and 2.6 ml in 2003 and 2013 groups, respectively. The mean difference in sperm count (mean = 12.8, standard deviation = 31.6, n = 100) was significantly >0 providing evidence that sperm counts have diminished in the last decade. Conclusion: There was a statistically significant 37% drop in mean sperm count and mean progressive motility worsened in the last decade. These may have far-reaching effects on infertility and its treatment.

Low Sperm Counts: Biophysical Profiles of Oligospermic Males in Sub-Saharan Africa

Introduction: Male infertility is a public health burden and a psychological dilemma in the life of the affected man. Subjects and Methods: A total of 911 men were studied retrospectively, from 2010 to 2015. Among these, 49.7% had normal sperm count, 39.3% were oligospermic and 12.0% were azoosper-mic. Azoospermic men were withdrawn from this study solely to investigate the seminal fluid parameters and the biophysical characteristics of oligospermic men in contrast to those with normal sperm count. Age was stratified into <30, 30 - 39.9, 40 - 49.9, 50 - 59.9 and ≥60 years; body mass index was categorized into underweight (<18.5), normal (18.5 - 24.9), overweight (25.0 - 29.9) and obese (≥30) and standard semen analysis was performed. Results: The means (±sd) of age and of BMI of the 802 subjects of the study were 42.7 (±7.0) years and 26.9 (3.9) kg/m2 respectively. There was no significant difference in the age or BMI of normal and oligospermic men. A total of 453 (56.5%) had normal sperm count while 349 (43.5%) were oligospermic. Compared to normal weight men, those overweight and those obese were, respectively, 1.11 (χ2 = 0.44, P-value = 0.51, OR = 1.11, 95% CI = 0.81, 1.54) and 1.56 times (χ2 = 4.50, P-value = 0.03, OR = 1.56, 95% CI = 1.03, 2.36) more likely to be oligo-spermic. The mean of normal oval head sperms was significantly higher (t = -7.31, P-value = 0.00001) in normal men (47.8 ± 8.9) than in oligospermic men (43.0 ± 10.7). Oligospermic men were over 4 times as likely to produce progressive sperm motility of <32% (χ2 = 70.90, P-value = 0.000001, OR = 4.24, 95% CI = 2.99, 6.02) than men with normal sperm count. Multivariate regression analysis shows negative but significant correlations between age and semen volume (coef. = - 0.04, Std Err. = 0.01, t = - 4.01, P-value = 0.0001, 95% CI: - 0.06, - 0.02) and between BMI and sperm count (coef. = - 0.18, Std Err. = 0.06, t = - 3.26, P-value = 0.001, 95% CI: - 0.29, - 0.07). Conclusion: Our findings suggest that overweight and obesity are associated with oligospermia and oligospermia is significantly linked with low progressive motility, and various sperm cell defects.

Endometriosis and Assisted Reproductive Technology: A Review Article

Background: Endometriosis is a chronic debilitating condition which affects 6-10% of women mostly in at the peak of their reproductive age group. One of the manifestations of this incurable condition is infertility. Up to half of the women with endometriosis will be infertile. One of the means of treating endometriosis related infertility is by using assisted reproductive technology. Objective: To review the literature, share information and our experience on this poorly understood disease especially as it concerns endometriosis and assisted reproductive technology. Method: A review of the literature and our experience in managing infertile women with endometriosis was done and relevant information to the topic retrieved and reported. Setting: Nordica Fertility Centre Lagos. A private assisted conception and endoscopy centre located in Lagos, Nigeria. Results: There are a variety of protocols advocated for assisted reproduction in infertile women with endometriosis. The long protocol with the prolonged down regulation appears to be the preferred method in women with good ovarian reserve as it results in better metaphase II eggs and embryos. Presence of endometrioma does not affect the outcome of IVF and so surgery must be indicated. Risk of disease progression is low. There also no proof that IVF influences risk of cancer of the ovary in women with endometriosis undergoing controlled ovarian hyperstimulation. Conclusion: ART using the long protocol is an effective means of treating infertility in women with endometriosis. It does not increase the risk of disease progression or cancer of the ovary.

Awareness, Knowledge and Perception of In-Vitro Fertilization among Final-Year Medical Students in South-West Nigeria

Background: In-vitro fertilization is a component of Assisted Reproductive Technique. Objective: To evaluate awareness, knowledge and perception of final year medical students in In-vitro fertilization. Method: A semi-structured questionnaire was served to 126 participants in September 2015. Result: Mean [±SD] age of the 69 males (27.1 [4.2]) in the study was significantly difference (t=3.15; P-value=0.001) from that of the 57 females (25.1 [2.9]). In all, approximately 35%were sexually active 6 months prior to the survey, including 28% and 3% with one and with ≥4 heterogenous sexual partners respectively while almost 37% had never had sex. Three (5.3%) females and 2 (2.9%) males had their first heterosexual intercourse at age ≤15. Almost 63% of them heard of IVF during lectures. About 90% knew that IVF involves bringing egg and sperm together outside the body and putting fertilized egg back into the womb. While 84% regarded IVF babies as normal, 72% thought that it is too expensive, though 70% would opt for IVF in case of infertility. In all, 82% agreed that the wife is commonly blamed for infertility. Conclusion: Major source of information on IVF was during medical lectures. Most of the respondents knew of basic IVF procedure. Assisted Reproductive Technology should be stressed more in medical curriculum.

Abdominal Scar Endometriosis and Hemothorax in a Nigerian Woman: A Case Report

We report here the unusual presentation of a 35-year-old nulliparous Nigerian teacher who presented with a 5- year history of primary infertility, painful menses and cyclical umbilical bleeding. Evaluation revealed a clinically stable woman with a midline, infra-umbilical surgical abdominal scar near the site of bleeding, a large right hemothorax on Chest X-ray, kissing ovaries on pelvic scan and abdominal mass on CT scan. Prior to presentation she had been histologically diagnosed with endometriosis in 2014 by laparoscopy and biopsy after several tests to rule out other conditions like tuberculosis. She had chest tube drainage of 800 ml of brownish, chocolatecolored fluid, 2 doses of GnRH agonist injection and eventually occlusion of the pleural space due to recurrence of hemothorax.

Risk Factors for Intrauterine Adhesions in a Black African Population -Nigerians

Background: Intrauterine adhesions are associated with certain uterine procedures such as dilatation and curettage, open myomectomy and Cesarean section as well as some infections. Objectives: To determine the most important risk factors for intrauterine adhesions among Black Africans Study design, setting and subjects: This was a retrospective study conducted at Nordica Fertility Center (NFC). A total of 905 patients from three cities - Lagos, Abuja and Asaba, who consulted for infertility related problems and on whom hysteroscopy was performed between January 2005 and November 2014, were studied. Main outcome measures: Performance of different uterine surgeries, type and number of different uterine surgeries performed, and presence or absence of intrauterine adhesions. Results: A total of 905 women on whom hysteroscopy was performed were included in the study among whom 264 (29.2%) were positive for intrauterine adhesions. Women with IUA were significantly older (t=5.34, P-value=0.00001) than those without IUA. IUA was common among women who were Chief Executives (21/52, 40.4%). The overall mean [± sd] number of myomectomy (0.58 [0.66]) and of D&C (1.68 [1.82]) were significantly higher in IUA-positive women than in IUA-negative women (t=10.66, P-value=0.000001; t=4.52, P-value=0.00001). The ratio of D&C per woman was 1.70 per woman in IUA-positive women compared to 1.1 per woman in IUA negative women. Women with IUA were about 2½ times more likely to have had open myomectomy than those without IUA (Crude odds ratio=2.36, 95% CI:1.75, 3.16) and were just about twice as likely to have had D&C compared to those without IUA (Crude odds ratio=1.92, 95% CI:1.42, 2.60). Correlation coefficient study indicates that IUA was significantly (P-value<0.05) associated with performing all uterine and adnexal operations especially D&C (r=0.023, t=4.42), open myomectomy (r=0.017, t=3.45), Cesarean section (r=0.037, t=4.39), ovarian cystectomy (r=0.06, t=4.86) and salpingectomy (r=0.111, t=6.37). When the number of uterine surgeries performed was considered, IUA significantly (P-value<0.05) correlated with age (r=0.097, t=12.42), Body Mass Index (r=0.162, t=15.45), and with the number of D&C performed (r=0.014, t=2.16). Conclusion: Uterine procedures like open myomectomy, Dilatation and Curettage and Caesarean section as well as adnexeal surgeries and the number of times these procedures are carried out are important risk factors for uterine adhesions in infertile black African women. Mitigating these risk factors can help reduce the incidence of intrauterine adhesions in these women and improve their fertility.

Biophysical Profiles of Infertile Women with and without Intrauterine Adhesions Detected at Hysteroscopy

Objectives: The aim of the study was to compare the demographic, surgical and fertility characteristics of two groups of infertile women (IW) with and without intrauterine adhesion (IUA) from a diagnostic hysteroscopy. Materials and Methods: One thousand one hundred and fifteen IW were included in the study. Intrauterine examination by hysteroscopy was performed on all the subjects to enable the observation of the uterine cavity for any abnormality or pathology. Biophysical profile of IW with normal hysteroscopy were compared with those having mainly IUA as abnormal finding on hysteroscopy. Results: A total of 1115 IW were examined among whom 427 (38.3%) and 688 (61.7%) had normal and abnormal findings on hysteroscopy. Of the 688 IW with abnormal findings, 338 (49.1%) were mainly due to IUA. The mean [± SD] age (38.1 [6.37] years) of IW with normal hysteroscopy (n = 427) was significantly different (t = -5.67, df = 748.2, P = 0.000) from that (40.6 [5.80] years) of IW with IUA (n = 338). Those aged ≥ 35 years were three times more likely to present with abnormal IUA than those aged < 35 years (χ² = 38.53; P-value-0.000; OR = 3.06, 95% CI = 2.13, 4.41). Conclusions: Our results indicate that age, body mass index, and previous uterine surgery, acting independently or synergistically, are likely risk factors for the development of intrauterine adhesions among infertile women in Nigeria.

Douching Practices among Hausa-Fulani Pregnant Women With and Without Bacterial Vaginosis in Zaria, Northwest Nigeria

Objective: The objective of this study was to examine patterns of douching practices and their association to vaginal infection among Hausa-Fulani pregnant women in Zaria, Northwest Nigeria. Study design: This health facility-based study was a descriptive cross-sectional investigation, with laboratory analysis for bacterial vaginosis and other vaginal flora. Results: Of 220 participants, 85.5% consented to regular douching practices. Commonly identified methods of douching were using hand to insert plain water (80.0%), insertion of toilet soap (55.0%), using warm water plus disinfectant/salt/ black soap (18.6%) and using a jet or stream of water (8.6%). Frequent douching was associated with douching during bathing (69.5%), after passing urine (34.1%), after sexual intercourse (16.4%), before sexual intercourse (5.9%) and at any other times (6.8%). Pregnant women who douche using fingers to insert plain water were over 1½ times more likely to have bacterial vaginosis (χ²=1.30, P-value=0.25, OR=1.67, 95% CI: 0.69, 4.09) and those who douche after sexual intercourse were about 3½ times more likely to develop Bacterial vaginosis (χ²=8.88, P-value=0.003, OR=3.42, 95% CI: 1.47, 7.93). Douching during bathing and after sexual intercourse were more prevalent among subjects aged Bacterial vaginosis positive women aged 30-34 years (100.0%) and those aged 35-39 years (75.0%) respectively. Conclusions: The practice of douching was common among the Hausa-Fulani ethnic group in Nigeria. Further studies are desirable to confirm douching practices and various vaginal pathology for effective control, education, and management of female genital tract.

Laparoscopic Myomectomy: A 6-Year Experience at Nordica Fertility Center, Lagos, Nigeria

Setting: Nordica Fertility Center, Lagos, Nigeria. Patients: Thirty-one consecutive Infertile Women (IW) with myomas. Intervention: Laparoscopic myomectomy. Main outcome measures: Pattern of myomas, complications, live births. Results: In all, 139 histologically confirmed myomas were removed from 31 IW (means (±) of age = 38.03 [5.3] and of Body Mass Index = 27.38 [4.6]) during laparoscopic myomectomy (LM) for symptomatic uterine myoma. Infertility was primary and secondary in 13 (41.9%) and in 18 (58.1%) cases respectively and their mean duration of trying to conceive was 5.69 (3.5) years. Six (19.4%) of these women had undergone previous abdominal uterine surgery including LM (2, 6.4%), open myomectomies (3, 9.7%) and appendectomy (1, 3.2%). The range of uterine size was 10-24 weeks. Fibroids were observed more in multiple sites (15, 48.4%) than intramural (10, 32.3%) or sub-serous (4, 12.9%) alone. Two (6.4%) fibroids were exclusively pedunculated. The largest number of fibroid seedlings removed from a patient was 14 and median diameter of the fibroids was 7 cm. Seven (23.0%) patients had post- operative complications two amongst whom had hemorrhagic complications including one hematoma and one excessive hemorrhage warranting conversion to open laparotomy in 1 (3.2%) patient. There was no association between previous abdominal surgeries, body mass index and the rate of complications. Overall mean blood loss was 399 mls (± 338 mls). Three (9.7%) women required post operation blood transfusion. Mean length of hospital stay was 2.77(± 1.43) days. After hysteroscopy at 8 weeks post LM, 14 (45.2%) of these women proceeded to in-vitro fertilization (IVF) treatment and 3 (21.4%) became pregnant and delivered live births, one with twins. Conclusion: There is relatively low complication rate and short mean duration of hospital stay with LM. Recommendation: Considering the benefits of LM, it is recommended even in low resource settings like ours.

Online Fertility Survey

Objective: To determine the level of knowledge on common fertility issues among the population studied. Outcome measures: Fifty percent or more of the respondents correctly answering a particular question was adjudged as sufficient knowledge of that particular fertility issue and less than 50% adjudged insufficient knowledge. Methodology: The study was conducted by the Nordica Fertility Centre Lagos in 2012. A simple multiple choice questionnaire with 20 questions about fertility was posted on the Nordica Fertility Centre Lagos website for visitors to the site to answer. Results were collated and analyzed using SPSS 17.0. Results: A total of 289 persons participated in the online survey. Majority of the respondents lived in the Lagos area but responses came in from virtually all over Nigeria. A few responses came from outside Nigeria. There was sufficient knowledge on such issues as definition of infertility, age at which womans fertility is maximal, frequency of intercourse per week when trying to conceive, who to see after a year of tests with no success, basic infertility tests for men, normal sperm counts, most common sperm abnormality, strongest risk factor for infertility in women, how long to wait before seeking help in women less than 35 years of age, what is unexplained infertility, meaning of menopause and what was the most successful option for older women trying to conceive. There was insufficient knowledge on sex positions increasing the likelihood of conception, monthly chance of conception, gender that experiences infertility most, causes of infertility, fertile period and irregular cycles. Up to 65% of the respondents felt certain sex positions increase the likelihood of conception. Over 30% said that a womans fertility begins to decline from 40 years and beyond. About forty seven percent felt mere change of dates of menses monthly meant cycles were irregular. Only 49.5% correctly knew the fertile period. About 61% thought monthly natural fertility/conception rates was 50-70%. Staphylococcus was considered the leading factor in the causation of infertility by 41% of respondents, scored higher than male, female and combined factors. Majority of the respondents, 42.9% felt women were the gender that experienced infertility most while 11.4% of them said it was the men. Conclusion: There is still a need to improve knowledge on fertility and infertility. The online portal is a good source for this.