INFERTILITY is a big problem in TT.
This was the view of Dr Catherine Minto-Bain who said in the Caribbean every one in six couples who want a first or second baby could not get pregnant.
In an interview with Sunday Newsday on the occasion of National Infertility Awareness Week (NIAW) (April 21-29), the medical director of the TT IVF and Fertility Centre said about 10,000 patients had been evaluated at the centre, and estimated 30,000 people or more were currently dealing with infertility in TT. She said the stigma surrounding the issue meant few people talked about it openly. Because of that, many people did not know how much of a problem it was, especially in TT where many young women were having unwanted pregnancies, and did not know their options.
Minto-Bain said many people, especially couples, felt shame and embarrassment about not getting pregnant so they delayed finding out why. Also, friends and family often said hurtful, unhelpful, and often incorrect things when they find out about the problem.
“People are afraid of talking about it. They don't want their family and friends to know and infertility is, of course linked with sex which is something we are bad about talking openly about in TT. There are many complex things linked in to the stigma, and it is different for everyone. There is a feeling that women are ‘not good enough’ if they cannot get pregnant or if they miscarry, and men sometimes feel less masculine if their sperm count is low.
“The media internationally perpetuate the problem by not talking about the issues celebrities face - many people have to see a fertility doctor. I was delighted to see Michelle Obama opening up and talking about their IVF as it will help other couples feel more normal and perhaps more able to talk about it.”
She said awareness was key because there were many misconceptions around infertility. For example, she said people believed stress was a cause but medical science research showed that was not true. She noted that “stressed” people at refugee camps and war zones got pregnant all the time. Their problem was that they had no access to contraception. Also, many people believe polycystic ovary syndrome (PCOS) and fibroids caused infertility. However, she said most fibroids did not and many women with PCOS conceived without help.
“The other problem is that doctors don’t get fertility training so people often end up with the wrong doctor. I was quite amazed when I arrived in TT 15 years ago to see that non-fertility specialists are keeping private patients in their practice, giving obsolete treatments for years. Some of these treatments, like testosterone injections, actually cause infertility and make things substantially worse for the couple. Other treatments like Clomiphene tablets just waste time if the tubes or the sperm are the problem. In the UK you do not see an OBGYN or urologist for infertility – they do not have the skills. You go to your GP (general practitioner) first and then a fertility clinic.”
“The solution for your infertility problem depends very much on figuring out what the cause or causes are in your case. This is why coming to a fertility centre is so vital. Other doctors forget to look at both of the couple or do not do the correct or up-to-date tests. This often leads to years of wasted time or, just as bad, having surgery that does not help your fertility or in some situations might even make it worse.... There is a huge need in TT to get good, evidence-based advice out to the public so that they can help improve their own fertility, and access proper advice from a medical professional when it is not happening easily for them.”
Causes and treatments
Minto-Bain said the most common infertility causes in TT were sperm and tube problems but many other issues, such as thyroid problems, diabetes, polyps, immune issues, erectile dysfunction, and endometriosis, could cause infertility.
She said recent research by the centre showed that, unlike other countries, in TT, male causes were the number one reason for infertility. Sperm problems that cause infertility could include low sperm count due to hormonal issues, poor diet, or heavy drinking; sperm that could not swim well and get to the egg; poor quality sperm that got to the egg and inside but could not make a healthy embryo leading to infertility or miscarriages; antibodies that made sperm stick together and not get into the egg; the use of drugs or gym supplements that contained ingredients that killed or harmed the sperm’s ability to fertilise the egg; and much more.
Tube issues, she said, were more complicated. “They have a complex role. First they have to find and pick up the egg and then they have to nourish the sperm with the correct environment and then let the sperm find the egg, bind to it, and get inside.”
She said tubes could be blocked, or damaged, unhealthy, or full of fluid which could find its way into the womb and wash away healthy embryos.
As with any other fertility clinic, the centre offered a variety of tests to find the cause for the infertility, and a variety of medical treatment options to try and get a couple pregnant.
She said insemination, diet, and lifestyle advice were common for minor sperm issues. Other treatments could include medication to grow eggs, keyhole surgery (laparoscopy), insemination, or sperm injection. The tubes may need by-passing with IVF (in vitro fertilisation) or repairing with surgery by a specialised fertility surgeon, of which there were only one or two qualified in TT.
According to Minto-Bain, it was a myth that expensive treatments were needed for everyone. “Some of our patients get pregnant with simple advice, and many can get their family with the more inexpensive insemination treatment. Others get referred into the public hospital for a surgery that can help them get pregnant at no cost. It is hugely variable and my advice is to get expert advice and then you will know what your options are. If you do need IVF and are under 34, there is the option of egg sharing to reduce your costs. Other couples are suitable for minimal stimulation IVF which cuts the cost by reducing the medications used.”
She noted that after looking at treatment options, costs, success rates, and their own chances, some people chose adoption. She added that it was common for the situation and process to cause anxiety and other emotional issues so the centre has expert counsellors on hand to assist couples.
“The first step is to get information by coming to see us and getting expert advice. Information gives you options. With knowledge about your situation, you become emotionally stronger. Once you know what the problem is you can face the next decisions.”