Dr. Babatunde Okewale, front man of St. Ives, enjoys talking about IVF and dissecting infertility. The good looking gentleman and Fellow of the Royal College of Obstetrics and Gynecology (UK) spoke with our Publisher/Editor-in-Chief, AZUH ARINZE, at the Arepo, Ogun State office of his newest venture, the female-sensitive radio station, WFM 91.7, on Wednesday, November 25, 2015. A father of four, he trained and qualified in 1985 as a medical doctor at the University College Hospital, in Ibadan, Oyo State. Thereafter, he travelled to the UK where he practiced for 10 years as an obstetrician and gynecologist at Leeds, Manchester and Oxford, before returning home to set up St. Ives Specialist Hospital, one of the leading IVF cum fertility centres in Nigeria. He shared some of the things that stand St. Ives out, the unknown causes of infertility, how to cope when IVF fails and more with us. Enjoy…
What got you interested in IVF?
Like I said, the first thing I specialized in is… I’m a gynecologist, first and foremost. I treat every aspect of women diseases. But when I came back to Nigeria, or even in the UK, I realized that over 50 percent of gynecological consultations in Nigeria had to do with fertility. Abroad, maybe people will talk about things like my periods are too early and the rest. But in Nigeria, over 50 percent of all the patients, gynecological patients you see, are talking about infertility and I had no choice but to sub-specialise in that field, otherwise I will not be able to help nearly half of my patients. So, I went back and sub-specialised in infertility. It took us like 10 years after I had started my gynecological practice in Nigeria before we opened the IVF and infertility units and today we thank God for that.
What distinguishes St. Ives from the other hospitals that are also into IVF?
Well, most IVF clinics or hospitals do only IVF. They don’t do anything else. But we are lucky we started being a hospital first for women, then the children aspect of our practice came along and then the family aspect came along, before we now opened another aspect that deals with infertility and IVF. So, we are a more complete (hospital) in a way. We don’t only get people pregnant, we also manage the pregnancy.
For people who really do not understand, what does IVF mean?
IVF basically means invitro fertilization. That’s the definition. Fertilization normally occurs inside the woman’s body in her fallopian tube. When a woman and a man make love, the sperm travels all the way; the woman releases the egg and fertilization occurs inside the tube. That is normal fertilization. In IVF, the fertilization occurs outside, inside the laboratory. What it means is, we pick out the woman’s egg from her body through the scan and the man produces the sperm and then we make sure fertilization occurs in the dish in the lab. So, that’s why it’s called invitro fertilization. The other kind of fertilization is called invivo; vivo means inside. Invitro means outside. Invitro fertilization.
From experience and with the benefit of hindsight, what would you say are some of the causes of infertility? Especially in Nigeria where you’ve been practicing for years now?
I think generally there’s a gradual increase in the incidence of infertility for various reasons. Part of the reason is people, especially women, are getting married at a latter stage than when they used to in our parents’ time. You find a lot of girls at the age of 30, 34, 35 that are not yet married and the fertility clock in a woman starts to decrease after the age of 35. The peak time a woman should get pregnant is somewhere between age 20 and 30. So, if you leave getting married and having a child late, then there’s a sort of infertility. Secondly, the incidence of sexually transmitted diseases is on the rise. Although, the common ones that we used to know in the past, the gonorrhea, etc, they are now on the downward trend, because of the strong anti-biotics that are presently in the society. But the newer types of infections, they are the ones that are very silent. They don’t cause any discharge or any…
(Interruption) – What are those ones called?
Chlamydia. That’s the No. 1. It’s quite common now. It causes sexually transmitted diseases, it blocks the women’s tubes, it damages the men’s testicles, because that’s where the sperm is. So, you find a lot of incidence of blocked tubes, because of the increase in sexually transmitted diseases and low sperm count.
When should a woman not try IVF? At what age should a woman shut her mind from going for IVF?
Personally, I believe it’s the fundamental right of every woman to have a child at whatever age she wants to have the child. I think it’s her fundamental right. Just like a man. You cannot ask when a man should not have children. You find 90 year-old men just marrying young brides and they have children. The issue is there’s a particular age at which the woman normally by herself will not be able to have a child anymore. For most women, by age 40, it becomes increasingly difficult for them to have children. For IVF, depending on which type of IVF you are doing, you can have children up to any particular age. Two years ago, we had a 60 year-old woman that had her own child. But I believe it’s a fundamental right.
When people come for IVF and it fails, how do you talk them out of the emotional and psychological pains and trauma?
I think that’s the most difficult part of IVF and that’s what I mean by the expectation in the environment. The greatest complication of IVF is failure. Not just ordinary failure; IVF comes with a lot of emotional baggage. The expectation is high, all the injections the woman goes through, the waiting period, before the pregnancy test is done, the cost (money) that had been sunk into the project and then finally if it doesn’t come out right, it could be quite devastating and that’s where counseling comes in. You try and counsel and the kind of feeling couples go through after a failed IVF is similar to having a miscarriage. They go through the period of grieving, guilt, blaming the doctor, blaming the hospital and what not. So, it’s usually a very emotional bit, but with adequate counseling one overcomes it.
What are those things that can make IVF to fail?
IVF can be likened to the work of a farmer or a gardener. A gardener and a farmer are interested in only two things – the quality of the seed they have and the quality of the soil in which they are going to plant the seed. If the seed is good and the soil is very fertile, the chances are the plant will grow. In the same way, when you break down IVF into its basic minimum, it depends on the quality of the seed, which is the embryo that is formed and the quality of the lining of the inside of the woman’s womb. So, when you hear that IVF failed, it’s either the seed, which is the embryo is not good enough or the lining of the womb is not fertile, it’s not good enough, which is likened to the soil and unfortunately, those two things are dependent on the woman’s age. The older a woman grows, the lower the quality of her eggs and the quantity of the eggs. And the worse the inside of the womb becomes. So, usually, most of the time, it’s either of these two things. So, when you are doing IVF, we are trying to make sure the seed or the embryo is of quality and you also try to make sure the inside of the womb is good.
Most people have this impression that IVF is very expensive. What’s the cheapest IVF that anybody can get? Especially at St. Ives…
IVF, whether it’s cheap or cost-wise, is usually a very relative thing. Frankly speaking, most of the things you do in IVF are very high-tech, most of the equipment, everything is imported. So, sometimes it is the cost of those things that is reflected in the patient’s payment. IVF is generally not cheap anywhere in the world. In comparative term, I think it’s cheaper in Nigeria…
But what’s the minimum amount that one can pay at St. Ives?
I think you should be looking at, inclusive of everything, something between N500,000 to a million. When we do our promos, which we do once a year, it usually comes to something like N500,000. But in a normal cycle, it could go as high as slightly above N1 million. But it’s (IVF) not the most expensive medical treatment. Kidney transplant is more expensive, cardiac surgeries are more expensive. But the reason why IVF is more emotive is because people don’t see infertility as an illness. So, sometimes if it’s not successful, it’s seen more or less like a wasted money.
You’ve been into medical practice now for over a decade. What would you describe as the most memorable occurrence at St. Ives since you set up shop?
There are quite a few memorable things, but I think in recent years, the most memorable thing was the delivery of the 60 year-old woman, who was the oldest mother in Africa. CNN and BBC came to interview us and to interview the woman. I mean, that was quite memorable.
What do you like most about being a medical doctor?
All I see day in, day out are people giving birth to babies. There’s so much joy in it. People giving thanks to God for getting pregnant and things like that. It’s a profession I can never leave.
What don’t you like about being a medical doctor?
Well, the things I don’t like about doctors, I can put them in perspective – the expectation is high in Nigeria about what and what a doctor cannot do; people assume doctors have all the answers, which they don’t. I think in the UK and America, people actually know the things doctors can do and cannot do. But the expectation in Nigeria is exceedingly high.
What is the greatest thing that being a medical doctor has done for you?
Being a medical doctor has exposed me to diverse kind of people; I’ve met the rich, the poor, the average, I’ve met different kinds of people. I’ve learnt to understand the psychology of people. It’s put food on my table and it’s allowed me to pursue my other passions in life.
Some people attain success in the medical profession, but they are not able to sustain it. Where do they normally miss it?
Like in many other businesses in the world, I think you get it wrong once the motive changes or the focus changes. I like to use this as an example: I’m a gynecologist, I believe as an expert or as a consultant that I know the A to Z of gynecology. If you wake me up in my dream, once you say there’s a problem in gynecology, I know what to do. It comes natural to me. So, I stick to that area of specialization. But I would run into trouble the day I start behaving or thinking I’m a neuro-surgeon and I’m called to do neuro surgery and I claim to know it. So, most of the time people lose focus about their calling. Even within Medicine. Unless you are a GP (General Practitioner), you cannot be a Jack of all trade. The things you can do, you do, the ones you cannot do, you refer to experts that are more knowledgeable than you in that aspect.
Constantly coming in contact with naked women, of different shapes and sizes, how does a doctor overcome the temptation of messing up with them sometimes?
Oh, you focus and stick to what you do. Otherwise you derail and the business also derails.
How much of a family man are you?
I am a family man. I have a wife, I’m married. My wife is Mrs. Kikiope Wale-Okewale. She’s a PR consultant, she also owns her own shop where she sells fabrics. I have four children – my first daughter is a medical doctor. She got married recently, she is in the US now. Her name is Dunni. Then, my son is a computer engineer. His name is Demilade. My other two children are Kikinyi and Koyinsayemi. They are younger and in the younger schools.
Away from work, what are the things you do to relax?
I create time a lot to unwind. My typical day is – I go to work by 9am, by 3/4 or 5pm, I’ve already wound up for the day, unless there are emergencies. I go out with my friends, I belong to Country Club, but I rarely go there. I just chill out with my friends generally.
NB: First published December 2015