We have been fans of Dr. Yemisi Adeyemi-Bero for a while, especially after reading about her relationship with Celebrity Photographer, T.Y. Bello, who welcomed the most gorgeous twin boys in 2014. Last year, we had the opportunity to meet her at a fertility seminar, and we were further star struck by her. The more we got to know her, the more drawn we were, not only by her expertise, but by the warmth of her personality, and her spirituality. In November 2015, Oluwakemi and I attended their monthly fellowship for TTC women, called Hannah’s Room (which holds on the 2nd Monday of every month), and it was a life changing experience! Last week, Oluwakemi was able to chat with her, so that we would be able to share with our Community Members, a better understanding of her work, her practice, and the woman herself.
What made you decide on the speciality of Obstetrics and Gynaecology, and eventually fertility?
First of all, for some reason, it happens to be a natural instinct for me. All my life, I have always wanted to be a doctor. I come from a medical background; my father actually trained me in medical school, and my mother was a midwife, who had her own clinic. So it was a natural flair. And I can remember vividly, as young as seven, I was walking in our garden once, and thinking “I would want to be able to help women, who can’t have babies have babies”. I did not know what that was all about then though.
I remember, there was a friend of my mom’s who did not have kids, and after my mom told me her story, I thought, you know what? I would like to help women like her!
What factors do think have contributed to the rise of infertility? And which types of infertility do you encounter most commonly?
Well, the four major things that are important are the eggs, the sperm, the woman’s uterine lining, and her ovum. Those are the things that contribute to natural conception. Perhaps the thing that has contributed to a rise in infertility is the environmental factor, majorly, more than anything else. We can’t really place our finger on it, but a lot of things are happening that can’t be explained, but environmental and lifestyle issues are major culprits.
Sperm count over the years has decreased, compared to way back. We hardly see normal sperm count these days, in all parameters. We also have situations where young girls come in their 20s, and their ovarian reserve is very low, and some can’t even produce any eggs; it is getting that bad. What we can attribute this situation to, more than anything else, is the environmental factor.
However, there is a practice in our society, which has not helped at all, especially when it comes to egg quality. Some people insert herbs trans-vaginally, in a bid to shrink fibroids, and for other reasons. We have noted that this practice absolutely destroys the reproductive tract of the woman, and we need to create more awareness discouraging practice.
What can couples do differently to prevent these from occurring?
Well, first of all, I will say, it is good to have knowledge about your reproductive system, and how conception takes place. So, if after a year without natural conception, it would be really nice to seek help fast.
It is also good to be well nourished; eat a balanced diet, consisting of fresh, organic fruits, and avoiding processed food as much as you can. The deficiency of vitamins could also stand in a couple’s path of achieving a natural conception.
Changes in lifestyle, such as dropping some bad habits like smoking and alcohol intake, are also steps in the right direction.
At what point should a couple consider Assisted Reproduction, IVF in particular?
Usually, there are some absolute and relative reasons for IVF. I will start with the absolute, meaning there is no way a person would be able to conceive, except they did IVF, barring of course, the supernatural, which we believe in here.
If a lady knows her tubes are blocked, completely blocked, then there is no need to wait for the one year. She needs to come immediately, so she can start the procedure.
If the man’s sperm count is very bad, or he has no sperm count, he should see a doctor immediately. There are things we can do to get the sperm. There is no need to wait for the one period, we usually advice. If there is an underlined issue, it is better to start on time, rather than wait.
If you have bad history of fibroids, it pays to go straight to a doctor, rather than waiting around.
Also, age! For the older age group, say from 37 and especially people in their 40s, there is no need to try. Just see a doctor immediately. Also, if you have tried for three years, regardless of the cause of the infertility or other reasons, it is advised that you go straight to IVF, rather than try other things.
At what point should a couple opt for more specialised assistance, like Donor Eggs/Sperm and/or Surrogacy?
Everything is individualised. For egg donation, we usually advise that when a woman is 44 years old and above, she should opt for an egg donor, although we individualize it, as we check their hormones and ovarian reserve, but most often that not, donor eggs would be a better option.
Now, we also do a test called the AMH, which kind of tells us how the ovarian reserve is. Usually values lower than one are associated with IVF failure, which has been proven over and over again. However, a few younger patients, 35 and below even, with values less than one, sometimes achieve pregnancies, because, like I always say, a young egg will speak for itself. So, if you have a value of 0.8 in a 29 year old, it is not the same as having it in a 41 year old. The 29 year old with such a value might not be able to produce as much eggs, but the one or two eggs you get will likely end up in a baby.
Usually, the number of abnormal eggs a woman produces increases with age. The older a woman is, the higher the number of abnormal eggs she would produce, and you know, nature has its own way of getting rid of abnormality. It is either it would not allow it to form, implant, or there will be a miscarriage. That is for eggs.
Like I said earlier, some younger patients may have inserted herbs, or suffered premature ovarian failure but, usually, that AMH is our guiding point. If it is less than one, we take it individually, and if your age is more than 44, we advise you to opt directly for donor eggs.
Now to the issue of sperm, and the use of donor sperm. Some men do not produce sperm. This condition is called Azoosospermia. How? It might be a problem of blockage, or of production. If it is a problem with blockage of the tubes transporting the sperm, we are usually able go into the testes, and get the sperm, and we have achieved pregnancies with this method.
However, some men do not produce sperm, either due to the fact that they were born like that, or a traumatic accident to the groin as a child, or childhood diseases like mumps. The testes may have been twisted. In these cases, we ask the couple to opt for donor sperm.
Some women’s wombs have been completely damaged, from scar tissue, either from repeated abdominal surgeries, fibroid surgeries, etc. These, if not done properly, can damage the lining of the womb, such that they stick together, called the Asherman syndrome.
Sometimes, you might be able to treat it somewhat, and some times, one is not able to get access to the uterus. In such a case, you would advise the woman to use a surrogate. Or some women are not born with wombs, but have ovaries, so you take their eggs, and transfer it into a surrogate.
Another medical indication for using a surrogate is if a woman is not medically fit enough to carry a baby, either because of a heart condition, or a bad case of sickle cell anaemia, where you don’t want to put the woman’s organs under stress.
Or occasionally, you have had repeated implantation problems, for unknown reasons, in which case, we would advise them to use surrogates.
Your clinic is renown for providing excellent donor and surrogacy services. How do you recruit Surrogates and egg donors?
We have someone in charge, who manages that department. There are some agencies that she contacts and communicates with. I can’t give details. What we know is that, once we get the donors, who are usually students, we interview them, we screen them, and explain exactly what it entails, and they sign consent, to confirm they know what they are doing, before we go ahead to use them.
Is there a difference between a Surrogate and a Gestational Carrier?
Well, there are two types of surrogates; one is Traditional Surrogacy, where the ovum of the surrogate is used. It is taken, combined with the man’s sperm, and transferred into the same surrogate through artificial insemination. That is traditional surrogacy, when part of the surrogate’s genes are involved in the foetus that is formed.
The other is the Gestational Carrier, where there is no DNA of the surrogate in the baby; she is just a carrier. It is just her uterus that is being rented, so to say. Usually, we do opt for the Gestational Carrier option. We avoid doing the Traditional Surrogacy, as much as possible.
Is there a particular reason for that?
Well, thank God, we have not had any litigation. It hasn’t come to that. But in event that it happens, once you do the DNA test, the Surrogate will have no claim to the baby, as her DNA would not show in the baby’s DNA. That’s the main reason we don’t do Traditional Surrogacy.
From your experience, how accepting is our society of Surrogacy?
Well, I will say years back, it used to be a taboo and unheard off. People did not even want to hear about it, when you suggested it. But people are now more aware, and we do it so often, because it is very necessary. In cases where the subject of egg donors and surrogacy comes up, it is usually a case of “You use this method, or you don’t have a baby”. So usually, when it gets to that point, people are accepting. Generally, it is more acceptable as people get more informed about it.
How easy is it to find appropriate surrogates for intending parents?
First of all, you have the option of meeting the surrogate, or not. We show photographs, tell them the background, and they can choose their surrogate,without meeting the surrogate, till delivery. We help them follow up on the surrogate.
But usually, it is quite easy. We have been doing it for a while, and the ones we have on ground tell their friends, family and colleagues.
What are the financial and legal aspects of this arrangement?
In Nigeria, there are no laws guiding surrogacy and ovum donation. They are just trying to make the laws. In our institution, we try to be as open and transparent as much as possible. We have a lawyer, who comes in, talks to the surrogate, and the intending parents, and they sign papers, and these contracts are binding. That is where we are now. Otherwise, there are no rules yet guiding this practice in the country.
And you know such things can be abused, so we try as much as possible to stay within the confines of both known and unspoken laws, and also follow some laws abroad, since we have no laws here. We also will not go below some ages, for a donor and surrogate.
For the financial aspect, sometimes the surrogate or donor may just be altruistic, meaning, she is just doing it for humanity sake. But in our environment, we know that people want to be paid for it. They are paid a fee, during the pregnancy, for maintenance and a bit more. While I don’t think this is the forum to discuss this, a surrogate is paid roughly anything from One Million Naira.
What is the screening process in choosing a Surrogate / Egg Donor?
For the Surrogate, she ought to have had a child before, so definitely must be over 21 years old, to have had a child before. We screen for infections, which include Hepatitis B and C, HIV 1 and 11, syphilis, and we take a detailed medical history, as well as a detailed physical examination. We do the same for the Egg Donor.
We know that the major motivation for both donation and surrogacy is money. Is there a limited number of times a woman can be a Donor or Surrogate?
First of all, the Surrogate must have had one child at least before, but we don’t usually want them to have had more than four or five births beforehand. It depends of how many she has had before she came in, so you need to work it out, because there are complications associated with the more children you have. If she’s had two children before and says, she doesn’t want more, you can use her twice, but you need to consider her age, and the number of children she’s had, and the number of children she still plans to have, before you make that decision.
For a Donor, the universal standard is she shouldn’t do it more than six times, but I tell you, six is even much, because in the Western world, they don’t harvest as many eggs as we do here. We tend to harvest more eggs in our environment, so I will say three to four times. But you see, these ladies go around clinics, and you don’t really know what’s going on. But I will just stick to six for now.
How much role does Counselling play in this process for both the Donor/Surrogates and Intending Parents?
It is absolutely important, because for the Donors, they complain of feeling empty afterwards, and sometimes, they are not even allowed to see the babies, so they need a lot of counselling, from the beginning of what to expect right through to the end. They need to be reminded that it is not their baby, they are just helping. They cannot afford to feel any attachment, and feel like they cannot let go. So we do a lot of counselling, and even for the intending parents, we do a lot of counselling for them too.
We do something called peer-to-peer counselling, where we introduce couples who have done surrogacy before to people who are just starting, and they discuss those things which they found challenging regarding the process.
But in our clinic, we haven’t had any problem. Once people decide, they go all the way. They are happy, and everyone is happy.
What advice would you give couples seeking to use Donor eggs or Surrogates for the first time?
Okay, usually what I say is, thank God for that option. There are people who are childless today, because they did not have that option years ago, so thank God for that option. For people who have issues coming to term with using a donor, I tell them, outside the biological inheritance of a child, there is the spiritual and the social inheritance. You have no control over the biological inheritance anyway, because why do you want your own biological child? You want the child to have your brains, your character, to look like you, but can you control that? No, it might not look like you, but like someone you have never met in your family, or may or not have your brains. You really cannot control these aspects, but you have control over the social and spiritual aspect of the child, so you can do a lot on that.
And speaking with people who were against it at first, but came round later, they tell you once you birth a child, you wouldn’t know the difference, because you didn’t create the child, it just came out of you.
I mean, you have already started bonding with the child from the womb. Apparently, it is the person who carries the child who determines the cross between the sperm DNA and the egg DNA, so you as a surrogate kind of have an influence on the baby that is formed. Once you birth the child, you wouldn’t know the difference in what you would have produced and what you have. Now, you just have to work on the spiritual and social inheritance, which is what God is looking out for; how well you nurture that child.
That’s why we are particular about surrogates not getting attached to babies they carry, because you are closer to the child you birth, than one a surrogate carries for you.
There are many mothers, who are not moms. It all depends on what you get out of it. Same with fathers and sperm donors. As the donor, or surrogate, we stress the need to keep things strictly confidential, and I see no reason for you to spread it to the world. It should be between the couple and them alone. For the sake of the child, keep it to yourself. It is useless information, if you decide to share. And let life go on as it is.
With surrogacy, it is all dependent on the couple, if they want to tell. If they want to make it seem as though they birthed the baby themselves, there are ways it can be done. It is all about what they want to do, and we help them achieve what they want.
What is the success rate of using these options to expand one’s family?
Well, the success rate depends on a lot of things, like the quality of the eggs, the quality of the sperm, the quality of the embryos, and the quality of the lining, and when we think the lining of a surrogate will be very good, we go for surrogacy, and if the embryos are good, we have been able to achieve 60 to 80 percent success rate.
The same for donors too. It could range from 40 to 60, even 80 percent, depending on other surrounding variables. Because donors have young eggs, and a lot is dependent on that.
How many cycles would you advice a couple starting out to prepare for?
Like I explained to you earlier, because donor eggs are young eggs, we tend to have a higher level of success, if the other variables are right. And a higher rate of achieving pregnancy in the first or second attempt. However, as with all IVF cycles, we advise they prepare for three cycles.
What are some of the challenges of egg/sperm donation and surrogacy that you have encountered?
Well, there is a complication of IVF called Ovarian Hyper-stimulation Syndrome (OHSS). Mostly because donors are young, they have a tendency to be over stimulated. It is a challenge, and we have to treat them, because we know it is a life threatening condition. We are always on top of the situation, watching and following up. We have never had any loss, and we will not have any, in Jesus’ name.
We haven’t really had much challenges so far, although we have had donor eggs not responding, even when we have done everything. The problem with them is that they go around clinics, and don’t tell you. It is an issue, we need to tackle here. The challenge with that is their eggs might not respond as well as you want, even when all other variables are right.
Is that not a challenge that Fertility Practitioners, which are still not that many in number, can tackle?
We are 46, 47 clinics doing IVF now, and there is no way you will know if a donor has gone somewhere else, at least for now. We don’t have records. We are trying to find ways to have a central donor bank, so we don’t have to deal with this challenge anymore.
Should a cycle fail, what kind of post-cycle support do you think a couple should get?
First of all, it is always better for them to come back to have a post cycle discussion, for them to talk, and to have closure, concerning that cycle. To talk about what might have been the possible cause of the failure, protocols, and what needs to be changed in subsequent cycles.
That’s all, a chat?
You see, sometimes, it takes a chat to truly understand a person’s chemistry. The lab investigations might not show it all and it would require a cycle to fully understand how a person would respond. Short of doing a cycle, you cannot know some things. After that, you can now know the other hidden things, and work on providing better options, and advise appropriately.
In all your years of practice, what have been your highest and lowest points?
I graduated in 1988, and started working in fertility in 2006, so that’s almost ten years. The worst part for me is having to tell a patient, that is so expectant, that the pregnancy test is negative.
I don’t like giving bad news, and sometimes, you achieve the pregnancy, and you do a scan, you don’t see sac, or you see sac and you don’t get a heartbeat. So it can be very depressing, even for me. I have had to make a conscious effort to break out of it.
Another low point is when there are complications. Like I told you, OHSS, it can be very bad at times, and a bit of challenge. But we have worked on it over the years, and have decreased our incidence rates of the ovarian hyper-stimulation syndrome.
The high point, of course, is our success. For us here, we take it spiritual, as we pray and praise God for every single pregnancy we achieve. It’s very exciting, and the highest points are when the ones you have given up on actually conceive. When you are just doing everything; the eggs, the lining and everything are not impressive, but yet they get pregnant! That can be very exciting.
How has experiencing infertility first hand helped you?
Well, at the time I was thinking that I wanted to help women who couldn’t have babies, I never fully knew what I was thinking. However, I experienced it myself. It took me 7 years before I had my son, so I was this woman who actually went through it as well.
Going through it has made me more emphatic, especially with women going through it, because when you tell them things and they say, “Dr. Bero, you don’t know how it feels,” I tell them I have been through it.
I went through IVF twice in America, when I lived there. Neither of them worked, and I know how hard I cried, when I found out I was not pregnant, each time. At the time, I was absolutely uninterested, as I was doing my residency in family practice in America, and thought if I did IVF, I would surely get pregnant. I was young and nonchalant about it.
I did it once, I didn’t get pregnant. Same for the second cycle, and I was shocked it did not work out for me. And then I got pregnant, the same month I came back home to Nigeria. I got pregnant naturally, by God’s grace.
As a wife and mother, how do you juggle your business and your personal life?
It can be very challenging but, thank God, my children are somewhat grown now, and are in boarding school. With my husband, initially, it was a bit of a challenge, because he knows I love what I do. After God, it is my family, and then my work, but he felt my work came before my family, but now, we have come to terms with it.
The good thing is that the children are grown now, and in boarding school, so I’m able to do more now than I would, if they were younger and at home. So, that has helped. And my husband has come to terms with my passion for this job.
I now understand why I’m the only woman doing it, because it takes so much out of you…so much! But I have managed just fine. Besides, I have very good staff, that we have trained over the years, and that has obviously helped a lot.
Given your obviously hectic schedule, how do you relax?
Well, I love swimming, I do that a lot. I do try to find time to travel, and do things. I do try. I play the piano, which is very relaxing. I do try to sort myself out, once I’m out of work. It’s just that, sometimes, I need to make that conscious effort to shut off and do something else.
If Dr. Bero wasn’t a doctor, what would she be?
You know, I have thought about that a lot. If I wasn’t a doctor, I probably would do something in interiors. I love interiors, I love doing up places, transforming spaces.
Did you decorate this place?
Yes, and I’m doing up the new location as well. Someone asked if I was going to get an interior designer, and I said never, because I’m very particular about things. I would probably have been an Interior Decorator or a full time Pastor.
© The Fertile Chick
Dr. Yemisi Adeyemi-Bero is the Medical Director of The ARK (The Alpha Assisted Reproductive Klinic), located at 7, Hannat Balogun Drive, Dolphin Estate Extension, Ikoyi, Lagos (Telephone: 0701 445 7782; 0808 753 4018; E-mail: firstname.lastname@example.org; Website: http://arklinic.com)