By Joshua Surtees From Guardian Media

The assumption that the Caribbean is a hotbed of fertility is a fallacy, local experts say.

Rising teenage pregnancies and large families with up to ten children can give a false picture of a highly reproductive population but, with a falling T&T birth rate (currently 15.2 births per year per 1,000 people), the medical director of T&T’s only IVF fertility clinic, Dr Catherine Minto-Bain, says we are just about replacing our population.

In reality, she says, T&T and the rest of the region has major problems that need to be addressed.

April 21-26 is National Infertility Awareness Week, a movement celebrating its 25th anniversary this year with events where people can find out about the issues involved.

Male infertility is the biggest problem. Last year, Health Minister Fuad Khan revealed that 34 per cent of T&T’s men have a low sperm count, based on tests over a two-year period.

At the T&T IVF Fertility Centre (TTIFC), Minto-Bain says, 90 per cent of the women who want to donate eggs are rejected because they don’t have enough of sufficient quality to be accepted.

Male and female fertility rates are the subject of ongoing research but, so far, answers are elusive. There appear to be no patterns according to ethnicity, geography or age in terms of male reproductive health.

In 2011, TTIFC published a report and held a symposium exploring male fertility levels based on a sample of its 3,000 patients.

They were interested in whether environmental pollution might be affecting fertility, but, the MD says, infertility did not cluster around any industries in particular, neither petrochemical nor farming.

TTIFC is now part way through a UWI-funded research study into T&T’s women, particularly the rise in the number of women with polycystic ovaries.

It is known that African-Caribbean women are more likely to have high numbers of fibroids (muscular tumours) in their ovaries than other ethnic groups—making it more difficult to get pregnant—and that they produce fewer eggs, with an earlier menopause. But the low number of healthy eggs in women in their late 20s and 30s was across all ethnic groups.

“Trinidad has big problems,” Minto-Bain said. “Obesity and diabetes are contributing factors. We currently have 4,000 on our books and we haven’t done any advertising campaign for eight months as we are inundated. It’s all word-of-mouth.”

Financing fertility treatment is a major issue for many in T&T. It’s certainly not cheap—full IVF costs $31,000.

But the TTIFC has adopted the UK-pioneered system of egg-sharing.

Under the system, if a couple is experiencing problems due to male factor (low sperm count), the woman in the couple can volunteer to donate eggs to the clinic, for the benefit of other women to use for IVF, and in exchange can receive IVF treatment themselves for $5,000.

This would have made a huge difference to women like Sherma Dyer (name changed)

Now aged 43, she and her husband began trying for a baby before they turned 25. They could not conceive and eventually went to a gynaecologist (there were no fertility clinics back then, TTIFC was established 17 years ago) who prescribed Clomid—the most commonly used fertility-aid drug.

When that didn’t work she had an operation to clear her blocked ovaries but, she says, “After a while I guess we kind of gave up. It was very costly to keep returning.”

At her age egg-sharing is no longer an option. In the end the couple adopted and now have a six-year-old child.

Adoption is an option Minto-Bain recommends to many of her patients.

“We have a good adoption board here in T&T,” she says. “We spend a lot of time talking to people about their options. These people are real. To go ahead with IVF they might have to re-mortgage a house, sell a car… Sometimes I tell them honestly IVF won’t work for them, so go for sperm donors or adoption.”

The TTIFC, unlike some clinics in the region, does not market itself heavily. “It’s a fine line between selling a product and selling dreams that are unobtainable. Many women won’t get pregnant through IVF,” she says.

At the other end of the scale, the more recent clinic in the Caribbean, the Barbados Fertility Centre (BFC) has been publicising its services more aggressively

Last month the BFC held a free conference in Port-of-Spain for people interested in IVF.

Established in 2002 by Dr Juliet Skinner it prides itself on being JCI accredited, the only fertility clinic with such accreditation in the Caribbean. Its marketing literature boasts that women travel from across the Caribbean and the world for treatment.

IVF treatments at the BFC are expensive. At US$5,500-6,500 it is an option that normal Trinidadians and Tobagonians might struggle to afford.

Simpler treatments such as intra-uterine insemination—the introduction of prepared sperm into the uterus—cost $375.

Speaking to the two women, one gets a sense of the competitiveness of the industry.

Minto-Bain describes the JCI as “a marketing tool for the US medical population, not IVF accreditation.”

In the Bajan corner, Dr Juliet Skinner, consultant gynaecologist at the clinic, says that “other clinics in the Caribbean do not work to a recognised accredited standard.” A claim Minto-Bain rejects, saying her clinics and services in Maraval and St Joseph are regularly inspected by accreditors working to the UK’s HFEA standards.

Minto-Bain says her multiple-pregnancy rates are very low: 3.8 per cent of conceptions are multiple.

“You need a low multiple-pregnancy rate in Trinidad because the public health system can’t cope with too many births and there is no private care. It’s not fair to overload the system with twins and triplets.”

Skinner, meanwhile, focuses on the success rates of her clinic, saying 80 per cent of women under the age of 35 achieve pregnancy after treatment.

FACTBOX

– Women are born with seven million eggs. Microscopic in size, they are released throughout the woman’s life in monthly ovulations, until she reaches menopausal age.

– Men are not born producing sperm but begin to at puberty and continue to produce sperm, typically beyond the age of the female menopause

– The first ever test-tube baby, Louise Brown, was born in Oldham, England, on July 25, 1978, after her mother was treated with the first IVF procedure by Patrick Steptoe and Robert Edwards. Edwards was later awarded the 2010 Nobel prize for medicine. It took 175 IVF treatments before Brown was conceived.

– Low sperm count in men is usually genetic but can also be due to lifestyle, injury, infection.

–       Information on National Infertility Awareness Week can be found at the website www.resolve.org

Dr Catherine Minto-Bain at work in her clinic the T&T IVF Fertility Centre in Maraval. PHOTO: Kristian De Silva

For more on this story go to:

http://www.guardian.co.tt/lifestyle/2014-04-14/caribbean-fertility-rates-low