Different Strokes for Different Folks but some ... - University of Ilorin

UNIVERSITY OF ILORIN
This 111 th Inaugural Lecture was delivered under
the Chairmanship of
ONE HUNDRED AND ELEVENTH (111 TH )
INAUGURAL LECTURE
“DIFFERENT STROKES FOR DIFFERENT
FOLKS BUT SOME COUPLES DO HAVE
THEM”
The Vice-Chancellor
Professor Is-haq Olanrewaju Oloyede
B.A., M.A., Ph.D., P.G.D.E. (Ilorin)
26 TH JULY 2012
BY
PROFESSOR ABDULGAFAR ABIODUN AKANBI
JIMOH (MBBS, FWACS, FICS, FWALS)
PROFESSOR OF OBSTETRICS AND GYNAECOLOGY
FACULTY OF CLINICAL SCIENCES,
COLLEGE OF HEALTH SCIENCES,
UNIVERSITY OF ILORIN, ILORIN, NIGERIA.
THURSDAY, 26 TH JULY 2012
Published by
The Library and Publications Committee
University of Ilorin, Ilorin, Nigeria.
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BLANK
PROFESSOR ABDULGAFAR ABIODUN AKANBI
JIMOH (MBBS, FWACS, FICS, FWALS)
PROFESSOR OF OBSTETRICS AND GYNAECOLOGY
FACULTY OF CLINICAL SCIENCES,
COLLEGE OF HEALTH SCIENCES,
UNIVERSITY OF ILORIN. ILORIN, NIGERIA.
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Courtesies
The Vice Chancellor
The Deputy Vice Chancellors (Academic, Management
Services, Research, Training and Innovations)
The Registrar
Other Principal Officers of the University
The Provost, College of Health Sciences
Deans of Faculties, Postgraduate School and Student
Affairs
Directors Unilorin and UITH
Professors and Other Members of Senate
The Chief Medical Director, UITH
The Chairman, Medical Advisory Committee, UITH
Heads of Departments, Academic and Non-Academic staff,
Unilorin
Heads of Departments, Clinical and Non-Clinical staff,
UITH
Members of the Academic and Non-Academic Staff
Traditional Rulers here present
Distinguished Invited Guests
Gentlemen of the Print and Electronic Media
Families (Nuclear and Extended), Relations and Friends
My Patients (Past, Present and Future) (I recognize you all
specially)
Students of the University of Ilorin and other sister
institutions.
Distinguished Ladies and Gentlemen
Preamble
Mr. Vice Chancellor Sir, To Allah belongs all glory
for making it possible for me to deliver the 111 th inaugural
lecture of this distinguished university- the ‘Better by Far’
university. In accordance with Allah’s injuction in the first
revelation of the Holy Quran, where the Holy Prophet
(SAW) and by extension all muslims were enjoined to read,
learn and propagate knowledge (Suratul ‘Alaq Q 96,v 1-5),
I stand here to share my experience with us and
demonstrate my modest contributions to knowledge and
practice of Obstetrics and Gynaecology.
I must also thank the University administration ably
led by the VC for my elevation to the exalted position of
Professor of Obstetrics and Gynaecology.
I am thankful to the entire University community
for giving me the opportunity to share with the community
(academic and non-academic) the experience of my life as
an Obstetrician / Gynaecologist as well as my contributions
to knowledge and practice of my specialty and
subspecialty.
This is the 4 th inaugural lecture to be delivered from
the department of Obstetrics and Gynaecology of the
University. The first three were delivered by my
teachers(Professors O.O. OGUNBODE, M. ANATE and
O.O. FAKEYE)-all retired from the university. I salute
them for their indelible marks left behind; all of them are
still alive and well. I can only pray for long healthy worthy
life for the three of them- so that we can still tap from the
depth of knowledge embedded in them.
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Introduction
This inaugural lecture is titled ‘DIFFERENT
STROKES FOR DIFFERENT FOLKS BUT SOME
COUPLES DO HAVE THEM’. What a title and of what
importance? One might ask. Before I attempt to answer
these questions, let me tell a little story about my life and
the circumstances that led to today’s event.
I was born into a humble but religious family some
fifty four years ago. I was the 7 th of their 9 children but as
at then and till now the 2 nd of surviving 3 children; the first
four having died at variable periods after birth; some were
said to be up to 3-5 yrs of age before death. My parents
relocated to Lagos before I was born; so I was delivered at
the only paediatric specialist hospital in Lagos, perhaps in
Nigeria at that time- Massey street hospital, Lagos . The
circumstances of my birth as a preterm (premature), the
divine and angelic (hospital and home) care given by IYA
IYABO – a new UK returnee and employee of the hospital
and of course, God’s will ensured my survival. We became
good family friends until I lost touch with her children few
years ago. God bless her eternally for me.
I started Islamic(Ile kewu) school at age three and
could not start primary school until age ten when my father
was fairly satisfied that it was safe enough for me to be
thrown into the terrains of western education. As if that was
safe enough, I had to send emissaries to him to allow me
undergo secondary and HSC education with the
understanding that my Islamic education and etiquettes
would not suffer. An event which was to shape my choice
of subspecialty later in life was the resit examination I had
in Obstetrics and Gynaecology at College of Medicine ,
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University of Ibadan. Up till today, I could not understand
how I failed that examination. However, I took it that Allah
wanted me to take closer look at that discipline and
considering the circumstances of my birth, I resolved that I
will specialize in Obstetrics and Gynaecology in order to
prevent preterm deliveries rather than having to treat them
when they are already born. Thank God I have overcome
and my story is that of grass to grace.
Many thanks to my two paternal uncles (Alhaji
Hamza Atanda and Alhaji Amoo), who contributed
financially to my education right from secondary to
university level. Without them, I probably will not be here
today rendering this lecture.
Figure 1: Showing Male and Female Internal Genital
PROCESS OF CONCEPTION
7/23/2012 5
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Organs
MALE REPRODUCTIVE
GENITAL SYSTEM
7/23/2012 6
The female reproductive tract consists of the
external genitalia (vulva) and the internal genitalia (vagina,
cervix, uterus, fallopian tubes). For fertility to occur, the
ovaries must produce good quality eggs at regular intervals
to be passed through the fallopian tubes. The implication of
these is that the internal and external genitalia must be
patent for pregnancy to occur and implantation to be
successful. For fertility to occur, the male reproductive
organ must be functional. The sperm is produced from the
testes bilaterally and passed a system of complex tubes to
eventually come out through the external urethral meatus
(penile orifice). For the male to be able to deposit the sperm
within the vagina, there must be adequate erectile function
of the penis.
The brain (higher centre) acts as the coordinating
centre to ensure that proper command messages are sent at
the right times for the right and adequate responses from
the ovaries and the testes. For example, in some individuals
with inadequate hormonal message from the higher centres,
there may be irregularity of menstruation, lack of ovulation
and consequently, inability to conceive. Some females lack
the ability to mobilize these higher centre hormones at all;
in these individuals, they may never initiate menstruation
Likewise in men, failure to adequately produce hormones
from the higher centres can lead to poor or no sperm
production at all.
Brief Overview of Infertility
Infertility can be defined as inability to establish a
pregnancy within a specified time, usually one year, in
a couple having regular unprotected sexual intercourse.
There has been a renewed interest in infertility and
reproductive health failure in Sub Saharan Africa in
spite of its high fertility. In the African culture, for an
infertile couple, the society views infertility as a social
stigma with considerable emotional stress. Family and
societal pressure on the infertile couple often
predispose to marital stress and instability, polygamy,
divorce, prostitution and in extreme cases, suicidal
tendencies (Ladipo 1986; Belsey 1976; Cates 1985) .
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Definitions
Primary Infertility
Failure to conceive after one year of
unprotected cohabitation in a woman who has never
conceived previously.
Secondary Inferility
Failure to conceive after a year of unprotected
cohabitation in a woman who had previously been
pregnant. If the woman had previously breastfed her
infant, then exposure to pregnancy should be
calculated from the end of the lactational amenorrhoea
period.
Pregnancy Wastage
The woman is able to conceive but unable to
produce a live-born.
Unproven Fertility/Infertility
This refers to problems sometimes perceived or
designated by couples as infertility in demographic
surveys, when in fact, the woman is virtually not at
risk of conception. The problem may be biological
(Lactational amenorrhoea - Anovulation), or among
couples practising contraception, or abstinence when
the consort is away.
Sterility
This is complete and permanent inability to
either impregnate or conceive. Individuals with
congenital absence of reproductive organs or who have
been sterilized qualify for such a designation.
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Incidence of Infertility
It is a worldwide problem affecting
approximately 10-15% of couples. Global variations
have been reported in the incidence of infertility from
as low as 1% to 1.5% in Korea and Thailand to as
high as 13% - 23% in urban areas of Columbia and
rural areas of New Guinea (Cates 1985).
The prevalence of infertility is particularly high
in Subsaharan Africa, varying from 20-46% in some
parts of West Africa. Countries like Gabon, Cameroon,
Equatorial Guinea, Central African Republic, Niger,
Mali and Zaire have levels of infertility among women
aged 25 - 29 years ranging between 7-50%. This high
level of infertility suggests that acquired causes of
infertility are prevalent in these countries. There are
also ethnic and religious bias in the prevalence rates
of infertility as seen in these countries (Ladipo 1986;
Mati 1986)
A WHO multicentre study showed that Africa
was the only region where majority of couples had
secondary infertility. In developed countries, the level
of primary versus secondary infertility was 71% and
29% respectively while comparative figure for Africa
was 48% and 52% respectively. Asia, Latin America
and East Mediterranean had levels of primary
infertility higher than secondary infertility. The same
study demonstrates that 64% of females patients in
African as against 38% of patients in other areas of
the world had post-infectious infertility. In Africa, up
to 65% of gynaecological consultations are for
infertility (Otubu 1995; Cates 1985). At the University of
Ilorin Teaching Hospital, Ilorin, more than 50% of
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gynaecological consultations are for infertility (Anate,
Akeredolu 1994, Jimoh 2004). Post –infectious infertility
are relatively commoner in East and Central African
countries than the West and South African countries
(Cates 1985, Jimoh 2004; Okonofua,Snow 1997).
In view of the much higher level of fertility in Africa than
in other regions, it is surprising to observe that, contrary to
expectation, the level of infertility is higher in Africa than
elsewhere. The regional averages subsume substantial
variation between countries and within regions. For
example, the proportion of women in their forties who are
childless in Africa ranges from a level of a few percent in
West Africa, to a fifth or a third of women in Central
Africa (Okonofua 1996).
Timeline Chance of Getting Pregnant within a Specified
Period
It is estimated that by six months of regular
unprotected intercourse, 60% of married couples are
expected to achieve pregnancy. By 12 months, up to
85-90% would have achieved pregnancy and at the
end of 18-24 months, up to 90-95% would have
achieved pregnancy. Younger women(35 years) do not have maximal fertility
potential like those between the ages of 18-35 years.
The need to investigate will therefore be predicated on
the urgent desire to have children by both partners,
the age of the female partner especially if she is over
30 years as fertility declines with increasing age after
35 years and if there are certain medical problems that
may impair fertility (Jimoh 2004, Otubu 1995).
Predisposing Factors to Infertility
Apart from age, marital and ethnic factors
highlighted above, other predisposing factors include:
Sociocultural Factors
Cultural practices such as age of marriage, type
of marriage (monogamy/polygamy), frequency of
intercourse and marriage stability have profound effects
on fertility. Dowry, female circumcision, pregnancy
care and traditional methods of delivery are plausible
variables underlying infertility.
Economic Factors
Micro and macro economic variables have
profound effect on fertility potential of the whole
population as was witnessed during the severe
Structural Adjustment Programmes (SAP) in Nigeria
between 1985 and 1995 when the fertility was down
to about 5.8 from about 7.0 the previous decade.
Degree of urbanization, education, industrialization and
available basic health care facilities are some other
indices which affect fertility. War, famine and
catastrophes have been shown to reduce fertility rate
as shown by the World Wars, Bosnian and Congolese
experiences.
Certain occupations and labour migration
increase the risk to sexually transmitted diseases
(STDs) including HIV/AIDS. Labour migration also
separates husband and wife hence reduces exposure of
the wife.
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Psychological Factors
Emotional tensions have been known to
contribute significantly to the functional capability of
the (Brain-ovarian) hypothalamo-pituitary-ovarian axis,
or by causing tubal spasms, vaginismus (painful vaginal
spasm), dyspareunia (painful sex), frigidity and
decreased male libido. Infertility can thus directly
cause emotional stress thus initiating a vicious cycle.
Investigations and treatment options in infertile couples
could also contribute to their emotional stress.
Counselling and empathy are important prerequisites in
assisting infertile couples. The high premium placed
on children in African cultures have also contributed,
in no small way, to this profound psychological stress
associated with infertility.
Causes of Infertility
Post-infectious infertility is commonest in Africa
than all other regions of the world. In the developed
world, infections play less role while hormonal,
congenital and psychological factors are important
causative factor (Ladipo OA 1986; Jimoh AAG 2004)..
In general, 10-15% is caused by ovulation
disturbances, 30-40% caused by pelvic factors, 30-40%
is associated with abnormalities in the males, and 10-
15% associated with abnormalities in the cervix. In
about 10% of couples, with the current techniques of
investigations, it is impossible to diagnose the cause of
infertility, hence unexplained infertility.
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Female Infertility
Tubal Factor
The tubal factor is the commonest cause of
infertility in the female. Tubal abnormalities, present in
50-70% of infertile women, are due to previous pelvic
inflammatory disease (PID). The sequale of such
inflammatory process is chronic PID, tubal blockage,
hydrosalpinges (swollen and blocked tubes) and periadnexal
adhesions. Postpartum and postabortal
infections are also important causes of PID. Less
common causes include infection of IUDs, post
surgical conditions (appendicitis, diverticulitis),
tuberculosis, schistosomiasis and pelvic surgery.
Endometriosis is a rarer cause of tubal obstruction in
our environment. Psychosomatic factors have been
implicated in tubal dysfunction while congenital tubal
aplasia or presence of convoluted tubes are extremely
rare causes of female tubal infertility.
Ovulation Factor
10-15% of female infertility is caused by
anovulation and luteal phase defficiency in this
environment. Polycystic ovarian disease (Stein-Leventhal
Syndrome) is characterized by enlarged ovaries with
multiple follicular cysts, menstrual irregularities,
hirsutism, obesity and some insulin resistance. Other
anovulatory causes include (1)hypothalamic
dysfunction of environmental, physical or emotional
origin (2) pituitary adenomas with or without
hyperprolactinomas and (3) hypogonadism with or
without luteal phase deficiency. Rarer causes include
pituitary hypofunction (Sheehan’s syndrome), primary
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ovarian failure e.g Turner’s syndrome, ovarian resistant
syndrome and contraceptives (oral, injectables and
norplant).
Uterine Factors
Common uterine factors such as uterine fibroids
and uterine polyps are often associated with infertility
or reproductive wastage. They cause distortion of the
uterus and fallopian tubes leading to infertility.
Postpartum, post-abortal, post-surgical or posttuberculous
endometritis may cause intrauterine
adhesions (uterine synechiae). Insufficient decidual layer
formation with lack of or improper implantation may
result from luteal phase defficiency.
Cervical Factors
Cervical factors resulting in infertility include
hormonal imbalance which causes poor quality cervical
mucus impenetrable to the sperm, cervical infections
with sperm antibodies, cervical stenosis due to
congenital defect or previous cervical surgery
(cauterization or cone biopsy). The role of
immunological factors in cervical infertility in which
women develop antisperm antibodies has received
considerable attention in the last two decades as a
common cause of hitherto unexplained infertility
(Ladipo 1986; Jimoh 2004).
vaginitis causing dyspareunia or vaginal stenosis
following chemical vaginitis are known though rare
causes of infertility.
Male Infertility
Interest in male infertility, responsible for 30-
40% of infertile couples, has increased over the years.
Subacute or chronic infection of the male genital tract
is a common cause of poor sperm production or
function. Common organisms implicated include
bacteria (gonococcal, coliform, staphylococcal), viral
(mumps orchitis, infectious mononucleosis), parasitic
(schistosomiasis, toxoplasmosis). Vasal or epididymal
blockage may result from these infections.
Congenital (cryptoorchidism), acquired (varicocele,
trauma, torsion of the testis) and certain endocrine
disorders such as diabetes mellitus,
hyperprolactinaemia, hypogonadism can reduce sperm
production and function. Chromosomal abnormalities
(47XXY/46XX) can cause disorders in sperm
production and function. Addictive behaviours such as
alcoholism and heavy smoking play a part in lowering
sperm function in men. Environmental factors (heavy
metals, excessive heat, radioactivity) and chronic stress
can reduce sperm function. Varicocele can be
unilateral or bilateral and are present in approximately
15% postpubertal males and 20-40% of infertile males
Vaginal Factors
Congenital or developmental defects such as
transverse or longitudinal septa, imperforate hymen or
stenosed fourchette can contribute to infertility. Severe
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Clinical Approach to the Management of the
Infertile Couple
A complete and detailed physical examination of the
couple is essential. Table 1 summarises the relevant
history and physical examination in the couple.
Table 1: History
Clinical Features in an Infertile Couple (Table 1).
Male
Duration of infertility
Profession/Occupation
Previous history of Sexually Transmitted Diseases,
Mumps orchitis
History of congenital malformations
Previous history of abdominal / genital surgery
including herniorrhaphy and hydrocelectomy.
History of diabetes mellitus and other endocrine
disorders.
Alcoholism, Excessive smoking
History of chronic drug use – Brinerdin, Aldomet,
Thiazides and Anticonvulsants.
Female: History
Duration and severity of infertility
Detailed previous obstetric history
Profession/Occupation e.g Students, Commercial sex
workers, Young professionals
Gynaecologoical history including menarche,
ketamenia, dysmenorrhoea, menstrual flow pattern
etc.
Previous history of sexually transmitted diseases,
mumps in childhood, congenital malformation.
Previous history of abdominal and pelvic surgery
(including pregnancy termination, myomectomy etc).
Previous history of contraception.
Previous history of tuberculosis.
Endocrine disorders.
Alcoholism, Excessive smoking and chronic drug
use.
Physical Examination
Female
Nutritional status – Height, Weight, Anaemia etc
Endocrine diseases – Thyroid, Diabetes mellitus.
Breasts – galactorrhoea, poorly developed breasts as
in Turner,s syndrome.
Hirsuitism, Voice changes
Abdominal surgical scars – appendicectomy,
laparascopy and laparatomy for intra-abdominal
lesions.
Previous cesarean section scars.
Pelvic examination- congenital malformation of
genital tract, PID, Endometriosis, Adnexal
pathologies.
Male
Habitus, General physical examination.
Genitalis – Penis – size, hypospadias, epispadias.
- Urethral stricture
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- Testis - size, location and position,
consistency, varicocele and other
tumours.
- Prostate - size, consistency, milking
of the prostate.
Investigations
Ideally, the couple need to be investigated together.
Since it is known that in African settings, in 30 –
40% of infertile couples, both husband and wife have
discernible problems. Proper counselling on the need
for these investigations should be offered. Efforts
should be made not to over or under prognosticate the
chances of the couple. Where it may not be possible
to start with the couple together, the woman can start
her own investigations pending the time the husband
could be invited and investigated.
Hysterosalpingogram showing the uterus and tubes
Fig.2a
Fig.2b
Figure 2a above shows bilateral tubal blockage while Figure
2b below shows bilateral tubal patency
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What is the local situation in Nigeria?
Infertility is on the increase in Nigeria. The
population that is involved with regard to infertility is as
high as 20-25 per cent of married couples. One in five
couples has fertility problems and the trend is on the
increase for two reasons.
- One, there is increased awareness about the
problem.
- Secondly, there are more problems that are
occurring within the system, that are stress-related
that are creating fertility problems.
Stress for both men and women (emotional stress).
Our society is a highly stressed society. From home to
work, and the kind of things that go on in our lives, we are
all constantly exposed to stress. There is stress in getting on
the traffic on the road; there is stress in achieving what you
want to do. Even, when you go to the store to buy
something, there is stress. There is fear from armed
robbery. Economic, financial stresses are equally important
because we live in a society that places a lot of emphasis on
money as opposed to value of professionalism. The level of
stress that goes into marriage planning and the money spent
by the couple is highly stress-related. All these have far
reaching consequences on a centre in the brain called the
Hypothalamus, the centre that controls some of the
reproductive functions. Stress is a condition that triggers
the adrenal gland (stress gland). When there is too much
pressure on the adrenal gland, it will control the ovary and
the sperm cell, and the brain. Under normal circumstances,
when it is stable, it balances these two hormones, the brain
and the hypothalamus and the ovary, so they circulate like
an orchestra in symphony, to bring out this tune and at the
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end of each month, it will clock at 28 days to produce
menstruation having released an egg. When the
hypothalamus malfunctions, it may affect the ovaries and
the woman may no longer ovulate every 28 days.
Sometimes it may be 19 days or it could be delayed.
Sometimes, it could lead to early miscarriages.
As for the effect on men, stress is known to reduce
sperm production by 15 per cent as it destroys the
spermatozoa.From the fore going , we can appreciate that
different folks have different strokes (stories) to tell and
contend with.
Age. Many people now marry late. Twenty years
ago, many ladies married at the age of 25 or even earlier.
Today, people are getting married at the age of 32 or older.
And for the men, it is even slightly higher (Nigerian
demographic survey, 2008). At this age, reproductive
function is already declining. From basic raw statistics, for
somebody that is between 16 and 21, fertility is almost 75
per cent. By the time you get to age 40, it has declined to
eight percent. In the US, 10 per cent of women between the
ages of 30-44 have impaired fertility and about 25 per cent
of these women will have infertility problems when they
get married. On a general level, we are looking at 37 per
cent of infertile women between age 35 and 44 having
infertility. As age progresses, the problem of fertility also
progresses. A higher percentage of women are having
fertility problem because we are not marrying early. If they
marry early, the problem should be less.
Weight. Obesity is a major factor in our
environment. Overweight women have polycystic ovarian
syndrome. It is a condition in which the ovary, rather than
produce follicles that will make egg, they produce empty
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follicles known as cyst, and these follicles will line the
ovary and they are not be able to ovulate. This is a
condition that creates infertility because the excess fat that
is there does not allow the ovary to have proper hormone
functions, so rather than have those hormones going to the
ovaries, they are working on the fat cells. This is an easily
treatable condition if detected early. Women who are also
underweight and those suffering from nutritional deficiency
and low vitamins also have problems with fertility, just like
marathon and long distance runners. Students preparing for
major examinations can experience menstrual difficulties
and may not be pregnant easily, even if desired. Caffeine,
smoking and alcohol intake can also cause infertility.
Habits like multiple sexual partners can lead to infection
and sexually transmitted diseases which is the core of
blocked tubes.
Environmental hazards:
Environmental hazards include electric generators,
smoke release and other pollutants in our environment lead
to infertility. Excessive use of alternative energy leads to
the release of hydrocarbons and they are definitely having
far reaching consequences on the sperm production process
in men and the ovulation process in women. In our society,
the level of pollution that we are witnessing now cannot be
compared to what we saw in the 70s and 60s. Almost every
other house has a generating plant and when there is no
light (public power supply), they all release fumes and
pollute the air.
Poor water source. We don’t have enough
regulation to control our water system and there are a lot of
poisons being released into the water system. In some
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cases, petrol stations are sited near the river. We site soap
and dry cleaning industries in the various places. These
have serious consequences on fertility.
Poor / Improper Urban Planning. Previous
governments made use of area planning by strictly
reserving some areas as residential and some for
commercial purposes. In developed societies, residential
areas are strictly residential, maybe with one or two corner
shops but here, areas reserved for residential are converted
to commercial use. All these emit serious toxins into the air
which we breath into our bodies.
Men are having very low sperm count. The
percentage of men with low sperm count is higher than that
in the western countries. For example, in the US, the male
problem is about 30-35 per cent, but in our country the
male factor is rising. The uses of hard substance, smoking,
alcohol and marijuana have far reaching effects on sperm
count and sperm production. In one unpublished work we
did in our department recently, 14% of men seen at the
general fertility clinic were azoospermic (no sperm count at
all) while those with low sperm count accounted for close
to 50%; those with sperm disorders were more than 60% of
the men attending infertility clinic at the UITH at Ilorin.
One may say that this is a skewed sample since it was taken
at an infertility clinic and may not reflect the true picture in
the general society but it all the same portends grave
dangers for the future of our and next generation if left
unchecked.
Occupational hazards
Those who work with heavy metals and those who
work in hydro and petrochemical industries are at risk. Men
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working in plastic and paint industries are also at risk,
because these are occupations that are known to drastically
damage the sperm. When couples are newly married, they
should begin to be aware of the anatomical and
physiological processes that control conception. They need
counseling and health education.
Other factors that contribute to low sperm count or
no sperm include:
Poor nutrition: low levels of folate, zinc and vitamin C
Genetic conditions such as cystic fibrosis
Environmental toxins such as chemicals in the
workplace
Lifestyle choices such as smoking, alcohol and illegal
drugs.
Weight gain/Exercise: Extra weight, especially around
the belly can contribute to reduced testosterone
production.
Frequent use of hot tubs: Heat certainly does kill sperm,
so if you’re trying get pregnant, it’s smart to avoid
using them.
Other medical conditions such as erectile dysfunction
or undescended testicles can also affect male fertility.
My foray into the subspecialties of Reproductive
Endocrinology, Infertility and Minimal Access Surgery was
predicated on the scourge that infertility has become
coupled with the 10-15% infertile couples that could not be
helped by conventional treatment options
After residency training and almost two decades of
medical training and work experience, I felt a sense of
desperation and urgency for the infertile couples who could
not be helped by conventional methods. I was trained under
Professor Donald Nzeh of the department of Radiology in
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two short courses in Abdomino-pelvic ultrasound, Doppler
Ultrasound organised by the Midland Ultrasound Research
and Education Centre, University of Ilorin (Affiliated to the
Jefferson Ultrasound Research and Education Institute,
Philadelphia).
Further training in Reproductive Endocrinology/
Assisted Reproduction took me to Nordica Hospital, Abuja,
Nordica Hospital, Copenhagen, Denmark, Worckharts
Hospital and Bangalore Assisted Conception Centre,
Bangalore, Karnataka, India and finally, for advanced
training in Al Azhar IVF Centre, Al Azhar University,
Cairo, Egypt. All these efforts have paid off with the set up
of both the Midland Fertility Centre, Ilorin and the recently
established UITH ART Unit.
My initial exposure to rudimentary endoscopy
(laparoscopy) was during the residency training years.
Recent trends in infertility management especially assisted
reproduction technology require that i must be grounded in
basic and advanced laparo-endoscopic surgeries. My
laparoscopic training was done at World Laparoscopic
Hospital, New Delhi in 2008 under the tutelage of
Professor Mishra, a genius who has trained over 3000
subspecialist endoscopic surgeons from all over the world
including the western countries. The centre is among the 15
accredited centres in the world by World Association of
Laparoscopic Surgeons (WALS). Threfore, what has been
my modest contributions to the knowledge and practice in
the field of my subspecialization in this country and
beyond?. The answer to this question shall be provided in
the subsequent discussion.
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Contributions in Reproductive Endocrinology / Infertility
Epidemiology / Aetiology of Infertility
Infertility remains a prevalent condition in this
environment (Ladipo OA,1986; Adetoro OO, 1988, Otubu
JAM, 1995, Anate M,1996, Olatinwo,Jimoh et al 2001,
Jimoh AAG 2004). It represents more than half of
gynaecological consultations (Jimoh AAG 2004, Okonofua
2006). Following the birth of LOUIS BROWN, the world’s
first IVF baby in November 25 th 1978, over 5 million
children have been born by assisted reproductive
technology methods as at the end of 2011. (ICMART
2012). Assisted reproductive technology treatment options
have contributed to peace in the world (Jimoh, Ghazal,
Ashaolu, 2010; Jimoh,Ashaolu,2010 )
Female tubal factor remains the commonest
aetiological factor in infertility in the couple as well as
specifically in the female.(Jimoh 2001, Jimoh, Agbede
2002, Otubu 1995). Male factor is an important factor in
infertility and constitutes a big challenge. Sexually
Transmitted Infections (Jimoh, Agbede 2002, Jimoh
AAG,2004, Nwabuisi, Onile 2001) have been implicated in
the causation of sperm abnormalities. In a study, Jimoh
AAG, Olawuyi S, Oyewopo, Omotoso G et al, 2011
showed clearly the contributions of male hormonal
imbalance contributed to male infertility. The hitherto held
notion that hormonal imbalance is uncommon in men is
untrue and not sustainable. Earlier studies (Olatinwo, Jimoh
et al,2001, Jimoh, Oghagbon, 2004a, Jimoh, Oghagbon,
2007, Oghagbon, Jimoh,2004b) established a link between
male hormonal status, serum lipid profile as well as male
biophysical profile. The studies showed that men who are
overweight or actually obese have lower sperm counts,
25
apart from the overbearing influence of infections, diabetes,
hypertension and their treatment modalities.
In another related study, Olayaki, Jimoh, Edeoja,
Biliaminu,2008 showed that cigarette smoke was
detrimental to sperm production from the testes. Oyewopo,
Jimoh et al 2010 also showed that dietary intake, either as
food or as supplements can act as endocrine distruptors,
thereby reducing our chances of producing good sperms
and eggs.
Olarinoye, Kuranga, Jimoh et al 2006 demonstrated
common prevalence of erectile dysfunction (impotence)
amongst type 2 diabetic men attending diabetic clinic at
UITH, Ilorin. Recent experience at Midland Fertility Centre
also reveals that erectile dysfunction is not only common,
but can incapacitate our work when we need the men to
produce their semen most; at the time of egg collection- in
this case, it is stress related.
In order words, what our bodies produce as men and
women by way of sex hormones, what we eat, drink and
smoke, the sexual habit we partake in can influence our
ability to produce children as men and women.
My Contributions to Infertility Treatment
Conventional treatment over a course of 1-2 years
will achieve pregnancy in about 80-85% of couples. Early
in 2002, I published an audit of Obstetrical and
Gynaecological surgeries done by me at HOPITAL
PROVINCIAL DE WELE-NZAS, MONGOMO,
EQUATORIAL GUINEA. Detailed there were experiences
with macrotubal surgeries in cases of tubal infertility in
women. Over a 29-month (march 1995-july 1997) period,
we achieved a pregnancy rate of (9)17.3% out of 52
26

patients. This may appear small to the unwary mind; we
need to remember that this was in a group of women that
had close to zero chance of pregnancy on their own without
assistance. I must thank Professor Momoh Anate for the
painstaking surgical skills impacted in complex
gynaecological surgeries like these. These surgeries are not
favoured again these days with the advent of Assisted
Reproductive Technology(ART) in Nigeria and elsewhere.
Other fertility enhancing procedures documented in the
series include Ventrosuspension of the Round ligament,
Myomectomy with careful conservation of the endometrial
layer (and if this must be breached at all, careful apposition
to restore function near perfect), Metroplasty of the uterus
(Repair of septated Uterus), Vaginoplasty (repair / resection
of vaginal transverse or longitudinal septa), Wedge
resection of polycystic ovaries etc. Since ART procedures
are expensive and beyond the reach of average Nigerian in
search of fertility, these fertility enhancing surgeries still no
doubt have their role to play.
Role of Laparo Endoscopy in Infertility
Management
Figure3. Laparoscopic view of
the pelvis: ovarian cyst.
Figure 4
27
28

Figure 5
Laparoscopic Pictures of Tubal Blockage (Figures 4 and 5)
Laparoscopy and dye test hydrotubation is believed
to be the gold standard for assessing tubal patency in the
management of infertile couples (figures 4 and 5).
Hysteroscopy remains a useful tool in the evaluation of
infertile couples with uterine/ endometrial factors. Akintobi
2010, Bamgbopa 2010, Ikechebelu 2010, Kupolati 2011
have shown the necessity of laparoendoscopy in the
management of infertile patients in our environment. In a
recent article, Jimoh, Omokanye, Saidu (2012) advocated
the proper use of laparoendoscopic surgeries for pre, intra
and post ART procedures. Judicious use of these
procedures makes diagnosis as to the exact cause of female
infertility to be known; treatments cost effective and
appropriate. It has been advocated that routine use of
hysteroscopy in all infertile is unnecessary. But our recent
29
study earlier referred to will suggest that in infertile women
over 35 years of age with past history of chronic pelvic
infections, termination of pregnancies with intrauterine
abnormalities will be good candidates whether they are
undergoing ART/not. It is known that uterine abnormalities
are common due mainly to infections (STIs) and curettage
of the endometrial cavity (D&Cs) – all these acquired when
these ladies were in their prime. Following marriage at a
more advanced age, the damage to the uterus and tubes will
coalesce to prevent fertility. Laparo endoscopic surgeries
are useful in this regard, including tubal repairs, tubal
disconnections, adhesiolysis, ovarian drilling of polycystic
ovaries etc.
The use of Single Incision Laparoscopic Surgical
(SILS) port of entry is one of the new revolutions in
laparoscopic surgery. It makes the surgery scar less,
aesthetically more acceptable and less painful; it obviates
the risk of periumbilical hernia. Deep Goel, 2011,
Abrahams and Nasir 2011, Jimoh, Omokanye, Saidu et al
2011 have shown that SILS have comparable advantage in
adults as well as in paediatric age group.
Role of Ultrasonography in the Management of Infertile
Women and Threatened Miscarriges
In three separate publications (Jimoh, Tabari,
Braimoh 2001, Tabari, Jimoh 2004, Jimoh, Omokanye,
Saidu et al 2012) Ultrasound is invaluable in the evaluation
and treatment of infertile women. When they eventually
become pregnant and present with threatened miscarriages,
ultrasound remains a cornerstone of treatment.
We showed that of all variables considered in
women with threatened miscarriages (USS derived GA vs
30

LMP GA, GSD GA, CRL GA, Characteristic of the
gestational sac, fetal heart activity etc), fetal heart activity
was the most powerful variable in predicting fetal viability
beyond age of viability. Next was the observed difference
between fetal age derived from LMP and USS. Where the
difference is more than two weeks in the first trimester, it
portends real danger for the fetus. It therefore should put
the physician on his/her toes as to the possibility of fetal
demise.
The same protocol was replicated in the group of women
undergoing ART at Midland Fertilty Centre. Having
become pregnant, it was observed that close to 24% of
them had threatened miscarriage. The results were not
different from the previous study – the implication of this is
that Post –ART foetuses are not significantly different from
non- ART foetuses given the same exposure to prompt
evaluation and treatment of their mothers. Over 60% of
such women carried their pregnancies to age of viability
(Jimoh, Omokanye, Saidu et al 2012) –ANOTHER CASE
OF DIFFERENT STROKES FOR DIFFERENT FOLKS .
With first trimester USS, it is possible to identify foetuses
that are at risk of dying in the first trimester, expelled in the
second trimester (cervical incompetence) or retained as
anembyonic foetuses (missed miscarriages). The Qu’ran
Surah Al mu’min, ayat 12-15. ‘’We created man from a
quitessence (gentle extraction) of clay. We then placed him
as drop(Nutfah) in a place of rest firmly fixed. Then we
made the drop into an ‘Alaqah (leech like) and then we
changed the leech like structure into a Mudgah (chewed
like substance) then we made out of that Mudgah bones
(skeletons) (Izam) then we clothed the bones with
flesh(muscles)(Lahm), then we developed out of him
31
another creation. So blessed be Allah the best to create’’.
Qu’ran Surah Al Zumar talks to us about the importance of
uterine and particularly endometrial function in
implantation. V6 ‘’He created you in the wombs of your
mothers from one stage to another and all along three veils
of darkness surrounded you’’ referring to 1. The abdominal
wall 2. Uterine wall and 3. The placenta and its chorionoamniotic
membranes. Others have also referred to the three
veils as the three layers of the endometrium.
Assisted Reproduction Technology in Ilorin-
Willingness to Utilize, Attitudes to its Utilization
In a community survey of 207 women of reproductive
age group in Ilorin West LGA, nearly all the women have
some idea of what ART is about. More than 65% were
willing to utilize this new technology if necessary so long
as they will achieve their desire. Majority were not willing
to be surrogate mothers; level of education shows
significant difference between those willing or not. This is
also replicated in willingness to advise their husbands to be
sperm donors.( Jimoh, Saka, Saidu et al 2011). Generally
speaking , muslims are reportedly less likely to accept ART
treatment than Christians. When they do, they would not
readily accept gonadal (egg and sperm) donation. Among
the Christians, the catholics were less likely to utilize ART
than other Christian faith groups. Almost all the muslims
were orthodox Sunnis. Among the Shia sect, there is a
slightly more liberal attitude to gonadal donation under
certain conditions. (Gamal Serour, 2005).-ANOTHER
CASE OF DIFFERENT STROKES FOR DIFFERENT
FOLKS
32

Low Cost Assisted Reproduction Technology in Nigeria
In a first paper of its type in Nigeria, Ashiru,
Fowora- Willadsen, Oyewopo, Jimoh 2010, demonstrated
through judicious use of culture media and other measures
the practicality of low cost IVF in Nigeria. The exhorbitant
cost of generating electricity, water, consumable etc may
render this very difficult on the long run if the Nigeria
situation does not improve. In India, the cost of IVF is
cheaper than in Nigeria because these challenges have been
overcomed amongst other things.
My Contribution to Schorlarship and Practice of
Minimal Access Surgery (MAS) and Assisted
Reproduction Technology (ART) in Nigeria and Beyond
Minimal Access Surgery (including laparoscopy
and hysteroscopy) has seen a resurgence in Nigeria within
the last seven years. As part of a global player, the Nigerian
gynaecologist of whatever subspecialty, must be conversant
with basic skills in minimal access surgery as well as
ultrasonography.
I have taken time to acquire skills in basic and
advanced laparo endoscopy, ultrasonography over the last
two decades, especially in the last decade. From the home
front, I can say with pride that our resident (post graduate)
doctors are all exposed at various levels of their training to
basic skills in these two areas. I am currently the chairman
of the UITH committee on laparoendoscopy (utilization
and skills acquisition).
At the national level, my contribution is in many
aspects.
1. As a member of World Association of Laparoscopic
Surgeons, Nigerian Chapter and current editor –in-
33
chief of its journal (Tropical Journal of
Laparoendoscopy), I continue to enhance theory and
practice of minimal access practice in this country.
2. As a member of SoGen(Society of Gynaecological
Endoscopists) – an afilliate of SOGON (Society of
Gynaecologists and Obstetricians of Nigeria), we
strife to deepen the culture of minimal access surgery
within the specialty.
3. I have been a key trainer/resource person at the
biannual training in MAS by Life Endoscopy Institute,
Nnewi, Anambra State, by Professor Joseph
Ikechebelu for about 4 years now
4. Globally, I am a member of WALS (World
Association of Laparoscopic Surgeons) whose
mandate it is to train more surgeons in basic and
advanced minimal access surgery. Professor Mishra of
New Delhi, India is the current Vice President and
editor – in –chief of its journal, World Laparoscopic
Surgery Journal. Efforts are underway to bring
training programmes to Nigeria in foreseeable future.
There is a working understanding between the
Nigerian chapter journal and the global society
journal.
5. I am a member of Society of Laparoscopic Surgeons
based in Florida, USA
In the sphere of assisted reproduction technology
theory and practice in this country, my contributions are
also multifaceted.
1. I oversee the operations of two fertility units in
Ilorin, two of the 25 centres in this country serving
34

a population of estimated 2-3 million couples
nationwide needing these services.
2. I am involved in the training of residents in the
theory and practice of ART
3. I have initiated series of research activities in this
field both as an academic and practitioner
4. I am a member of the Unilorin Stem cell research
group and the editor-in-chief of its upcoming
journal (International journal of Experimental and
Clinical Stem Cell Research).
Nationally
5. I am one of the six professors of medicine in
Nigeria (nearly all gynaecologists) who are
involved in the practice and research in ART
6. I am a governing board member of the Nigerian
Fertility Society (headed by Professor OF Giwa-
Osagie), different from SOGON, whose
responsibility is to regulate the practice of ART in
all its ramifications in this country.
7. I am a member of the important sub-committee on
ethics of Nigerian Fertility Society HEADED BY
Professor Mrs Ogedengbe.
Globally
8. I am happy to have contributed to the 5 million
babies achieved through ART globally since the
birth of LOIUS BROWN 34 years ago.
Coincidentally, her mother (the first woman to have
documented case of successful IVF procedure) died
6 th June 2012. May her gentle soul rest in perfect
peace.
35
9. I am a member of ESHRE (European Society of
Human Reproduction and Embyology).
10. I am a member of the Committee of Medical
Editors (including) the subsect on human
reproduction
11. I have participated in international meetings to
spread the gospel of assisted reproduction and
efforts in achieving low cost IVFs especially in
resource limited countries
Ethical Issues in Assisted Reproduction
There is probably no where in medical practice that
ethical issues are closely interwoven with the practice than
in human reproduction especially assisted reproduction.
The major issues involved are Counselling,
Informed Consent, Beneficience and Non-Maleficience.
Counselling and informed consent must be undertaken at
every stage of the treatment, whether the attending
physician / gynaecologist would have made the same
choice or not.
A case involving the regulatory body Human
Fertilization and Embryology Authority (HFEA) in UK and
a couple who were acchondroplasiacs (a form of dwarfism)
is a classic example. The court of law that intervened in the
case awarded the right of the couple (potential parents) the
right to have a child from Preimplantation Genetic
Diagnosis(PGD) that will look like them against the
position of the HFEA. The ground of the judgement was
predicated on informed choice has been taken after due
counselling has been given. It was also noted that the
condition (acchondroplasia) is not a lethal/contagious
condition that is dangerous to the society. Since the couple
36

wanted a child that looks like them in every respect and
who they can relate with without discrimination, the court
praised them for their intention to be potential good parents
and as such who will bring forth good children to the
society (BENEFICIENCE AND NON-MALEFICIENCE).
Another notable example is who owns the child
from a donated egg pregnancy? What right has a surrogate
mother over the child she bore? These and many more are
areas of research searching for answers in our local
environment. Another case of DIFFERENT STROKES
FOR DIFFERENT FOLKS BUT SOME COUPLES
DO HAVE THEM
Apart from my core interest in infertility, MAS,
Ultrasonography, I have looked at many other aspects of
our specialty in other to improve the lots of our women
A. Obstetric Care in Pregnancy and Delivery
In a series of 15 articles over 12 years, my contributions
can be summarized as follows:
1. Obstetrict height remains a useful tool in screening
women at risk of difficult deliveries that may lead
to obstructed labour and death.(Jimoh AAG,2001;
Jimoh AAG,2004; Jimoh, Abubakar 2004;
Jimoh,Balogun,Abubakar 2005)
2. Antenatal Care remains a useful preventive
approach to stemming the tide of maternal
mortality.(Jimoh AAG 2003)It helps to prevent
maternal morbidies and operative deliveries.
(Ijaiya,Aboyeji,Fawole,Jimoh 2005; Jimoh,Nwosu
2007; Jimoh,Aiyeyemi 2008;Jimoh, Akintade,
Balogun,Aboyeji 2007)
3. Antenatal blood donation policy of UITH has
reduced our mortality rate of the last
decade.(Balogun,Jimoh,Nwachukwu 2005;
Balogun,Raji,Jimoh 2009; Jimoh,Saidu,Saka 2011).
B. Infections in Obstetric and Gynaecological
Practice
HIV/AID
In a series of 5 papers, we have shown that:
1. The scourge of HIV/AIDS among pregnant women
is real. (Jimoh AAG 2003)
2. HIV infection is prevalent in other parts of the
African continent and that Nigeria should learn
from the screening programs from Equatorial
Guinea. (Jimoh AAG 2004)
3. Antiretroviral drug use is still not common. The
knowledge, attitudes and practice of its use is not
encouraging even amongst students of tertiary
institutions in Ilorin.(Jimoh, Saidu, Saka et al 2008)
4. Several factors were identified hindering acceptance
of HIV/AIDS Voluntary Counselling and Testing
among youths in Kwara State. (Yahaya,Jimoh,
Balogun 2010).
5. Cervical Lesion can be used as prognostic factor in
AIDS (Saidu,Jimoh,Saka 2010)
C. Malaria in Pregnancy
In a series of 7 articles, we have shown that:
1. Malaria infection is endemic, even among pregnant
women in Nigeria and Equatorial Guinea. (Jimoh
AAG 2003, Jimoh AAG 2004)
37
38

2. We advocated the use ACTs (Antimalarial
Combined Therapy) (Jimoh AAG 2006)
3. Primigravidity, Age, Parasite load and other comorbidities
affect pregnancy outcome. (Jimoh AAG
2003; Jimoh 2006; Kolawole,Jimoh,Kanu,Balogun
2007; Omokanye,Jimoh,Saidu 2012;
Kolawole,Babatunde,Jimoh 2010)
D. Chlamydia Trachomatis Infection in Obstetrics
and Gynaecology Practice
Chlamydia trachomatis infection is known to play a
major role in causation of tubal damage in female
infertility. It is also implicated in sperm abnormalities in
male infertility. Jimoh, Agbede 2002 looked at the
importance of this agent in the pathophysiology of
infertility among couples. Serological evidence of post
chlamydial infections in women with ectopic pregnancy at
Ilorin suggested very strong correlation between the
chlamydial infection and ectopic gestation (Abiodun,
Ijaiya, Fawole, Jimoh 2007).
E. Fertility Regulation in Women
We showed that Intra Uterine Contraceptive
Devices (IUCD) are safe, well tolerated and effective.
(Jimoh,Balogun 2004; Jimoh 2004; Jimoh,Akintade, 2010;
Akintade, Jimoh 2011). Even in cases which are
complicated, outcomes are good. Minilaparatomy for
bilateral tubal ligation is a safe procedure and effective.
(Abiodun,Esuga,Balogun, Jimoh et al 2010).
Spouses of breastfeeding women need to be counselled
in order to make breastfeeding adequate, useful, protective
against pregnancy.(Jimoh AAG 2004)
39
F. Gynaecological Oncology
In a study to evaluate knowledge, attitude and
practice of cervical smear as a screening method for
cervical cancer among female health workers in Ilorin,
Aboyeji,Ijaiya,Jimoh 2004 found that the knowledge about
cervical smear was high, but utilization was very poor. We
advocated health education and counselling for all women
of reproductive age group. Establishment of a national
programme on prevention of cancer of the cervix was
advocated.
In a study involving HIV positive women as
subjects and non-positive as controls, the incidence of
cervical smear premalignant abnormalities were commoner
in the HIV positive group. It is known that HIV positive
women are at higher risk of cancer of the cervix due to
prolonged exposure to human papilloma virus infection. It
was suggested that routine cervical smear tests should be
part of the routine tests for HIV positive women. (Saidu,
Jimoh 2010).
Recommendations
General Public –
– We should learn to take our health issues seriously.
It is obvious to us from this presentation that our
fertility potential rests largely on us. What we eat,
drink, smoke and the type of life style we live can
impair largely our fertility. Obesity, Sexual
promiscuity, Alcoholism, drug abuse etc have
contributed in no small measure to the rising profile
of infertility in our environment.
40

– Men ought to know that they are directly
responsible for infertility in up to 40-50% of cases;
they should avail themselves the opportunity of
treatment options. They should drop the tonga of ‘it
can never be me’. In established cases of female
involvement alone, the men should take more care
of their infertile wives . It surely takes two to tango.
– Girl child qualitative education will no doubt help
in raising awareness about sexuality education;
become better adults and future parents
– Prayers help a lot. Spiritual intervention does help
before, during and after the treatment. Allah said
in the Qu’ran that men and women were created to
give birth to offsprings. ‘’SOME WERE GIVEN
MALES, SOME FEMALES WHILE SOME
WERE GIVEN BOTH MALE AND FEMALE.
AND SOME WERE NOT GIVEN AT ALL. HE
(ALLAH) IS THE BEST DISPOSER OF ALL
AFFAIRS. So beseech Allah even if you belong to
the group who do not have’’. Q42.V 49-50
University of Ilorin/University of Ilorin Teaching
Hospital
– There is a need for an institute of maternal and child
health to be established to handle the twin problem
of mother and child. Infertility management or
prevention of infertility is an integral part of such
services to be rendered. Collaborative Research in
all areas of infertility and fertility issues can be
better addressed.
– The Stem Cell Research group has woken from its
slumber. The efforts and vision of the University
41
Administration is commendable but more needs to
be done to achieve what we need to achieve.
– The University health centre can be upgraded to
handle more women’s health issues, including
collaboration with the Guidance and Counselling
Centre on regular basis. The young students (male
and female) should have access to information
about their reproductive rights; potentials etc and
what can improve/impair such.
Political Administration in the Country
– There must be political will on the part of
governments at all levels to improve the lots of our
women. Budgetary expenditure on health in this
country is very low compared to the WHO
recommendation. Directed programmes to tackle
STI in both sexes, puerperal sepsis in women,
effective family planning services will go a long
way in stemming the tide of preventable infertility
in this country.
These services should be further strengthened at the
primary care levels all across the country
– The service of infertility treatment can be
subsidized by the government at all levels. People
may argue against that in view of our perceived /
real overpopulation. For those women who do not
have the fruits of the womb, no efforts from the
governments are too much. ENI TO KAN LO MO
42

NMA/SOGON/NGOs
– The Nigerian Medical Association should intensify
efforts that the national health bill is assented to by
the President of the federal republic soonest. This
bill has adequately taken care of many of the points
raised above. Society of Gynaecologists and
Obstetricians of Nigeria (SOGON) should be at the
forefront of treatment and prevention of infertility
in this country. SOGON with FIGO can play
advocacy role in ensuring that the governments,
NGOs etc sustain their roles in maternal and child
health.
Acknowledgements and Appreciation
All praise be to ALLAH, the Lord of the universe.
Allah raised from obscurity to limelight. Who would ever
imagine OMO IYA ELEPO will become a professor of
Obstetrics and Gynaecology.
I dedicate this lecture to my parents. My Late
father, Alhaji Jimoh Iyanda AJIA was an embodiment of
good virtues. He passed away 7 1/2 years ago. Though he
was not young when he died, we miss him a lot. I
personally cannot pass a day without remembering him, he
was my first mentor. May ALLAH GRANT HIM AL
JANAT FIRDAUS. Alhaja Hawawu Abio Jimoh AJIA,
alias IYA ELEPO represents the other half of the vehicle
that has sustained me this far. At 93 years, you are still very
young and agile to die now. May Allah spare your life
many more years to come? I cannot thank her enough for
all the things she had done for me. I thank Allah for her
life.
43
To my teachers, Professors Ogunbode, Anate,
Fakeye, Nzeh, Svend Lindenberg of Denmark, Gamal
Serour of Al AZHAR UNIVERSITY IVF CENTRE,
Mishra of New Delhi. I cannot thank you all enough. Only
Allah can reward you. Special mention must be made of Dr
Ibrahim Wada, he is a personal friend as well a teacher. We
have come to appreciate ourselves more. I thank him a lot
for going the extra mile with me.
To my mentors, Professors Anate, Giwa-
Osagie,Svend Lindenberg, Gamal Serour and Mishra. You
have all impacted on me in many ways you cannot and
might not imagine. I continue to keep the flags flying and
mentoring the younger ones.
My colleagues at work(both academic and clinical)
have been all wonderful. We have had our ups and downs
but I must thank you all.
I also dedicate this lecture to all my past, present
and future patients particularly the infertile patients. I can
share your pains and triumphs. Thanks for walking the
walk with me.
To the entire family members of AJIA-
AKUNNUEWU FAMILY (Paternal) and KAWU-OGIDI
(maternal) in Nigeria and diaspora, I say a big thank you
for standing by me and my family. May Allah reward you
all accordingly. I must specially thank my other siblings ,
you have all been wonderful people. We will continue to
uphold the good virtues left by Alhaji Jimoh, our
progenitor.
To my father-in-law, Alhaji Abdulkadir Oba Aburo
and my mother –in-law, Alhaja Halimat Oba Aburo, I want
to thank both of you for being there for us. I could not have
wished for better in-laws.
44

My friends at all levels deserve special mention;
right from childhood (Alhaji Mubarak Oniyangi),
Secondary school (Alhaji Abiose, Barr Elegbede, Mrs
Shoyemi) University mates (Profs Salako, Olaopa, Aziken,
Drs Olagunju, Olatunji, Musa etc) Colleagues too
numerous to mention. I must salute young ones who have
worked and stood by me in thick and thin. God bless you
all.
Staff and students(including resident doctors) of
department of O&G Unilorin and UITH, I thank you all.
Special mention must be made of staff of Eyitayo Hospital
as well as Midland Fertility Centre, Ilorin. Thank you for
tolerating me. Our bigger dreams will come true. All staff
and students of Al – Alim group of schools deserve special
mention and commendation.
My special regards and thanks to my darling wife, a
special friend and soul mate for almost twenty-five years.
She has been a major pillar of support all the way. Only
Allah can thank you well enough. Our children (Mubarak,
Zainab, Abdulgafar, Kamaldeen, Fatimat) have been a
source of joy to us. We could not have asked for better
children. I must personally thank them on behalf of my
wife and I for being good children.
Once again, I thank the Vice Chancellor and the
University administration for making it possible for all of
us to be here to listen to my moderate contributions to the
knowledge and practice of obstetrics and gynaecology with
special emphasis on reproductive endocrinology/infertility,
Minimal Access Surgery and Ultrasonography.
My Vice Chancellor, Sir, Ladies and Gentlemen, i
thank you all for honouring me with your presence at this
occasion. God bless you all
45
References
Abiodun, O. M Esuga, S. A Balogun, O. R. Fawole, A. A
Jimoh A.G. Trends in the use of Female Sterilization
through Minilaparotomy for Contraception at a Teaching
Hospital in North Central Nigeria. West African Journal
of Medicine.2010
Abiodun,M O, Ijaiya, M A, Fawole, Jimoh A A G. A study of
Serological Evidence of Prior Chlamydia Trachomatis
Infection in patients with Ectopic Pregnancy in Ilorin,
Nigeria. European Journal of Scientific Research, 2007;
16(2): 461-466.
Aboyeji, A.P, Ijaiya, M.A, Jimoh, A.A.G. Knowledge, Attitude
and Practice of Cervical Smear as Screening procedure
for Cervical Cancer in Ilorin, Nigeria. Tropical Journal
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Pregnant women towards Antenatal Blood Donation
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Bamgbopa KT. Hysteroscopy and Assisted Reproductive
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Cates W, Farley T M M, Rowe A. Worldwide patterns of
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Ghazal A, Jimoh A A G, Ashaolu O. Bio safety issues in peace
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Isiaka-Lawal S, Adesina, KT, Saidu R, Ijaiya, M.A, Jimoh,
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Jimoh A A G, Agbede O O. Chlamydia Trachomatis Infection
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Jimoh A A G, Abubakar D. Antiretroviral Treatment in Africa.
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Jimoh A A G, Ghazal A, Ashaolu O. Peace issues in Assisted
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Jimoh A A G, Ibrahim H. Isiaka –Lawal S, Okesina S, Balogun
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Jimoh A A G, Tabari M. Braimoh T A. Clinico-sonographic
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Jimoh A A G, The Management of infertility. Nigerian Medical
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Jimoh A A G. Complications of IUCD use in Ilorin. September
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Jimoh A A G. Epidemiological Study of Malaria parasites in
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Jimoh A A G. Materno-fetal Haematological Relationship in
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Jimoh A A G. Obstetric Height ‘At Risk’ and a need for rethink.
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2001. Vol. 8. 32-35.
Jimoh A A G. Utilization of Antenatal Service at the Provincial
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Jimoh A.A.G, Balogun, O.R, Abubakar D . Maternal Height as
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Jimoh AAG, Agbede OO, Abdulraheem IS, Saka MJ, Abubakar
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48

Attitude and Practice. Nigerian Medical Practitioner.
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Jimoh, A Gafar, Ezenwafor Grace. Abdominal Hysterectomy at
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Kolawole O M, Jimoh A A G, Balogun O R, Babatunde S, Kanu
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African Journal of Endocrinology and Metabolism.
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52