LONG before couples actually start trying to conceive, most of them dream of the day that they will become parents. Unfortunately, the journey to conception for at least 15 per cent of the world's population who come face-to-face with the devastating reality of fertility and reproductive-related challenges may be arduous, especially for couples in third world countries like ours, where resources are scarce and couples have little knowledge of how or where to access effective, economical medical advice and treatment.
Fortunately, more specialists are investing in reproductive and fertility health, and have dedicated their time to optimising the natural fertility of couples through medical innovations, therapies and other most effective treatments to help them get pregnant.
Meet some of the local experts who are improving fertility health and reproductive care for couples facing infertility.
Dr Patrice Monthrope
Dr Patrice Monthrope is an obstetrician/gynaecologist/fertility specialist and senior medical officer for Noel Holmes Hospital. He is also the medical director at City Centre Health & Wellness & Western Fertility in Montego Bay.
He received his medical and specialist training was at the University of the West Indies (Mona) and his master's in Human Reproduction and Embryology from the University of Valencia.
Dr Monthrope has been performing the Tubal Cannulation procedure used to treat blocked tubes in patients diagnosed with proximal tubal occlusion successfully for over 10 years, with many successes.
The procedure is performed hysteroscopically which is a minimally invasive procedure that uses a small scope used to view the inside of the uterus after entering the vagina and cervix (no cutting is involved). It is then possible to view the entrance of each Fallopian tube where it is attached to the uterus, this area is called the ostia and is where the proximal blockage often occurs and thus it can be cleared at this time. Cannulation is a day case procedure, thus the patient is able to go home the same day and most times return to work the following day.
If successful, the procedure allows the patient to avoid a more expensive, invasive surgical procedure and also the need for In-Vitro Fertilization (IVF) which was thought to be the only solution for patients with proximal tubal occlusion at one time.
Many countries like Jamaica with a high incidence of tubal factor infertility (blocked tubes) are also the countries that have reduced access to diverse and affordable fertility treatments. Dr Monthrope said that fertility treatments in such countries are usually a low priority with government reproductive health programmes using resources to focus on family planning and contraception rather than infertility. This results in poor access and often cost-prohibitive treatments for infertility that are not covered by insurance. The need for equity and access to diverse fertility treatments in developing countries is a well-recognised challenge.
As a fertility specialist, Dr Monthrope also offers other affordable and innovative solutions to patients with fertility challenges.
Dr Monthrope's study was recently published in the Journal of Minimally invasive Gynaecology, November 2021 edition. The abstract/study was also presented virtually at the American Association of Gynecological Laparoscopists 50th Annual Conference in Austin Texas.
Dr David Brown
Dr David Brown is an obstetrician gynaecologist with over forty years in the medical field. He is known for his efficient care for his patients based on medical knowledge and also his application of practical nutritional advice to effect excellent care. Dr Brown is internationally recognised for his technological innovations during his tenure at the Cornwall Regional Hospital where he was the head of the department for Obstetrics and Gynaecology for two decades prior to his retirement from that institution. He is also a member of the Royal College of Obstetrics.
He has focused on life-saving techniques to prevent haemorrhaging in childbirth by the application of special clamping protocols. He has initiated the use of misoprostol as a means of “ripening” the cervix effecting timely delivering which prevents foetal distress, injury and death. One of his most recent innovations is the development of a surgical technique, Suture Homeostasis, a method of conservatively managing ectopic pregnancies, which has proven successful in retaining tubes, ensuring continued successful fertility outcomes for patients suffering from an ectopic pregnancy. Dr Brown was inspired to develop an alternative to traditional techniques where the woman's tube was removed because of the damage caused by the ectopic pregnancy and the impending risk of intra-abdominal haemorrhage. Unfortunately, this technique limits the chances of ever again getting pregnant naturally. For these women, in many instances, their only gateway to motherhood is IVF, which is quite expensive – and therefore not accessible, especially not without loans, to the average citizen.
Dr Brown received both his undergraduate and graduate-level training at the University of the West Indies, Mona. Dr Brown work over the years has been widely published in international journals; in November of last year he presented his recent “tube preservation” technique at the American Association of Gynecologic Laparoscopists (AAGL) in Austin, Texas.
Dr Brown's dream is to see more of the local fertility innovations taught and practised locally to provide women with the most cost-effective and efficient options. “Our solutions are right here at home in Jamaica. We have the hands and hearts to save our lives and secure the best interest of our children. The care of women by us and women of themselves is a secure bedrock for thriving, healthy successful population,” he said.
Dr Sharifa Frederick
Dr Sharifa Frederick spends most of her days at the Hugh Wynter Fertility Management Unit (HWFMU) at the University Hospital of the West Indies (UHWI), with families exploring the barriers to their conception efforts and devising plans to surmount them.
She has a vested interest in creating equal opportunities for patients wishing to conceive but are plagued by fertility-related challenges.
She acknowledges that her passion to pursue obstetrics and gynaecology, and her ultimate love affair with fertility management, were heavily influenced by her father, Professor Joseph Frederick, a trailblazer in the field who has been recognised for his pioneering work in assisted reproductive technology in Jamaica. Professor Frederick also spearheaded the establishment of the Assisted Reproductive Unit, which provides services for the treatment of infertile couples in Jamaica and throughout the region.
Dr Frederick received her Bachelor of Medicine, Bachelor of Surgery (MBBS) from UWI, Mona. She later completed her residency in obstetrics and gynaecology and her fellowship in minimally invasive surgery and reproductive medicine at UHWI.
Professor Joseph Frederick
Professor Frederick is widely recognized for his pioneering work in assisted reproduction technology or in-vitro fertilization in Jamaica. Having received training in the United Kingdom and the United States of America, he established the Assisted Reproductive Unit which now provides services for the treatment of infertile couples in Jamaica and throughout the region. The Unit has been very successful in its operations and achieved six live births in its first treatment cycle.
Professor Frederick was primarily responsible for the introduction of operative laparoscopic procedures at the UHWI. The unit is now able to treat patients with ectopic gestations as outpatients, and to perform other advanced gynaecological operations. The programme has strong international appeal and is offered regionally.
Professor Frederick's research interests have focused on the epidemiology of specific conditions within reproductive health, particularly uterine fibroids and pelvic inflammatory diseases, both of which can contribute significantly to gynaecological symptoms and admission to hospital and have a major impact on reproductive function and fertility.
Other research has focused on male and female infertility, and the increasing prevalence of male infertility. Professor Frederick has also conducted research on the role of auto antibodies in spontaneous recurrent abortion.
Arising from this research, he has published 24 papers in peer-reviewed journals and has also written laboratory manuals and chapters in recognized textbooks.
His professional activities have achieved widespread recognition. He is a member of the Accreditation Team of the Royal College of Obstetricians and Gyanecologists (UK) for hospitals employed for training in this discipline.
He has contributed most significantly to international literature in the area of uterine fibroids through two well designed pioneering clinical trials aimed at reducing blood loss during the removal of fibroids. He has also co-authored important research on labour inducing agents, one of which has proven to be very cost effective and is widely used worldwide. These three studies have the highest citation index in the history of the Department of Obstetrics and Gynaecology and have helped to change clinical practice in the local setting.
Professor Frederick received his undergraduate and postgraduate training at The University of the West Indies, Mona Campus obtaining the Bachelor of Medicine, Bachelor of Surgery as well as the Doctor of Medicine degrees from the institution. He has been recognized by the Royal College of Obstetricians and Gynaecologists, UK and the American College of Obstetricians and Gynaecologists with the award of Fellowship to these colleges.
Dr Vernon Dacosta
Dr Vernon DaCosta heads the Hugh Wynter Fertility Management Unit at The University of the West Indies (The UWI) and has been a celebrated specialist in fertility and in vitro fertilisation for over two decades.
He has implored women to have some of their eggs, or fertilised embryos, stored until they are ready to have children.
“They say that the best time for a woman to get pregnant is between 24 and 28, but many of those who come to us now are in their 40s, which is way too late,” Dr DaCosta lamented, noting that infertility is on the rise globally in both men and women.
“Overall when you look at sperm quality and quantity for, say, over the last 50 years, there has been a significant decline right across the globe. This has a lot to do with food and lifestyle choices. There is also the fact that women are delaying childbirth. Many women now are waiting until they have completed university, start their jobs, and then by the time they realise, they're in their 40s.”
He maintained that age is the most important factor in infertility.
“Your fertility potential as a woman starts to decline after 28 years old,” he said. “If you are going to delay having children, come in your 20s or early 30s and let us collect your eggs, freeze them, and then when you're ready, you come back for them.”
He mentioned the test, the Anti-Müllerian hormone (AMH), which we can do for women as a screening test,” he explained. “Just like you would screen for diabetes or hypertension you can screen for your ovarian reserve [egg count] where you do this blood test, and if it shows that your ovarian reserve is very low, then we'd advise you that you need to get pregnant now. If you don't plan on getting pregnant then we'd collect your eggs, freeze them, and then you can come back whenever you find your partner.”
He added: “Once we thaw it out, we fertilise it through a process we call ICSI [Intracytoplasmic sperm injection], where we get the sperm and inject it into the egg, and then once it starts to develop then we put it back inside the uterus.”
Donor sperm, he said, is available for women who can't find, or who choose not to have a baby with a partner when they are ready to have children.