Fay­ola K J Fras­er

The Trinidad and To­ba­go IVF and Fer­til­i­ty Cen­tre is a gem in our coun­try and re­gion, that has fa­cil­i­tat­ed count­less fam­i­lies with the most pre­cious gifts of new life. The cen­tre, through its work over the past 20 years has achieved some ma­jor feats, in­clud­ing the birth of the first IVF ba­by in the Eng­lish-speak­ing Caribbean in 1997 and pro­duc­ing ap­prox­i­mate­ly 3,000 ba­bies since 2008.

Two of the trail­blaz­ing women be­hind this gru­elling but deeply re­ward­ing un­der­tak­ing, who are mak­ing a no­table im­pact on the lives of fam­i­lies in T&T and be­yond, are Dr Cather­ine Minto-Bain, the med­ical di­rec­tor, OB-GYN and Fer­til­i­ty Spe­cial­ist, and Son­ja Man­kee-Sook­er­am, Lead Em­bry­ol­o­gist.

Women, men, or cou­ples who find them­selves on the doorstep of T&T IVF, of­ten seek help for var­i­ous rea­sons. Ac­cord­ing to Minto-Bain, “Peo­ple come to us say­ing they have trou­ble get­ting preg­nant, or they are get­ting old­er and want to freeze their eggs in the cur­rent state, or they are sin­gle but want a ba­by and are look­ing for a donor sperm.” In some cas­es, as de­scribed by Minto-Bain, there are even ex­ten­u­at­ing med­ical cir­cum­stances, such as up­com­ing chemother­a­py to treat breast can­cer/tes­tic­u­lar can­cer.

These cir­cum­stances land women and men at T&T IVF to pre­serve their eggs or sperm to have the op­tion of hav­ing a ba­by post-can­cer treat­ment. Up­on ini­tial in­tro­duc­tion to a new pa­tient, the clin­ic of­fers an ini­tial as­sess­ment to de­ci­pher the rea­sons for the pa­tient not get­ting preg­nant and some­times of­fers an easy fix or oth­er times refers the pa­tient to the IVF process.

Part of the job of both Minto-Bain and Man­kee-Sook­er­am is to ed­u­cate and raise aware­ness around the vi­a­bil­i­ty of IVF, giv­ing hope to those who of­ten feel that all hope is lost.

In-vit­ro fer­til­i­sa­tion, or IVF, has been com­mon­ly ig­nored as a vi­able op­tion for fam­i­ly ex­pan­sion in the Caribbean, or viewed with sig­nif­i­cant scep­ti­cism, where peo­ple re­fer to the prod­uct of the process as “a test tube ba­by”. Man­kee-Sook­er­am de­scribes IVF as a “three-phase process, where we first take eggs from the fe­male and sperm from the male and put them to­geth­er in one of two ways. Then we look for fer­til­i­sa­tion and de­vel­op­ment of the eggs, and dur­ing those days we hope that it will be­come an em­bryo. Once we have the em­bryo, we place it in the uterus of the woman and wait for it to im­plant.”

In their ded­i­ca­tion to ex­cel­lence, these women have em­ployed the most up­dat­ed AI tech­nol­o­gy to “score” the em­bryo, es­sen­tial­ly run­ning a pho­to of the em­bryo tak­en from un­der a mi­cro­scope in an AI pro­gramme to score the vi­a­bil­i­ty and ge­net­ics. How­ev­er, even with the as­sis­tance of the most up­dat­ed tech­nol­o­gy, the clin­ic has a preg­nan­cy rate of ap­prox­i­mate­ly 60 per cent preg­nan­cy af­ter plac­ing em­bryos in the woman. To pa­tients, Minto-Bain said al­though they want to in­spire hope, “we still don’t have a fool­proof way of know­ing which em­bryos will im­plant.”

The trans­paren­cy and hon­esty of Minto-Bain’s ex­pres­sion of their im­plan­ta­tion rate de­fines T&T IVF’s ap­proach to their pa­tients and is one of the clin­ic’s lega­cies. “We val­ue the health of the ba­by and safe­ty of the moth­er over preg­nan­cy rates or com­mer­cial gain,” she says, which is al­so in­di­cat­ed by their rea­son­ably scaled costs of IVF in com­par­i­son to oth­er clin­ics in­ter­na­tion­al­ly and even in the re­gion. Minto-Bain’s lead­er­ship is char­ac­terised by ded­i­ca­tion to pa­tients and fam­i­lies, en­sur­ing that every pre­cau­tion and care is tak­en along the jour­ney.

“I don’t sleep at night,” Man­kee-Sook­er­am laughs, “es­pe­cial­ly when we have em­bryos in the in­cu­ba­tors.” She de­scribed it as an ho­n­our and re­spon­si­bil­i­ty to be trust­ed with pa­tients’ pre­cious eggs, as “these be­long to re­al peo­ple and we are tasked with car­ing for them.” They there­fore en­sure best prac­tices in reg­u­lat­ing the en­vi­ron­ment that the eggs and sperm are stored ac­cord­ing to sci­en­tif­ic stan­dards. Man­kee-Sook­er­am sleeps with her phone un­der her pil­low, as if any of the stan­dards are breached–for ex­am­ple, if the in­cu­ba­tor drops be­low the reg­u­lat­ed tem­per­a­ture–an alarm is set off and she hur­ries in­to the clin­ic re­gard­less of the time of day or night.

Both women have been on count­less jour­neys with fam­i­lies over the col­lec­tive decades of their work at T&T IVF, and re­mem­ber fond­ly the way that giv­ing hope and giv­ing life has shaped them.

Man­kee-Sook­er­am who has loved sci­ence since she can re­mem­ber her­self, still re­calls her first IVF preg­nan­cy as one of the ca­reer-defin­ing mo­ments of her jour­ney. She found her­self ec­sta­t­ic when the em­bryo was im­plant­ed and the pa­tient be­came preg­nant, and her work meant so much to the pa­tient’s fam­i­ly, that they, moth­er and son, still vis­it her every year since. Minto-Bain, on­ly a year af­ter she had be­gun work­ing in fer­til­i­ty, found her­self go­ing against the opin­ion of a pa­tient’s “em­i­nent” OB-GYN, who told her that she would nev­er con­ceive, even with IVF. “I be­lieved she had at least a five per cent chance, in a small win­dow of time,” Minto-Bain said, re­mem­ber­ing the firm stance she brave­ly took.

The pa­tient con­ceived, and “at long last got her ba­by” who is now in his late teens. Minto-Bain re­called feel­ing over­come and over­joyed to see their tran­si­tion from heartache caused by their strug­gles to the joy of be­com­ing par­ents. This mo­ment root­ed her strong­ly in her self-con­vic­tion that she knew what she was do­ing, and con­vinced her to be­gin do­ing fer­til­i­ty full-time.

Al­though these women and their team are do­ing in­cred­i­ble work, and po­si­tion­ing T&T as a leader in the re­gion for IVF and fer­til­i­ty, many women still feel in­tim­i­dat­ed to be­gin a jour­ney of IVF.

Ac­cord­ing to the World Health Or­ga­ni­za­tion, one in six peo­ple glob­al­ly are af­fect­ed by in­fer­til­i­ty and strug­gle to get preg­nant. Minto-Bain ad­vised that women take so­lace in these sta­tis­tics, and know that if con­cep­tion is a strug­gle, you are not alone. She al­so en­cour­aged women to get as­sessed as a first step, rather than mak­ing as­sump­tions so they can un­der­stand their op­tions.

The T&T IVF clin­ic does not cater to any de­mo­graph­ic but sup­ports women of all dif­fer­ent ages, races and so­cial class­es. As a 20-women-strong staff, she said they are a com­mu­ni­ty that bol­sters all their pa­tients dur­ing their re­spec­tive jour­neys. Man­kee-Sook­er­am’s main piece of ad­vice is to not wait un­til it’s too late. She ad­vised cou­ples and women to not wait longer than six months of ac­tive­ly try­ing to con­ceive (for women un­der 35) and not longer than one year for women 35 and above be­fore they seek sup­port and as­sess­ment.

In the kitchen of the T&T IVF clin­ic, there is a board which holds cards and pic­tures from fam­i­lies whose ba­bies have been made pos­si­ble with the in­ter­ven­tion of these in­cred­i­ble women. Cather­ine Minto-Bain and Son­ja Man­kee-Sook­er­am have worked tire­less­ly to not on­ly give gifts of life to these fam­i­lies but do so with the ut­most care and con­cern, en­sur­ing that trans­paren­cy and ethics are at the core of their ethos. Their lega­cy of ex­cel­lence has pro­pelled T&T to the fore­front of IVF in­no­va­tion in the Caribbean, and peo­ple from the Caribbean di­as­po­ra and even from the Unit­ed States come to T&T to start their fam­i­lies. How­ev­er, even with their ex­pan­sion and uptick of for­eign clients, Minto-Bain af­firmed that they “re­main pas­sion­ate and com­mit­ted to Trinidad & To­ba­go, and cre­at­ing fam­i­lies for peo­ple in this coun­try.”