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When IVF Fails, Other Therapies Can Help

Thursday, April 26, 2018

Tracking progress in infertility treatment

Prof Dapo Ashiru

In recent years several fertility experts and other stakeholders have focused intensely on the issue of infertility. Infertility is more critical because of the United Nation’s declaration that everyone has the right to have a baby. In other words, having a baby should be by choice. Hence everything must be done to get everyone access to fertility care.
Infertility is the inability to get pregnant after a year of unprotected intercourse. About 10 per cent of couples in the United States are affected by it. Both men and women can be infertile. According to the Centers for Disease Control,  a third of the time the diagnosis is due to female infertility, a third of the time it is linked to male infertility, and the remaining cases of infertility are due to a combination of factors from both partners. The cause is unknown for approximately 20 per cent of couples. The reason is not determined (unexplained infertility). Consequently, the WHO meeting has now made clear definitions for male infertility and female infertility distinct from each other.
An NGO, the Merck Foundation, under the leadership of its Director, Rasha Kelej, collaborating with the African Fertility Society, has enabled us to unravel through the various campaigns in Africa some of the consequences of infertility on the continent. In Nairobi, a lady called Jaque got her two hands amputated by her husband because she did not have a baby! She became famous worldwide as one of the stigmas that come with infertility even when it is the man’s fault in 50 per cent of the cases. It is why we need continuous education on this subject that affect many homes and marriages.
There is a worldwide emotional epidemic of infertility. As of today, 25 per cent of couples are infertile. Even in India which has severe overpopulation, the most common reason for a visit to the doctor is infertility.
In Nigeria, infertility which used to be a small area of gynecology practice, has now become a vast discipline with several doctors devoting their clinics solely to it.
During the recent conference of the African Fertility Society and the International Federation of Fertility Societies in Kampala Uganda, held on March 1, 2018, the number of IVF clinics in Nigeria was revealed to be close to 70. The number of IVF clinics in Africa is near 160, and in comparison today the number of clinics in Chicago city alone is over 80! It is clear that Nigeria is now recognised worldwide as a part of ART (Assisted Reproductive Technology) providers. We can confidently say today that virtually 95 per cent of IVF cases are treated in Nigeria by Nigerians.
Thirty years ago, more than 80 per cent  of complicated cases of IVF in Nigeria had treatment abroad. These practitioners, under the monitoring guidelines by the Association of Fertility and Reproductive Health in Nigeria  and The African Fertility Society, have saved the country and Africa several resources in foreign exchange being spent previously on overseas medical treatment for infertility.  It is noteworthy that many of the African countries still cannot provide ART services, however.
It is now well known that human ability to get pregnant decreases with age, which explains why only one per cent of teenagers are infertile while a vast majority of infertile couples are in their 30s. It is well documented that from our teen years when the last thing we want is a child, to our mid-thirties when we are finally secure enough to start our family, our ability to conceive decreases almost by 25 per cent.
Research shows that in the past 30 years, infertility has increased and those over the age of 30 have the most problems.
If you are in your 30s and have been working to establish yourself in your profession, please take note.  In planning to start a family in a few years, you should realise that there is a 25 per cent chance you will not be able to do so without medical intervention. It is for this reason that the definition of infertility is made to include a person of age 35 years who has not been able to achieve pregnancy within six months of attempt at conception.
Other factors that may make it difficult for you to get pregnant include abnormal organs, immunological factors and another malfunctioning of the body system. The dramatic increases in infertility over the last 30 years are due to various factors. They include increases in sexually transmitted diseases, environmental toxins in our food – such as heavy metals in fish, environmental pollution particularly in the oil-producing geographical zones, declining sperm counts from absorption of toxic substances and even the increased tension and anxiety of the modern life.
In all other animals except humans, the desire to have sexual intercourse is timed to correspond precisely to that moment when the female is ovulating or producing eggs for fertilisation. Take for instance a dog or a rabbit. Once the woman is ovulating, she seeks out the male, and, after intercourse, the female is usually pregnant with multiple pregnancies. Humans, however, desire to have sex at any time regardless of whether there is an egg that can be fertilised in the woman and it makes us reproductively more inefficient than other animals.
We know that in all species, there is a very short window; in fact, a matter of days during each month that the female is fertile and can get pregnant with intercourse. The timing of sex is therefore crucial if a species is to have an efficient and high fertility rate.

source: the punchonline


Monday, April 16, 2018

‘IVF treatment is sometimes the first option for some couples’ Dr. Tunde Okewale

Babatunde Wale Okewale, MBBS (IB); MRCOG (UK); MFFP (UK); FRCOG (UK) is a man of many parts. An Obstetrician and Gynaecologist, he is also a fertility expert, an author, a philanthropist and a broadcaster. He is a Fellow of the Royal College of obstetrician and gynaecologist UK (FRCOG), member of the Faculty of Family Planning and Reproductive Health (MFFP), UK, member of the European Society of Human Reproduction and Embryologist (ESHRE), member of the American Society of Reproductive Medicine (ASRM) and member of the Association for Fertility and Reproductive Health Nigeria (AFRH). Chairman of St. Ives Healthcare organization, owners of St. Ives Hospitals, Family, IVF & fertility clinics, Ives Medicare HMO and a member of Ives Medicare Foundation, an NGO helping to ease healthcare access to thousands of under- privileged Nigerians, he is a well known advocate of the total well being of women, women healthcare, health education and the empowerment of women in every sphere of the society and the author of the best selling book, “How to get pregnant and have a baby.” In this interview with TOBI AWODIPE, Okewale talks about their success with IVF so far, cost of IVF being a major drawback and the opening of a new IVF clinic in Abeokuta

 

Tell us about IVF in layman’s terms
Invitro fertilization is an assisted reproductive technology commonly referred to as IVF.  IVF is the process of fertilization by extracting eggs, retrieving sperm sample and then manually combining an egg and sperm in a laboratory dish. The resulting embryos are then transferred to the uterus.


What is your success rate with IVF in Nigeria so far?
Our average success rate after taking into account the different ages of women we see is about 40% per one IVF cycle. Age is a critical factor in own egg IVF. Our success rate for women below 35yrs and for women irrespective of age using donor egg is above 60% per one IVF cycle.


Cost of IVF treatment is a major drawback for several couples. How are you intending to make this service affordable for everyone who desires it?
IVF cost is a major factor worldwide. Many countries in Europe that are socially responsive to the plight of infertile couples subsidise the cost for their citizens. We are proud to say that we are in the forefront and the pioneers of low cost IVF in Nigeria. Our aim from inception is to offer an affordable and success-oriented IVF service. We have consistently partnered over the last 10yrs with an NGO and together, we offer a heavily discounted IVF program twice a year to couples who need IVF but otherwise cannot afford the cost of IVF for various reasons. A sizeable number of our nearly 2000 IVF babies so far are from this discounted IVF program. In fact the oldest IVF mum in Africa, Omolara Irhue, at 60years, was a beneficiary of the program. I mentioned her name because she is proud for us to use her as an example to encourage others. Her interview with BBC has been a source of encouragement to many couples that heard it and had given up in their quest for conception.


Any plans to partner with health insurance schemes to make IVF more accessible and less expensive?
We have been partnering with Ives Medicare HMO, an NHIS registered Health Maintenance Organisation (HMO) for the past five years by giving generous discounts for clients who need IVF and who have health insurance with them. Our foundation also has various health schemes ranging from free health care services for thousands of under privileged Nigerians and it is well known for its yearly half price subsidized price cut for infertility and IVF services to couples that cannot otherwise afford the huge cost of IVF and fertility services.


At what point should couples seek IVF treatment?
IVF is not necessarily a last option for infertility treatment. It is sometimes the first option in some cases. For instance, in elderly couples that need donor eggs or in bilateral tubal blockage, IVF would be the first recourse. Having said this, the indications for IVF include patients with tubal blockage, premature menopause, endometriosis, severe low sperm count, advanced female age and unexplained infertility. Whatever the indications, it is important for couples that have been diagnosed with infertility to seek a fertility expert’s help in good time so that a diagnosis can be quickly reached and appropriate treatment commenced at an early age. Success from infertility treatment including IVF is better when the woman is younger. From 40 years and above, fertility starts to decline and the success rate start to reduce as well.


What is your health check program all about?
St. Ives HealthCare is much more than our IVF/ Fertility clinics. Apart from our new clinic, which we will be opening in Abeokuta tomorrow and will deliver all-inclusive services, we presently operate two specialist hospitals in Ikeja and Ikoyi, two IVF/Fertility clinics, a family clinic and an HMO. Different health check program packages are available in our specialists’ hospitals, family clinic and HMO.

Fertility experts want stricter regulations for IVF practice

*Seek laws to reduce stigma, discrimination against childless couples in sub Saharan Africa

President, African Fertility Society (AFS) and Medical Director of Medical Art Centre (MART) and MART Detox Clinic, Ikeja, Lagos, Prof. Oladapo Ashiru, has urged governments across Africa to introduce stricter regulations for Assisted Reproductive Techniques (ART) and In Vitro Fertilisation (IVF) as well as laws to reduce stigma and discrimination against childless couples.

Ashiru, who is also the joint pioneer of IVF in Nigeria, at the first International Infertility Symposium in African held in Kampala, Uganda, said there are plans to di-stigmatise infertility, strengthen human capital in ART in Africa by training more clinical embryologists and empower brutalised infertile women who have passed the child bearing age.

Ashiru said a team of experts raised by the World Health Organisation (WHO) had developed Fertility Guidelines especially on the practice of IVF/ART in Africa.
Ashiru said: “The long awaited change in fertility mind set of the African will now begin to change for ever. The withering childless African woman blamed, for far too long, for the infertility of any cause should at last begin to expect an improved quality of life as the bravado men climb down and calm down in the face of evidence-based fertility recommendations made.”

The theme of the symposium is “Infertility awareness, Access, Capacity building and management in Sub-Saharan Africa for Happy families.” AFS, the International Federation of Fertility Societies (IFFS), the Uganda Ministry of Health and Uganda Fertility Society hosted the symposium.Uganda’s State Minister for Health, Sarah Opendi, said: “Infertility is a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. It is a reproductive disease that affects both men and women; with the WHO indicating that 50 per cent of infertility is as a result of the male factor.

“For the first time, an international conference of this magnitude is holding in sub-Saharan Africa. This provides a unique opportunity for Africa’s infertility care providers, trainers, researchers and policy makers to pool and share knowledge and experience with experts from across the world.” Opendi said government would this year introduce a law on fertility aimed at reducing stigma and discrimination against barren women and men.

“Currently, there is no law that regulates the fertility clinics that are in place in the country and yet the demand for fertility services is growing daily due to technology…We need to regulate this sector,” Opendi said. Opendi said the new law on fertility would include the issues of donor sperms, donor ovaries, surrogate mothers and others.“Before the end of this year, we shall have a draft law on fertility issues…presented to parliament for consideration,” she said.

Opendi said infertility has been a great issue in the country and many barren women are considered as useless and cursed.“I want to appeal to the public that there is a difference between womanhood and motherhood. So, my failure to become a mother doesn’t mean I am useless in society and there is nothing else that I can do. So, stop stigmatizing women and men who have not given birth because it’s not their choice. They should be given equal opportunities in our societies,” she said.

Infertility issues have been neglected not only in Uganda but also in the whole of Africa and other developing countries, but the developed world has gone ahead to handle the infertility issue.

“Although Uganda has a high fertility rate [about seven children per woman], there are a big number of couples who suffer from infertility. In Uganda, about 10 to 15 per cent of the couples cannot have children due to infertility, but 50 per cent is [dependent on males],” she said.She advised couples with infertility issues to always go to hospitals for help instead of going to witchdoctors or pastors.

“In women, causes of infertility include unsafe abortions, fibroids, blocked fallopian tubes due to untreated Sexually Transmitted Diseases, poor nutrition and others,” she said.The deputy speaker of Uganda parliament, Jacob Oulanyah, who opened the symposium on behalf of President Museveni, said the major cause of infertility issues in Uganda is due to untreated infections.“All couples are advised to seek early treatment on STDs to avoid infertility,” he said.

UITH celebrates IVF children’s birthday

The University of Ilorin Teaching Hospital (UITH), Ilorin, has declared its commitment to sustain its services to humanity in the area of Intro-Vitro Fertilisation (IVF), just as its successes in the area have been described as the highest in the history of the gynaecoloy aspect of any public health institution in Nigeria.

Speaking at the one-year birthday celebrations of five of the children of the hospital, a retired Professor of Obstetrics and Gynaecoloy from University of Benin Teaching Hospital (UBTH), Austine Orhue, said the hospital, with the success rate of over 80 per cent, should be rated the best in the country.


Besides, the centre, established three years ago, has a record of 50 children, including a triplet and five sets of twins. 

According to Orhue: “Even though the UITH could not be regarded as one of the first generation of teaching hospitals in Nigeria that started the IVF, its success story in the last few years could be regarded as second to none in any public hospital in Nigeria.

“It has, therefore, given us a ray of hope that public hospitals in Nigeria have a brighter future.”

Orhue commended the hospital’s management, led by Prof Abdulwaheed Olatinwo, for setting up the centre, “that has put smiles on the faces of many couples initially stigmatised as barren.”

In the same vein, Olatinwo said the management has prudently managed its meagre internally generated revenue (IGR) to set up the centre, just as he described its charges as one of the cheapest in the country. 

The CMD, who prayed for the sustenance of the visions of the IVF centre after the expiration of his tenure of offices, urged Nigerians to always embrace patriotic acts that would make the country great.
The elated parents proudly displayed their babies, including a set of twins, to the admiration of the UITH management and staff and other well-wishers.

Diet improves pregnancy chances in women receiving IVF by 68%

New research has found that women who follow a “Mediterranean” diet in the six months before assisted reproductive treatment have a significantly better chance of becoming pregnant and giving birth to a live baby than women who did not.

Researchers asked women about their diet before they underwent in vitro fertilisation (IVF) treatment and found that those who ate more fresh vegetables, fruit, whole grains, legumes, fish and olive oil, and less red meat, had a 65-68 per cent greater likelihood of achieving a successful pregnancy and birth compared to women with the lowest adherence to the Mediterranean-style diet.

The study, which is published Tuesday in the journal Human Reproduction, focused on dietary patterns rather than individual nutrients, foods or food groups. It assessed the diet of 244 women via a food frequency questionnaire when they enrolled at an Assisted Conception Unity in Athens, Greece, for their first IVF treatment.

The questionnaire asked them about how often they ate certain groups of food in the preceding six months; the results gave the women a MedDiet Score, which ranged from 0-55 with higher scores indicating greater adherence to the Mediterranean diet. The women were aged between 22-41 and were non-obese (body mass index of less than 30 kg/m2).

Researchers, led by Associate Professor Nikos Yiannakouris at the Department of Nutrition and Dietetics at Harokopio University of Athens, divided the women into three groups depending on their MedDiet Score: the first group had scores between 18 to 30, the second scored between 31-35 and the third group scored between 36 to 47.
They found that compared to the 86 women in the highest scoring group, the 79 women in the lowest scoring group had significantly lower rates of pregnancies (29 per cent versus 50 per cent) and live births (26.6 per cent versus 48.8 per cent).

Affordable IVF for Nigerian Couples

Lagos State University Teaching Hospital (LASUTH) has solicited for partnership to achieve affordable Assisted Reproductive Technology, ART, popularly known as In Vitro Fertilization (IVF) for indigent infertile couples.

The Teaching hospital, recorded a milestone of 74 live births at its Institute of Fertility Medicine, IFM, department of Obstetrics and Gynecology through the ART, under its Memorandum of Understanding, MOU, with a private Fertility facility, The Bridge Clinic.

Speaking at the institute’s celebration of the milestone, the Chief Medical Director, LASUTH, Prof. Adewale Oke, represented by the Director of Clinical Services and Training, Dr Ayoade Adedokun lamented that many homes have been broken with so many women shattered emotionally due to infertility issues, adding that the IFM partnership with the Bridge Clinic which have produce 74 babies since its inception in 2011 have will bring smiles to these women as well as others who can’t afford the high cost.

According to the hospital’s Chairman of IFM Board, Prof. Adetokunbo Fabamwo, the cost of one ART cycle in private facilities ranges from N1 million to N2 million, with the institute providing same quality service at N500, 000 at the moment, adding that plans are underway to further reduce the price to as low as N250, 000 to ensure that all indigent couples have opportunity to have their own babies, which could be achieved through partnership.
“The IFM aims to bring the use of ART at a highly affordable rate to indigent patients who battle infertility but unable to afford the high expense of procuring available ART service from a normal setting. The idea of the partnership is to reduce cost by 50 per cent and even further bring it down by 25 per cent. ART is the technology used to achieve pregnancy in procedures such as fertility medication, in vitro fertilization, IVF and surrogacy. It is reproductive technology used primarily for infertility treatments, and is also known as fertility treatment,” he said.


Adetokunbo explained: “The idea was that the Bridge Clinic would partner with LASUTH’s Department of Obstetrics and Gynaecologist and in the process transfer knowledge and technology over five years to LASUTH. The technology is able to bypass a lot infertility hurdle to achieve conception. Yet, globally, only 35 per cent success rate could be achieved in the use of ART. IFM has recorded between 38 to 40 per cent success rate so far. To achieve 25 per cent further reduction, IFM would partner some pharmaceutical companies to get drugs at a very cheap rate, and this would enable the facility further reduce the cost of a circle of ART by N150, 000.

“So far, originally the IFM aims to achieve autonomy and break away from the Bridge Clinic after five years of the initiative, but now the MOU has lasted six years

Fabamwo added that there was the need to train more fertility experts in the hospital as only two persons had been trained as consultants on fertility matters in the hospital.

In his remarks, the Chief Executive Officer, the Bridge Clinic, Dr. Jide Ojo, said that IVF awareness was low in the country, with many dying in silence because they feel stigmatised and do not know where to seek help, adding that there is the need for more awareness so that a lot of people will know where to go to access these services.