Wednesday, July 6, 2011

IVF has broken the myth of infertility – ALU

Dr. Alu

The myth of infertility being a problem associated only with women has since been broken, as studies have revealed that men also share a part of the burden of infertility in marriages.
In the view of the Chief Medical Director, Maitama Hospital, Abuja, Dr Francis Alu, “Although the woman is always looked at as the culprit with little or no sympathy and/or patience from others, it must be stated that the man equally contributes to infertility hence infertility is regarded as a disease of the couple.

Alu, who is also consultant obstetrician and gynaecologist remarked that the single most important factor in infertility is the age of the female. “Age is not a significant factor in males. This is however, different in females. The chances of a couple achieving pregnancy in any given month is about 25 percent in young people and 15 percentat the age of 40 and less than 5 percentafter that. Fertility declines substantially after age 35 in a woman such that a woman has only half the chance of becoming pregnant than she did at the age 25. It drops rapidly after 40 and pregnancy is rare for the first time after age 45. Miscarriage is also common due to abnormal embryos with increasing age.
Giving a ray of hope for couples seeking to get pregnant, he said the advent of the ground breaking medical procedure of Invitro Fertilisation (IVF) treatment has however given hope of a better way to manage infertility.
Alu however cautioned that, “ IVF is not just a solution, but there certain things you must bear in mind before you go for IVF. The cost is very high and it is very stressful and very frustrating, there is no guarantee of success. The success rate is about 20 to 25 percent, people who require this treatment are older people because the embryos are usually abnormal so miscarriages are quit common so even though you can achieve pregnancy, it is the responsibility of IVF doctor to explain these things to the patients so they will be well prepared.
He said IVF treatment has helped many women who ordinarily as a result of tubal damage can not get pregnant. Alu further said in the past there were just very few but quite a number of people are now coming out in specialisation in such area. In Abuja alone we have abut five centers , but now they are over 20. “It is a very, very challenging area and is very lucrative area too and it is rewarding if you get the result you tend to be happy so people are also going into it, but as I said the only draw back is the cost how many people can afford the treatment, the second draw back is there is usually no guarantee of success that’s the truth unless the person is younger.
He hinted that government is contemplating an intervention measure that would substantially accommodate couples. As a result of the cost involved government has not really gone into the issue of assisted reproduction techniques but they have been called by surgeons, gynaecologists and the Nigerian Red Cross that they should at least pick up one or two teaching hospitals, to subsidise this treatment.
However in Abuja , the National Hospital has taken a bold step. There is now an Assisted Reproductive Technology Unit in National Hospital but apart from that I think Benin is trying to have an advanced technique.
And people are saying that government should subsidise it to accommodate those who do not have fund to patronise the various hospitals that have it for now.

Nigeria: IVF Still an All-Comers Affair – Debate Rages Over Ethics of Practice

By Onche Odeh
The absence of a regulatory framework for fertility treatment in Nigeria has continually put a growing number of couples in need of In vitro Fertilization and other Assisted Reproductive Techniques (ART) on the vulnerable edge.
Added to this, is the growing incidence of public distrust for the health system in Nigeria, has encouraged quackery in the highly specialized field of medical technology.
This has become a major issue of concern to experts, especially at a time debates are raging over what passes for ethical or not in Assisted Reproduction among various groups of people.
This played up at a recent jaw-jaw session held in Lagos between medical experts, representatives of religious groups, media and others organized by the Bridge Clinic, one of the first few fertility treatment centres in Nigeria.
There, it was reiterated that a growing number of Nigerians, especially females are faced with the sad society-induced consequences of not being able to conceive and have babies naturally.
Managing Director, Bridge Clinic, Dr. Richardson Ajayi, noted many Nigerian couples are truly finding it difficult o have babies naturally, but added that the advent of IVF and similar techniques have brought succor to many people in the country as well.
He, however, said, “The absence of regulatory framework has made it difficult to ensure standards are kept, as some people, because they have the money to buy equipment would just go into fertility treatment.”
At the Society of Gynecologists of Nigeria (SOGON) conference held earlier in Abuja, Ajayi emphasized that all stakeholders must look at the state of regulation around the world and focus on ethical issues that might have to be considered in Nigeria before making proposals for deliberation.
At the Lagos session, he noted that “the United Kingdom and other countries already have resounding frameworks for the regulation of fertility treatment,” adding that Nigeria must begin to think in that light.
Meanwhile, in a collective resolution, experts, religious, leaders and others present at the Lagos meeting agree that IVF, is an ethical practice, although questions were raised by the religious groups
“The catholic does not support any act that would amount to termination of life and in IVF and similar procedures we do know that the unwanted embryos, which by all definition is already a life are destroyed to avoid multiple implantations are destroyed. This the catholic does not accept,” Catholic priest, Sylvester Nwutu, noted.
According to him, the catholic supports natural means of procreation because it fosters the God-given union between the couples involved.
Similarly, a Muslim cleric, Suleyman Fulani, noted that some of the procedures are accepted as medical exigencies by Islam so long it is not performed by the opposite sex in cases that require the patient baring intimate parts of the body.
It was difficult convincing attendees at that event that surrogacy, was indeed ethical as some of them believe, there are other means of achieving this.
The catholic cleric, just like an Anglican Priest at the event, thinks adoption is a good option for those desiring of babies, considering the huge tendency of parental crisis that could emanate.
Consultant Obstertrician and Gynaecologist (O&G), Professor Friday Okonofua, however, pointed out that surrogacy does not run foul of ethics.
“In surrogacy, the sperm and egg that achieved fertilization are actually from the couple and not the person carrying the baby. There is no genetic input from the surrogate mother at all,” Okonofua said.
It was, however, unanimously accepted at that meeting that IVF and ART for single women and same sex couples should not be encouraged, hence rated as unethical.
Consultant O&G at Lagos State University Teaching Hospital (LASUTH), Dr. Niyi Oduwole, said, “Agreed, westernization is catching up with us, but we should also be cautious to imbibe, as much as possible, the good things and not the bad ones. IVF for same sex, singles should not even be in our thinking otherwise it would be a lost fight to ever convince anyone that the process is ethical at all.”
In Anglican priest’s words, “we are raising a society of responsible people. Any woman who wants to have babies should just go and get married otherwise, should adopt a child.”
Mr. Emmanuel Ugoji of Ipas Nigeria, however, added another tilt to the arguments, when he said, “In all of this, choice should determines what action a couple takes. What if you are neither a Christian nor Muslim, and not guided by the respective laws and doctrine. What do you do when you are confronted with issues on childbearing in a country like Nigeria. The couple still must make a choice on what is good for them, although the eventual decision must be guided by adequate knowledge.”
IVF and Intra-Cystoplasmic Sperm Injection (ICSI) are two commonly used procedures to achieve conception in couples with ICISI being specifically used to treat male factor infertility.
According to experts, one in every four couples in Nigeria may have difficulty achieving conception through natural means, highlighting the increasing problem of infertility. Most of these cases are caused by infections over time, of the female reproductive tract, tubal blockage or rupture as well as low sperm count and poor sperm quality, among others.
Although, infertility among many couples is perceived as mostly from the female, studies have shown that a growing number of males factor infertility, which is associated with various factors.
A case-control study of risk factors for male infertility in Nigeria by Friday Okonofua and four others Infertility is associated with various proxies of sexually transmitted infections (STIs) and poor healthcare-seeking behavior for STIs in Nigerian men.
The study, which also featured in the Asian Journal of Andrology, found, in a multivariate analysis that male infertility was significantly associated with bacteria in semen cultures, self-reporting of previous use of traditional medications and moderate to heavy alcohol intake, but not with smoking and occupational types.
They also found that infertile men were significantly more likely than fertile men to experience penile discharge, painful micturition and genital ulcers. They are also less likely to seek treatment for these symptoms and more likely to seek treatment with informal sector providers.