Monday, October 29, 2012

Infertility: Causes, costs of a rising problem

dr. abayomi aiyesimoju

Many homes are going through the frustration and agonies of childlessness, with observers saying the problem of infertility is fast-becoming a plague in the country.

In Nigeria today and the world at large, the desire of every couple is to become parents within the first or second year of married life. Some couples have this dream fulfilled, while there are quite a number of others who do not. There are also couples who already have one or two children and want more.

Infertility, according to medical experts is the inability of a couple to get pregnant after a year or more of trying. The prevalence of infertility in Nigeria is between 20 and 25 per cent among married couples. It has been found that female factors are responsible in 40 per cent of cases; male factors account for 40 per cent; the remaining 20 per cent are the combination of both.

Experts list the causes of male factor infertility to include: poor sperm count, poor motility, total absence of sperms and testicular cancer, while some reasons adduced for female infertility include: tubal blockage, endometriosis, elevated hormones and lack of ovulation (that is, when a woman does not produce any eggs).

According to them, many of these factors often lead to the high incidence of sexually transmitted diseases, which is a preventable condition. Unfortunately, by the time the couple seeks help for their infertility, the damage has already been done and will require some form of infertility treatment.

In many cases, especially in the country, women are blamed for childlessness in marriages. It is in fact common that men are absolved of any blame in such circumstances, as a lot of people believe, albeit ignorantly, that the problem of infertility is exclusive to women. However, medical research had proven that men and women do share equal blame for infertility.

Although experts agreed that the problem of infertility in men could be genetic (inborn) or could be as a result of illness or injury, they are also of the opinion that many other factors including the lifestyle of the individual play major roles.

According to Dr. Abayomi Aiyesimoju, a Lagos-based Consultant Physician, a lot of factors could be responsible for infertility in men. Some of these factors, according to him, are preventable. Simple things like placing laptop on the lap, wearing of tight underpants and constant riding of bicycle could make a man infertile.” These activities can lead to increase in the temperature around the testes (the organ responsible for sperm production in men). One thing that the testes do not like is heat and any activity that heat up the testes could lead to infertility in men,” he explained.

Speaking further, Dr. Aiyesimoju said the eating of food from plastics placed in a microwave oven could affect a man’s fertility. “When you put a plastic in a microwave, the plastics are known to contain substances that have hormone-like effects and if you keep consuming that every day, somehow it is going to affect your hormonal system and the essence of the reproductive function has to do with the right state and function of the hormones”, he stated. Rather than use plastics, the expert advised men to use plates made of ceramics, noting that ceramic plates were completely safe.

The main factors that could affect a man’s fertility, according to the physician, include exposure to pollutants in the environment, use of herbicides and pesticides, as well as certain drugs used in the treatment of other ailments. “Unknown to many, ulcer drugs like cimentidine can affect fertility. Also, aspirin and anti-malarials can reduce sperm count. Furthermore, radiation treatment and chemotheraphy for cancer patients can reduce sperm count,” he added.

According to experts, lifestyle problems such as excessive alcohol consumption, cigarette smoking and drugs like marijuana could also affect a man’s fertility.

Aiyesimoju disclosed further that marijuana could lower sperm count. Apart from this, he said poor diet and age could reduce a man’s fertility. He said, “If a man is malnourished, his fertility can be affected and of course, the older one gets, the less fertile he becomes.”

Another problem he identified that could lead to infertility in a man was the presence of varicose veins (veins that have become permanently swollen or enlarged.

He noted that varicose veins in the scrotum can cause congestion, which may prevent free flow of blood and eventually affect the supply of nutrients to the male organ.

It is common to find many homes, where couples have been running from pillar to post in their desperate search for the blessing of the womb. They move from one worship centre to another or from one herbalist to another who professes to have a panacea for infertility. Some claim to seek unorthodox means towards overcoming the challenge. A lot of them doubt the efficacy of western medicine on the issue of infertility. But a Consultant Obstetrics and Gyneacology and Managing Director of Bridge Clinic, Lagos, Dr. Richard Ajayi, said with advancement in medicine, it was now possible for infertile couples to have their own children through various assisted reproductive techniques. Such techniques, according to him, include: Ovulation induction and cycle monitoring, Intrauterine insemination with partner’s sperm (IUI), Donor Insemination(DI), In Vitro Fertilization and Intracytoplasmic Sperm Injection(ICSI).

He explained that ovulation induction and cycle monitoring could be used for women with irregular menstrual cycle such that if ovulation was absent drugs may be administered to stimulate egg production. “IUI is performed on women with healthy fallopian tubes and it involves the injection of treated sperm from the husband, partner or donor into the uterus through the cervix. DI is used for men who have no sperm in their ejaculate”, he said, adding that: “The most effective treatment for women with absent, blocked or damaged fallopian tubes is the IVF in which we create a condition to allow the sperm and the egg to meet as if it is happening inside the woman’s body.”

Also speaking on the issue, another assisted conception expert who is also the Medical Director of St. Ives Hospital, Lagos, Dr. Tunde Okewale, however, lamented on the cost of IVF in Nigeria which according to him was beyond the reach of many infertile couples in the country. He disclosed that an IVF cycle cost between N800,000 and N1million. While calling on the government to urgently pay attention to infertility problems, Okewale said: “Infertility has to be recognised for what it is. If individuals have heart problem, government sees it as a disease condition; orthopedic hospitals for people who have broken bones, but government generally tends to see infertility problem as a personal problem and not as a medical problem.”

Okewale spoke on the negative implication of infertility, especially on general society, hence the issue should not be handled with levity. “When a couple is infertile, it goes beyond a personal problem but a social problem. When couples are infertile, it affects their families and so many people around them because they go through all sorts of emotions. Even the marriage is at stake. Other vices such as adultery, polygamy, illegitimate children and sexually transmitted diseases can result from there. So, it is a social problem on its own and the responsibility of government is to tackle social issues. That is why in the UK, the government lists out some criteria on infertile couples that need IVF and the government not only pays for it but they pay for three cycles for those people.”

by muda

Friday, October 12, 2012

AFRH endorses guidelines for IVF practice in Nigeria THE

THE Association for Fertility and Reproductive Health (AFRH) of Nigeria has approved minimum standards for clinics offering Assisted Reproductive Technology (ART)/In Vitro Fertilisation (IVF) in the country.
President AFRH, Prof. Osato F. Giwa-Osagie and Vice President and Chairman Guidelines and Regulation Committee (GRC), Prof. Oladapo A. Ashiru, in a press statement said AFRH has now finally endorsed the guidelines for practice in Nigeria.

They wrote: “These guidelines which has been produced over the last four years after the first meeting at the University of Benin, was presented at the meeting of the General Assembly of the association in Lagos in November 2011, by a committee under the chairmanship of Prof. Oladapo Ashiru.

“The General Assembly then approved this regulation in principle subject to any further input and modification from members. Those inputs were presented and the final guidelines were presented for final ratification for the committee of experts meeting at the Medical ART Center (MART) in Lagos on September 26, 2012. The President of the Association, Prof. Osato Giwa-Osagie, Prof Oladapo Ashiru, Vice-President and Chairman of the GRC, and other members were in attendance.”
The guidelines focused on the type of personnel that can operate in an IVF Clinic, the qualifications, and experience necessary for such clinic operations and also on the number of embryos that can be transferred in a treatment cycle, recommending a maximum of two for patients less than 30 years old, three for 31 to 38 years old and not more than four for those above 38 years. It also requires and mandates all IVF Centres to keep records of procedures and have informed consent.

ART encompasses a variety of clinical treatments and laboratory procedures, which include the handling of human oocytes, sperm, or embryos, with the intent of establishing a pregnancy.
This includes, but is not limited to, ovulation induction, IVF, ovum pick-up, embryo transfer, gamete intra fallopian transfer (GIFT), zygote intra fallopian transfer (ZIFT), embryo biopsy, pre implantation genetic diagnosis (PGD), embryo cryopreservation, sperm or oocyte or embryo donation, and gestational host/ surrogacy and other aspects of ART.

The AFRH further noted: “These guidelines are designed to assist ART programmes in establishing and maintaining a successful clinical practice and set criteria that meet or exceed the requirements suggested by the AFRH for certi?cation of ART laboratories and clinics.
“Treatments for the infertile couple are evolving rapidly, and advances in ART are the best example. Periodically, the AFRH reviews and publishes updated guidelines to de?ne the minimum standards for ART programs and for human embryology and andrology laboratories.

“This document is designed to assist ART programmes in establishing and maintaining a successful clinical practice and sets criteria that meet or exceed the requirements for certi?cation of ART laboratories. This document is not designed to cover all clinical situations or practices, but rather should be reviewed carefully by ART program and laboratory directors to ensure that their programs’ practice re?ects current recommendations.”


Monday, October 1, 2012

30,000 babies born through IVF in Nigeria

IVF technique records 40% increase in pregnancy rate
NEW advances in technology, facilities, drugs and expertise have led to a 40 per cent increase in In Vitro Fertilisation (IVF)/ first test tube baby pregnancy success rate in 34 years, with an estimated 30,000 babies in Nigeria and five million globally.

The first IVF baby, Luis Brown, was born in England 34 years ago, while the first in black Africa was on March 17, 1989, at the Lagos University Teaching Hospital (LUTH), Idi-Araba.

IVF, which involves placing an egg and sperm together in a petri dish for conception, and a sub-category known as ICSI (intracytoplasmic sperm injection) where the sperm is inserted with a micro-needle directly into the egg, have become commonplace.
But it has proven controversial over the years, with some fearing it paved the way for so-called designer babies whose characteristics are chosen by parents.

The Vatican considers it immoral because of the wastage of a large number of embryos, and the procedure has been criticised for allowing women to have children until a much older age.
Olushina Eghosa Oluwaremilekun was born to the family of Mr. and Mrs. Pius Oni after five years of painstaking research by Profs. Osato Giwa-Osagie, an obstetrician and gynaecologist and Oladapo Ashiru, an endocrinologist.

Ashiru, the joint pioneer of IVF in Nigeria, said the country had recorded 40% increase in IVF pregnancy success rate from 10 per cent in the 70s to 50 per cent in the 2010s. He said since the first success 23 years ago at LUTH, about 4,000 babies had been born through IVF in Nigeria.

The European Society of Human Reproduction and Embryology (ESHRE) in a story published recently by Agence France Presse (AFP) said as the initial controversy over man’s scientific manipulation of nature has faded, about 350,000 babies conceived in petri dishes are now born every year. That represents about 0.3 percent of the 130-million-odd babies added to the world population annually.
The International Committee for Monitoring Assisted Reproductive Technologies (ICMART) at the 28th annual meeting of ESHRE, which opened in Istanbul, Turkey, on Sunday said the five million IVF babies mark was based on the number of IVF and Intra Cytoplasmic Sperm Injection (ICSI) treatments recorded worldwide up to 2008, and estimates for the years thereafter for which confirmed figures are not yet available.

The data showed that about 1.5 million IVF and ICSI treatments are now administered around the world every year - more than a third of them in Europe.
ESHRE noted that success rates have stabilised, with about a third of fertilised embryos implanted resulting in a live birth.

While reacting to the global estimate released by ESHRE, Ashiru told The Guardian that that scenario was due to improvement in the pregnancy success rate of the technique.
Ashiru said: “The overall pregnancy rate has improved significantly from five to 10 per cent in the late 70s and early 80s to 20 per cent in the 1990s. The current global pregnancy rate is between 25 and 50 per cent depending on several factors like age, weight, and state of health of the couple as well as the facilities and expertise available at the IVF centre.”

He noted that the technique was enjoying a lot of patronage in Nigeria because most hitherto infertile couples now had their own babies. He said IVF had helped couples select the sex of their child and avoid genetic abnormalities through Pre Implantation Genetic Diagnosis (PGD).

Ashiru, who is also an adjunct professor at the University of Illinois Chicago, United States and Medical Director of Medical Art Centre (MART), Lagos, further explained: “I am familiar with this compilation. The International Federation of Fertility Societies (IFFS) compilation last year was estimating the numbers to be over 4.5 million babies as at 2009. The latest, which is to be presented at the ESHERE meeting of over five million is to be expected. Babies born in Nigeria through IVF should be approaching 4,000 based on the performance indicator we get from various centres across the country.
“It is also correct to say that now in the year 2012 with over 5000 IVF Clinic world-wide, of which about 26 are from Nigeria the number of babies born word wide daily would be substantial.”

According to Ashiru , IVF centres abroad run an average of 10 to 100 IVF cycles per month and that the Medical ART Centre runs an average of 25 cycles per month.

He, however, said that there were several comments on IVF cost and the use of ICSI as opposed to the conventional IVF in the publication.
Ashiru further explained: “I want to say that each person makes comments based on their preference. Those that do not have the IVF programme say the cost of IVF is expensive, while those who do not have the facilities for ICSI in their IVF programme says that ICSI may produce abnormal babies. From our experience at the Medical Art Centre and some other centres in Nigeria there is no difference between the conventional IVF and IVF/ICSI.

“What we have experienced is that some people especially those with advance maternal age have the tendencies to have abnormal embryos. When they go through our screening with PGD during their IVF treatment, we found out that some embryos that could have been considered normal for transfer are not and hence not transferred while only the normal embryos are transferred. This way one is sure that should the conception occur it will be from chromosomal normal embryos, thereby reducing the chance of abnormalities.

He added: “We have equally done this successfully in couples who are sickle cell carriers that end up with normal babies with AA or AS genotype eliminating the risk of SS genotype babies.”

Ashiru said the improvement in IVF pregnancy rate had come with a cost.

“With regard to cost, the truth is for the IVF success to have moved from a 10 per cent pregnancy rate to about 35 per cent rate, a lot of improvement came from the various manufacturing industries from the drugs to the media and expertise as well as the equipment to achieve the greater success; those improvement don’t come cheap,” he said.

Chairman of the ICMART, David Adamson, said: “Millions of families with children have been created, thereby reducing the burden of infertility.”

A member of the team that helped conceive the world’s first IVF baby, Louise Brown, born in 1978, Simon Fishel, said: “The five million milestone ‘justifies all the legal and moral battles, the ethical debates and hard-fought social approval.’”

ESHRE said there was a trend in Europe to implant fewer embryos at a time, causing a drop in multiple births, which carry a higher risk of complications for the mother, a lower baby birth weight, and developmental difficulties.

The number of triplets has fallen below one per cent, said the statement, “and for the first time, the twin delivery rate was below 20 per cent.”