EXPERTS CALL FOR REGULATION OF IVF PRACTICE

IVF experts in the country have raised the alarm that due to lack of regulation, childless couples are being exploited in fertility clinics.

Invitrofertilisation (IVF), a method of conception for couples that cannot have their own babies, is becoming increasingly popular nowadays. So far, over one million babies have been conceived through the test-tube method globally.

Even in Nigeria, where many couples who have fertility challenges are yet to access IVF, over 40,000 babies have been born through the procedure.

Infertility among women and men is on the rise, hence the growing popularity of this procedure.

However, experts have raised the alarm that due to lack of regulation from government, fertility treatment in Nigeria is being infiltrated by quacks.

According to the Chief Medical Director, The Bridge Clinic, Dr. Richard Ajayi, more than 60 per cent of people offering IVF service in the country do not have the facilities and qualified personnel for it, but they continue to do so in order to get money from patients.

Ajayi said that due to the perceived financial benefits and patronage, doctors and health workers who know little or nothing about IVF have continued to take advantage of couples in need by offering services they lack the right infrastructure to offer.

The procedure is not cheap and it depends on one’s location in the country. A round of IVF goes for between N 500,000 and  N900,000.

He said that in addition to knowledge, the state of medical equipment and facilities in an IVF clinic could determine the success of an IVF procedure.

He said, “If you claim to be an IVF expert and you don’t have the right equipment to check if the sperm you have collected from the husband is fertile or the eggs you have collected from the woman are good, then you have offered a sub-standard service.

“If you do not have the right incubator or freezers to ensure that the eggs you collected are properly preserved and stored, then you have exploited your patient.

“If you do not have the machine to ensure that you transferred the right embryo into the womb, then how do you know that it would survive? For a round of IVF to be successful, a clinic must have the right laboratory.

“How many IVF clinics have the personnel and equipment for this? How many women even know this?”

Ajayi noted that because government is yet to see infertility as a public health concern, it has also failed to regulate IVF treatment.

He added, “Some doctors and even nurses claim to be doing IVF. And because it is not regulated, we cannot police or prosecute anybody. So patients are just paying for services that are not rendered.

It is so bad that some doctors even offer money-back-guarantee for IVF. They are marketing it, knowing well that it is not every woman who is infertile that needs  IVF.”

Ajayi stated that this infiltration of quacks in fertility treatment has increased the number of Nigerians travelling abroad for IVF treatments that is available in the country.

He said, “We cannot allow this to continue. Many women have lost millions of naira to quacks in the name of IVF. They are now confused as to where to go because they have done it in one or two clinics in Nigeria and it failed.

“So, it is those who can afford it that can even travel to the United Kingdom for treatment. It is another form of medical tourism that should be discouraged.

“Government must regulate it to protect Nigerians and also stop the millions of naira they spend in foreign hospitals on IVF when it can be done here.”

Professor of Gyneacology and Obstetrics at the Lagos University Teaching Hospital, Idi-Araba and co-pioneer of IVF in Nigeria, Osato Giwa-Osagie,  agrees with Ajayi that lack of regulation has also encouraged unethical practices, such as the transfer of multiple embryos in spite of the dangers it poses to both mother and child.

Giwa-Osagie said that though the ideal practice was the transfer of a single embryo to reduce complications and health risks, many fertility clinics in the country continue to transfer more than two embryos.

According to him, multiple pregnancies has an increased chance of resulting in miscarriage, premature birth and  the mothers often experience a lot of complications including high blood pressure, especially in Nigeria where there is poor maternal health care.

Giwa-Osagie said,“ Multiple transfers are also more likely to result in premature birth  and premature babies are more likely to have congenital problems like cerebral palsy or birth asphyxia. But the practice now is that women who have conceived through IVF have twins, triplets and even quadruplets.

“These doctors endanger the lives of the mother and the babies because when you transfer more than two embryos, you may have more than two babies. When you have three, four babies or more, the complications for the mother and babies are much higher than when you have one.

“In exceptional circumstances, the people who are over 40 may take three because their fertility rate is low. But people should not transfer more than two.”

While canvassing the regulation of the procedure, he noted that such would serve as a check for practitioners who have been making false claims to lure fertility challenged couples to their clinics.

Giwa-Osagie said, “Many claim that they have 60 per cent pregnancy rate when in actual fact it is 25, just to entice women to patronise their clinics. But if it is regulated, we can verify such claims by the number of babies that are born and it will form a basis for licensing of practitioners.

“We must regulate how many embryos should be transferred. We must determine what qualifies you to operate an IVF clinic and what should be the qualification of doctors who offer infertility treatments”

 

by Bukola Adebayo

CHANGING IVF’S ELITIST VENEER

Tunde Okewale was writing his school certificate when the first test-tube baby was born. So it seemed fitting he would aspire to be a gynaecologist. There is an equally-compelling tale about Okewale, medical director of Lagos-based St. Ives Specialist Hospital. He runs a programme that makes the otherwise expensive fertility treatment accessible to couples for whom that alternative may have been shut. Lanre Odukoya writes

Speaking on the vision that has kept him in business, the chief medical director of Ives Hospital, Okewale said: “First of all, I’m an obstetrician and a gynaecologist. The job of a gynaecologist is basically women’s health; that’s what I was trained for. I was trained at the Royal College of Obstetrics and Gynaecology in the United Kingdom before I came to Nigeria. When I returned to Nigeria, I had a choice of floating a general clinic but I decided to focus on the area of my strength.

So, we started the hospital by just being a women’s hospital. Over time, the women started bringing their children, so we brought in the pediatricians and it became a women and children hospital and that’s our core area of practice. But along the line, the women would also bring their husbands; that’s where the family healthcare side of it evolved. Over the years, we found out that reproduction is a very big part of a family survival. We saw so many couples coming to the hospital for cases of reproduction, so it became a charity part of our practice. We treat women with fertility problems up to the stage of IVF at present.”

He recounted the story of a 53-year-old woman who recently benefitted from his intervention at no cost at all. “Fortunately for the woman, at the time she came here, we were doing our annual half-discounted price promo for IVF. We have an NGO arm, Ives Medicare Foundation. At a specific month of the year, our partner would subsidize the cost of IVF for those who want to do it in that particular month. The reason for that is that quite a sizeable number of women who require IVF cannot access it because of the cost. So, increasingly in our environment it was becoming an elitist kind of intervention. I guess it’s quite expensive to do IVF and that’s the reason for this intervention once a year. But in participating in the promo, they still pay us our money, but as far as the patients are concerned, they’re paying half price.

“Basically, what the foundation is telling us is that, treat this people and come to us for the bills. So, there’s that program in place and last September when that particular one was being done, a woman came along but couldn’t even come up with the half price that was advertised for IVF then. In a practice like this, most of the times, you rarely come on a one-on-one contact with the chief medical director until the last minute; you would have probably seen the other doctors or nurses. She was very fortunate that I was the first person to see her when she came that fateful day. When I listened to her story and after proper counseling because of her age - she was 53 - we decided that the foundation should pay half of the price and we as an organization will pay the rest. That was what kind of intervention we gave to her. IVF is not hundred percent certain but I think God just honoured her by making success of that story.”

Like many fertility experts, Okewale offers a grim prognosis on the gynaecological situation in Nigeria. “About 50 percent of all gynaecological consultations in Nigeria now have to do with infertility. There are other issues like fibroids and the rest of them, but even the bottom line of the fibroid, what people are saying in effect is that they cannot have children. So, infertility has suddenly assumed big proportion of all gynaecological consultations for obvious reasons. The society starts counting the months for every couple that gets married and when pregnancy is not seen after a short while, they put the couple under tremendous pressure. The pressures come from the family members, friends, acquaintances and so on.”

But he adds that many causes of infertility which inadvertently give rise to the need for IVF are preventable. “The first thing is that if you understand why infertility occurred, then it’s easy to prevent those causes. Generally speaking, there are five basic requirements for women to get pregnant: the first requirement is that the man must have adequate sperm of good quality and quantity. At least the cells in the sperm must be a minimum of twenty million. The second requirement is for a couple to know when their fertile period is, that is the time the woman is ovulating. The third is that the inside of the woman’s womb must be able to accept and keep the pregnancy. So, there must not be any problem inside the womb that will disturb the pregnancy. This is where the issue of fibroids comes in. The fourth is that the woman’s fallopian tubes must be open so that the eggs can enter it and meet with the sperm. It’s like a conduit pipe that connects the woman’s eggs and the sperm. Finally, the woman must produce quality eggs every month.”

About how long a woman should monitor these developments before she comes for consultations, the demure physician said: “Ideally, if a woman comes for any gynaecological consultation within a one month cycle, all those five requirements could be known. From the day she begins her period till when the period ends, the test to check out those five things would have shown results. And a solution would be proffered straight away. The mistake in Nigeria is that people think the same solution applies to all cases of infertility. But if you look at those five requirements, you’d realize that they’re different. At the end of every investigation of infertility, the treatment you give to a woman who is not producing eggs is different from the one for the woman whose tubes are blocked. So, IVF is not suitable for every woman who is trying to get pregnant.

There are indications specifically in the history that will say, your own best solution is IVF, like the case where the two tubes are blocked, IVF is the perfect solution. If the sperm count is low and it’s about five million, IVF is the best. The minimum sperm count here is twenty million, but if you have about eighteen to nineteen million, drugs can work at that level.”
As promising as it always seems though, there are reported failures in IVF procedures. In the event that all these conditions are met and a woman still cannot conceive, he explained: “In about 10 percent of women who come for fertility test, at the end of the month when you check those five things, there may be nothing wrong.

In such situations, we’d say they have what we call unexplained infertility and there’s a treatment for that. Basically, what unexplained infertility means is that the sperm and the eggs are not meeting for some reasons. It could be that the mucus in the cervix is blocking the sperm and so on. And there are specific treatments for that. Unexplained infertility is a well recognized situation which affects up to about 10 percent of the married couple. Another problem in our environment is stress. A lot of couples are not even making love at the right time to even allow for pregnancy because of their work schedule. Maybe they had been living in Nigeria and it’s been all work; they would go on holidays for a few weeks and when they return, they are pregnant. So, change of environment especially if there’s no problem, can aid the healing process.”

In-Vitro Fertilization essentially is fertilization that occurs outside as opposed to the more traditional In-Vivo Fertilization which occurs inside. “What we do is that we bring out the woman’s eggs into a separate dish in the lab. We treat the eggs and when the man produces the sperm, we treat the sperm by separating the good from the bad ones. And we use that sperm to fertilize the eggs in the lab when the fertilized eggs have started growing in the lab. Then we place the embryo back into the woman’s womb. When this is done, you bypass the tubes totally because you don’t need them now,” he said.  

“In IVF, the last frontier that has not been cracked is that if you interview some people, they would tell you their IVF failed and that it never worked until the third attempt. You can place four embryos that look equally good inside a woman’s body while the body would accept one and reject the three or accept two and reject two sometimes or accept all the four and sometimes not accept any. It’s still a mystery. And this is what everyone is working on the world over. Any doctor who predicts a hundred percent success of any IVF procedure is obviously lying.”

Okewale grew up at a time when, as he recalls, “people were complaining of austerity in the late 1970s”.  But he notes nonetheless that things were more organized. “My father was a broadcaster with WNTV then Ogun Radio in those days and I have a sister, Toun Okewale, who’s into broadcasting too. My mother was a teacher and a trader and life was good. I’m the second child. Growing up, the only thing I thought about was becoming a broadcaster because it was the earliest influence over my life”

He may be a fertility expert, but he’s not at sea on matters of fashion and style. “Sometimes I wear my tie, suit and the white coat to the office, but today is more or less not a very busy one for me. I use the gym to stay fit. I patronize local designers but mostly wear ready-made stuff because I don’t trust people cutting and measuring me before they go and sew. I’d rather enter a shop, see what I like, if I put it on and it’s my size, I’d just buy it. What I’m wearing today is a product of Vans Kere. I love the good things of life, I socialize, I go on holidays and do regular things men do. I drink occasionally. I would only take a Cabernet Sauvignon, I’m normally not a beer person,” he said on this sunny Wednesday.

 

By Lanre Odukoya

SOURCE: THISDAYONLINE

EXPLORING IVF TREATMENT IN NIGERIA

Infertility is not something people choose, yet one in every four couples in developing countries has been found to be affected, and more people are getting infertile. In view of this, Uche Uduma spoke with some fertility experts, in a bid to find out the procedure for fertility treatments in Nigeria.

In-vitro fertilisation is a conventionally assisted fertility technology whereby, an embryo is created outside the womb and then transferred back into the woman’s womb after fertilisation has occurred.

Before now, couples trying to have babies through IVF travelled abroad for treatment. However, in the past few years, fertility clinics have sprung up in different parts of the country. And this innovation has changed the prospect of thousands of couples that were unable to have children. For Maryam (surname withheld), a civil servant based in Abuja, the option of IVF treatment came up when she couldn’t conceive after 11 years of marriage.

According to her, “I opted for IVF with my husband after we had tried to have a baby without success. Three years ago, my husband suggested we try IVF. I wanted it abroad but my husband insisted we should do it in Nigeria. Both of us went through investigative laparoscopy to find the cause of the infertility, then we began the treatment. The whole IVF cycle took us about six weeks after which I was able to conceive.

However, the treatment failed after I had a miscarriage. I must tell you it was really painful because that was the first time I ever got pregnant and it was coming 11 years after we got married.  We gave it another shot, the second ,time it was easy. I knew what to expect and my husband too was very supportive. We went through the whole process together till I conceived again, this time it was successful. I am still thanking God”.

How In-Vitro Fertilisation Works

The Chief Embryologist, Nisa Premier Hospital, Abuja, Dr Rabi Ahmed-Odia who spoke with LEADERSHIP Sunday explained the procedure for conventional IVF.

According to her, “In vitro fertilisation means creating embryo and fertilising it outside the body while In-vivo means inside, that is when the sperm and the eggs come together in natural conception, everything takes place inside . But what we call conventional IVF means, mixing the sperms and the eggs together in a dish, and the following morning, one could check for fertilisation. 

In that case, within the maximum of 18 hours, one would see signs of fertilisation. Then we transfer it back into the patient. It basically means, creating embryos outside the womb. But if you do what we call Intracytoplasmic Sperm Injection (ICSI) where we assist the sperm and inject it into the egg, then you can see signs of fertilisation in 13 hours.”

Available Range Of Fertility Treatment In Nigeria

Conventional fertility treatment in Nigeria today offers wide range of treatment options available anywhere around the world. 

The Chairman and Founder of Nisa Premier Hospital, Dr Ibahim Wada, who spoke with LEADERSHIP Sunday, stated that all the procedures that are available anywhere in the world are now available in Nigeria.

 “I can’t think of any procedure that is available anywhere in the world that is not available here in Nisa Premier Hospital. We do In-Vitro Fertilisation (IVF), Intracytoplasmic Sperm Injection (ICSI), Intra-Uterine Insemination (IUI),  sperm storage, Pre-implantation Genetic Diagnosis (PGD) as well as blastocyst culture. We have facilities for vitrification and offer all the services that any fertility centre can provide.

Dr Wada further revealed that medication and operation are conventional methods used in treating infertility.

According to him, “on woman’s side, we have conventional treatment, one of which  is to give tablets to the patient so that she can ovulate because her problem is that she cannot produce eggs. Another one is sometimes to operate the patient,usually with blocked tubes. The tube is where the egg and the sperm meet so if it becomes blocked you are infertile.

Therefore, there is a conventional treatment of operating on the fallopian tube to try to open it up or removing fibroid that has been distorting the womb and making it difficult for the woman to conceive.

“On the man’s side, there are also conventional methods; a man with low sperm count will benefit from some drugs depending on why he has low sperm count. A man could have low sperm count from what is called varicocele. In such case, operation could be done to correct the varicocele.

Cost of IVF

The Chief Embryologist, Nisa Premier Hospital, Abuja, Dr Ahmed-Odia, explained that the cost of IVF treatment largely depends on the patient’s age as it affects the cost. “The cost of drugs can range between N300,000 to N1million, if the woman is a lot older. But if the woman is younger, it will be cheaper in  terms of the amount of money for the drugs, usually between N250,000 to N300,000. Everything that we use is imported which means, with technical fees, everything will be about N850,000. So, it is based on the patient’s age and the type of procedure.”

Factors That Determine IVF Success Rate

The Chairman and Founder of Nisa Premier Hospital, Dr Ibrahim Wada, also stated that the success in IVF treatment include quality of the sperm, quality of the eggs and the patient’s age.

“The older a woman gets, the less the quality of her eggs and the less quality of the embryo that comes from those eggs.  Most importantly, the womb lining has to be receptive to the embryos. Success rate varies from centre to centre, most importantly according the patient’s age. Here if one is under 30, the success rate is over 60 per cent. If 30 to 35 years,  the success is about 50 per cent and if 35 to 40, it is about 40 per cent. If the patient is over 40 years, it is about 33 per ent. But here in Abuja, I’m glad to tell you that our own range is 40 to 60 per cent which is the result you expect from any of the best centres in the world.

So, in my view, the success rate compared to that of UK is very good. We started this journey in Abuja 15 years ago and at the last count, we have had over 15,000 babies.”

Risk Associated With IVF

Dr Wada, disclosed that the most common risk associated with IVF is Ovarian Hyperstimulation Syndrome (OHSS). “When we give the drugs to a woman so that she can produce many eggs, some over react.

Though the dose maybe low, their body might be sensitive. In particular, these are women with polycystic ovaries; they produce more than 15-20 eggs at a time so the ovary gets tired and it starts loosing fluid into the abdomen. The abdomen can become swollen and painful. They are very mild cases and the women don’t need treatment to recover.”

by Uche Uduma

Eko Hospital records first quadruplet delivery through IVF

A 30-year-old woman, Mrs Funmi Oguanigie, on Friday gave birth to quadruplets at the Eko Hospital in Lagos.

The delivery is the first in a single delivery in the hospital in 25 years.

Oguanigie, a resident of Anthony Village in Lagos State, was delivered of two boys and two girls at about 3 p.m. by a team of doctors, led by a Chief Consultant Gynaecologist and
Obstetrician at the hospital, Dr Adegbite Ogunmokun.

The babies, who weighed 2.22kg, 2.29kg, 2.24kg and 1.94kg respectively, were delivered through caesarian section.

Speaking with NAN shortly after the delivery, Ogunmokun said that mother and children were in stable condition.

He said that the babies were conceived through In-Vitro- Fertilisation (IVF), carried out by the hospital.

The doctor said that this was the first time such number of multiple babies would be delivered at the hospital since the hospital was established in 1988.

The gynaecologist expressed delight over the feat, advising couples desiring babies to seek medical help early.

“ We encourage them to report their cases early. There is help out there; every problem has a solution. We give God all the Glory,’’ he said.

Ogunmokun said that the IVF process would take between six and eight weeks, costing about N750,000 which patients could pay installmentally at the hospital.

 

Source: reporters365.com

 

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 oyeniran...source:tribune.com

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.”

 

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.”

Detoxification: New trend in fertility treatment

One of the major reasons why people marry is
to have children, but according to a World Health Organisation statistics, one
in four married women in most developing countries are childless because of
primary or secondary infertility; while research also shows that male factors
account for between 20 and 30 per cent of infertility. As technology advances,
however, fertility experts say detoxification programme can make couples
fertile. SOLAADE AYO-ADERELE reports
For 17 years, Mr. And Mrs. Olayiwola waited for a
child but none came. Mid last year, they were introduced to a fertility expert
who took them through a simple process of detoxification programme that included
weight reduction and general system cleansing.
In less than 12 months of accessing treatment
which was followed by in-vitro fertilisation, they achieved the hitherto
elusive pregnancy and had a set of quadruplets early February.
Detoxification is the physiological or medicinal
removal of toxic substances from a living organism, including, but not limited
to, the human body.
A professor of reproductive endocrinology,
Oladapo Ashiru, has decried the rising rate of infertility among couples, based
on the number of people seeking medical assistance to conceive.
Ashiru, who heads the Medical Assisted
Reproductive Technology Centre, a fertility clinic based in Maryland, Lagos,
said one in every six couples has difficulty in conceiving, underscoring the
need to seek medical advice.
Studies have shown that male factors account for
between 20 and 30 per cent of infertility; 40-50 per cent with the woman, while
between 30 and 40 per cent are due to problems in both man and woman.
Experts say conception and pregnancy are
complicated processes that comprise the production of healthy sperm by the man,
healthy eggs from the woman, unblocked fallopian tubes that allow the sperm to
reach the egg, and the ability of the fertilised egg to implant in the uterus
and grow in a good environmental and hormonal condition.
“If one of the processes is impaired, infertility
can be the result,” Ashiru says.
He explains that infertility is sometimes as a
result of toxins in the body, which might have been accumulated over a long period
of time.
“It is known that some undigested food products
can remain in the intestine for up to 200 hours — instead of the normal 18
hours — and produce toxins that are stored in the body for months or years.
This causes certain types of infertility,” Ashiru explains.
He notes that in the female, the causes of such
infertility include obesity (associated with polycystic ovarian syndrome and
endocrine disorders), increased maternal age, hormonal imbalance, stress,
infections, toxins from the environment and improper nutrition.
Male factors are said to be due to deficiencies
in semen and semen quality, erectile dysfunction and genetic factors which are
as a result of environmental toxins, as well as toxins produced from diet,
which leads to hormonal imbalance and infertility.
“The accumulation of these toxins from the
environment will begin to manifest by the time a man reaches age 40-55 years.
At this time, men experience an ageing phenomenon similar to the female
menopause called andropause. This is as a result of gradual decline in the
level of testosterone,” the professor explains.
According to him, this decline has effects on
bodily functions, such as mood swings, depression, erectile dysfunction,
fatigue, hair loss, hot flushes, irritable men syndrome, urinary problems and
weight gain.
“These conditions may occur faster as a result of
exposure to environmental toxins, psychological stress, obesity, and
infection,” he says.
Andropausal symptoms and effects can be reduced
by regular general detoxification treatment, body cleansing and in some cases,
bio-identical hormone therapy, experts say.
According to the American Fertility Association,
recent studies suggest that toxins in the environment are not only damaging the
reproductive capacities of men and women, exposure to ubiquitous dioxins such
as cigarette smoke, lead and mercury, and some agricultural pesticides are
known to be direct threats to a couple’s ability to conceive or achieve a
healthy pregnancy.
The association avers that troubling new research
suggests that a broader range of chemicals — including many that are associated
with everyday products such as household cleansers, personal care and beauty
aids, and even plastic water bottles — could have a much more complex and
far-reaching impact on men and women’s fertility.
“With the advent of the chemical and synthetic
toxins such as pesticides and herbicides, plastics and cleaners,
pharmaceuticals, and vaccinations, food additives, and food contaminants, fuel
emissions, insecticides, and fungicides, comes a constant onslaught of chemical
toxins that our bodies are just not equipped to deal with.
“In relation to fertility, this has huge
implications, as the synthetic chemicals modify the hormones that control the
reproductive system, and can alter the sex hormone levels. This is a very
intricate, finely balanced system that involves a multitude of different
hormonal transactions to occur simultaneously. As soon as anything interferes,
as we are finding out, the whole system can be affected,” AFA says.
AFA argues that one of the effects of toxic
overload is that females become more masculine and males become more feminised.
“The toxins enter the sperm and eggs, and effectively poison them, so that if
there is fertilisation, there is an increased risk of miscarriage,” it says.
Indeed, in late February 2005, at the Vallombrosa
Retreat Centre in California, the Fertility/Early Pregnancy Compromise Work
Group of the Collaborative on Health and the Environment, and the Stanford
University School of Medicine’s Women’s Health hosted a seminar titled,
Understanding environmental contaminants and human fertility compromise:
science and strategy.
Here, the experts argue that every day, we are
continually exposed to toxins from our environment, preservatives in food,
drugs, cosmetics, stress, poor eating habits and lifestyle which result in
premature ageing, allergies, food intolerance, cancer, hormonal imbalance,
obesity and infertility.
Ashiru notes that over time, these toxins
accumulate in the major organs and tissues; and if not eliminated or
neutralised, will lead to auto-intoxification and organ damage. “This is why
total body cleansing — that is detoxification — is important; it helps to
remove all these toxins,” he says.
A number of fertility centres are now
incorporating detoxification cleansing programme as a diagnostic and
therapeutic measure in the management of infertility as a new trend in assisted
reproduction. There are a few of these clinics all over the world — one in the
United States of America, the United Kingdom, and Austria.
Currently, Nigeria hosts one of such clinics, the
MART-Life Detox Clinic, which is a subsidiary of the MART Clinic, headed by
Ashiru.
“The detox centre is in collaboration with
Viva-Mayr Health Resort in Austria, which was established in line with the
modern Mayr Medicine Therapy — a medical therapy programme that has been in
existence for over 100 years,” Ashiru says.
He explains that the treatment is a combination
of different holistic health concepts whose objective is to rejuvenate the body
functioning system and dynamics to its maximum efficiency, with the overall aim
of achieving a healthy life style, younger look and increased life span.
“The detoxification programme also has the advantage
of weight loss, improved medical conditions and enhanced fertility,” Ashiru
intones.
An accomplished clinician and author, Dr. Jesse
Hanley, says one of the definitions of aging is based on how quickly the body
repairs itself; implying that detoxification can significantly increase the
chances of fertility in women by improving the circulation of blood to the
ovaries, uterus, hypothalamus and the pituitary.
Ashiru says detoxification optimises liver
function to remove and prevent excess accumulation of unwanted hormones, among
others.
Scientific studies suggest that detoxification
programmes normalise the hormone and endocrine system that regulate ovulation,
especially if polycystic ovarian syndrome (an abnormality of unknown origin
whereby the ovary produces cysts instead of follicles that produce eggs) is an
issue.
Again, Ashiru says, “It positively affects the
hypothalamic pituitary ovarian axis that plays a key role in fertility,
regulates menstrual cycle, increases blood flow to the uterus to improve the
chances of embryo implantation and also reduces anxiety and stress that may
significantly decrease fertility.”
Hanley suggests that it helps to remove heavy
metal deposits from the uterus, fallopian tubes and other reproductive organs.
Ashiru says fertility cleansing is not just for
women, but also for men, as sperm quality can be affected by toxicity as well.
“Recent studies are now pointing at hormonal
imbalance and environmental factors leading to low sperm count (oligospermia),
absence of sperm cells (azospermia) and erectile dysfunction,” Ashiru warns;
saying that male infertility can be improved by total body detoxification
through weight reduction, body cleansing, and healthy eating habits.
Enumerating the success stories from
detoxification program, Ashiru says these include the reduction in the dosages
of blood pressure and diabetic medications, in addition to enhanced fertility
among relevant patients.

Nigeria: Having Bundles of Joy Through IVF - How Affordable?

Most couples yearn for children whorepresent their union and signify their future. However for a significant
number of couples, researchers have found out that for about 1 in every 4
couples, this desire cannot be fulfilled without some assistance. However, In-Vitro fertility (IVF) has been a solution to many couples facing infertility
problems in Nigeria, but can the average Nigerian really afford it?
By Amarachi Ebeogu

Some couples have had varying challenges with the process, others have a different story to tell about IVF, an emerging panacea to infertility, especially in Nigeria. IVF has been a solution to the stigmatisation of infertility in marriages especially here in Nigeria.

In-vitro fertililisation is a process by which egg cells are fertilised by sperm outside the body. IVF is a major treatment in infertility when other methods of assisted reproductive technolgy have failed.
Although IVF is gaining popularity in Nigeria, many people are not totally aware of the process, the running costs, the
clinics or centres where IVF treatment is performed, the success rates and also its implications and challenges.
Due to the stigmatization in this part of the world, couples who try IVF keep it confidential, and as a result of that, people do not know much about it or how it works.
IVF may be used to overcome female infertility due to problems of the fallopian tube, making fertilisation in vivo difficult. It may also assist in male infertility, where there is defect in sperm quality and in such cases intracytoplasmic sperm injection (ICSI) may be used, where a sperm cell is injected directly into the egg cell.
This is used when sperm has difficulty penetrating the egg, and in these cases the partner's or donor's sperm count is
very low. ICSI results in success rates equal to those of IVF.
In the course of this research, people who have IVF where found and here are some of the things they had to share:
Farouq, an engineer who lives in Maitama claims that he and his two siblings have done IVF. Sharing his experience, he
said he had his set of twins three years ago through IVF but that he was
extremely reluctant before the process because he was scared and he knew little or nothing about it.
" I fought with my wife for a very long time because she kept talking to me about us trying IVF and I wasn't interested" Farouq said " though I spent almost N3,000,000, but am a happier man today because my little angels give me so much joy and also make me a proud father" he added. "My sister and her husband who did IVF got quadruplets, although one died before birth the three are very strong and healthy" he concluded.
"When I had my first IVF treatment in a clinic in Lagos, I was admitted for 3 days after the egg recovery because of the pains, hyperstimulation and so on and there were still no results.
I was surprised that I did the same egg recovery in another fertility clinic in Lagos, I was able to drive home within an hour and also had positive results afterwards," Mrs Ajayi explained.
She added that the professionalism, the results and the love shown is all that matters, and not the cost.
IVF, if not done by experts can be very challenging, but in any case there are more recorded success rates today. For IVf to be successful, it typically requires healthy ova, sperm that can fertilize and a uterus that can maintain pregnancy.
A civil servant who pleaded for anonymity for personal reasons, said she had some challenges in the past with IVF. She explained how scary it was when after the transfer of the egg she bled after 3days and eventually lost the pregnancy. She said she is taking her time to look for a good clinic.
Not many Nigerians can afford to do IVF because of the cost. Most doctors say it is very expensive in Nigeria because of the power situation.
Faced with the challenge of payment for the procedure, a couple who reside in Nyanyan, Abuja, who have been married for 11 years without any success in getting pregnant say they hope to visit the fertility clinic but they cannot afford it right now because they do not have enough funds for it.
"Traveling out does not guarantee the success rate, it is your knowledge and how up to date you are and your ability to play God less that determines your success as a fertility surgeon. I trained in Canada and it is the same procedure you will go through so be guided, "advises Dr M. Haastrup .

Source: allafrica.com

ANOTHER FEAT IN IVF RECORDED BY NAUTH GYNAECOLOGIST

Another feat on Invitro Fertilization (IVF), has been recorded by the Nnamdi Azikiwe University Teaching Hospital, NAUTH, Nnewi, Gynecologist, Professor Joseph Ifeanyichukwu Ikechebelu, the Medical Director of Life Specialist Hospital, Nnewi with the delivery of a baby boy – Favour, through Invitro Fertilization (IVF).

This brought to five women who have delivered through the process in the hospital within the last 6 months.Confirming that the mother and child were in stable condition, Ikechebelu, said the baby boy delivered Saturday by 8.02 weighed 2.7 kg.

Ikechebelu who is a Professor of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital Nnewi and his team of doctors, nurses and embryologists performed the cesarean operation to deliver the baby and concluded other processes within 45 minutes.

“This is the fifth time this processes is being carried out in this hospital. Our first baby-baby Joseph through IVF was delivered on 6th August, 2011, second was triplets delivered on 17th November, 2011; third baby boy was delivered on Nov 28, 2011.The 4th were triplets again delivered on December 26th, 2011 and this one now.

‘‘We have over ten women already pregnant and carrying their babies and we are monitoring them pending their time of delivery’’.

Life Specialist is the only fertility hospital in Anambra State specialized in putting smiles on the faces of our women who could not ordinarily conceive and deliver their babies normally’’.Every couple still have a chance of having their own babies.

Here we specialize in turning tears into joy.”Her mother (the babe’s grand mother) , name withheld by this medium said she and members of her family were overwhelmed by joy at the sight of the baby.“We are happy for this opportunity because for sometime now, she was unable to conceive and deliver her own baby but we are happy and to God be the glory.

Dr Osuorah Chidebele Donatus , a Pediatrician with Nnamdi Azikiwe University Teaching Hospital, Awka described the processes of IVF as an artificial way of conception through some complex medical procedure outside the woman’s womb before implanting it back into the woman’s body through surgical process.