The Hannaniya's quest for a child

It was gladness and great joy as embryos frozen more than 5 years earlier in England were sent to a Lagos clinic, transferred to Gladys’ uterus, successfully implanted and ended in a delivery of twin girls 29 weeks later…

Dr. Gladys Duruyani and Dr. Ishmael Hannaniya were married for 20 years and just like any other couple, they tried to have children.

However, unlike others, it took them several years to conceive and despite the challenge with conception and their expectations, all the pregnancies unfortunately ended in miscarriages.

This was a very grieving deal for them because the babies would grow to about five or six months in the womb and then a miscarriage would occur and some of these miscarriages were for multiple babies.

The enlightened couple utilized their globe-trotting exposure to seek medical solution overseas, all to no avail. Eventually as time progressed, Duruyani became ill and was diagnosed severally with various kinds of ailments.

She developed a type of cough the doctors could not understand and on the film some dark spots were seen in her chest region and lungs. Being devoted Christians, they sought medical solution to all the challenges yet committed them all to the Lord as they expected some miracle.

Eventually the Lord took this strange ailment away from her. Their challenges were numerous, and one day, while they dined at a Chinese restaurant in Abuja, Duruyani began to bleed.

She knew what was happening. Her husband, who is a microbiologist, a specialist neuro-physician, also rushed her to three different hospitals. Unfortunately, in each hospital, the senior doctors had all gone home.

After the third stop, he rushed her to the National Teaching Hospital where he found out again that all the senior doctors had also closed for the day.

At this point of desperation, he had to take the bull by the horn, choosing to go against the ethics of his profession that advise against a man performing such a major surgery on his spouse. He had a vague idea of what to do, besides there were some junior doctors around.

With the few junior doctors on duty, they quickly set up the theatre and began the surgery to take out the blood clot that was about to snuff life out of his beloved wife until an experienced doctor who came around the hospital for an entirely different reason heard of the situation and ran to take over the surgery already in progression.

On another day, she felt ill and in the cause of seeking a medical solution in South Africa, they were told that the blood result was bad news. The South African doctors gave the verdict; they were shaken and took the challenge once more to the Lord in prayers.

They said, “it was a rare form of blood disease.” The couple were shocked and torn apart for a while but braced up, rejecting the doctor’s report and holding unto the Lord’s report.

They sought medical solution in the UK afterwards and the doctors became puzzled and asked “who said she had a blood disease, a rare form of blood cancer? To the glory of God, the results of the latter test showed there was no trace of the cancer.

Did a miracle take place? They rejoiced and praised the Lord. Soon after this great news, they got a call from the South African doctors stating that there was a mix-up with her tests.

They investigated further and confirmed that she did not have any form of cancer in her system. Having gone through so much and having wailed on the Lord in the secret place of the Lord, they remained sober and thankful for once more sparing her life from the clutch of death.

After a while, they tried to have children again but it was to no avail as the series of miscarriages continued. Eventually they figured that since her womb could not keep the pregnancies, they would consider the option of surrogacy.

Their Harley Street doctor who is one of the first doctors in the world to successfully deliver in-vitro (IVF) babies had been very sympathetic to their cause and after series of the failed IVF had suggested surrogacy to them.

They began the necessary procedures and as embryos could be stored for years, they decided to store the excess embryos while they sought for a surrogate mother to carry their child.

Unfortunately, the surrogacy laws in Britain were so strict that it would have been impossible to find a mother to carry the child. The doctor who was natively Greek suggested that they find a surrogate in Greece.

They quickly embraced the idea but it was soon forgotten because there was a serious problem with the transportation of the embryos out of the region. When that failed, they tried to transport the embryos to Nigeria but the results were the same as that of Greece. It seemed like they would never be able to have their own children so they opted for adoption.

They adopted a little boy now six years old and they later adopted a girl who is now aged four. Duruyani’s body had gone through so much strain over these years and age was not on her side as she was classified as High Risk Pregnancy (if she took in).

On two occasions she had been diagnosed with a strange form of cancer, and later lymphoma, she had suffered a hemorrhage, suffered from a strange cough which left dark patches on her lungs, she had suffered emotional, physical and psychological trauma at the travails she had gone through amongst other health challenges too numerous to mention. She had also been on total bed rest all through these series of pregnancies that resulted in miscarriages.

Yet from all these, the Good Lord delivered her from the cold hands of death. Her husband, Hannaniya, who is a rare Igbira man from Kogi State and a distinguished gentleman remained a most loving husband to her, an Igbomina from Kwara State and kept all their travails away from family and friends.

THEY loved and doted on their two adopted children and once more wondered if it was necessary to have more children having gone through so much agony in their quest for their own biological children.

The Lord understood the desires of their heart and decided to seal their faith with a remarkable gift to them in the year 2014. They got a call from their doctor in Harley Street that the Law had lifted the storage limit of the human eggs/embryo which negated the earlier law of five years. Perhaps because they were silently thinking once more of their unborn children, they became expectant as a result of the serendipity they experienced.

Once more at this point in time, her embryos were still available and having tried all to no avail, including the suggestion of surrogacy that could not hold for statutory reasons, their deciding to try once more was not out of place.

This time they asked for the frozen embryos to be sent to Nigeria and this became the appointed time for them, as they were able to transport these embryos and implant them in Lagos, Nigeria.

Twenty-nine weeks after the implantation of the embryo, Dr. Hannaniya, while at work, got a call from the surgeon that his twin baby girls had been delivered weighing 0.9kg and 1kg respectively. He could not believe his ears and questioned the time and date of delivery to which the surgeon responded that it was either they were saved at that point in time or they were lost like all the others gone.

Dr. Hannaniya, knowing what everybody in this country and beyond knew which was that the babies had a slim chance of survival in a country like Nigeria, did not get excited. He did not worry either but chose as usual to leave this one more challenge to God.

For the first time their babies had been delivered alive so it was clear that the Lord had given them the miracle of an identical twin birth but with the incessant power outages and the inadequate medical care especially for neonates in the incubators, what would be the fate of these little ones? As usual and with wisdom, he chose to keep the news away from family and friends for he did not want to get excited over his preterm babies. They willingly submitted the case to the Lord and waited for time to celebrate if it was the will of God for them.

As God gave his approval, both babies survived and were christened Grace and Esther on Sunday, 22nd March 2015 at the time of their expected date of delivery.

The other two children who had been adopted were also christened on the same day aged six and four. There was a lovely celebration of the two healthy babies and their older adopted siblings afterwards at the beautiful event organized by the family in the Federal Capital Territory of Abuja. Their phenomenal testimony was shared by the husband himself and all those present were amazed as Dr. Hannaniya shared this incredible testimony of over 90 minutes while their guests were entertained with food and drinks.

Their parents, siblings, relations, friends, colleagues and well-wishers were speechless and moved to tears of joy for the Grace of God on his beloved children, Duruyani and Hannaniya, as they finally found complete joy in their now family of six.

There were great lessons to learn from the power of prayers and the power in sealed lips for they did not give room to any interference or sympathy from family and friends.

They had toured the world in search of children of their own, they had spent money over the years, the Lord continued to provide for them and eventually when they least expected it, the Lord showed them that something good could still come out of their own country, Nigeria, and this was the serendipity of our Lord, the perfection of science, their dogged hope and above all, the abundant blessings of the Great God they serve.

 

 

 

First Surrogate In-vitro Fertilization (ivf) Baby In South East Nigeria

On Friday the 3rd of April 2015 in LIFE SPECIALIST HOSPITAL LTD Nnewi Anambra State a major medical breakthrough occurred. The South East of Nigeria took delivery of its FIRST SURROGATE IN-VITRO FERTILIZATION (IVF) BABY. This feat was achieved by a doctor who has achieved so much in this area over the past few years, Professor Joseph Ikechebelu. Facebook doctors spoke with him but before you read the interview, what is IN-VITRO FERTILIZATION INTRACYTOPLASMIC SPERM INJECTION (ICSI)
IN-VITRO FERTILIZATION (IVF) is a series of complex procedures and the most effective form of assisted reproductive technology (ART) used in the treatment of fertility and some genetic problems. It has offered hope and put smiles on the faces of couples who for reason or the other have not been able to achieve pregnancy and have a child of their own. fertility-image

IVF entails collecting/ harvesting mature eggs from the ovaries and fertilizing them in the laboratory using the sperm. When the egg and sperm fuse and form the embryo, it is then transferred to the uterus for implantation and growth into a baby (the so called test tube baby). The eggs and sperm can come from known or unknown donors, fused and transferred to a recipient (mother) who will then carry it to term and own the baby. Sometimes, a man whose partner can not carry a pregnancy but can produce eggs, can have the eggs harvested, fertilized by the partner’s sperm and transferred to another woman’s womb (surrogate mother), who will carry it to term, deliver the baby and hand it to the parents. One cycle of IVF can take about two weeks and can be time consuming,expensive, minimally invasive but it is worth the try. It can also produce twins or triplets (multiple pregnancy) of desired sexes. You are a candidate of IVF if you have the following:

a) Damaged or blocked fallopian tubes

b) Ovarian failure

c) Malignant diseases of the uterus or other parts of the reproductive system

d) Tubal removal or sterilization

e) Unexplained infertility


INTERVIEW WITH PROF. JOSEPH IKECHEBELU

Anambra state is proud to record the birth of the first surrogate baby girl, born on friday the 3rd of April 2015 at 6.35am at the fertility centre of LIFE SPECIALIST HOSPITAL Nnewi in Anambra state.

In an interview with the Medical director and owner of the hospital, Professor Joseph Ikechebelu, (a professor of Obstetrics and Gynaecology) Nnamdi Azikiwe University Teaching Hospital, he told us that choosing fertility (which is a branch of Obstetrics and Gynaecology) to him, is like a calling from God. Hear him….

FBD: We are members of the team of Facebook doctors, an online health magazine or blog. We logged on to facebook yesterday and saw you in a picture with a newborn baby who you described as the first surrogate child from IVF in your clinic, so we decided to come and find out more about it and the IVF. Prof how did you get into IVF/fertility and why did you choose this area?

Prof: (laughs) Let me say that I actually chose fertility as a calling. Some people may have it as a place where they like to be but as for me, it is like a directive from God to move into fertility and help people achieve their life ambition of becoming pregnant and having a baby.

FBD: You must be very good at it because we have heard reports and when we got here we were like “is this the humble place where these things happen?”

Prof: (laughs heartily)

FBD: It is something to celebrate really but what exactly is in-vitro fertilization?

Prof: IVF is a special reproductive technique for achieving a pregnancy where you harvest the egg from the woman and sperm from the partner and fuse the two in the laboratory, when the embryo is formed, you put it back in the womb to grow. In-vitro means outside the body, so it is a fertilization that is taking place outside the body but you have to return it into the womb for it to start growing.

FBD: And now we have a surrogate baby, that means somebody else carried the baby? PROF AND BABY Prof Ikechebelu and the new surrogate baby

Prof: (nods) Beautiful! In surrogacy as it is called, for one reason or the other the womb of the woman can not carry the pregnancy but she still has ovaries and can generate her own eggs. So in this particular woman we had, she has an absent uterus, a kind of malformation she was born with. But she has her ovaries and eggs, so all we did was harvest her eggs and the husband’s sperm, fertilize it in the laboratory. When it formed an embryo, we transferred it into a 3rd party, the surrogate mother.

FBD: How did you get the 3rd party?

Prof: The 3rd party is usually a person who is willing for a fee to give the service. All they need to do is write an agreement and carry the pregnancy, deliver and hand it over to the couple because the genetic material is from the couple. This is where you want to have a baby of your own…because when we talk about the levels of parenting or what makes a child your own, the genetic material must come from you. All you lack is the suitable environment to grow the embryo and that’s what is ‘hired’…we hired a womb to carry the pregnancy.

FBD: But in hiring a womb to carry the pregnancy, does it not affect the baby..I mean the environment where the embryo grows?

Prof: No! Usually once there is fertilization and the embryo is formed, every genetic material it needs to grow is there, all you need is the environment. It is just like taking a newborn baby whose mother died after childbirth and give it to a foster parent for them to bring him up.

FBD: That brings me to ethics and genetic engineering and mutation. What is your take on this?

Prof: Genetic engineering…yes, it’s in progress now and they are even talking about cloning, These are all new technologies and fal louts of IVF.

FBD: Is it right or wrong? What do you think about it?

Prof: Mmmm…aah..The question whether it is right or wrong is relative. Why I said that is this; If it is used for the purpose of advancing knowledge and science, it is right. But if it is used negatively to kill or produce a technology that destroys life, then it is wrong. BABY1 The New Surrogate Baby

FBD: How far has IVF gone in helping those in the conditions you mentioned?

Prof: That’s a very good question. I will say that IVF is a God-given procedure and has helped so many couples who for one reason or the other cannot have a child. Some people because their fallopian tubes are blocked, they live a life of condemnation, some people because of a surgery they did that destroyed some parts of their reproductive system, it is not a fault of theirs. Some men whose spermatic cord are mistakingly tied for instance, during herniorrhaphy but still have sperm in their testes, are some of those cases that IVF has provided an answer to. The sperm or eggs in these cases can be harvested and used to achieve pregnancy and the couples will be satisfied. Remember that marriage in an African setting is for child bearing. No matter how much love they confess to each other other, once a child is not there, the love vanishes. (general laughter).

FBD: So sir, what are the dangers associated with IVF?

Prof: The dangers are minimal I will say but the one we really know of is hyperstimulation syndrome. During the process of trying to get the eggs, if you overstimulate the ovaries, they can develop hyperstimulation syndrome and if it is severe, can lead to death. But every doctor who is using this technology knows how to avoid that, using proper precautions. Once the syndrome is not there, you can do IVF as many times as it is possible.

FBD: How far has IVF spread in Nigeria? Is it something we have cottoned on to?

Prof: IVF is all over the country and has come to stay, the challenge is that it is still very expensive. In developed countries, people have health insurance and can take care of about 6 cycles of IVF, but in Nigeria, people pay from their pockets. PROF1 Professor Joseph Ikechebelu MD Life Specialist Hospital Nnewi

FBD: Why is it so?

Prof: Because our health insurance scheme is still very young, so they start by covering those basic ailments that affect more people- the masses. Fertility affects just about 2-3% of the general population.

FBD: What is your advice to people out there who have fertility problems?

Prof: Well my advice is if you want to have a child of your own when natural conception is impossible, IVF provides a solution to that so once you can afford the money, go for it.

FBD: Are you also advising people all over the country who need IVF to come down to Nnewi?

Prof: There are many fertility centres all over the country where IVF is done, but if you feel that what we are doing is good enough for you and you have faith, why not? I always tell people to have some faith in whatever they do. This is science but we still need to have some faith.

FBD: I was going to ask what it is with doctors and faith because everywhere you go, you hear them saying something like In God we trust….We treat but God heals…

Prof: (smiles) Yes, faith is important because we still have some limitations in IVF. There are some certain areas that are not within our control for instance, the preparation, harvesting of the eggs and the fertilization can be controlled, we can put it in the incubator, we can even do intracytoplasmic sperm injection (ICSI) where we can select a single sperm cell and inject it into an egg…yes we can do all that but once the embryo is formed, check it, select it and put it inside the womb, at that stage of what we call embryo-endometrial cross stuck, from there, we have no other control and that is where we apply faith to get it to implant. We however, know that there are things that can be done to increase the rate of implantation but they are still under research. That is also the stage where most IVF procedures fail.

FBD: Alright prof, thanks for granting us an audience, we are most grateful.

Prof: Thank you.

FBD: uhm…, we also wish to talk to the surrogate mother and the biological mother of the baby, is it possible?

Prof: Oh well, it is possible and i have spoken to them earlier about it but high level of confidentiality should be maintained in this case…you understand?…

Written by Dr. JOY OKECHUKWU EBUSSON of facebookdoctor team

Nigeria records Oldest IVF Mother in Africa as 60 year old delivers baby girl

A woman said to be 60 has just been delivered of a baby at a Lagos hospital. For 31 years, Mrs Omolara Irurhe was globetrotting not for pleasure but in search of a child. She was a guest in the best hospitals.

But in 2010, her journey ended in the most unlikely hospital and country when she began an Invitro Fertilization (IVF) treatment at the St. Ives Hospital in Lagos. On Monday, what began as a seed hope four years ago culminated in the delivery of a bouncing baby girl.

Mrs. Irurhe becomes the oldest IVF mother in Africa. The global recognition for oldest IVF delivery goes to Rajo Deri Lohan, an Indian who in 2008 was delivered of a baby at 69 years.

The IVF Unit at St. Ives Hospital successfully aided the conception and delivery of the baby and has now equaled the United Kingdom’s record of IVF age delivery.

The team of doctors at the hospital was led by the Chief Medical Director, Dr. Tunde Okewale, who expressed joy at the successful delivery. Okewale said the physical condition of the mother – and not just the age – is a major factor that determines the success of conception and delivery through IVF.

“We treat only after strict medical check of couples. For us, age is not important in our decision to take her on; what was important is the physical condition of the mother. Older women generally make better patients in our experience,” Okewale said.

The new mother was full of enthusiasm and joy over her new baby. She said what kept her going after many years of childlessness was faith in God and a belief in herself.

Mrs. Irurhe said she had tried to have a baby for many years and had gone to many hospitals both within and outside the country for a solution to her childlessness. But in 2010, her journey came to an end when she was introduced to St. Ives Hospital and the treatment began.

“I believe we should not limit God and what the doctors can do in this modern age. I believe this is the appointed time. I was very hopeful throughout the years I was childless and I remained focused on God. We went to many hospitals but we didn’t give up,” she said.

The joyful mother said her husband’s Catholic faith prevented him from marrying a second wife as the two of them put their faith in God.
“We didn’t have much pressure, even though our marriage is cross cultural –I am Yoruba; my husband is Edo- but we remained hopeful,” she said.
Desmond Adekunle Irurhe was elated at the birth of his baby. When asked if she supported his wife going for the IVF he replied: “ I supported her throughout because my wife was dogged and she believed in herself. When I saw her faith, I had no choice but to go with her. She kept telling me she would have her child”.

The husband said even though there was some pressures, it wasn’t too much. “I wasn’t thinking of another wife. I came from a monogamous family and I decided she is all I will have. The family was understanding too and we fought together to get this baby.”
Irurhe praised the medical team at the hospital, saying they made everything easy for them. “ The hospital didn’t give us any problem, they were very helpful and we thank them for the successful delivery.”
With the successful delivery, hope rises for older women who may want to go the way of IVF in child conception. In Nigeria, the cost of the IVF treatment varies but from available statistics, the most expensive treatment is under N2million. The Iruhres paid less than N1 million for their successful treatment.

“I will advise couples who are trying to get a baby to try the IVF. My case has rekindled hope for the barren woman. I will say the couple should relax and take it as it comes, they will surely smile,” the mother said.
Having a first child at the age of 60 years may not be the norm but for the mother, it is an experience she does not mind going through again. “ I don’t know if I will have another baby, but if the doctors say I can, I will try it,” she said, smiling.

Mrs. Omolara Irurhe: We have tried for many years to have a baby and after we failed to get a baby naturally we opted for the IVF. We had gone to many hospitals before here but the treatments that we received didn’t work. We came in contact with this hospital in 2010 before we delivered this baby.

“I give glory to God, we kept our faith in God, we believe this is God’s appointed time.

The Hope Valley Clinic introduces new IVF technique to tackle infertility

Towards  reducing the burden of infertility in Nigeria, a new  In vitro Fertilisation (IVF) technique- Intracytoplasmic Morphologically Selected Sperm Injection (IMSI) has been introduced by The Hope Valley International Clinics Ltd, Lagos designed to achieve a  higher clinical pregnancy rate.

 The technology  according to the hospital  is capable of   magnifying sperm 600 times more than other  existing techniques like the intracytoplasmic sperm injection (ICSI)  for better fertilization and implantation of the human eggs.
IVF and other assisted reproductive technologies have become a well accepted  medical treatments for infertility globally .

Available statistics show that  over  4,000 babies have been born through IVF  in Nigeria and five million globally.

The first IVF baby, Louise 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.
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.

Managing Director of  the clinic, Dr. Michael Ogunkoya, said the technology  was introduced to assist couples with fertility problems have their own children, stressing that  IMSI is an essential tool for breaking barriers in infertility management.
Ogunkoya stated that the overall effect of availability of IMSI was to improve success rate in terms of pregnancy rate and take home baby rates which has “ become evident at The Hope Valley Clinics in the last few years.”

REGULATING IVF TREATMENT IN NIGERIA

InVitro Fertilisation (IVF) is increasingly becoming a
method of bringing joy and laughter to fertility challenged couples all over the world. According to recent reports over one million babies have been conceived through the test-tube method globally with 40,000 taking place in Nigeria.

Many marriages which had hitherto hit the rock in Nigeria due to the problem of childlessness have been restored. So, it’s all kudos to the technology and the experts who have been involved in the service, particularly in Nigeria.

However, for us to continue to enjoy the benefits of the life giving  technology, it is important, doctors and other stakeholders look into some disturbing practices that have crept into the scene. There seems to be no regulatory measures concerning the practice as a result of which incompetent and unethical methods are now the order of the day.

I recently heard a story of how a donor egg was used for a couple without their consent. Fortunately, the woman had a little knowledge of IVF procedure and was able to detect that something was wrong. She knew that for an embryo to be produced, a woman’s egg should be collected and fertilized with a man’s sperm.

But in their own case, her husband’s sperm was collected after which she was asked to come to the clinic for embryo transfer. She was surprised and wanted to know how the embryo came about without her egg. What followed was accusations and counter accusations between the couple, the doctor and his staff which eventually ended at the police station.

A lot of other cases of unethical practices abroad. Practitioners do all kinds of things to convince couples that they are the best and live them to their clinics, just to make money.

In 2012, the Association for Fertility and Reproductive Health (AFRH) of Nigeria, approved minimum standards for clinics offering Assisted Reproductive Technology (ART)/IVF in Nigeria.

The guidelines which focused on the type of personnel that can operate in an IVF Clinic, the qualification, and experience necessary for such clinic operations also outlined the number of embryos that can be transferred in a treatment cycle. It recommended a maximum of two embryos for patients less than 30 years old, three for 31-38 years old, and not more than four for those above 38 years. It also required and mandated all IVF centres to keep records of procedures and have informed consent.

Unfortunately, accounts of couples who have undergone IVF treatment show that what obtains in many clinics is far from the recommendations of AFRH. In some cases, like the one I narrated earlier, the details of the procedure are known only to the doctor. Capitalising on the ignorance of some couples and their desperation to have their own children, the doctors manipulate the procedure, throwing all ethical guideline over board to achieve results. Many of them insert up to seven fertilized eggs instead of the recommended numbers inspite of the dangers it poses to the mother and the baby.

What about quacks who have hijacked the technology. At a public event recently, the Chief Medical Director, The Bridge Clinic, Dr Richard Ajayi, lamented that more than 60 per cent of people offering IVF service in the country do not have the facilities and qualified personnel for it, but have continued to do so in order to get money from patients.

He 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.

We all know that IVF treatment is very expensive. Infact, to go through one treatment cycle, some couples have to sell their properties or borrow money from different sources. It will therefore, be intensity of those  in authority to allow these couples to be ripped off by doctors, both the qualified and unqualified ones. The  procedure for IVF and the cost should be standardised.

Strict regulation and monitoring of IVF activities in the country is the only way to protect the patients and eliminate quacks from the system. It will also serve as a check for medical practitioners who have been making false claims to draw more patients. As Professor Osato Giwa-Osagie, co-pioneer of IVF  in Nigeria advised, “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.”

In addition; couples opting for IVF should be educated properly on the procedures for the treatment. Ignorance, can be very dangerous to the mother, the baby and can lead to continuous waste of money and emotional trauma.

 

By Calista Ezeaku

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