IVF has broken the myth of infertility – ALU

Dr. Alu


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

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

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

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

More Nigerians Are Opting For IVF

Interview with Dr. Richardson Ajayi

When did you start operations?
Our IVF centre has been running in Lagos since 1999 and we got our first babies a year after. In 11 years, the process has produced over 1,200 babies. With a lot of experience from operating in Lagos and Port-Harcourt, we decided to come over to Kaduna because we got a lot of requests in the North from people, who had to come to Lagos. I think we should look at IVF in the same way we should look at anyone with a medical condition. If you have diabetes, you take insulin; if you have hypertension, you take anti-hypertensive; if you have kidney failure, you have a kidney transplant. If you cannot get pregnant by yourself, then you need help. In that case, we simply take the sperm from the man, the egg from the woman and put them together to form an embryo out of the body because the man and woman are not making the embryo by themselves. This could either be because the man’s sperm is not strong enough or there is a blockage in the tube preventing the sperm and eggs from meeting. It could also be that the woman is not producing enough eggs or has fibroid within the uterus. What IVF does is to reproduce the conditions within the woman’s body out of the body so that the eggs will seem like they are inside the body and continue to develop.

What is your assessment of the society’s attitude to IVF?
I think there is a tremendous acceptance. As I said, it’s a medical problem and once people are clear about medical conditions, like any other medical problem, they look for help and ways of treating them. In our Lagos clinic, we have an average of over 1,200 new patients every year. And since we started in Kaduna in January this year, we have had over 150 patients. I think the demand is there and increasing. The response is fair, perhaps because we are a specialist unit. We are not for everyone, but for those who need our help. The important thing is that it helps couples to remain together and have children of their own.

You have been involved in this for years, what factors have you identified as aiding or hampering IVF success in Nigeria?
IVF is not like medical operation that has an objective end. The objective is to put the sperm and the egg together. Sperm and egg forming embryo is not the same as pregnancy. So, we put the embryo in the woman. One out of every four times that we do this, we get pregnancy. After insertion, using the IVF process, the embryo must continue to divide and must connect with the woman to form placenta and draw life from the woman. All of these are not under the control of the IVF process. The IVF process ends when we put the sperm in the woman. But the process that leads to pregnancy is beyond us. But what we do is to put in our prayers that everything will work out.

Have you had any successful case in Kaduna since you started?
We are starting our first batch of treatment in Kaduna in April. And we are hoping to record about 30 per cent success rate.

You just said the success rate is 30 per cent. If it fails, what happens to the money paid?
We are not inhuman and unfriendly; we give a discount on subsequent cycles.

What are the cost implications if an individual is to go through the process?
At the moment, we are charging N450,000 here in Kaduna. But in Lagos and Port-Harcourt, we charge N600,000 and above. Obviously, it is because the equipment and managing the units are very expensive.

What have you identified as the causes of impotence in our society?
Society has changed; social demography has changed. The age girls begin to have sexual intercourse is lower; many had multiple sexual partners before they got married and sexually transmitted diseases are much more common.

SOURCE: THENEWS.COM

IVF IS IT!

At over 50 years of age, half of that as a married woman, Fadekemi Williams (not real names) had given up hope of having a child of her own. She had undergone a variety of orthodox and unorthodox conception procedures, all without a positive result. But about five years ago, Williams, who works with one of the General Hospitals in Lagos, told a friend about the problems she was getting from her in-laws on account of her childessness. The friend suggested Assisted Reproductive Technology. She was not overly excited about the idea. But after much persuasion from her friend, she agreed to give the procedure a shot.

Unfortunately, the first round did not go well. The doctor harvested 10 viable eggs, but none of them fertilised. The second visit two years later was fruitful–a set of triplets at the age 53. Williams’ babies were produced from her eggs and her husband’s sperm and were delivered through Caesarean Section at the Lagos State University Teaching Hospital, Ikeja.

Ngozi Nwueze, a staffer of the Lagos State Teaching Service Commission, also experienced childlessness for many years before considering the same procedure, better known as In-Vitro Fertilisation, IVF. Ngozi had been married for eight years. Fertility specialists discovered that she had scarred tubes, endometriosis-a condition that occurs most commonly within the Fallopian Tubes and ovaries that may lead to painful menstruation-and fibroid tumours. Ngozi and her husband could not afford the cost of IVF, so they opted for less expensive treatments.

As a last throw of the dice, they decided to save up money and try IVF at a clinic in Lagos. After three attempts, Ngozi became pregnant and now has a son. “The first three attempts were so heart-rending. Thanks to my husband, who encouraged me to try again. Although the cost was so high and almost affected his business, he told me not to worry. Now, I am a proud mother of a healthy boy,” she told TheNEWS.

IVF appears to have grown in popularity in Nigeria, where there are no fewer than 14 IVF-focused clinics. Most of the clinics were established in the last six months. The latest entrant is the EkoCorp Fertility Centre, an arm of Eko Hospital plc in Lagos. The most prominent are The Bridge Clinic, St. Ives Clinics, Roding Medical Centre, Medical Art Centre, Hope Valley Fertility Clinic, Nordica Fertility Centre and Omni Advanced Fertility Centre, all in Lagos.

Others are M&M Hospital, Aba, Abia State; Nisa Premier Hospital and National Hospital, both in Abuja.

The clinics offer a wide range of services such as Intra-Cytoplasmic Sperm Injection, ICSI, (a procedure in which a single sperm is injected directly into an egg in an attempt to achieve fertilization); intra-uterine insemination (otherwise called artificial insemination.It is the process by which sperm is placed into the female reproductive tract for the purpose of achieving pregnancy), sperm donation, surgical sperm retrieval (a procedure in which sperm is removed from inside a man’s genitals instead of waiting for the sperm to be ejaculated out), surrogacy, egg donor and intra-fallopian transfer (a method in which eggs are removed from a woman’s ovaries and placed in one of the Fallopian tubes, along with the man’s sperm).

However, the cost and wide error margin of the procedure continue to keep many of those who need it away. Chances of success vary widely for each patient, say experts, depending on the cause of individual infertility problem and age. According to experts, the success rate of 25 to 30 per cent of IVF treatment in Nigeria is the same as obtained anywhere in the world.

Chances of success will depend on many factors, including the cause of the fertility problem and age. The older a woman is, the less her chances. Women above 35 years have far slimmer chances. Women under 30 years are said to have a one in four chance of getting pregnant using the procedure. For those over 40 years, it is one in ten. “Usually the success rate of IVF treatment depends on the number of cycles. One attempt of IVF cannot give you more than 30 per cent chance. So, people have to try it several times. We tell people that the more they do it, the brighter their chances. The success rate of nature is about 18 to 20 per cent every month. If IVF can give you 25 per cent, it is a little bit more than what nature can do,” said Dr. Chidozie Egwuatu, consultant gynaecologist and Medical Director, Lifegate Specialist Hospital, Ogba, Lagos. In Nigeria, many of the clinics claim fantastic results on the successful birth rates in their clinics. Some claim as high as 40 per cent success rate.

Dr. Egwuatu revealed that to increase the chances of success, some clinics abroad ask patients to pay for four, five, six attempts at a go, before they start treatment. The thinking is that a woman’s chances of success are higher in multiple IVF treatment.

Dr. Abayomi Ajayi, medical director, Nordica Fetility Centre, Lagos, said what IVF tries to do is a replication of what happens in a woman in a natural cycle. “IVF babies are normal babies and that is because the quality control system in the body is not tampered with in IVF. That is why we have normal babies. People want to increase success rate without decreasing the quality of the baby. So that is usually the balancing act that is being carried out in researches,” Dr. Ajayi informed.

The cost of IVF in Nigeria, said experts, is also reasonable. This is said to have encouraged a number of Nigerians resident overseas to come home and take advantage of the lower cost for some treatment cycles before returning overseas. In the United States, the average cost is between $10,000 and $12,000, while in the United Kingdom, a cycle costs between £4000 and £8,000. This includes fertility testing and consultation fees. In Nigeria, it costs between N300,000 and N1.5 million for a cycle of treatment, depending on the clinic.

The Bridge Clinic in Lagos is reputed to be the first IVF-focused clinic in Nigeria. It opened in 1999 and has been at the forefront of new developments within the field. Recently, the clinic claimed to have achieved success in gestational surrogacy, the first pregnancy in Nigeria attained through Intra- Cytoplasmic Sperm Injection and testicular sperm procedure. Also, the clinic claimed to have treated over 4,500 clients. It recently celebrated the birth of over 1,000 babies to families that had difficulties conceiving.

“We are committed to providing superior IVF services comparable to international standards. We do not create children; only God has the power to do that. But through our assisted conception services, we have been able to bring succour to thousands of couples experiencing fertility challenges all over the country and beyond,” Dr. Richardson Ajayi, Medical Director of the clinic said at the opening of its fourth facility in Kaduna.

Nordica Centre recently introduced an IVF technique that doubles the procreation chances of men with abnormally low sperm count and poor sperm mobility. The new technique is called Intra-Cytosplasmic Morphologically-selected sperm injection, IMSI. This enables the direct selection of good sperms from the man and then injecting them into the woman’s egg to successfully achieve pregnancy.

Ekocorp Centre claimed it had its first batch of IVF patients in December 2009 and till date, 57 patients have so far obtained treatment at the centre. Out of that figure, 27 pregnancies were recorded, a 36 per cent success rate in less than two years of operation, according to Dr. Sonny Kuku, Chairman, EkoCorp plc. “As at now, we have 10 children delivered from treatment received at the fertility centre and 13 ongoing pregnancies. Our results to date are respectable and compare favourably with what obtains in fertility clinics of similar status in the developing world,” Kuku said at the opening of the clinic in February.

St. Ives Clinic, run by Babatunde Okewale, claimed it has successfully delivered close to 200 IVF babies in its less than a decade existence. Just recently, the clinic announced the delivery of a baby girl by the oldest IVF mother in Nigeria, 57-year-old Mrs. Adeyemi Taiwo.

In Nigeria, unlike in other climes, women still shy away from sharing their experiences after successful IVF treatments. Many women would rather attribute their conception and eventual delivery to spiritual intervention.

—Funsho Arogundade

Source: thenewsafrica

Eko Hospital champions fertility treatment in Lagos, launches new center.

Nigerian couples seeking high standard fertility treatment can now access such services as Ekocorp Plc, owners of EKO hospitals, officially launched its fertility treatment centre in Lagos.
The initiative is aimed at alleviating challenges of couples in achieving pregnancy as well as raising the bar in infertility treatment.
During a media presentation of the centre, dubbed Ekocorp Fertility Centre, Chairman/Joint Chief Medical Director, Ekocorp Plc, Dr. Sunny Kuku explained that the need to ensure quality and accessible specialist fertility care at the highest level informed the set up of the centre.
He said 57 clients have so far obtained treatment at the centre, out of which 27 pregnancies were recorded, averaging 36 per cent success rate in less than two years of operation.
Kuku also said with such fertility centres in place, more Nigerian couples would have access to high class Assisted Reproductive Technology (ART).
Giving insight into the growing infertility rates in Nigeria and the world at large, he said: “Normal sperm count is now 10 million. It used to be 40 – 50 million. This means that the chance is now lower for the woman to get pregnant. Untreated infection is a major cause of infertility in our environment. It could lead to low sperm count in men and blocked tubes in women. But when a woman is highly fertile and the man has low sperm, the woman can compensate for that and it is verse versa”
The Chief Medical Officer, Eko Hospitals, Dr. Adegbite Ogunmokun, said the centre would provide avenue for training specialist doctors with interest in fertility care in line with their philosophy. “The first batch of patients were treated in November/December 2009 all had Sperm Injection (ICSI) and out of 11 patients, four were successful, that is 36 per cent, and have had their babies now, two sets of twins and one singleton delivery and one early pregnancy loss. Treatment of infertile couples continued thereafter in batches up till now.
He hinted that the centre is equipped with state-of-the-art equipment as well as an experienced team of fertility care specialists “As at now, we have conceived and delivered 10 children and there are 13 ongoing pregnancies. “Our results to date are respectable and compares favourably with what obtains with fertility clinics of similar status in the developing world.”
He said the success story right from take-off provided the needed comittment of the Board of Directors and the team of experts managing the centre to its success and growth.
The centre, which is equipped for IVF and other novel ART procedures, also has in place a quality based, result oriented, patient-centered fertility care programme with good prospects for rapid growth and expansion.
Specifically it offers treatment only to couples with women aged
25 – 55. He said the age of the woman among other considerations, determines the number of embryos transferred into her womb. “We usually implant two embryos especially in younger women. But in older women, three embryos are transferred because chances of achieving and retaining pregnancy are lower. That is why they often have multiple births.”
Stating that the centre was concieved 10 years ago, he explained that the need for adequate preparation, logistics and the drive to get it right from the beginning, delayed the takeoff of the programme till 2009.
However, the centre plans to continue with the same focus but with increased vigour, commitment of providing high quality fertility care and to take the practice to the next level. “We intend to let the whole world know that we are there for them and that our processes and procedures are tested and can be trusted, even with our modest achievement” he added.jor cause of infertility in our environment. It could lead to low sperm count in men and blocked tubes in women. But when a woman is highly fertile and the man has low sperm, the woman can compensate for that and it is verse versa”
The Chief Medical Officer, Eko Hospitals, Dr. Adegbite Ogunmokun, said the centre would provide avenue for training specialist doctors with interest in fertility care in line with their philosophy. “The first batch of patients were treated in November/December 2009 all had Sperm Injection (ICSI) and out of 11 patients, four were successful, that is 36 per cent, and have had their babies now, two sets of twins and one singleton delivery and one early pregnancy loss. Treatment of infertile couples continued thereafter in batches up till now.
He hinted that the centre is equipped with state-of-the-art equipment as well as an experienced team of fertility care specialists “As at now, we have conceived and delivered 10 children and there are 13 ongoing pregnancies. “Our results to date are respectable and compares favourably with what obtains with fertility clinics of similar status in the developing world.”
He said the success story right from take-off provided the needed comittment of the Board of Directors and the team of experts managing the centre to its success and growth.
The centre, which is equipped for IVF and other novel ART procedures, also has in place a quality based, result oriented, patient-centered fertility care programme with good prospects for rapid growth and expansion.
Specifically it offers treatment only to couples with women aged
25 – 55. He said the age of the woman among other considerations, determines the number of embryos transferred into her womb. “We usually implant two embryos especially in younger women. But in older women, three embryos are transferred because chances of achieving and retaining pregnancy are lower. That is why they often have multiple births.”
Stating that the centre was concieved 10 years ago, he explained that the need for adequate preparation, logistics and the drive to get it right from the beginning, delayed the takeoff of the programme till 2009.However, the centre plans to continue with the same focus but with increased vigour, commitment of providing high quality fertility care and to take the practice to the next level. “We intend to let the whole world know that we are there for them and that our processes and

A pregnancy from IVF is a miracle - Dr. Richardson Ajayi

As a young doctor working in the United Kingdom, Dr. Richardson Ajayi regularly witnessed difficulties experienced by Nigerian couples who were traveling abroad for fertility treatment. He became convinced of the need to set up such a clinic in Nigeria. He acknowledged the importance of ensuring the clinic was of the same standard as available in the United Kingdom.

So in collaboration with consultants from Kings College Hospital, London, he conceptualized The Bridge Clinic to provide the same quality of services in compliance with the strict code of conduct of the Human Fertilisation and Embryology Authority (HFEA) of the United Kingdom. The ISO certified Clinic which marked its 10th anniversary recently has had a consistent pregnancy rate that has led to the birth of over 1,000 babies. In this interview with Sola Ogundipe, Ajayi gives a rundown of the contributions of The Bridge Clinic to successes of IVF in the country . He also talks about issues related to healthcare delivery. Excerpts.

What’s your assessment of the standard of care in Nigeria?
I think it is wrong to assume that in Nigeria as a resource-poor setting, we cannot have the same standard of care available abroad. There is only one standard of care enforced by licensing and regulation abroad and we have to be at the same level here in Nigeria.
The Bridge Clinic clocked 10 recently. What has it been like doing IVF for one decade?
It’s been like swimming against the tide. The first thing we had to deal with in the early days was creating the infrastructure. We also had to create the staff because IVF was not taught in the schools so we had to focus on training. After that, we had to convince the patients because IVF was still relatively new. People had to be convinced that IVF was not by choice. It was the way to go. The question of the cost was also there. But the key thing was to convince the people that they needed IVF which had become the cornerstone of infertility treatment.

I make bold to say it is wrong for anyone to attempt to treat infertility of more than three years standing without resorting to IVF. IVF makes the coming together of the sperm and egg possible to attain pregnancy. It is able to generate embryos for the couple. The union that is not taking place in the body of the woman makes pregnancy unattainable. We can make that happen.

The Bridge did not pioneer IVF in Nigeria. What innovation did you introduce?
Before we started IVF in Nigeria, everybody was doing it as part of their general medical services, but it was The Bridge Clinic that made a bold decision about IVF. We can reproduce it, we can sustain it, and we can make it into an ongoing concern. We are not experimenting and we are ready to stick our neck out.

We are confident because we have done it and shown how it is done, others have come. There needs to be focus on quality. Healthcare is all about intervention. Evidence-based medicine says anything you do must have a scientifically verifiable outcome. This must be so from the patient’s point of view. There is no point going to see a doctor who is saying I’m just trying my best. The service must be guaranteed.

How would you describe IVF to a lay person?
A pregnancy from IVF is a miracle. It gives access to an opportunity for a blessing. IVF is not a guarantee. A month in your bedroom gives 20-25 per cent of getting pregnant. IVF does the same. The fact that IVF is not a guarantee is not a failing of the IVF process, but a reflection of human reproduction. IVF does not improve on the natural human fertility, but it improves chances for couples who are not getting pregnant naturally. If you are not getting pregnant naturally, then you are operating on a zero per cent chance every month. IVF takes you to 25 per cent chance which is what the natural process is.

There have been issues about declining male fertility, could you shed light on these?
A Finnish study shows a declining sperm count over the generations. Our grandfathers had higher sperm count than our fathers who had higher sperm counts than our generation. There are many theories, but a common theory is that the male of our species is getting exposed to a lot more female hormones than ever, basically due to a lot of xerophenes in the atmosphere. This comes from plastics used for packaging; plastics used for computers etc. These xerophenes have female hormone oestrogen-like effects and exposure of males to them could be deleterious.

There are reservations about the regulation of fertility treatment in Nigeria. Please comment.
Regulation is one of the biggest problems we have in Nigeria. It is absolutely essential that we have adequate regulation of the profession, but the shame of it is that we are never going to have regulation here in Nigeria for a long time to come. For whatever reason, there is no political will to go in that direction. The reason is that those who can make the changes are not interested. There are different standards. We at The Bridge Clinic decided to play at the highest level from the very beginning. We decided to work as if we are regulated by the Human Fertilisation and Embryology Authority (HFEA) in the UK. One of the stipulations of the HFEA is that any clinic that runs IVF must have a quality management system, so we implemented such a system and actually had our recertification audit recently. There were recommendations about what we needed to do. For instance, we were told we have to use only disposable equipment because of the infection risk associated with sterilisation. It is one of the standards that are being pushed in Europe.

For instance, sterilisation procedures must be of such a high standard to be acceptable that it is better to just use disposables and this is what we are moving towards. By the end of April this year, we at The Bridge Clinic would have converted to using disposables. These recommendations are going to cost us about N25 million, but they are necessary improvements, even if they are not going to be seen on the outside. They are internal, like writing a patient’s name on a dish with a pen. Some of these pens have special constituent called volatile organic compounds which may have detrimental effect on the embryos. So now we have to go and buy a special pen that is only available in Europe at more than 30 times the cost of a normal pen. These are the standards we are setting for ourselves and they are the highest. As a result, we turn out to be more expensive than every other person doing IVF.

Are you saying high standards are the way to go?
The point here is that if we have chosen these are our standards, it would be difficult for others who have not decided to go down this road to say let us go and regulate together. As I said earlier, I believe there is only one standard of healthcare. Because of my heritage, I worked in the UK for a number of years and I came back to Nigeria with a vision of reproducing what I’ve learnt. When I go back to see my colleagues in the UK I need to be able to tell them this is what I am doing. Not that I am compromising to manage in Nigeria.

The standards we set for ourselves are very high, but I believe that should be the reference. That is the standard the rest of the world utilises and we shouldn’t have a Nigerian version. We should have the same as the rest of the world. For example, the laboratories that we use are standard. We were part of the group that set up PathCare which is the only ISO 1009 certified laboratory in the country so that we can assure the quality of care we give our patients. In the UK, America or South Africa, you cannot run a lab unless you have this certification, so it is the same standard.

What is the Vision of The Bridge Clinic?
Our Vision is to be the reference point in healthcare delivery because of our philosophy of benchmarking with international standards and I believe that with time there will be the realisation from the customers and service providers that there needs to be some kind of assurance level in healthcare delivery. And that assurance level is quality. Once that realisation is there, the change will occur. I actually think it has started to occur because there is now an association for quality in healthcare. With that kind of change, we can move in the right direction.

You have a Foundation called Aspire, what does it do?
We have a Foundation called Aspire. It has two objectives. One is to provide information about our LIHN initiative (Let It Happen Naturally). It is an intervention for infertility. There are posters circulating around. The second initiative showcases the free packages The Bridge Clinic offers yearly. It goes through a process of helping people and if it shows that someone is eligible, they obtain assistance. We get their tests done at PathCare which is supporting for free, and we have a pharmacy that supplies their drugs for free. When you put all these together, we can provide access. We can do a few cycles every month through this programme. The potential beneficiaries present themselves at our Centre in Oduduwa Crescent, GRA, Ikeja. They complete a questionnaire and show evidence of payment. We are also talking to the universities to provide them with IVF support. This is called the low cost IVF initiative where we manage an IVF Centre but provide services at a heavily subsidised cost. That subsidy is enjoyed by the patient. So the University can provide the service at an affordable cost to those who need fertility treatment.

What is the public perception of infertility?
The nation’s maternal mortality rates remain high and are a priority for government. This may affect the perception about infertility. But the World Health Organisation (WHO) defines health as the complete state of physical and mental well being, so infertility is a cause of a lot of mental instability, ostracisation and is an important issue that requires attention. Unfortunately we are not getting the right kind of support we need here.

The National Health Insurance Scheme (NHIS) is a form of legislation and if it is changed that it should provide some form of support for management of infertility, then it would be done. There are two sides. You can look at the employer perspective whose concern is to protect itself from recurrent expenditure, and women having children is a recurrent expenditure, because not only are you going to pay for them to have the children, you are also going to pay for someone to cover their position when they are on maternity leave. So from this point of view, most companies do not look after reproductive treatment. But it is something we should look at because it is important. Infertility is a cause of social problems.

What are the common causes of infertility in this environment?
There are many peculiarities of infertility. The most common is the prevalence of tubal infertility. There are many incidences whereby infertility is caused by blockage of the fallopian tubes. Many reasons account for this. First there is a high rate of unsafe abortions leading to a high rate of infection as a complication of the abortion because abortion is illegal in Nigeria and people tend to do it illegally hence all the risks. If we look at it in the loosest term, abortion is illegal in Nigeria.

Second it the high rate of sexually transmitted infections which are associated with pelvic inflammatory disease and tubal blockage there is also high prevalence of fibroids and many have operations to remove them many of which are complicated with adhesions formation and tubal insufficiency. Because it is difficult to regulate hygiene standards and all that, there is a high rate of infection after child birth, sepsis, and sometimes even in the process of testing if the hygiene standards are not as good as they should be this can lead to tubal infertility. So there are so many compounding factors leading to this and this has to do with the peculiar nature of our healthcare delivery system in Nigeria.

Then there is male factor infertility. This is more difficult to elucidate because we are experts on women, the so-called experts on men are urologists, but the urologist is not really interested in reproduction, rather he is interested in the urinary system. Beyond saying there is a high prevalence of infertility, I would be speculating without any evidence that these are the reasons. But there is a high prevalence in Nigeria anyway. People often say it has to do with the level of pollution and contamination of the environment. There is also high incidence of infection which can cause obstruction of the tubes in the man.

In your view, which is the way forward for healthcare delivery in Nigeria?
There needs to be uniformity within the healthcare profession. We need to put our house in order before we can go out to talk with a single voice. It is a gynaecologist who has had experience in this field is qualified to set up a fertility centre. In more developed countries that is how it is. In Nigeria, everybody is setting up an IVF Centre, so when you set up a society of IVF practitioners, everybody will turn up.

How then will you expect uniformity about recommendations to the governing body and to the government?
I think the Nigerian Medical and Dental Council needs to set up a health professionals Council, which must be an independent body that regulates doctors. The Council must set standards and the consumers must be part of the council and there must be representatives of each specialty. It must be independent and must be objective. Once this can be done, it will be easier to regulate the system, but currently we cannot do that. We cannot ask the practitioners to regulate themselves. There needs to be an independent body to do that only then can we move forward and legislate.

IVF: Nordica reduces cost through egg sharing by Azoma Chikwe

The Medical Director of Nordica Fertility Centre, Dr Abayomi Ajayi, has advised couples seeking solution for fertility through In-vitro-fertilization (IVF) to be mindful of where they go to for treatment. Speaking during Nordica Open Day recently at Nordica Fertility Centre, Ikoyi, Lagos, Ajayi noted that it has become necessary to warn patients because many quack and sub-standard IVF centres are springing up everywhere in the country.

He spoke on this and other issues. Excerpts:
Open Day programme
We have seen from our experience that the main problem with assisted conception is still awareness. Not only awareness in the sense that people don’t know that it exists, but also awareness because we want the consumer to be intelligent, to be learned, so that you can ask questions wherever you go.

We are not saying that everybody should come to Nordica, wherever you are going, just be sure you are going to the proper place. You are asking the right type of questions, you can only do that when you have enough knowledge of how things work. Because we hear all sorts of stories of how people say they are doing assisted conception in Nigeria, which is not true.

So, unless you know how it is done everywhere in the world, we know that some people will not go to the internet to go and goggle In-vitro Fertilization (IVF) procedures, but we can show them how it is done, then, you take it from there and ask wherever you are going, what is the difference between what I saw here and what you are doing? So that you can be able to say whether anybody you are seeing is making sense. So what we are doing is to enlighten the patients and also to raise awareness.

Results
Well, I can only talk about people who come to me, I know they are getting results. And that’s what we are saying, go to places where you can get results. And you can never get results if the proper thing is not done.
Acceptance
If you ask me, I think IVF is being accepted, of course, but I think it can get better. There are different groups of people when you talk of awareness. Some do not know it exists at all. Some know that it exists but they don’t believe it can be done, either because of their previous experience or whatever. And probably, another group are people who probably think they cannot afford it.
So, every group has different needs, and we need to meet those needs. If you ask whether it is being accepted, I think yes, it is being accepted actually.

Awareness
Because we have a limited budget, we can only do the best that we can . And that’s one of the things we are doing, we are raising awareness. Also, we are improving not only with the patients, we are also doing a lot of things with the doctors. Improving their skills, we teach ultra-sound to the doctors because we have seen there are very few places where ultra-sound is taught in Nigeria. I think they are up to ten. They can learn ultra-sound, learn it properly. We also teach endoscopy.
As we are trying to increase awareness to the patient, we are also improving the quality of healthcare. Because we cannot claim to be an island. Though we have an island of services, where other people also know a few things that you know about and that’s the only way we think we can contribute to improving the level of healthcare in the country. That’s just the bits and pieces of what we can do.

Indigent patients
We have a scheme for people who cannot afford IVF. We do eggs sharing for the younger ones. Through the egg-sharing scheme, if you are below 34 and everything is alright, it is possible for you to do IVF paying only N100, 000, but you share your eggs with other people. That way, we can bring it down for people who are younger.

But for other people who are not as young as that, the only thing we do is to rely on the programme that we have which has to do with a non-governmental organisation, which we call Fertility Treatment Support Foundation (FSS). They have a website.
Of course, we also think it is also proper to make IVF more accessible in the sense of going to the people rather than having them all come to Lagos. We have a branch now in Asaba.

Grassroot
When you talk about grassroot, I know another question that is being asked all the time is cost. That’s for government to go to the grassroot, because they probably might be able to provide the treatment either subsidized or completely free. But if you are looking for people to be able to pay, then, you need to get your target audience right. I think the first group of people that we need to appeal to are people who can read and write. Before we take it to the rest of the people.

Infertility
Infertility is not peculiar to this generation alone. If you look back, there are some people you can remember, maybe our own category of grannies who didn’t have children. They might not have been many, but they were definitely there. You can remember one granny or one aunt who didn’t have children, so infertility has been with us from time past.

However, the treatment of infertility depends on your civilization. In some parts of Nigeria before, I think it happened in all parts of Nigeria, when a man is infertile, it can be arranged for the brother to be sleeping with the wife, and it is a guided secret, they swear so that was how they were solving those issues then. But now science has come, and nobody want anybody to sleep with his wife if he can afford the treatment.
So I think one of the things we are seeing is that there is more report, people are coming forward with more cases of infertility because they knows it is possible for it to be treated now.

Fertility nurses speak on IVF
Tina Igbokwe: “IVF is a solution to many infertility problem or challenges. For the fact that the success rate is not 100 per cent does not mean it does not work. It works. The percentage is between 25 and 30 per cent. And I think that’s a good one because what does nature even offer us? Nature gives us about 18-20 per cent. So if nature gives you 18-20 percent and IVF gives you 25-30 per cent that means it is a good one. And it has put smiles on the faces of so many couples, it has brought joy to many homes.
“IVF has come a long way in Nigeria. And it is getting better by the day. We are getting more results. Last year we had wonderful results, this year we will even do better.”

Gbemisola Babalola
“IVF has provided succour for couples who have lost hope of conception. It is solution for a lot of couples that have lost hope of having children. Some go home with twins and triplets.”