Saturday, May 16, 2015

Renewed hope for motherhood through IVF

AGBENI Market is a popular market in Ibadan, Oyo State. It as a notorious market for adulterated or fake drugs such that the job of any helmsman at the National Agency for Food Drugs Administration and Control (NAFDAC), cannot be complete without close monitoring of this market. But that is not all about this market at the city centre, as it is home to other goods and services. The best place to visit for household utensils, toiletries and foodstuff, is still Agbeni.

You can then imagine the hustle and bustle going on in this market on a daily basis. Men, women, young and old are engaged in one transaction or the other at any point in time in the market. But tucked in the bowel of this market is 47 year old Muniat Oladipo.

On the outward, she could pass for a well to do trader. And that is what she is. But beyond the fa├žade is an unhappy woman that has been denigrated and called names by her womenfolk in the market for a challenge that was not her creation. She is childless after many years in matrimony.

Indeed, life without a child for a woman of her age bracket is comparable to the taste of solution inside the gallbladder of a famished and dehydrated cow in the mouth of a thirsty marathoner.

Besides, like the Biblical Hannah who was repeatedly taunted by her rival Penninah for being childless in the house of Elkanah, Mutiat, had to painfully bear her “unfortunate condition” for 20years.

“The most painful thing then was listening to deliberate discussions of some women of child bearing age in my presence, of such issues as labour pains, ante natal care, immunization of babies, dentition experienced in baby growth and such other stuffs in an efforts aimed at making me feel as if I am not a complete woman.



“Some called me a witch, others said I had donated my ovaries to the occult world and therefore would not, for life,. be able to carry my own baby. We had visited too many spiritualist we thought should be potent enough to make me carry the seed of the womb to no avail. But throughout all these ordeals my greatest strength was the unwavering supports of my 62 year old husband, Asimiyu, who never, for once, left me in the lurch.”

Time was ticking for Muniat. Hope was giving way and despondency was setting in. Indeed, menopause was knocking at her door. But she was not willing to give up. And just at the nick of time miraculously, a lifeline came from the horizon. This time, through the support of improved technology, Muniat became a proud mother of a baby girl.

Muniat was the cynosure of all eyes at the University of Ilorin Teaching Hospital (UITH), recently when she was delivered of a baby girl through the hospital’s third successive Assisted Reproductive Technology (ART) thus terminating her experience of  20 years of marriage without a conception.

After the delivery via caesarian session at about 10:45 am by a team of Gynaecologists led by the Chief Medical Director of the UITH Professor Abdulwaheed Olatinwo, the mother gazing at the baby weighing 3.2kg said sobbing, “so I can be a mother at last.”

UITH is the third public hospital in Nigeria after National Hospital Abuja and University of Benin Teaching Hospital (UBTH) with the services of the ART unit.

According to Olatinwo, in whose tenure,the Renal unit of the hospital  had performed the first Kidney Transplant in a male patient, added that arrangement had been concluded for the first Open Heart Transplant (OHT) of the UITH by June this year.

The elated Olatinwo, a Professor of Gynaecology and Obstetrics, disclosed how the hospital had sponsored, to India on training, a team of Gynaecologists led by Dr Lukman Omokanye, to learn the  skills of the IVF.

Already, the IVF unit of the hospital, has become a much sought after centre by patients and their relatives just as it has equally become a financial autonomous section.

The CMD noted: “We don’t need to travel outside Ilorin for what can be done here. The IVF depending on its type can be done here with a paltry sum of about N600,000. We even give some rebate, through the hospital revolving funds, to some indigent patients.

“But we are canvassing more of private supports for the unit, especially in the area of adoption of some couples in need of its services. Today, we are training doctors from other hospitals on the IVF. Very soon, we shall be receiving patients from outside the country paying us hard currencies to strengthen the nation’s exchange rates capacity.”

According to the mother of the baby, “I had lost any hope of having my own baby in life. I had been to many hospitals, visited countless spiritualists to no avail. But today, looking at this baby, I know that there is nothing God can’t do. I thank God and all the health workers who took very good care of me here at the UITH.”

She was married to her husband some 20years ago. She recalled how she was diagnosed of Fibroid (Myomectomy) 12 years ago in a private hospital in Ibadan and the growth was also promptly removed.

When all efforts at conceiving failed even after the operation, the woman, now exhibiting knowledge of many medical terminology apparently due to her ordeal and frequent contacts with medical practitioners  said she was referred to the UITH for more investigations on her reproductive system. This according to her was five years after her last menstruation.

“The UITH doctors told me of the need to make my womb active because a woman of my age and who had last seen her menstrual period some five years ago would practically be having a dead womb.

“They commenced treatment by first placing me on medication. When it was time, they fertilised my eggs with the semen of my husband. On the third day, they transferred three embryos into my activated womb. After three weeks, they conducted a pregnancy test on me and it was positive.

“It was like a dream to me when the doctors asked me to commence ante natal at the sixth week of the pregnancy. My husband asked me to hide in Ilorin. I had to put up with my brother, Alhaji Ajibade Suleiman until I was delivered of this miracle baby. I never thought that a woman at menopause could still have a baby.”

Speaking with The Guardian on telephone from Ghana, the husband, said the day of the birth of the baby would remain indelible in his mind and a date that has taught him the greatest lesson that God is just and loving to those who diligently await his promise.

He added, “I am extremely happy today and will be eternally grateful to God and all the medical team at the UITH who assured us of the success of the IVF when we commenced the treatment with them.

“I must confess to you, I never thought it would work out well at the initial stage, but my wife was very optimistic of the positive outcome of it. She increased my faith on the IVF and today we are grateful to God and all those who stood by us in our sad moment of life.”

For Suleiman, the elder brother of the proud mother of a new born baby, the love of the husband of his sister remained the impetus that sustained the woman throughout her waiting period.

Suleiman said: “he did not just profess love to my sister, he showed what love is. Even though my sister is not his only wife, he showed her exceptional love and refused suggestions of a divorce common with many African men, including my humble self. Today, he has showed us the results of being patient.”

Speaking with The Guardian in Ilorin, Omokanye the Reproductive Medicine Clinician of the UITH advised couples with challenges of conception not to lose hope of a reversal of their conditions but with a caveat that early presentations of their cases would boost their chances under the IVF.

Besides, he praised the UITH management for the vision of the programme, just as he urged women already carrying the toga of barrenness to have faith in God and seek for more medical solutions to their challenges.

“We always emphasis the issue of age in IVF procedures, because early ages make women to have the ability to produce fertilisable  eggs. So women with this presentation should, apart from putting their trust in God, seek early medical solution towards boosting their chances.”

Although, two previous successes had been recorded before this feat at the hospital, Omakanye said the case of Oladipo was unique due to her menopausal stage when she presented at the hospital.

However, while medical experts said IVF is the best treatment for certain kinds of fertility problems, they are of the opinion that it can be demanding and doesn’t always result in pregnancy.

They suggested that if one is about to start a course of IVF, such person should find out as much as he can about the treatment, adding that knowing what to expect can make IVF easier to manage.

What is IVF?
When a couple conceives naturally, sperm from the man and the egg from the woman meet in the woman’s fallopian tubes. These are the tubes that join the ovaries to the uterus (womb). One sperm penetrates the egg and fertilises it.

In IVF, this process of fertilisation happens outside the woman’s body. A woman’s eggs are surgically removed and fertilised in a laboratory using sperm that has been given as a sperm sample.

Next, the fertilised egg, called an embryo, is surgically implanted into the woman’s womb.

Typically, one cycle of IVF takes between four and seven weeks.

What to expect of IVF treatment
IVF does not always result in pregnancy.

In the UK, around 20-25% of IVF treatment cycles result in a birth. In general, younger women have a higher chance of success. Success rates decrease dramatically in women over 40 .IVF can be a physically and emotionally demanding process. Some men and women have mental health or emotional problems such as anxiety or depression during or after IVF.

If you’re undergoing IVF, ask about counselling to help with the emotional impact of the process and its results.

IVF risks
There are health risks involved in IVF treatment. These include:

Multiple pregnancy
There is an increased chance of multiple pregnancy with IVF. Multiple pregnancy has health risks for both the mother and children as twins or triplets are more likely to be born prematurely and to be underweight at birth.
Ovarian hyperstimulation syndrome (OHSS).

Drugs used to stimulate the ovaries during IVF can lead to ovarian hyperstimulation syndrome (OHSS).

In OHSS, the ovaries enlarge and become painful, causing abdominal discomfort. More severe cases can lead to shortness of breath, fluid retention in the abdominal cavity and formation of blood clots. In these cases, you may need a stay in hospital.

Infection
When eggs are removed from the woman, a fine needle is passed through the vagina and into the ovaries. There is a risk of introducing infection into the body, though antibiotics and surgical hygiene ensure that this rarely occurs.

How IVF is performed 
The IVF technique was developed in the 1970s. It may differ slightly from clinic to clinic but a typical treatment is as follows.

For women
S
tep one: suppressing the natural monthly cycle
You are given a drug that will suppress your natural menstrual cycle. This is given either as a daily injection (which you’ll be taught to give yourself) or as a nasal spray. You continue this for about two weeks.

Step two: boosting the egg supply
Once your natural cycle is suppressed, you take a fertility hormone called FSH (follicle stimulating hormone). These fertility hormones are known as gonadotrophins. This is another daily injection  you give yourself, usually for about 10-12 days, but it can vary depending on your response.

FSH increases the number of eggs your ovaries produce. This means more eggs can be collected and fertilised. With more fertilised eggs, the clinic has a greater choice of embryos to use in your treatment.

Step three: checking on progress
The clinic will keep an eye on you throughout the drug treatment. You will have vaginal ultrasound scans to monitor your ovaries and, in some cases, blood tests. About 34-38 hours before your eggs are due to be collected, you’ll have a final hormone injection that helps your eggs to mature.

Step four: collecting the eggs
For the egg collection, you’ll be sedated and your eggs will be collected under ultrasound guidance. This involves a needle being inserted through the vagina and into each ovary. The eggs are then collected through the needle.

Some women experience cramps or a small amount of vaginal bleeding after the procedure.

Step five: fertilising the eggs
The collected eggs are mixed with your partner’s or the donor’s sperm in the laboratory. After 16-20 hours they’re checked to see if any have been fertilised.

If the sperm are few or weak, each egg may need to be injected individually with a single sperm. This is called intra-cytoplasmic sperm injection or ICSI (see below).

The fertilised eggs (embryos), continue to grow in the laboratory for one to five days before being transferred into the womb. The best one or two embryos will be chosen for transfer.

After egg collection, you will be given medicines, either progesterone or hCG (chorionic gonadotrophin), to help prepare the lining of the womb to receive the embryo. This is given either as a pessary (which is placed inside the vagina), an injection or a gel.

Step six: embryo transfer
The number of embryos to be replaced should have been discussed before treatment starts.

Women under 37 in their first IVF cycle should only have a single embryo transfer. In their second IVF cycle they should have a single embryo transfer if one or more top-quality embryos are available. Doctors should only consider using two embryos if no top-quality embryos are available. In the third IVF cycle, no more than two embryos should be transferred.

Women aged 37–39 years in the first and second full IVF cycles should also have single embryo transfer if there are one or more top-quality embryos, and double embryo transfer should only be considered if there are no top-quality embryos. In the third cycle, no more than two embryos should be transferred.

 

Thursday, March 27, 2014

UNILORIN Teaching Hospital, Mother celebrate birth of first test-tube baby


Mrs. Ramat Jamiu’s joy knew no bounds when she was delivered of a bouncing baby boy in Ilorin, the capital of Kwara State. Her bundle of joy had arrived after nine tormenting years of childlessness and anxiety.

The nursing mother had cause to be grateful to the doctors at the University of Ilorin Teaching Hospital, whose expertise had ensured the safe delivery in the first place.

Jamiu’s baby is the product of the hospital’s first successful attempt at In-Vitro Fertilisation. With this feat, the UITH officially joins the list of teaching hospitals that have undergone this medical procedure in the country. The others are the Lagos University Teaching Hospital, Idi-Araba, Lagos; Obafemi  Awolowo University Teaching Hospital, Ile-Ife, Osun State, and  the  University College Hospital, Ibadan , Oyo State.

In an interview with our correspondent on Friday, Jamiu admitted that initially she had refused to undergo the treatment.  Eventually, she decided to give it a try after the doctors told her that IVF was her only chance of having a baby of her own  – husband, a professor of Islamic and Arabic Studies at the Kwara State University, encouraged her, she noted.

The ‘brand new’ nursing mother said she had visited several private hospitals in Kano, Abuja and Lagos – in search of a solution to her childlessness and had spent a lot of money, but failed to achieve any positive result until her husband advised her to try a teaching hospital.

She said, “It is a shameful experience not to have a baby after several years of marriage. But thank God, I am happy now that I have a baby of my own. I have been to hospitals across the country. I spent so much money, but in vain. Eventually God answered my prayer and things worked well for me at UITH. For the couples who are having difficulty in child birth, they should know that God is capable of giving them a child. When God says your time has come, nothing will stop it.”

Still relishing the arrival of her baby, Jamiu urged Nigerians to have more faith in the public healthcare system. She advised fertility-challenged couples to take advantage of the benefits of modern medicine to solve their problems.

She said there was no reason for Nigerians to seek medical treatment abroad since the local hospitals were capable of handling their cases at cheaper costs.

So far, over five million babies have been born, via IVF, in the world since the birth of the first test tube baby, Louise Brown, in a London Hospital in 1978. Also, an estimated 2000 babies have been born through the same procedure in Nigeria.

The consultant obstetrician and gynaecologist at the UITH, Dr. Lukman Omotayo, said Jamiu was managed by the hospital for about one year before she had the baby through a Caesarian Section last Friday.

Omokanye said, “Infertility in marriage is not just for the woman; both the husband and the wife must be involved to achieve any form of success. That is what happened in this case; we had her husband cooperation all the way.”

He said that after several consultations with the woman and her husband and every possible case of gynaecological deformity had been ruled out, the hospital had decided to try IVF.

“Fortunately we found out that the husband’s sperm, in spite of his age, could fertilise  his wife’s eggs and that she also had viable eggs that could be fertilised by sperm. So, we were expecting a fruitful result. The procedure is to get fertilisable eggs from her. It took us one month.

“First, she was down-regulated with a drug called Suprefact® for 14 days. We prepared her for eggs collection and subsequently we did micro epididymal sperm aspiration to obtain sperm from the spouse to fertilise her eggs through a procedure called intracytoplasmic Sperm Injection.

“We injected the sperm into each egg. This was then incubated for 72 hours and confirmed evidence of fertilisation.  After 72 hours, it became an embryo.  This was later transferred into her womb.  That is what eventually developed into pregnancy. Pregnancy was confirmed after two weeks of transfer into the womb.”

Omotayo said that prior to delivery, Jamiu had been coming to the clinic every two weeks to ensure that the baby was fine because, according to him, the pregnancy was very special.

He said that the pregnancy was uneventful, meaning that there was no complication, apart from the conventional challenges of pregnancy, such as abdominal discomfort and occasional body weakness.

Omotayo said , “We confirmed that she was carrying a baby boy after 18 weeks. She was meant to deliver on August 16, but this kind of special baby could not be allowed to go through the stress of labour. Another thing about this pregnancy is that the baby was coming as a breech (a baby comes with the feet as opposed to the head). However, there were no hitches during delivery. He weighed 3.25kg. This is a memorable day in the history of UITH as the centre also witnessed the inauguration of several projects.”

Also, the UITH Chief Medical Director, Prof. Abdulwaheed Olatinwo, described the development as another major breakthrough recorded by the institution in its quest for medical advancement.

He said, “I am very happy for the family and UITH. We are happy that we were able to do this. For a very long time, we kept our competence and capability in assisted reproductive technology low so that there would not be much noise.

“This is the beginning of good things to come. I said with prayers and the support of people, by the grace of God, before the end of the year, we should have the first baby through laboratory procedure.”

Olatinwo said the UITH was capable of assisting more mothers in Kwara State and beyond to achieve conception. He added that the hospital had also bought some modern medical equipment for this purpose.

 

Sunday, February 24, 2013

Couple breaks ice on IVF success


SAMUEL, 48, and Victoria, 42, Olayiwola have become the first couple to publicly acknowledge that they were able to have quadruplets after 17 years of marriage, at first attempt, through In Vitro Fertilisation (IVF) in Medical Art Centre (MART), Maryland, Ikeja, Lagos. The Olayiwolas, pastors at Living God Preparatory Assembly (Rehoboth Basilica), Abule-Egba, Lagos, on Thursday, February 9, 2012, became proud parents of three girls and a boy – Elizabeth, Mary, Samuel and Deborah. The quadruplets were delivered under the watchful eyes of Prof. Godwin Ajayi at Lagos University Teaching Hospital (LUTH), Idi-Araba.

The Olayiwolas, who celebrated their 17th wedding anniversary on Sunday, March 4, 2012, got to know of the services offered at MART by the Joint Pioneer of IVF technique in Nigeria and Adjunct professor at University of Illinois United States, Oladapo Ashiru, through an article published in newspapers.

When the couple got to MART, Victoria was diagnosed with blocked fallopian tubes and overweight. She was put through a detoxification programme and had to lose 20kg before the technique started. Victoria and Samuel were put on some antioxidant drugs to boost the quality of eggs produced by the ovaries and the sperm from the testicles.

How did it all happen? Samuel during a thank you visit to MART recently told The Guardian: “I am here to show my appreciation to the man God used to bring joy to my family.

“Two things worked for us; our faith in God and level of education. Number three is our family members; maybe because they believe in God they did not put much pressure on us. Finally what helped my wife was that I had the insight that when you are talking about infertility it may not necessarily be the lady. My wife and I, we prayed and the day I saw professor’s interview in the newspapers, the spirit of God said to me ‘this is an opportunity you should not allow to pass you by.’

“When we finally got to Prof. Ashiru he told us that we could not wait any longer trying other methods due to our ages, that we have to go straight to the sure method. My wife had blocked fallopian tubes. When Prof. heard our ages he said ‘where have you been?’ I am 48 and my wife 42. I got assurances from Prof. that my sperm and my wife’s eggs were okay. He said I was okay but needed to take some drugs to make my sperm better.”

What were the challenges? Samuel explained: “When it was confirmed that my wife was pregnant I was weary when I was asked to go and sign an undertaking that if anything happened, the hospital would not be liable. But Prof. explained that it was to make sure that I understand that if problem arises that the two teams will solve it together and not to heap the blame on the hospital.

“Another issue was during the period of transfer of the embryo back into my wife, Professor travelled and left it for his assistants. My wife was worried but I told her that Professor must have set everything right. After the implantation, the first scan showed three fetuses but by the second one, the fetuses were four; this was because one of the embryos turned to twins, it later divided again.

“Another issue was when two of my babies needed blood and my blood was taken to check whether it matched for possible transfusion. I was jittery because of stories I read of the use of donor sperm. But I prayed that my blood corresponds to theirs. I did not doubt MART but you know naturally I was worried. But when it was confirmed I was very happy.

“Another challenge was when Professor advised that my wife needed the best obstetric care for the babies to be delivered successfully. We wanted to travel abroad for the delivery but we had problems getting United Kingdom (UK) visa. I already had South Africa visa so it was easier to get for my wife. Along the line I was told that South Africa may have the facilities but Nigeria has better hands. Prof. Ashiru recommended Prof. Godwin Ajayi of LUTH. He said Ajayi is one of the best hands.

“When we got to Prof. Ajayi, he did not allow my wife to go home that day. She was immediately admitted in his clinic at LUTH. We had problems during the January strike against fuel subsidy removal. The doctors were helpless in helping. But we prayed that the strike got resolved quickly.”

On why benefitting couples were not enthusiastic to come forward? Samuel said: “People are not keen to come forward to accept that their children were born through IVF probably because of societal perceptions. As a man of God I feel I should not cover it. Personally, this issue of nobody coming out is somehow. But I said that if God will answer me I would testify publicly. In this modern age there is nobody that is not assisted by technology whether it is scan or drugs. The first time I met Prof. Ashiru he was talking about his new technology. He said ‘don’t let this woman get beyond the opportunity.’”

Samuel in a letter of appreciation to Prof. Ashiru made available to The Guardian said: “On behalf of myself and my wife, I wish to appreciate you for deploying your God-given wisdom and knowledge at ensuring that we have children of our own. Sir, you are a channel who God used to give us everlasting joy; this we are very much grateful.

“…I must add Sir, that with this type of opportunity and prayer, many would stop visiting herbalists that usually compound their problem. Words cannot express our gratitude.”

To this, Ashiru responded: “I think we should recognise that the gentleman that came here is the first to go public. We at MART have been well commended to be the best in Africa. We have improved the technique in such a way that we are now having several multiple pregnancies. But in the developed world now, they do not want to hear the word

multiple pregnancy. They are looking at the economies and all the complications.

“So, the preaching is to reduce the number of embryos. We have done that and the multiple pregnancies we are having this year is less than what we had three years ago. Two years ago we were having quadruplets because we were using four embryos. Now we have reduced the number of embryos we are putting back to just three. But as God will do it, this three ended up four because of twinning.

“But among the people who have benefited, the Olayiwolas are coming out to break the ice in such a way. The last time we had this type of event, the woman wanted to but the husband did not allow her. People should recognise that there is a technique that can help people. People are now coming from throughout West Africa to benefit.”

On whether there were challenges in handling the Olawiyolas case? Ashiru said: “I think they were very lucky, there were no hindrance. There was little or no challenge. All they had to do is to take medication to make sure the ovaries and sperm were fully functional. They took antioxidant drugs to ensure better sperm and ovarian production. The next thing was that the woman had to lose weight. She lost 20kg. She had to go through our detoxification and weight loss programme.”

Ashiru, who is also the medical director of MART further stated: “This thing will demystify IVF. In some years back if people delivered through caesarean section they did not want people to know. I thank the Olayiwolas that they are able to come forward. I hope by so doing Nigerians will know that IVF is a normal process and these babies are normal children.

“I have been in this process since 1981 but the successes have been hidden because people do not come forward and even when they do, they come with pseudo-names. The Olayiwolas’s success is the reward for patience and dedication. I take this as God’s help from the Almighty. To me this call is a call to humanity, to service.”

Saturday, June 9, 2012

‘I didn’t know that treatment for our issue was a bus stop away’

the quadruplets below:Elizabeth, Samuel, Mary & Deborah
Seventeen years ago when they got married, Samuel and Victoria Olayiwola had no idea of the battle they had to wage against childlessness. Doctors told them they were perfectly normal to have kids. But they didn’t, until they read an article in Sunday PUNCH and their story changed for the better, writes SOLAADE AY-ADERELE. His effusiveness on the phone was palpable. And when he presented himself physically to be interviewed for this story, his joy was infectious. He simply couldn’t contain his gratitude to God and his physician.
His wife was no less happy, though she seemed to be savouring the reality of becoming a mother for the first time after 17 years of marriage.
For Mr. Samuel Olayiwola and his wife, Victoria,
the joy of being parents after nearly two decades of trying for children is indescribable, what with the attendant frustrations and search for solutions that took them to various hospitals before they finally berthed at the Medical Assisted Reproductive Therapy Centre, Lagos, headed by internationally-acclaimed fertility expert, Prof. Oladapo Ashiru.
Tracing the history of their childlessness, Samuel says the problem became more complicated when doctor after doctor told him and his wife that they were perfectly normal to achieve pregnancy as a couple. This was after they had done all that was humanly possible yet unproductive.
“When you are told you have no biological impairment as to be barren, then you wonder what the problem is all about,” the joyous father reminisces. The puzzle and prayer continued until, as Samuel
says, he read an article about the possibility of having children through scientific processes as published in the Sunday PUNCH of February 6, 2011. Without wasting time, he located Prof. Ashiru who was interviewed for the story.
Even after meeting the professor of reproductive
endocrinology, who is one of the two pioneers of in-vitro fertilisation in Black Africa in 1984, and produced the first test tube baby in West Africa in 1989, Samuel still hesitated to access the available treatment; the cultural
bias against the treatment he was being introduced to was a deterrent, never
mind the nights of tears he and his wife had had to endure as a result of their childlessness. Relations on both sides of the divide were able to convince the couple that there was nothing wrong in the treatment on offer, and, some months after the first visit to MART, the Olayiwolas commenced treatment. In less than one year, their dreams were fulfilled via the delivery of a healthy set of quadruplets.
As Samuel and Victoria Olayiwola were interviewed
for their story, it was obvious that the delay wouldn’t have dragged on for so long if the various doctors they had seen earlier had diagnosed the problem. In
fact, the case seemed so minor that, unlike some IVF cases where the patients have to undergo many trials before conception can be achieved, Mrs. Olayiwola
got pregnant the very first time she went through the treatment — a feat which Ashiru attributes to superior technological advancement that MART uses.
Ashiru explains that about 20 per cent of female
infertility can be attributed to tubal causes; and this can be as a result of Pelvic Inflammatory Diseases, infection during medical procedures, when faecal matter comes into contact with the vagina, high fever in children, and sundry other reasons.
In the case of PID, Ashiru says, as an infection begins, the body gets ready to attack. White blood cells and other fluids fill the tubes to fight the infection. If the body resistance is good, it wins; but in the bargain, the fragile walls of the tube get scarred.
“Due to this, the end of the tube towards the ovaries can get partially or completely blocked and scarred tissues form on the outside of the tube. These circumstances can affect the functions of the
ovaries and the fallopian tube and can lead to infertility,” he says.
Because of the sensitivity of couples that come for fertility treatment, Ashiru says, MART takes patients through some counselling sessions, preparatory to the actual treatment, during which they are told the nature of the problem and the appropriate treatment.
While Ashiru says age is no barrier when couples come for IVF treatment, he does agree that after age 40, both woman and man may need a little treatment to boost the eggs and the sperm respectively.
Indeed, according to a 2004 issue of the American
Journal of Gynaecology, in one study of couples undergoing high-tech infertility treatments, researchers concluded that a man’s chances of fathering a child decrease with each passing year.
In the study, the odds of a successful pregnancy fell by 11 per cent every year; while the couple’s chances for obtaining a successful live birth declined even farther. “In such situation, the man receives medications to make the semen viable,” Ashiru says.
Hence, when Samuel demurred after his first visit to the clinic, Ashiru warned that considering that both husband and wife were in their 40s, it was advisable to get the job done while the window of opportunity was still open.
Ashiru also discloses that sometimes, a woman can
be taken through weight loss programme prior to IVF treatment if she’s considered overweight. Victoria went through this, shedding almost 20kg in the process.
While studies connecting obesity to anovulation
(failure to produce eggs or to discharge them from an ovary) are not new, a study led by Dr. Van der Steeg, a medical researcher at the Academic Medical Center in The Netherlands shows that even women who regularly ovulate experience sub-fertility when their body mass index is in the overweight or obese category.
In other words, the researchers found that women
with regular cycles and otherwise no obvious fertility problems still have a hard time getting pregnant if they are overweight. They also found that the
more overweight the woman is, the lower her chances of pregnancy.
Ashiru says excess weight in women prevents
fertility by many factors. “For one, ovarian hormone is destabilised, making
hormonal stimulation complicated when undergoing IVF treatment, as treatment can disappear into fatty tissues, among others; hence the weight loss advice
where necessary, which we have found to be effective over the years.”
While the couple would not put a price to the treatment they received, Ashiru jokes that they paid for a child and got four in the bargain. What happened is this: generally, in any IVF treatment, embryos are transferred into the woman. In the early days of IVF, more embryo transfers
took place in part because the rate of success was quite low; and patients sometimes went through several trials — sometimes as many as 10 or more cycles
before conception could take place. Then, it was common to have sextuplets.
However, as technology advances, the picture becomes clearer and, to make for the health of mother and child(ren), fewer embryo transfers are done. In fact, in recent times, experts advise that no more
than three embryo transfers should be done. So, the Olayiwolas had three embryo transfers, and an egg later divided into two, with all of them surviving till birth. The
couple had three girls and a boy.
After Victoria’s pregnancy had been confirmed, the Olayiwolas didn’t want to take chances. Samuel decided to take his wife abroad, where he thought she could obtain the best monitoring while the pregnancy lasted. The couple obtained South African visas, but Ashiru
successfully talked them out of it, referring them rather to a trusted colleague of his, a professor of Obstetrics and Gynaecology at the Lagos University Teaching Hospital, Godwin Ajayi, who nurtured Victoria under his
care, successfully delivering her of the children on February 9.
When asked what his advice is for couples-in-waiting, Samuel says it’s better for them to seek treatment once it has been confirmed that something is amiss.
Indeed, doctors advise couples to seek viable
treatment if, after one year of unprotected sexual intercourse they fail to achieve pregnancy.
Samuel says that until he came about the Sunday
PUNCH article, he wasn’t aware of any such treatment. “Knowledge is power,” he confesses.
Ashiru commends the Olayiwolas for “putting a
face” to the IVF treatment. This becomes necessary, he says, because couples are almost always reluctant to come out in the open to say they’ve accessed IVF
treatment simply because of the ignorance and cultural bias that people still have about the procedure.
Explaining the scientific advancement that has
been achieved through the IVF, Ashiru says, “with IVF, even couples who are both sickle cell carriers can have absolutely normal children without a trace
of the disorder. We deploy a technique called pre-implantation genetic diagnosis (PGD) to determine the healthy genetic status of embryos before transfer. Ditto for other genetic disorders like Down’s Syndrome, etc.
“Children born through the IVF are as normal as
any child and there is no reason whatsoever to see them otherwise,” Ashiru concludes.
SOURCE PUNCH NIGERIA

Friday, April 20, 2012

Sex selection: Between desire and necessity

dr. ogunkoya


GOD gave us choice so we have the right to choose!” Henrietta was telling John,
her husband why they needed to have a girl third time around. The couple
already had two boys, Kenneth and Kevin who were 5 and 3 respectively.
Now Henrietta was pregnant again and
her belief was that baby No. 3 should be a girl. But John was being more
practical. “Let’s not tempt God. It doesn’t matter whether this child turns out
to be a boy or girl. If God wanted us to be choosing, He would have asked Adam
and Eve to choose,” he argued.
According to John, God didn’t give
Adam and Eve choice for their children’s gender, rather, in His wisdom, He gave
them Cain and Abel, both boys.” We should be thankful that we even have
children that are healthy and normal. Children are the same after all.”
But Henrietta would have none of
that. “Children are not the same because there are boys and there are girls.
They are different and we should have both. We already have two sons and that
is enough. I want a daughter and I am willing to do whatever is necessary to
get one,” she said with finality. The argument continued.
The Abahs had a similar challenge.
Like every other couple in this part of the world, Josephine and Joseph Abah
looked forward to having children with a balanced gender bias. Eleven months
after their wedding vows, their first child arrived. It was a boy.
Their joy knew no bounds, more so
when they live in a parochial society where male children are give preference.
But this joy was short lived. Few months later, it was discovered that the baby
boy had Haemophilia, an abnormal blood clotting condition more common in males.
The Abahs were devastated. They
tried again for the second child. The second baby also turned out to be a boy.
Alas, he also came down with the same disease condition. Neither Josephine nor
Joseph could explain their predicament.
The search for treatment began.
During one hospital visit, they met a doctor who explained more about the
condition and possible treatment. They were told the disease is sex-linked and
prevalent in the family, and that a way out is to try sex selection principles
through assisted reproduction to reduce chances of having another male child
with such condition
Said Josephine, “It dawned on us
that even though we are capable of making children naturally, we can only have
healthier children through In-Vitro Fertilisation, IVF. We went to a very good
fertility treatment centre in Lagos. We did it and we were able to select the
preferred sex for our baby.”
However, gender balancing or gender selection
has remained an issue, especially in Nigeria. Many homes have been broken but
with the advent of science of gender selection many homes will be saved.
Hope Valley Fertility Clinic is a
major player in the technique. Thanks to the technique, Josphine now has a baby
girl.
Toyin Odoh also benefited from the
wonders of IVF. Diagnosed with Turner ’s syndrome, a condition that results
from a missing or incomplete sex chromosome, for Toyin and her hubby, Ben, it
was like there was not going to be normal children.
After two years of unsuccessful
attempts, they turned to fertility clinics. Although, they were in London,
Toyin returned to Nigeria for treatment. The couple’s testimony was moving. “In
199 I was diagnosed of Turner syndrome and this means I cannot conceive
normally. We have been married for two years wish to have our own children”
At first, “I read an interview of
Dr. Michael Ogunkoya of Hope Valley Fertility Centre, Victoria Island, Lagos. I
called him from London, explained my condition and he invited me over. I came
to Nigeria in April 2009 and he placed me on medication for IVF and one month
later to God’s glory, it was successful.
After all my treatments abroad, it
was at the Hope Valley Fertility Clinic, I was treated and conceived. I thank
God for putting smiles in my home and family,” she noted.
Sex selection fact and myth
A Consultant Gynaecologist &
Fertility Specialist, Ogunkoya who successfully handled the cases enumerated
above gave insight into the many issues surrounding sex selection, as well as
increased reports on male infertility and why multiple births are occurring in
older women.
An experienced physician of
international and local standing, he explained: “Sex selection has always been
on the agenda for many homes in Africa before now. Even the old Chinese
believed that the male sperm comes from left testis. There have been other
efforts around the world to influence sex of babies. In Nigeria for instance,
some people believe that if some people use some back of trees or leaves they
will have male children.”
Ogunkoya who stressed that there
have been so many tales and myths that are completely not true about sex
selection, said: “Sex selection is not all about balancing sex rather the main
aim of sex selection is to reduce and prevent abnormalities.
The fertility specialist who stated
that many IVF babies have been delivered at Hope Valley Clinics said sex
selection has also been successfully achieved. “Apart from gender balancing,
there are other reasons, one of such is to avoid sex link disorders that are
prevalence in some families like colour blindness, haemophilia and acute
haemophilia.
Sex selection allows such families
who are prevalent to such disease conditions to decide the gender that suits
their family. Like in the case of Josephine, the couple was able to decide
whether to have a male child or a female child.
Sperm sorting
Ogunkoya noted that the only
clinically proven method of sex selection was the MicroSort Sperm Sorting
Theory. “The MicroSort principle is a clinical technique used to sort and
separate the two different types of sperm, X and Y, that is the female and the
male sperm.
Once the sperm is sorted out, it can
be artificially inseminated (IUI), in this case you would need the sperm
sorting to be done on the day of ovulation.” Although it said that sperm cannot
be sorted into the two types 100 per cent accurately, clinical examination has
shown success rates for girls is 90 per cent while male chances of success fall
around 75 per cent.
According to him, “For a Nigerian
couple that needs the procedure, we are living in a parochial society where
there are much desire for male children, here if somebody has good sperm and
wants a male child we collect sperm from him and freeze it and send to
MicroSort abroad in a special container and when it gets there the separate the
male sperm and female. So separation has always been on our agenda but it
attracts extra cost”.
Explaining how the separation is
done he said: “The principle of MicroSort is based on the fact that the female
sperm has a bigger DNA and attracts more dye to the DNA, when you now put the
sperm on a conveyor belt, on either side you will now put an anti- dye which
will now attract DNA.
The anti dye will therefore attract
the sperm that has more dye to the female sperm to the side. So female sperm
tends to aggregates more to the side of the conveyor belt while the male sperm
remains at the centre. The sperm has a head, neck and a tail. This head is
where the DNA is. The female sperm DNA is fatter, and sluggish in movement, and
because the female sperm is fatter the DNA is more and that of the male sperm
is slimmer but faster.
Male sperm vs female sperm
“When the sperm is poured on the
conveyor belt, and the anti – dye, on either side, you put an anti- dye; the
dye will stain the head of the DNA because the DNA attracts the dye. So the
head of the female will attract more dye because it is a bigger DNA.
The sperm is moving along the
conveyor belt and the anti dye both sides will sort of, attract the dye like a
magnet and iron. If you put a magnet here and an iron is moving there, it will
attract the iron because the magnet is there.
If you put the sperm with the dye on
their head and an anti dye on the same axis, but all along the conveyor belt,
you find more dye by the side than the centre. And because of the dye on the
head of the sperm, it will attract more dye
“At the edge of the conveyor belt
you find more female sperm at the periphery while the anti dye is at the centre
where you find the male sperm. They have used the mere fact that the male sperm
contained less DNA and less dye than the female sperm which contained more DNA
and more dye in separating them since the anti – dye attract and the female
sperm to the side.
So the principle is therefore
separating the female sperm and male sperm. At a distance, you discover that
many of the sperm at the side will be female and many of the sperm at the
centre will be male. And it is the only objective demonstrating method of sex
selection known. It is still under research. It is still not available.
So for some reasons when you
separate such sperms, the person who wants female will take and the person who
also wants the female will use the female”
However, due to extra costs, most
clients opt for another method of sex selection which is a bit more scientific.
“It is the fact that some people make love around the time of their ovulation.
This involves timing of intercourse.
The idea is based on the fact that
female sperm are larger and slower and Male sperm is faster but more fragile.
So a few days before ovulation favours the larger but slower female sperm while
sex at the time of ovulation favours the faster male sperm”.
However, Ogunkoya counseled that
this method requires careful counting and ovulation testing to determine
exactly when the ovulation will occur. The fertility expert who noted that the
recipe for success is not just simple but a combination of so many factors
which includes diligence, hard work and transparency to patients emphasized on
factors such as regular updating of equipment, training and retraining of
staff.
Desire for male children
According to him: “There is more
desire for male babies but statistically most IVF babies tend to be male a
ratio of about 8 to 2 or 4 to 1. We cannot tell you precisely, the basis for
that. In our practice we have noted that. In our practice we have sort of noted
that there must be a factor within the concept of Assisted Reproduction which
imposes that. We are yet to find out the science behind it.
“Somehow, the process of IVF relies
on the fact that sperm should be able to fertilise the egg to make embryo. It
is usually that the sperm that is moving faster to get to the eggs should make
the embryo. We still don=t know. A lot of efforts have to be put into it. May
be we should start marking sperm to know which one makes the embryo. It is also
possible to actively influence sex by selecting them”
Explaining the advent of multiple
births in old women, he notes; “During the process of IVF we normally transfer
more than three embryos back to the woman’s womb although these days, you only
need to transfer less than three embryos.
In some cases one and the idea is
that most European communities rather not have multiple pregnancies and
deliveries because of the social preferences. In Africa, we like multiple
births and in fact we celebrate them. The tendency therefore is that if you go
to such countries today, if you have 10 embryos, the highest they can transfer
is two.
And if you probably have twins
before and you do IVF again, and the eggs are beautiful, they will probably
transfer only one egg. There is the advocacy for two embryo transfer or one in
some countries. But in Nigeria we still transfer up four embryos for reasons
that we welcome triplets. If the three or four embryos are implanted properly
that may result to triplets or quadruplets. So there is propondence of multiple
births in Assisted Reproduction than in non assisted births.
Male infertility
“Yes as a woman gets older, the eggs
become older as in fewer quality and quantity because as she gets older at age
13, the eggs that are being released are of a better quality than the eggs
later in life. That is the law of natural selection. But to a man is the same
but that of a man is to a lesser extent because the sperm of a man of 20 years
is definitely better than that of a man of 30 years.
As a man’s age advances, the sperm
gets poorer. It is easy to say that more men are getting problems of
infertility but all is enough awareness. The apparent increase of male problems
is created out of increase awareness. If there is any increase at all, it could
be traced to environmental problems and nutrition.
Increase awareness, a lot of people
now know where to go for their problems, there is no true increase in male
infertility it is increase in awareness. Women are now being encouraged to come
forward and the women are also being encouraged to bring their husbands along for
necessary tests.
Multiple births
In Africa people do not talk about
their pregnancy and a lot of people do not talk about achieving pregnancy
through IVF. They prefer to keep it secret. Anybody who gets pregnant at the
age of 42 is mostly through IVF but I am not saying that at 42 women cannot get
pregnant on their own.
But in reality, after age 45, it is
really difficult for women to get pregnant on their own apart from assisted
reproductive system. If they introduce two to three eggs and most times the
result came out to be multiple births and for somebody at that age, will want
to have three or more children at a time and forget about having more.

source: vanguard; by chioma obinna

Tuesday, February 14, 2012

ANOTHER FEAT IN IVF RECORDED BY NAUTH GYNAECOLOGIST



Another feat in Invitro Fertilization (IVF), has been recorded by the Nnamdi Azikiwe University Teaching Hospital, NAUTH, Nnewi, Gynecologist, Professor Joseph Ifeanyichukwu Ikechebelu, the Medical Director of Life Specialist Hospital, Nnewi with the delivery of a baby boy – Favour, through Invitro Fertilization (IVF).This brought to five women who have delivered through the process in the hospital within the last 6 months.



Confirming that the mother and child were in stable condition, Ikechebelu, said the baby boy delivered Saturday by 8.02 weighed 2.7 kg.



Ikechebelu who is a Professor of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital Nnewi and his team of doctors, nurses and embryologists performed the cesarean operation to deliver the baby and concluded other processes within 45 minutes.“This is the fifth time this processes is being carried out in this hospital. Our first baby-baby Joseph through IVF was delivered on 6th August, 2011, second was triplets delivered on 17th November, 2011; third baby boy was delivered on Nov 28, 2011.The 4th were triplets again delivered on December 26th, 2011 and this one now.‘‘We have over ten women already pregnant and carrying their babies and we are monitoring them pending their time of delivery’’.



Life Specialist is the only fertility hospital in Anambra State specialized in putting smiles on the faces of our women who could not ordinarily conceive and deliver their babies normally’’.Every couple still have a chance of having their own babies. Here we specialize in turning tears into joy.”Her mother (the babe’s grand mother) , name withheld by this medium said she and members of her family were overwhelmed by joy at the sight of the baby.



“We are happy for this opportunity because for sometime now, she was unable to conceive and deliver her own baby but we are happy and to God be the glory.



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




Saturday, June 19, 2010

Lagos Hospital Delivers Nigeria’s Oldest IVF Mother

A Lagos based specialist hospital, St. IVES has successfully delivered a 57-year-old woman, Mrs. Adeyemi Taiwo, of a bouncing baby girl. This was achieved through the Invitro –fertilization, IVF, unit of the hospital.
According to the Chief Medical Director of the hospital, Dr. Tunde Okewale, the delivery is the oldest case he has handled since the Fertility Unit of the hospital was established.


“The woman is arguably the oldest IVF mother in Nigeria. Interestingly too, the baby weighed 2 kg when it was delivered at 7.45 a.m on May 11, 2010 after 35 weeks of gestation,” Okewale stated.

The baby was delivered through C/S after comprehensive IVF treatment at the hospital by a team of five doctors which comprised of Obstetrician and Gynecologist, Embryologist and Neonatologists.