Experts, during a conference, predicted that Nigerian couples in need of assisted reproduction would increase. They, however, warned that the technique could remain unaffordable to many infertile couples.
John Idowu, a resident of Lagos, has been on wheel chair since 2004 when he was knocked down by a hit-and-run commercial bus. Idowu has accepted his fate and he is getting on with life.
But the concern of the 34-year-old man and his wife now is their childlessness. “I married in 2003 and was involved in the accident in 2004. Since then, I have not only lost the use of my legs, but also my erection. My wife would have left if not because she is a faithful woman. Doctors have told me that there is hope for me. According to them, we can have children through assisted reproduction techniques.”
As a result of the growing problem of infertility confronting many Nigerians, including Idowu, experts at the 2008 scientific conference of the Association of Resident Doctors, Lagos University Teaching Hospital, Idi-Araba last Wednesday, discussed the challenges of assisted reproduction in Nigeria.
The experts said that between 10 and 25 per cent of couples in developing countries, including Nigeria, were infertile. According to them, one out of five couples in Nigeria is infertile. A gynaecologist, Prof. Frank Giwa-Osagie, in a paper titled, “Assisted Reproductive Technique in West Africa and Nigeria-Its evolution and challenges,” said that infertility had grave consequences.
“Childbearing has a pivotal place in survival and flourishing of marriage and lineage. Infertility leads to social stigma, unhappiness and marital as well as sexual problems,” he said. The professor stated that despite the high rate of infertility, assisted reproductive techniques were still beyond the reach of million couples who were agonising because of infertility.
Also, the Medical Director of St. Ives IVF Centre, Ikeja, Lagos, Dr. Tunde Okewole, noted that the awareness about assisted reproduction was still low in Nigeria. Explaining the relationship between spinal cord injuries and male fertility, Okewole confirmed Idowu’s statement. He said that the physically challenged man could benefit from assisted reproductive techniques.
Okewole stated that men with spinal cord injury could find it difficult to achieve erection because the nerve that propelled erection in the lower part of the spine had been damaged. “Without erection, the sperm cannot be released. In in-vitro-fertilisation, the sperm is retrieved artificially and used to fertilise the egg,” he said.
IVF involves fertilisation outside the body in an artificial environment. It includes placing the sperm with an unfertilised egg in a Petri dish to achieve fertilisation. The embryo is then transferred into the uterus to begin a pregnancy or cryopreserved (frozen) for future use.
A cycle of IVF involves stimulation of the ovary to produce several fertilisable eggs; retrieval of the eggs from the ovary; fertilisation of the eggs and culture of the embryos in the IVF laboratory and placement of the embryos into the uterus for implantation, called embryo transfer (ET)
IVF was originally devised to permit women with damaged or absent fallopian tubes to have a baby. Normally a mature egg is released from the ovary, then enters the fallopian tube, and waits in the neck of the tube for a sperm to fertilise it. With defective Fallopian tubes, this is not possible. The first IVF baby, Louise Joy Brown, was born in England in 1978.
In Nigeria, assisted reproductive techniques were pioneered by Professors Frank Giwa-Osagie and Oladapo Asiru at LUTH in 1989. Currently, there are 14 IVF centres in Nigeria, leading Ghana that has four; Cameroun, two and Senegal two.
Giwa-Osagie said that about 3,000 cycles of IVF were done annually in Nigeria. According to him, the 14 IVF centres in Nigeria comprise 12 private and two public institutions. The two government hospitals that have IVF centres are the University of Benin and the National Hospital, Abuja.
The professor put the cost of IVF per cycle in Nigeria at between N350,000 and N900,000. From Giwa-Osagie’s presentation, it is clear that not all cycles of IVF succeeds. He explained that for standard IVF centres, the pregnancy rate is 15 to 33 per cent per embryo transfer. An embryo is an egg that has been fertilised by sperm in a Petri dish. The pregnancy rate in low cost IVF is 15 to 20 per cent.
Explaining challenges facing ART in Nigeria, Giwa-Osagie said that they included its high cost and absence of regulation. He stated that the procedure had not attracted government’s attention because of the high disease burden in the country. “In a country that official minimum wage is $80, it is unaffordable to many Nigerians,” he said.
The professor predicted that increasing number of HIV positive Nigerians would seek assisted reproductive techniques to prevent transmitting the disease to their children. According to him, in Uganda, assisted reproductive techniques are on a large scale among people living with HIV.
Calling for regulation of the procedures, Giwa-Osagie stated that there should be minimum standards. According to him, the right to health should include ART.
Another expert, Dr. Ibrahim Wada, said that to make IVF affordable to many Nigerians, more public hospitals should establish the centres. He stated that a funding mechanism should be devised for low and middle low groups.