BRIDGE CLINIC RECORDS MILESTONE

The Bridge Clinic, the leading assisted-conception unit in Nigeria, reached a major milestone in its 10 year existence recently when it recorded its 1000th live birth.
A statement by Amaka Agu said the baby girl who was born at 8.30am on Thursday 12 November, 2009 at Finnih Medical Centre, GRA Ikeja weighing 3.1kg was born, following a second treatment cycle by In-Vitro Fertilisation (IVF) with Intra-Cytoplasmic Sperm Injection (ICSI), to a couple who had experienced infertility for 13 years and sought treatment at The Bridge Clinic.
The Clinic, an ISO 9001:2000 accredited assisted-conception unit, has successfully set itself apart as one of the leaders in the field of assisted-conception by being the fertility clinic with the highest record of deliveries in Nigeria today.Currently operating three branches in Ikeja, Victoria Island (both in Lagos) and Port Harcourt, the Bridge Clinic provides high quality fertility treatment in Nigeria; treatments which many of their patients believe is comparable to similar facilities abroad.The company’s Managing Director, Dr Richard Ajayi announced that “Our record is currently unparalleled in Nigeria. We are dedicated to ensuring our clients’ main objective of delivering healthy babies is met and our record of 1000th baby is proof we haven’t reneged on our aim.”He declared that the clinic is determined to maintain these impressive results, stressing that the level of professionalism and care would be maintained through continuous staff development and training.
He also stressed that the clinic would always keep up with cutting edge developments in its field of assisted-conception and reproductive medicine in general.Ajayi said, “The joy of the clinic’s 1000th birth is like an early Christmas present for us at The Bridge Clinic; a present that reminds us that all the hard work and dedication we put into assisting couples experiencing delays in childbirth is worth it.”
SOURCE: THISDAY

Governor’s Wife Pregnant Through IVF

The first lady of Oyo State, Chief (Mrs.) Kemi Alo-Akala has been in an unusually gay mood of late. The Oyo State first couple and their immediate family are expecting another baby. The mother of four-year old Olakunle is pregnant and people close to her say that her pregnancy was made possible via invitrofertilisation.

Mrs. Alao-akala, 45 who is the second wife of the Oyo State Governor, Otunba Christopher Alao-Akala, had her first born, when she was well over 40 (also by IVF) and her quest to give her hubby the second issue informed the IVF effort, which has paid off right now. The first lady had been very happy over this development having waited for four years.

SOURCE: COMPASSNEWS

'Infertility Is A Shared Responsibility Between Husband And Wife'

DR. Michael Olugbenga Olukoya is the Managing Director of Hope Valley, a fertility centre, whose offices are scattered across Lagos, Abuja, Port Harcourt, Kaduna and Benin City.
In this interview, the University of Lagos trained fertility specialist revealed that the challenge of infertility is a shared responsibility between couples. The former Managing Director of Dolphin Medical Centre, Lagos, also dispels the popular belief that children born through In-Vitro Fertilisation (IVF) are less human, saying that they are as perfect as any human being conceived through naturally.

What is the level of acceptance of In-Vitro Fertilisation (IVF) in Nigeria?
We have to talk about the level of awareness first of all. The awareness level of In-Vitro Fertilisation (IVF) system is very low. We are trying our best to create awareness. And that is very expensive.
Why is the awareness low?
Our people generally are very slow in imbibing new technology and culture. Some don't even believe that it exists even though it has been in the world for 35 years now.Our level of education is a major factor in the acceptance of IVF. Otherwise, many people just go to the mosque or the churches to seek succour.But when you are very educated, you are more likely to seek knowledge in the scientific field, rather than go to the unknown field of babalawo (native doctor).
I also think that our government has not done enough not only in fertility treatment, but also in creating awareness for it. We usually do immunisation for polio, meningitis among others for children. Thank God that we are doing something about that in Nigeria. But there are many other areas in medicine where the government needs to have been involved before now. But our government has not done these.
To those who may not be familiar with IVF, what is it all about?
In-Vitro Fertilisation (IVF) is the process of fertilizing eggs for conception outside the body of the woman. Naturally, they are fertilized inside the body of the woman. It is the egg and the sperm that become the baby. The egg is released from the woman and the sperm goes to meet the egg during intercourse. That is what happens naturally.
But in IVF, we don't allow that to happen. We take the egg from the woman outside and take the sperm from her husband, and mix them together outside her body. When they have united, we put the union back to her womb where it normally should be and that would results in pregnancy.
Why do you do this?
We do this because for some reasons. Some women are not able to get pregnant on their own for three, five, six or more years. Therefore, to create solution to this abnormality, some scientists began to work on that problem some 35 years ago. That was how IVF became established.
How true is the popular belief that IVF children are less human and that they have a lot of challenges?
That is not true. Like any new thing, IVF is subject to speculations. When IVF first came to the world some 35 years ago, all these fears were there. Like everything scientific, facts and evidence have come to assure us that babies born through IVF are as normal or even more normal than those born through non-IVF methods.
Any example in the world to show for this?
Many as I just told you. Science does not believe on hearsay. There must be proof. Over 10,000 babies have been born worldwide through IVF. Scientists have done research on their developments, their intelligence quotients (IQs) and their abilities to re-produce. And the results are marvellous as they are perfect.
Oftentimes, when couples fail to have children, the woman, not the man, is often blamed for the abnormality. As a fertility specialist, is it true that the woman is always the cause of the problem?
The problem of infertility occurs in about one out of six couples. We are confident to say that the problem is as common in the male as it is common in the female. Generally speaking, we say it is 40 per cent the male problem, 40 per cent the female problem and 20 per cent should be shared between them. So, the woman should not be blamed all the time.
What are the challenges of practising IVF or assisted re-production system in Nigeria?
First of all, not a lot of people can to afford it because of the cost. Therefore, you see a lot of people coming to you and begging for discount. That is a bit difficult. And one has to bring the things needed for the system, not from Nigeria, but from abroad. We have mentioned that a lot people don't even know that we have IVF in Nigeria. And those who know find it difficult to accept it as they prefer babalawo. And when they cross that Rubicon and come for the treatment, to be able to afford it is a big challenge.
For those who overcome that problem, it is a big challenge for us because we have to source the materials we need, not from within Nigeria, but from abroad. Just imagine the problems that would create -problem of foreign exchange, transportation, and storage among others.
Operating in Nigeria means that we have to have electric supply through generator 24 hours of the week and 365 days of the year. Because of the challenge of inconsistent electricity supply, you find us having two generators, UPS, Solar electric system as alternative power sources. Those are heavy challenges indeed. My colleagues who do the same thing abroad don't have to bother about erratic electric supply, or even expend money on generators and alternative electric supply. They don't have problem of electricity failure.
In spite of these challenges, what has been your breakthrough and high points in the practice?
It has been quite rewarding, when we look at where we are coming from nine years ago. We will soon hit the 700 mark of IVF babies we have delivered. That is a huge leap and satisfying result.
We have received many awards including Development in Nigeria Merit Award (DINMA) for excellence in medical science in 2004; Diamond Award for Professional Excellence in Human Medicine (DAPEHM) in 2005. We have also won the West Africa Direct Marketing (WADM), West Africa's Merit Award of Excellence in Fertility Services in 2007 and West Africa's Best Gynaecologist and Fertility Consulting Hospital of the Year.
Even being able to make a woman pregnant is a big reward. Each time we come with positive result, it is a celebration time for the patient. A special high point was when we achieved pregnancy in a 45-year-old woman using her own eggs. And that is the first to be done for a woman above 40 years in sub-Sahara Africa. We have been able to make many mothers deliver twins and triplets so many times or get pregnancy in some abnormal situations. We have been able to make a Turner Syndrome patient get pregnant and delivered of her baby. Turner Syndrome is a syndrome in which a human being is born, looks like a female, but the ovaries are very tiny in size, just because something happened during the genesis inside the womb. Therefore, they are not well developed. Their chromosome pattern is abnormal. Therefore, they are born with very small vagina, with small uterus and the ovaries are almost non-existent. This category of women create a challenge for the gynaecologist and big challenge for the fertility specialist.
How satisfied are you with healthcare funding in Nigeria?
The health sector has been under-funded. We have not really started. Let government tackle the challenges we have in the primary healthcare (PHC) system first, such as immunisation, health screening, health awareness creation before talking about assisted reproduction.
What do you want Nigerians to know about IVF?
I want Nigerians to continue to imbibe the faith that there is always treatment option for those couples who have challenges with having babies. And they have to help themselves by coming forward for help.
What do you want government to do to boost fertility treatment.
Government should try and do its best like what foreign countries are doing in helping couples with these challenges. In countries like Sweden and Norway among others, government helps these types of patients financially. Government may not pay fully for the cost of the treatment; it can offer to buy the drugs or subsidise the cost of the drugs. This is what is happening all over the world.
Do you see the National Health Insurance Scheme (NHIS) playing a role in insuring these types of patients?
No. It can't play a role because of the cost implication. No, it does not fit in. Unless government sits down to formulate some policies, I can't see that happening.

INFERTILITY IS HELL FOR AFRICANS

infertility is hell for africans

Fertility technique selects healthier babies

Ten successful pregnancies from a new in vitro fertilisation (IVF) technology in Nigeria, called Pre-implantation Genetic Diagnosis have been announced by the Medical Art Centre, in Ikeja, Lagos.

The technique was first announced at a clinical meeting of the Society for Endocrinology and Reproduction, in April 2009 and it is said to be able to predict embryonic future thus selecting healthier embryos (product of fertilisation).

“The process will in turn reduce the chances of a repeatedly failed pregnancy through IVF and secondly, prevent children born with abnormalities such as sickle cell anaemia, Down Syndrome, Leukamia, et cetera,” said Professor Ashiru, Director of the Centre. “We diagnosed 20 women using this new technique in April 25th-28th; today, 10 of them are pregnant and five of these are carrying twin pregnancies.”

Not new
The method, though not new, is yet to be administered by the 16 IVF centres in Nigeria, Prof. Ashiru explained. The current pregnancy rate achieved by IVF is 30 per cent or lower, this according to IVF experts is due to abnormal chromosomes in embryos. But this new technique, he said, promises to select the healthiest embryos, at the laboratory level before implanting into the mother’s womb.
“This is another level in IVF and it helps us detect abnormal chromosomes in embryos and discard them,” Ashiru said.
“For instance when we can take a woman through IVF, we can get 10 embryos from her. Out of these 10, we will get a biopsy to get the genetic composition of these embryos. We can decide whether these embryos are male or female embryos, we can decide whether they have sickle cell, or whether these embryos will have leukemia in (the) future or whether it will be diabetic, we can know some of the abnormalities that may occur in a person a late age, by looking at those embryos.”

Explaining further he said, “For example in a couple who are AS, we can now select the AA embryos alone and transfer them to the mother.
“We don’t have to wait until the baby is born or the pregnancy is formed to abort the pregnancy which is what they do now. We can do it at the embryo level. We can do it at the embryo level and it will take three to four days in the laboratory.”
In vitro fertilisation
IVF is a process where infertile couples can get children through artificial insemination. The woman’s egg is fertilised by her husband’s sperm outside the body (in a test tube in the laboratory), the product, called an embryo is then implanted into the woman’s womb, where it grows into a normal pregnancy.
Nigeria has one of the highest infertility rates in the world with one to four individuals experiencing difficulty getting pregnant. However, fertility experts say causes are due to sexually transmitted diseases, hormonal and lifestyle factors.
An adjunct professor at the University of Illinous, Chicago, Prof. Ashiru said he was determined to create such a centre in Nigeria, following four in United States and two in India, using expertise from both countries.
“Pre-implantation diagnosis will save the cost of Nigerians travelling out of the country to seek help,” he said.
He added that though it costs an additional 3,000 US dollars over the normal cost of IVF which is from N500,000 - N700,000, the cost is justified, when compared to that of IVF and the aforementioned risks.
Women who have reached an advanced maternal age and those with repeated IVF failures or miscarriages, form the clientele.
“The pregnant women are in their 14th week now and they attend the antenatal clinic at our centre twice every month,” he revealed. “The next batch will be in August.”
SOURCE: 234next

We’ve had 923 Test tube babies in 10 years

The Bridge Clinic was set up to provide high quality fertility treatment inducing Invitro-Fertilization (IVF) and Intra Cytoplasmic Sperm Injection (ICSI) in Nigeria.

The clinic has been assisting couples experiencing difficulty with conception since 1999 and with the birth of over 923 babies, they gained the experience to meet the needs of their clients.It is a legal requirement in developed countries like the United Kingdom (UK) that all clinics carrying out fertility treatment that involve human gametes such as IVF are licensed by the Human Fertilization and Embryology Authority (HFEA). Unfortunately, there are no such regulatory authorities in Nigeria.But Dr Alla Arilesere, Head of Department, Medical Services, Bridge Clinic, said that the Bridge Clinic recognizing the importance of such regulation have always functioned on if it were one of the clinics regulated by the HFEA.

According to her, “We are mainly focusing on human reproductive medicine, that is helping infertile couples to achieve pregnancy. Naturally, conceived pregnancy in the bedroom that you don’t spend money, you also have about 25 per cent success rate just like Invitro-Fertilization (IVF). The problem could be perhaps fertilization, perhaps implantation, perhaps the ovaries, perhaps the quantity of the eggs or sperm. It takes more than one month for couples without any problem to achieve pregnancy. This is normal, it is acceptable all over the world.“And that is what is applicable to our assisted reproductive technology.

We transfer embryo on a certain day, what happen to them after the transfer, we wouldn’t know their fate. But the aim is to assist them, at least watching them for awhile, at the transfer, after the transfer, may be wonders will happen, at least the woman will eventually get pregnant.On the issue of high cost of IVF, she said, “At the beginning, I mentioned something about quality assurance, for us to be able to maintain the quality, we cannot compromise on that, it is expensive. Quality is expensive. Firstly, we use high technology equipment, which is important. Secondly, we ensure that we successfully deliver services to our customers, we don’t cut such corners. We must deliver at whatever cost. And it has to be high tech.“Everything that we use for IVF is imported, incubators, culture media, all the materials for IVF, scanning machine, microscope, laboratory and training of laboratory staff. We are trained in Leeds in UK which is one of the leading reproductive science institution in the world, running the medical site, these are all expensive.

Presently, there is proliferation of IVF clinics in the country. And there is fear it might promote quackery. Dr Alla has this to say

, “Actually, we have the annual conference of Nigeria Fertility Society, where we look into issues like this, and we are coming up with ideas and suggestions. The Nigerian Medical Association is the one to control the issue of quacks and things like that. basically, any clinic or hospital that has been registered for the practice, every doctor is supposed to have licence for practice which is to be reviewed every year. Not only IVF clinics, so many other clinics are coming up. Who are setting them up?“I hope the government have something on the ground to be able to control it. Not only assisted reproductive hospitals, but any hospital or clinic at all. Because we have also identified the fact that there are no regulatory bodies in Nigeria for IVF, we are bench- marking ourselves with the Human Embryology Association in the UK. We have from there who came here to audit our reports and procedures. Basically, we practice international standards. We are benchmarked with whatever that is going on in the world. We can’t spread our standards to other clinics because they are supposed to do it on their own.Does the proliferation of IVF clinic in Nigeria mean that the infertility rate in Nigeria has increased? Dr Arilesere said, “Basically, from the statistics, in developed countries, the rate of infertility is between eight and 15 per cent. That means between one out of 12, one out of eight. But in Nigeria or sub-Saharan Africa at large, the statistics indicate that the rate of infertility is 25.This is about double or even triple of what it is in developed countries. Perhaps, it is sexual indiscipline, it could be tubal factor because the rate of woman infertility is about 40 per cent. Perhaps early exposure to sexual life, and may be the use of contraceptive drugs, people right from secondary school or primary school take contraceptive to prevent early pregnancy.“At the age of 13 or 14, girls exposed to sex can become pregnant. So what do they do? They go to the back door to remove the pregnancy so that their patents do not find out. In the process of removing the pregnancy, they may be creating future problems like blocked tubes or infections. Over the years, the rate of fertility, even the quantity of the semen is going down. Perhaps it have something to do with radiation, solar energy, temperature factor, stress, too much of computer.Continuing, she said, “There are two types of IVF, Conventional IVF and ICSI Conventional IVF is applicable to couples where the semen quantity meet minimum of 20 million, that is the semen quality. And the strength of the IVF, whether conventional or ICSI depends on the same quality only. So, for a couple to be qualified for conventional IVF, the count must be at least 20 million, motility must be at least 40 per cent, minimum, morphology must be at least 15 per cent, minimum.

“In the history of the Bridge Clinic, since 1999 all the couples that have been coming for IVF treatment, they have conventional IVF. They have fertilization period of up to 80 per cent. That means all the couples that are treated, 80 per cent unfortunately did not reach embryo transfer stage because those couples are not applicable to conventional IVF.“What is ICSI? ICSI is Intra Cytoplasmic Sperm Injection. Any couple that do not meet any of the requirements that I mentioned, like high motility and morphology, they need ICSI. There is not much evidence to show that ICSI give a high rate of abnormality among children born through it. The perception that there is high rate of abnormality among children born through IVF may be coming from the internet or may be some wrong information. Comparing children who are born naturally with ICSI babies, there is no significant difference.”

The Bridge clinic hosts 10th anniversary photo exhibition

The Bridge Clinic, a renowned Fertility Clinic in Nigeria recently organised a five-day photo exhibition as part of the events lined up to mark its 10th Year Anniversary at Terra Kulture, in Lagos State.T

he exhibition tagged Celebration of Achievements” to reflect the mood of The Bridge Clinic after one decade of successfully assisting couples to fulfil their dreams of parenting their own children, was declared open by Mrs. Ibukun Awosika who is the Chairperson of Chair Centre and former Chairperson, Women in Management and Business (WIMBIZ).“Celebration of Achievements” had on display photos of children from birth to nine years old and also of The Bridge Clinic’s facility, all telling pictorial stories of the children’s successes and excellence.The uniqueness of the photo exhibition was evident in the sophistication of the imagery which portrayed artistically the very advanced technology at The Bridge Clinic. Also, the young talented photographer, Seyi Body-Lawson, creatively captured the essence of each child’s special achievements, talents, dreams and personality in vivid images that spoke volume.The children had outstanding records in sports, art, computer technology and exceptional academic performance from their various schools, at home and abroad. One of them represented Nigeria at an international gymnastic competition in Singapore recently.

Mrs. Awosika congratulated The Bridge Clinic for the “Celebration of Achievement” initiative commending the artistic and creative qualities of the photos of the children. She also advised couples to take advantage of the fertility technology available at The Bridge Clinic to resolve their fertility problems which can be a huge challenge in a society like Nigeria.Dr. Richard Ajayi, the Medical Director of The Bridge Clinic during his speech at the event revealed that The Bridge Clinic” has assisted a lot of couples and have been blessed with the birth of about 1,000 babies. He said: “Celebration of Achievement’ is organised to celebrate the accomplishment of these children.

Today we celebrate these children who have all grown to become great assets to their parents and also a source of our own fulfilment.” He attributed the facility’s achievements to the commitment, loyalty and professionalism of the staff over the years.The Bridge Clinic is known for its many innovations which have improved the standard of fertility medicine in Nigeria. It is the first ISO certified clinic in Nigeria and its many milestones include Birth of the first babies by Intracytoplasmic Sperm Injection (ICSI) in 2000, delivery of the first baby by ICSI and Surgical Sperm Collection (SSC) in 2000, birth of the first baby through IVF Surrogacy in 2003, implementation of an internationally certified Quality Management System by TUV Austria in 2004 and the Launching of “Let I Happen Naturally” (LIHN) in 2004The Bridge Clinic is currently the only fertility centre in Nigeria to publish its results (including pregnancy rates). The Bridge Clinic also has its results independently verified by Akintola Williams Deloitte.

Pre-implantation genetic screening holds in Lagos with 25 IVF patients

THE Medical Art Centre (MART) Maryland, Ikeja, Lagos, has started a Pre-implantation Genetic Diagnosis (PGD) with 25 In Vitro Fertilisation (IVF) patients.

Co-pioneer of IVF technology in Nigeria and Consultant Reproductive Endocrinologist at MART, Prof. Oladapo Ashiru, at the monthly clinical meeting of the Nigerian Society of Endocrinology and Metabolism (NSEM), hosted by the Centre last week, presented the technique for pre-implantation genetic screening, which was currently used for 25 IVF patients at the Medical Art center between April 21st to April 28, 2009.

"MART has commenced the technique of pre-implantation genetic selection for genetic abnormalities and sex selection in Maryland Ikeja. The first batch went through oocyte recovery, Intra Cytoplasmic Sperm Injection (ICSI), PGD biopsy, and Embryo Transfer between April 22nd to April 28th, 2009," he said.

Ashiru, who is also an Adjunct Professor at the University of Illinois at Chicago, United States, in his lecture titled "Highlights of Assisted Reproductive Technology and The place of pre-implantation genetic diagnosis in Nigeria", said PGD is the next focus of cutting edge work in the IVF field. He said PGD is for the elimination of abnormal genes and gender selection.

MART, in January 2009, announced the establishment of pre-birth genetic screening for sex selection and sickle cell disorder.
His colleague from Mumbai Dr. Satish Sharma, who is the only person in India running a satellite PGD, amplified the presentation in details.
The meeting was chaired by Prof. Oladapo Ladipo, the President /Chief Executive Officer of the Association for Family Health, Ibadan.

The other speaker was Dr. Satish Sharma, who spoke on the technique of pre-implantation genetic diagnosis. Those present at the seminar included Prof. Osato Giwa-Osagie, who with Ashiru recorded the first IVF delivery in 1989, Prof. Akin Osibogun the Chief Medical Director of LUTH, several other professors and senior doctors from the NSEM.

WHY MOST NIGERIAN MEN HAVE LOW SPERM COUNT

Professor of Anatomy and Reproductive Endocrinology, Medical Art Centre, Ikeja, Lagos, Oladapo Asiru, traces the history of in vitro fertilisation in Nigeria and gives reasons for increasing infertility in the country, in this interview with NIYI ODEBODE.

There has been controversy over the history of in vitro fertilisation in Nigeria. Can you give a brief history of the practice?

The experimental work on in vitro fertilisation was started in Nigeria in 1983 by Dr. Akin Abisogun and me. When we succeeded in performing IVF in experimental animals, we started it in humans in the latter part of 1983. For the first time, in 1984, it led to a pregnancy. The first pregnancy ended up as a miscarriage. Following that, it became a big household event. Our success generated a visit of the then Minister of Health, Dr. Emmanuel Nsan, to our centre as well as a visit by his successor, Prof. Olikoye Ransome-Kuti, who established a ministerial panel to look into our work.

Prof. Osita Giwa-Osagie and I were successful in achieving the feat, which was among the few in the world. By 1986, we had delivery from gamete intra fallopian transfer. In 1989, we succeeded in having a baby girl born from IVF. The mother was a woman whose two fallopian tubes had been removed in England as a result of an ectopic pregnancy. She came to Nigeria, we were able to do IVF for her and she got pregnant on the first attempt. The Lagos University Teaching Hospital's magazine published it. Mr. Onajomo Orere of The Guardian reported it when Mr. Lade Bonuola was the editor. It was also reported by Ms. Luisa Agunyi-Ironsi of Tell magazine.

By 1998 and 2001, two other doctors joined the IVF programme in Nigeria. Today, we have about 15 IVF centres.

With your explanation, what would you say about a claim that the first IVF baby in Nigeria was delivered in Abuja in 1998?

It is totally incorrect. The first IVF baby was delivered in 1989. She is still alive. It was well publicised as I had said. The woman was interviewed. When the publicity became too much, her lawyer wrote to us that we should stop it.

What are the recent developments in assisted reproduction?

We are moving to another level in assisted reproduction, which is pre-implantation genetic diagnosis. Before we can take a woman through IVF, we will have a biopsy to know the genetic composition of the embryos. We can know the male and female embryos. We can decipher an embryo as a sickle cell embryo or whether an embryo will have leukemia in future or whether it will have diabetes. We can know the abnormalities that occur in foetus by looking at the embryo. For example, if an AS person marries an AS person, we can select the embryo that is not SS and transfer it to the mother.

We can do this at the embryo level, which is about four days in the laboratory. We have set up the technology in collaboration with my colleague, Dr. Satishkumar Sharma of Craaft Clinic, Mumbia, India. We have about 25 patients going through it. At the end of the day, the pregnancy and the baby will be normal because we would have selected the embryo. We are doing it for those that are very old, those who have had failed IVF and those who have had repeated miscarriages. Many people, who are pregnant, lose the pregnancies because the embryos are not normal.

If you go through IVF, if you have three embryos, if one of them is not good, it will affect the other two. If you remove the bad one, and use the two good ones, the pregnancy will survive. What we do simply is to discard bad embryo and take those that are good and transfer them into the woman.

What is the financial implication? It is expensive, but it is better to go through it than to spend money on IVF and not get pregnant. The technology was developed in Chicago. My colleauges from America, who were supposed to come, were afraid of coming to Nigeria because they felt they would be detained and kidnapped.

When you are transferring technology, your partners must come here and use your system. I went to India and Chicago. I felt that it could be done in Nigeria. We have people who need it, especially the sickle cell people. Instead of asking them to go to America, which is very expensive, we can do it here. Even in America, there are about four centres that are main centres. We plan to make this place a centre of pre-implantation genetic diagnosis in Nigeria.

We can then have satellite centres coming to use the facilities here. You have not talked bout the cost implication. You know IVF is between N800,000 and N1m. With this technology, you will need another $3000. Government can assist by removing taxes and cutting duties on the drugs, which are very expensive.

You mentioned miscarriages. What causes miscarriages?

The commonest cause of miscarriage is abnormality in embryo. Nature will not allow abnormality to occur. If the child is going to be abnormal, there may be a miscarriage. We have found out that a high percentage of miscarriages are due to abnormality of the embryo which are equally environmentally induced, such as exposure to X-ray, chemical and toxins.

There are many centres that claim to do infertility treatment, particularly assisted conception and reproduction. Can you differentiate between the two?

Some people think that if you take the sperm and introduce it to the woman, that is assisted reproduction technology. No, that is assisted conception. In assisted reproduction technology, you must take the sperm and take the egg and manipulate them outside the body, in the laboratory, and take it to the woman. Some people do not need IVF; they only need artificial insemination. If I have a woman that is 22 years and trying to conceive and there is cervical hostility, artificial insemination is sufficient. But by the time women are getting old, there is no time for trial and error. IVF is the answer.

I must add that there are some people who are not medical doctors but claim that they are doing infertility treatment and IVF. They are all over Lagos deceiving couples who need treatment. People are being deceived because of the prevalence of infertility in Nigeria. What are the causes of infertility? We have male factors.

Most of our men in this country have low sperm, particularly those ones I see in my clinics. And what are the reasons? They include infections, alcohol, cigarette smoking, occupational hazards, pesticide, toxic pollution in the environment, use of artificial sweeteners like saccharine and wearing of tight pants.

For women, the causes include infections, blockage of tubes and occupational hazards which affect ovaries.

Are more people coming for IVF in Nigeria?

There is more awareness of IVF in Nigeria. More people are coming for it because they know there is a solution. More men are now coming out. They know there is a solution. However, many people are not ready to come out to say that they have done it.

Through donor sperm, we’ve produced 2000 babies – Prof Giwa-Osagie

When Prof Osato F. Giwa-Osagie (OON) and a few of his colleagues at the Lagos University Teaching Hospital (LUTH) disclosed, in the early 1980s, that they could assist couples having infertility problems to achieve pregnancies through other means, not many believed them. In fact, their claims were subjected to close scrutiny by two panels set up by the Federal Government before being given a clean bill of health.

However, these In-Vitro Fertilisation pioneers were forced to go it alone due to government’s unwillingness to offer adequate support and assistance to them at the time.Subsequently, Giwa-Osagie, who is the president of the Nigerian Fertility Society (NFS), went solo because as he put it, "I was not prepared to be intellectually dead."

In 1987, he set up the Advanced Fertility Clinic (AFC) in Lagos and the decision paid off.

In this exclusive interview, the renowned gynaecologist and obstetrician speaks on the evolution of his specialised practice in the last 21 years among other issues.

Advanced fertility centre at 21

It has been quite challenging. When I came back to Nigeria in 1978, 30 years ago, I found that virtually every gynaecologist considered himself to be a specialist in treating infertility. But I soon realised that most of them were treating infertility as generalists would do, not as sub specialists or super specialists. So, I took it up at that level. I applied modern techniques. Indeed, we kept adding more modernisations to improve the efficiency of the processes we were doing to increase the convenience both for the practitioners and the patient, and, therefore, to cover more and more causes of infertility. These included ultra-sonography and sperm banking, among others. That’s how it has evolved.

Twenty one years down the line, we remain committed to making a difference in the lives of our patients. With our pioneering role in assisted reproduction, we are committed to bringing the benefits of modern science to the healthcare of men and women of all ages. We practise medicine with empathy and regard our patients as our ambassadors at large. Through the use of advanced technology and motivated staff, we are producing results of international standard in a patient friendly atmosphere.

It was a humble start but we are moving ahead. But as I said earlier, it has been a challenging experience at 21.

Sperm bankingInitially, all we did was just check the tubes, check for ovulation and give the patient some drugs to stimulate ovulation. Most people were not doing artificial insemination. In fact, the first papers on artificial insemination were published in the 1970s by people like Prof Akingba, Prof Chukwudebelu, Prof Ladipo. But when we set up Advanced Fertility Centre in 1987, we set up a human sperm bank, which was the first in the whole of West Africa, East Africa and Central Africa. Nobody else at that time had a human sperm bank.

Now, why did we need a sperm bank? We needed a sperm bank because it allows you to store the sperm so that it can be used for the patient, if, for instance, her husband is not around. It allows you to use sperms that had been screened for people who cannot produce sperm just the way you use blood bank to serve people who need blood.

Of course, when assisted conception became more advanced, sperm banking became imperative. For instance, in the age of HIV/AIDS, you are no longer allowed to do insemination using fresh semen. So, what is done is that you freeze the semen, you test the donor twice to make sure that they are negative for HIV, hepatitis before you can now use it to inseminate of for In-Vitro Fertilisation (IVF). You cannot do that unless you have a sperm bank. It means now, in effect, that any place that is doing something like IVF must have a sperm bank whereas it was a novelty when we started.Advent of IVF in NigeriaSecondly, with Prof Ashiru at the Lagos University Teaching Hospital (LUTH) and Prof Abisogun, we again, had started IVF in the whole of West, East and Central Africa. I know this because I keep records of what is going on in my special area so I know who is doing what, where and when.

After we succeeded in IVF in 1984, we had the first baby in 1989, almost 20 years ago. We were not able to continue in the public hospital because the Federal Government, at the time, was not prepared to fund the process. You have to have equipment, you have to have drugs and you have to have a means of getting money that you will use to maintain the equipment and pay for the drugs for the patient. That mechanical was not available as in early or mid 1980s at Nigerian teaching hospitals. So, we had to make a choice. Prof Ashiru decided to go to USA. He was there for some years but has since come back and started his own practice. I stayed. I decided that if I was to stay in Nigeria, I must be able to do what I am interested, in otherwise I would go intellectually dead. And I was not prepared to be intellectually dead. With the assistance of some family members, friend and old school mates, we were able to purchase and instal sperm bank, utrasonagraphy as well as pay for our embryologist, Mrs B.O. Kayode to go abroad and train in sperm preservation and the embryology of IVF so that she became the first female IVF embryologist in the whole of West Africa.

Once we had that in place, we started offering it to patients. This was how the IVF was set up at Advanced Fertility Centre then at Surulere, Lagos. We moved to Onikan in 2001 and of course, we updated our equipment. We now do ICSI. It allows you to inject one egg one sperm, which for those who have very low sperm count.

Achievements

We’ve had over 2000 pregnancies of donor sperms. We’ve been having successful IVF pregnancies and deliveries since around 1988. We had our first set in our new location at Onikan, Lagos, in 2001. It was a set of twins. We have also been successful in getting pregnancies using donor eggs for people who don’t have ovaries and don’t menstruate at all. We have success there, including menopausal women, women who are no longer menstruating. These are all techniques available in assisted conception world-wide. They are now available in Nigeria.

At 21, Advanced fertility centre is a thing of obvious satisfaction to me.But even more satisfying to me and my colleague, Prof Ashiru, is that we started IVF in West Africa when people thought it was not possible. Many of our colleagues criticised us and said we were making false claims. There were two panels set up by the Federal Government to look at our work and confirmed that we were doing the correct thing.

Today, there are 14 IVF centres in Nigeria and that for me is a thing of great joy. You start something and many people join in, you should be happy about that. Out of the 14, seven are in Lagos, three in Abuja, one in Benin City, one in Aba, two in Port Harcourt and I understand one will be starting soon in Enugu. The one at the National Hospital Abuja, which AFC assisted to start, was the first government-funded IVF centre in Nigeria, followed by the one at UBTH, Benin City. So, that is satisfying to the pioneers and it made my staying in Nigeria and not going abroad worthwhile.

If you go abroad, everything is ready for you, between three and six months you are already doing the procedure. We started it from scratch here and we had no support from the government at all at that time. Now the climate is more civilized, better informed and people know that these things are available and can make informed choices.

Turning point

From the pint of view of my practice, the turning point was when I was able to give sufficient confidence in some people to make them prepared to assist me to fund what I wanted to do. You can have very bright ideas but if you cannot get the money from the bank, friends or relations, you cannot get anywhere. That is a constant truth. But I was lucky I had that breakthrough in the mid’80s, which was why I was able to start in 1987. The next thing was when we were able to obtain a loan from the United Bank’s for Africa (UBA) to reequip our hospital and modern machines which is the situation we are in now.

It is not easy to repay loans but we thank God that we were able to handle that in AFC.

Assessment of healthcare under democracy

In the field of healthcare, the major positive thing I have seen is that the whole issue of maternal and child health is being taken more seriously than ever before. And the health system is being geared towards attempting to achieve the Millennium Development Goals as they apply to mother and child health.

Secondly, under the democratic dispensation, HIV/AIDS started to be tackled very seriously. I remember when even enlightened people, in place like Lagos were saying it didn’t concern them. This was because they were still suffering from the believe that HIV/AIDS only affected homosexuals or those that had blood transfusion. But now everybody knows that in Africa the major route of spreading HIV/AIDS is through sex, heterosexual sex.

CondomsThe level of advocacy and, indeed, the enlightenment campaign by journalists is amazing in the last eight years or so. So, we’ve made much impact in terms of HIV/AIDS. And as my own support to the fight against HIV/AIDS, I have been distributing condoms free at various places I go. I travel much in this country and I know what men can do when they are out of their homes. I see them surrounded by young ladies in hotels all over Nigeria and I say to them when we meet socially, if you must have sex with the these ladies that you hardly know or even ladies that you know but obviously you cannot vouch for you might as well use condom.

Initially, people would think that maybe you are encouraging promiscuity, but the truth is that if people could abstain from sex there would be no unwanted pregnancies, there would be no sexually transmitted diseases and HIV/AIDS would go down tremendously. The fact, however, is that people cannot abstain from sex and many of them cannot help but have sex with more than one partner. Now, when you have sex with more than one partner, you can never be sure where that partner has been or would be. Therefore, if you are going to do that, you must protect yourself. Far from encouraging promiscuity. That strategy is to assist those who cannot obtain but we still believe that abstinence is the cheapest and the surest way of not catching HIV/AIDS in Africa.

Why Nordica is offering free IVF treatment, by Ajayi

In recent times, there have been some misconceptions about Assisted Reproductive Technique (ART), especially In Vitro Fertilisation (IVF).

A school of thought says it is fraught with risks due to multiple births and caesarean births. Another is worried about the high cost, lack of regulation and guidelines; and indiscriminate springing up of fertility clinics. There are also fears that IVF babies cannot compete favourably with those born through natural means.

Director, Nordica Fertility Center, Victoria Island, Lagos, Dr. Abayomi Ajayi, in this interview with CHUKWUMA MUANYA throws more light on these misgivings on IVF, why Nordica is offering free IVF treatment to Nigerians, plans by the clinic to offer free treatment and screening services to more Nigerians; among other things.

There are heightened fears on the perceived risks associated with Assisted Reproductive Technique (ART), especially In Vitro Fertilisation (IVF). A school of taught says that it's association with multiple pregnancies and Caesarean section increases the chances of mother and child mortality. How true is this?

Yes! Multiple pregnancies, we know that about 25 or 30 per cent of babies born from assisted conception, especially IVF will be more than one. Therefore the more the number of babies the higher the risk of operative deliveries to start with. That is one way of looking at it. Of course we know the procedure that assisted conception involves. It involves multiple ovulation sometimes even multiple transfer of embryos and therefore sensible success rate. And one of the problems of this is multiple pregnancies and multiple births. They are the attendant risk of this multiple transfer. You remember the one that happened recently in the United States which was overblown. But in this environment we tend to tolerate multiple pregnancies better than Caucasians for whatever reasons. Naturally, Nigeria and the Republic of Ireland have the highest twinning rates in the world. So, there is something in us that carries at least two better than the Caucasians. But when it gets beyond three now it becomes something.
But unfortunately the procedure of IVF also involves transferring more than one except now in Europe where they are doing what is called single embryo transfer.
We have not started doing that here in Nigeria and I am not sure whether we are looking forward to doing single embryo transfer, except in very selected patients. Because like I said we tend to accept multiple births.

It is has also been said that IVF is bedevilled with multiple births because the practitioners are trying to increase the chances of conception?

Yes! That is the thing, because here everybody pays out of pocket. Government does not pay for anybody and therefore you want to maximise the chances without causing any harm to the patient and that is why we do not transfer more than three. The worse case scenario we have triplets, which even without IVF in this environment almost every obstetrician would have had to deliver one or two triplets in his career.
So triplet is still not being frowned at but higher order of multiples above triplets is what people are not comfortable with.

Considering what happened in the United States where assisted conception led to sextuplets, what are the chances on the procedure we practise in Nigeria on your patients having such?

in Nigeria it is better we confine it to not more than three because there is no support system here, unlike in the United States. You remember when the woman even had the babies there was a Nigerian that had sextuplets before who came to visit, and all the children survived. That is of course because services are well advanced, if they have to take over the ventilation of the babies, they have the facilities. But here it is not readily available.

Another issue is that of cost. It has been suggested that it costs between N600 and N1.5 million to procure one cycle of treatment, making it out of reach of the ordinary Nigerian. And in that cycle, the chances of the woman getting pregnant is not more than 30 per cent. How true is this?

That is true! The success rate of IVF is about 25 to 30 percent and that is any where in the world. What IVF tries to do is what happens in a woman in a natural cycle. And the success rate of nature is about 18 to 20 per cent every month. So if IVF can give you 25 per cent, it is a little bit more than what nature can do. And therefore the success rate is like that and people are still working to see how we can improve the success rate. But as of now that is it. One thing we cannot afford to do is compromise standards. IVF babies are normal babies and that is because the quality control system in the body are not tempered with in IVF.
So, that is why we have normal babies. So 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.

On the issue of cost I can only talk about my own centre, I do not know how much other people charge. I know that there is no treatment that is up to N1.2 million for a cycle in my centre.

But people are crying that they cannot afford this. How much do you charge for an average cycle here?

We charge between N600 to N800, very maximum N900. You always take things out of context not comparing it what happens in other parts of the world. For instance in the United Kingdom, a cycle costs about $4000, that is without the air fares and other logistics. We have to bring in all the materials we are using even our consumables from there. And they do not have the problem of electricity supply. I have three electricity generating sets here now, and if I tell you how much I spend on diesel every month.
There are costs for us that we need to meet, but we are also mindful of the environment in which we practise that it might get to a point and people will not be able to afford it. But is not as bad as it sounds most of the time.
Do you have plans for the ordinary Nigerian to be able to access this assisted fertility technique considering the cost and the economic realities. Practically a couple that earns an average of N100,000 month cannot afford it. How can it happen?

The bad thing about our environment is that you have to pay for everything out of pocket. There is nobody helping you, no government to help, whatever. Whether it is possible for government to help, I am not very sure. You know that the government is saddled with so many responsibilities now. But the good thing here is that we have the extended family network. Infertility is always a challenge not only to the couple but to the whole family. So even if you are earning a N100,000 you will see the rate that family members are ready to help because they know that if you do not have this, you will continue to look for it and it is unsettling.
Even the World Health Organisation (WHO) defines health as not only physical but also emotional. Therefore if someone has something troubling him or her, is not likely to be at his or her best and people are aware of that. So, it is like people rally round. I am sure that is not everyone that comes around here is paying out of their own pocket; this like most of the time a joint effort. We are mindful of that in this environment, and that is why we want to give the patient the best value for their money.

Do you have a program to help those who cannot afford it?

Yes! We did this EART (Expanding Access to Reproductive Treatment), which has crystalised now to Fertility Treatment Support Group (FTSG). There is now a support group that is incharge of that program. We are still running it this year.
The programme is offering free IVF treatment to patients. It was so rewarding to us that really encourage us. We tried to get sponsors last year but we did not succeed. Well, we got some sponsors; some of the media houses came to our rescue. But we did not really get anybody to bring out the money, so it was like we sponsored almost the whole thing and that limited the number of women we could give access to. But we are still working on it, to see how we can increase the number.

How many women or families have benefited from this programme?

What we have in mind is that we are going to give free treatment to 16 women; we are going to be giving two women every quarter. But we are going to be giving free screening to 10 women every quarter.
And out of these ten women, we choose two people. The first set that we gave was so revealing. There were some things that we found out, that out of these 10 people- some that were not even part of the two that finally had IVF- there was a life saving situation in one of the women. I am not sure whether the woman would not have dropped dead one day if the condition was not diagnosed. She had what was called a polyp in the uterus and she was bleeding every month, and they were not doing anything about it. It was during our screening that we saw that, and what we now did was to use what we call hysteroscope to bring out the polyp. She is alright now, she does not have a child yet but she is alive and well. And that made us to see that it is beyond even having children, that this programme can also help in sustaining health in this environment.

Another issue is the fear that people born through IVF cannot compare favourably with people born through natural means. Some suggest that IVF babies are not normal or not perfectly normal. Can you compare children born through IVF with those born through natural means?

The answer is yes! As I told you earlier on, all the quality control system in the body are reclaimed in IVF and so babies born through IVF are normal babies. We have had over three million babies born all over the world by IVF and they are perfectly normal babies from what statistics have shown us. You can talk to even some of our own babies. One just came on Saturday.

How many babies have been born in this facility through IVF?

We presented our figures a few weeks ago, over 268. We still have about 60 women on the waiting list, and two of them have delivered.

What is the age of the first IVF baby?

The first will be five in September

Boy or Girl?

A boy, Julian.

What is the next thing for Nordica? What are your plans for the future?

Well! Two things we did. We had a dinner where we invited all stakeholders, including the press to see what we have done so far in our last six years of establishment of Nordica. We also wanted to work with the media in raising the awareness on endometriosis. So these were two things we wanted to do together. It is very important for the public to be aware of things concerning assisted reproduction, for it to always be in their consciousness that it is necessary for some people to have assisted conception and they should not leave it as the last resort; that when you need it, you need it and you should go for it soon enough because we know that success decreases with age especially of the woman. Also for us to raise the awareness of this condition called endometriosis, which is not given its proper place in media practise in Nigeria.

What is endometriosis? And what is its impact on fertility rate in Nigeria?

Well endometriosis is the occurrence of endometrial tissue in any other place apart from in the endometrium (the inner lining of the uterus). And what happens is that this endometrial tissue reacts to the hormone that the woman secrets every month, just like the endometrium does. You see what happens it that the women sheds her endometrium when she sees her menstrual cycle. The same thing she now sheds the endometrium in order places apart from inside the uterus. So you can imagine if it is on top of the ovary, she is now shedding her endmetrium inside the abdomen. So with time there is a collection of blood, which contains some unwanted substances and it starts to form what we call additions or scarring inside the woman. So, definitely because of this, it disturbs the anatomy of the reproductive organ leading to infertility.
The other way is that because of these chemicals that are contained, which is not normally in the abdomen, these chemicals are released which kill eggs and ill sperms. So two ways that endometriosis can affect fertility is either chemical or mechanical.

What the percentage of the infertility caused by endometriosis?

It would be around 20 to 40 per cent.

You said its being neglected?

When we were in medical school we were told 15 years ago that endometriosis was not common in this environment. Now, whether it was not common then or we were just simply missing it, I do not know. But I know now that it is common. Maybe because we now have better facilities to diagnose and we are better skilled at doing some of things. But it is not a peculiar thing to Nigeria, because in the United Kingdom, between the unset of symptoms and diagnosis takes about eight years in which she must have seen about five doctors who will not have made the diagnosis. And that is where records are kept. So in Nigeria, where records are not kept, many women go through out their life time without a diagnosis.

At what stage will a couple need assisted reproduction and how should they go about?

I think the question to ask is at what stage will they need intervention, evaluation of a doctor. This depends on the age of the woman to start with because there is no particular age at which women get married.
It is when the man comes along. So if the woman is above 35, then after six months of trying she should see the doctor who should do some investigation. But if she is less than 35 years she can wait for one year and then see the doctor. But if there are obvious things in the offing then she does not need to wait this long. For example if her menses are irregular; if the man has some history of trauma to the testes while he was younger, undescended testes. Those are things that are obvious and they are pointer to the fact that you do not need to wait, you need to quickly see the doctor. When these things are not present, we allow six months for women who are above 35 and above, and we allow one year for a woman who is less than 35 to be properly evaluated

Are you concerned about late marriage especially by women, and its impact on childlessness?

I think that is a fact all over the world. Women are going to school more than they used to do before and that also is taking a toll on fertility, because we know that a woman is most fertile in those years that they go to school. And by the time they finished school they want a career and may be Mr. Right might not come on time. All these are things that might hinder reproduction when they finally decide to do that. So what we try to let people know is that no matter what you do, nobody is against a woman having a career or whatever, do not forget to have children at the right age.

Another issue is that of quackery. Some clinics are making audacious claims on IVF. Do you have an association? How is the regulation of the practice in Nigeria?

Regulation. None for now and that is one of the things that we are clamouring to have in our industry.

So for now what the IVF clinics do is just to register with the Medical and Dental Council of Nigeria (MDCN) and the Nigeria Medical Association (NMA)?
You are just a doctor and that is it. If you are a gynaecologist, you belong to the society of Gynaecologists of Nigeria (SOGON).

Do you not think this is a dangerous trend, and you are allowing cracks in the practice?

Obviously, it is not a very healthy development. If you trace the history of IVF all over the world, it is just the same thing that happened even in UK that is happening here. We need to form a strong body that will see to it. But of course we cannot do anything without the government, because no matter how we need policing and the only person that provides policing in Nigeria is still the government. So it is for us to have a body and then align with the government in order to give teeth to whatever regulation that we want to be in place.

More studies are implicating petrochemical products and paints as major causes of infertility. How strong is this link?

Well! The environment has always played a factor in fertility especially with industrialisation. We know there are so many hydrocarbons in the atmosphere that can be converted into oestrogen (female sex hormone) and when a male is exposed to a particular level of oestrogen it affects spermatozoa formation. Everywhere in the world the environment's an issue. In Denmark, it has been shown that in mothers who smoke their boys usually have lower sperm counts.

What is your advice to Nigerians to things they should do to ensure that they stay fertile? Or have maximal fertility rate?

I think the most important thing is that you live a healthy life. And living a healthy life involves what you do, what you eat and what you drink. And probably even what you wear. It is better to maintain a healthy Body Mass Index (BMI) and that might involve exercises. BMI is a measure of weight in kilograms over height in metres square (kg/m2). BMI between 20 and 25 is normal/healthy, 25 to 30 is overweight, and above 30 is obesity. And then you must watch what you eat also to ensure that you are eating balance diet. Not too much alcohol, if possible none at all. Sometimes we talk about this cotton underwear. Some people who are on the borderline, this might be helpful for them. Limit the exposure of the testes to hot temperature. Avoid hard drugs, avoid if possible smoking, it has been known to affect both the man and woman. No obesity, and if you can be in control, choose the job you do.

What is your parting remark?

Infertility will always be with us and therefore it is important for people to know what to do when they face the challenge of infertility. It is important for us to give the right knowledge to people, so that they will do the important thing when they are faced with the challenge of infertility. I am not saying that you should not go to any religious setting, but they should do the right thing go to the proper places where they can be helped. The most important thing is for you to know where you can be helped; you need knowledge. The Internet is there. I keep saying that to my patients.

Assisted reproduction answer to infertility

Like a million stars, she is illuminating the lives of couples having infertility problems, turning their anguish to joy. Indeed, her heart bleeds for couples who have difficulties in having children of their own as and when required; hence, she feels duty-bound to give them succour even when their cases have been written off.Undoubtedly, Mrs Bobo Kayode, Nigeria’s first female embryologist, has been able to stand out as nature’s assistant in the laboratory of procreation. Her organization, Omni Medical Centre (OMC) and Advanced Fertility Clinic (AFC), Lagos, has, over the years, recorded remarkable feats in assisted conception and reproduction techniques. These include assisting a woman suffering from Turner’s Syndrome (absence of ovaries) to achieve pregnancy and deliver safely, multiple births through IVF.Equally remarkable, her clinic has pioneered low-cost In-Vitro Fertilization (IVF) in Nigeria. The effort, she says, is aimed at helping those who cannot afford the full course treatment.In this encounter, the executive director of OMC and AFC explains why she is assisting men to impregnate their wives, recent developments in her special field among other issues.

Why I assist couples have children?

I am directly in charge of the fertilization laboratory. Basically, we do much work with couples that have fertility problems. I have chosen to tread this path because I know what people who do not have children of their own go through. Over the years, especially in the African society, we get to see thatmany people usually look down or heap scorn on childless women. What most people do not actually know is that child bearing is a two-way thing involving a male (husband) and a female (wife). And over the years, there has been many myths and beliefs that anytime there is a problem with child bearing, the problem is from the woman in a relationship.But it is not always so. We are in this business to get people to be aware of how to get pregnant when they are married or decide to raise a family. If there is a problem when you do not get pregnant as at when you want it, what do you do? When you have actually taken a decision, what kind of decision do you take? What kind of factors do you look at before reaching a decision? And when you’ve actually taken a decision, what do you do if one treatment or another fails?

There are various factors to be considered to be able to treat or accept people having infertility problems. In a nutshell, we assist people achieve pregnancy if they are having problems doing that on their own.Causes of infertilityThere are various causes of infertility. It could be male-factor problem or it could be female. It could also be genetic. If it is a male factor problem, we are talking about the male having problem to produce sperm or the male having problem to release sperm. For the female, it could be tubal blockage; it could be endometriosis. It could be absence of a womb. One of our major breakthroughs a couple of years ago was when we had a woman who had a residual uterus. She was treated and she gave birth to a baby boy. That woman was practically a male, but we thank God we were able to take her through the proper treatment and today she has a baby boy.

There could be various physiological things wrong in the uterus that would prevent a woman from actually getting pregnant. Indeed, there are various factors that could cause infertility to the male and female.

I would say that there has been an upsurge in infertility because of various factors: the kind of food we eat, stress, the environment we live in, lack of adequate medical care at the appropriate time. These and more have caused an upsurge in infertility in both male and female. And there has been a rise in male infertility recently because of many factors. Males are now smoking more, they are now drinking more, they are now wearing more tight fitting clothes. These are some of the things that affect men not to produce enough sperms.

Talking about stress, because of the genetic makeup of men, they are more prone to stress because of the responsibilities that a lot of them bear. This has contributed to the increase in male infertility problems.

When to seek treatment

We always advise couples that come to us to complain of their inability to achieve pregnancy that they must have been having unprotected sex for at least 12 months before they can begin to think that they may or may not have fertility problems. If a woman has been meeting regularly with her husband unprotected and she does not get pregnant in 12 months, she should please go and see a qualified gynaecologist.Assisted Reproduction Techniques (ART)In Omni Medical Centre and Advanced Fertility Clinic, we take in a patient that comes with her husband because we must meet the couple. They see the medical doctor and they are also counselled. Then we take them on various tests. Immediately after they have seen the gynaecologist, we do what we call investigative surgery, a situation whereby we look at the female internally to determine if the patient has a clear uterus, clear tubes and visible ovaries. From there, we go to hormonal treatments.

We assess and do various tests to find out the semen analysis, then to inseminations. From inseminations we go on to either In-Vitro Fertilisation. If there is a problem with the male regarding sperm production, we actually go into the testes and have his sperm extracted. If there is need for ESCI, we do it. We can go to IVF or other techniques that would result in embryos being fertilized, cultured and put back into the female uterus.

Cost implication

At our own clinic, we have pioneered what we call the low-cost IVF in Nigeria. It is a course of treatment whereby those who cannot afford the full course treatment are taken through the minimal drug stimulatory regime that would at least encourage their follicles to be developed and produce ocytes that would enable us to proceed with the treatment. The minimum cost of that procedure is about N280,000. I am happy to say that we’ve had pregnancies from low-cost IVF. The other day, a woman came in and she was taken through the minimal dosage required.

I think the whole thing cost N320,000 and she has a baby boy. There are several others that we have put through that regime that have actually gone home smiling with their babies.Now depending on the patient’s response to the drugs, she might have to go the full IVF treatment. That could run from about N650,000 to N750,000 per cycle. If we are going to do an ESCI cycle, we will be talking about N750,000 to N1 million

depending on the patient’s response to the drugs and the entire procedure.

However, not all patients require IVF or ESCI. Insemination costs between N20,000 and N60,000 depending on the cycles and number of procedures required per cycle.ChallengesFirst of all, you must be a patient individual to engage in Assisted Reproduction Technique (ART). You must be ready to endure and keep at what you are doing diligently. You must be able to stick to your lab protocols, stick to your drug regimes and alter when necessary for various patients depending on their responses. You must remain focused to achieve results. It is good to interact with other people in your field of specialization, but don’t be carried away by the results he claims to be getting because that could be a great deterrent. It could disturb or discourage you if you believe or concentrate on what people say they are doing. Just do what you are doing diligently and properly. The end will always lead to success.

There is the problem of lack of infrastructure in Nigeria. We all know about the epileptic power supply in the country. I don’t think there is a cycle we have run without having to use own our generators and inverters. All these increase the financial burden to make sure the procedure is done properly and all the regimes are administered properly and that you meet the actual conditions that would give you optimal embryo growth and development. Of course, the staff must be trained and retrained to keep abreast of modern techniques. Unfortunately, after training the staff, they run away to another clinic before you know it. So, high staff migration is a big problem and it is quite difficult to get staff that are trustworthy that will stay with you and carry on with your standard of treatment and procedure to ensure that you actually get your desired results at all times.Advancement in assisted conception and reproduction techniquesMy best moment was the first delivery through IVF we had at the then Osagie Medical Centre, Surulere before we changed to Advance Fertility Clinic (AFC). It was around 1988 or 89. Another major breakthrough was helping the woman who has residual ovary to have a baby boy about four years ago. Indeed, we have recorded several landmark situations including having twins through IVF.Only recently, we did a batch of ovary donation cycle for five women whose average age was 56, and four of them got pregnant. It was wonderful, amazing. Indeed, one of them was about 61 years old and got pregnant. The procedure entailed stimulating a young ovary donor, collects ocytes from her and fertilize them with the older patients’ husbands’ semen and the resulting embryos were then transferred to this group of five women. The youngest was 55 and the oldest was 61. We were all very thrilled.

Ethical issues

Talking about sperm and/or eggs being donated for couples, some issues bothering on ethics come up, such as right of child, confidentialities of the transaction and ownership of the child, among others. A counsellor plays a very important role in counseling the sperms and ocytes donors as well as the carriers of such garment. The person who owns the sperm or egg (garment) doesn’t necessarily own the baby. Therefore, one must ensure that the legal aspect are tied up so that you can be sure that whosever eventually get pregnant with whichever sperm or eggs does not begin to give you problem in future or the male or female donor of Ocyte or sperm does not give problem later. In other words, these have to be discussed and agreed.
SOURCE: SUNNEWSONLINE

In Nigeria, people see IVF as a last resort – Dr Tunde Okewale, IVF expert

Dr Tunde Okewale is the proprietor of St Ives Hospital, a Lagos-based centre noted for producing test tube babies. In this interview , he speaks about his modest success story and why doctors should operate within their areas of specialisation for maximum success and rest of mind.

Why did you name your hospital St Ives?

We named the hospital St Ives for various reasons. During my residency training in obstetrics and gynaecology in the UK, I worked in a small town called St Ives. It is one of the coastal towns, rich in history and tourism, and I fell in love with the town and the name. That is one. The second reason is that in Catholic parlance, the patron faith of lawyers is St Ives, and my wife is a lawyer. So, when we were looking for a name for the hospital, we settled for St Ives

Infertility is on the increase among Nigerian couples. As a specialist in that area, what would you say is responsible for the development?

There are various reasons for the rise in infertility. But the two major reasons in our environment are one, there is an increase in sexually transmitted diseases that are poorly treated. The second reason is that people are getting married very late, particularly women, and we all know that the earlier a woman gets married, the better. For childbearing, women are at the peak of their fertility between the age of 20 and 30. But for career purposes, they delay marriage until they are 35 or 40, when their fertility has started dropping.

But some couples read diabolical meanings to the problem…

Well, as a scientist and a medical doctor, I am not saying there are no diabolical reasons. But until all other scientific reasons are explored, I think it is wrong for someone to read diabolical reasons to infertility. It doesn‘t take rocket science to know that if you live a reckless sex life, you are exposed to recurring genital tract infection. The end result is infertility. If you have had various D&C, abortions, you might have problems later in life.

But people resort to spiritual homes in search of a child. Can that provide a solution?

There is nothing wrong in going to churches for help in terms of problems generally, not just infertility. But even in the churches, any thorough pastor will want to explore other means before considering spiritual solutions.

Here, you help couples to achieve pregnancy through IVF. How is that done?

Ordinarily, when a man and a woman have sexual intercourse, the woman gets pregnant. But there are people who that simple method does not work for. So, what we do is that we take the man‘s sperm and put it in a laboratory setting. We remove the woman‘s egg from her body and fertilise it with the man’s sperm in the lab. When pregnancy is formed, we return the fertilised egg into the woman’s womb.

It sounds very easy?

It is not. It is a sophisticated technological procedure. But for some couples, that is the only solution. IVF was first used as a method of assisted conception in the UK in 1978. The first test tube baby was Luis Brown. It is a well tested and safe method. And for some couples, that is the only way, especially women who have blocked fallopian tube and men who have very low sperm count.

How popular is this method in Nigeria?

For those who are well informed, it is popular. There are presently about 12 IVF centres in the country. Unfortunately, it is not something you advertise; it is only for informed people. Again, unfortunately for infertile couples in Nigeria, they see IVF as the last resort, whereas abroad, if you observe that you don‘t get pregnant as normally as you should, it is more or less the first option. The problem with IVF is that the older the woman is, the less successful it is. So you find that a lot of couples, when they are already in their forties, that is when they begin to turn up for IVF.

What has been your experience so far in this field?

It‘s okay. We started our unit in April 2007 and we had our first IVF baby in June 2008. It was well celebrated. From June till now, we have had about 12 other pregnancies in various stages. Even though people seem to be sceptical about the technology, more and more people are becoming aware of it now.

How affordable is IVF for the average Nigerian couple?

Well, everywhere in the world at present, IVF is not a very affordable procedure because of the financial input required to set up a standard IVF lab. And that is why only 12 centres in Nigeria offer it. But we are trying to make it more affordable, because those who need it most are the ones that are least informed about it. Comparatively, if you are to have an IVF in the UK, it will cost about 5000 pounds. In the US, it is between 10,000 and 20,000 dollars. In Nigeria, it varies from N350,000 to N1 million. It is not cheap; let me put it that way. But it is a method worth embracing by some couples because of its high level of success.

Did you deliberately take to this aspect of medicine?

I trained as an obstetric and gynaecologist in the UK. I worked in many units. IVF is a specialty under infertility. I was fortunate to work in units that are offering IVF in the UK. When we started the hospital in Nigeria, we were running basically obstetrics and gynaecology. We offered various infertility treatments for a long time without an IVF unit because of the cost of setting one up. What we were doing was referring those who needed IVF abroad or to other centres. But when we managed to gather enough money, we set up our own. We sent a number of our staff abroad for training. I also went for refresher courses and training in the UK and India. We collaborated with some foreign companies.

I want to assume that the biggest challenge in this kind of business is constant power supply. How do you cope with that?

That is a very good question. Those are some of the things that add to the cost of IVF in Nigeria. For our lab, NEPA and generators are like standby; the lab is basically run by UPS and inverters for 24 hours. We cannot afford not to have light for a split second. We invested a lot in UPS and inverters.

So if you were to meet the new health minister with your experience so far, what would you tell him?

There is a disconnect between what people talk about as regards the ratio of doctors to patients. There are a lot of highly trained medical personnel outside the public sector; but they are underutilised by government. There are only a few that are absorbed in the public sector, while many are left outside doing far below their capacity in the private sector. That is why such doctors go outside the shores of Nigeria. Of the 12 IVF clinics I just told you exist in Nigeria, only two are owned by government. In the whole of Lagos, the foremost government hospital, which is LUTH, does not offer IVF, not to talk of LASUTH. All the hospitals offering IVF are privately owned. In 1978, UK came with the first IVF baby. Later that year, India reported their own. By 1979, Australia reported its. In 1980, the US did. In the early 80s, there was a claim in LUTH of their first IVF baby. Now you would expect that between that time and now, there would have been an explosion in numbers like it happens everywhere in the world. India has over 300 IVF clinics. Ditto for the UK and the US. So there is a disconnect here. From 1980 when LUTH reported till now, we have not heard anything. Even now, LUTH doesn‘t have an IVF clinic. That is a problem. Government needs to invest massively in the health sector.

What government is doing is building poorly equipped massive structures, which they call hospitals. If you go to most of the world‘s renowned hospitals in the UK, you will be surprised with their simple structures. But when you enter, everything that makes an hospital function is there–equipment, personnel, infrastructure. Water runs, there is light, activities go on smoothly. But what we are building in Nigeria is structures, nothing more.

Why did you come back to Nigeria to practise?

I came back because I felt my services would be better needed here than any other place. If I was in the UK, I would be working within an IVF unit. But here, I was able to initiate the setting up of an IVF unit. The other thing is that you will ask me why I didn‘t go to the public sector. We all know that dreams die quickly in the public sector.

Did your parents push you towards medicine?

My father was not a doctor; he was a broadcaster. He was one of the pioneer broadcasters in the old Western Nigerian Television. He was one of those who set up OGBC and OGTV. My sister, Toun Okewale, is a well known broadcaster as well. I come from a family of broadcasters.

So, why didn‘t you go into broadcasting?

I love broadcasting. In fact, I love the entertainment industry, but I just didn‘t toe the line.

How was growing up like?

Growing up was beautiful. I grew up in a civil service setting. The environment was okay. We were not rich but everything was working. There were no strikes in schools. Everything was normal.

Where did you start your medical training?

I got my first degree in Medicine at UCH, Ibadan before I went to the UK for further studies and practice.

Why did you go for a lawyer?

Well, actually, when I met my wife, she studied French, but eventually, she went for Law.

Some doctors would prefer fellow doctors as wives...

I never thought of getting married to a doctor. The life of a doctor is strenuous, at times abnormal. Some doctors cope, but it would be too boring for me if two of us were doctors.

What of the kids?

Well, they are free to make their choice. One of them is in medical school already.

What managerial skills does a doctor need to run a hospital successfully?

The truth of the matter is that most doctors are not trained in management. That is why most of the hospitals have crowds and yet they run at a loss. Again, a lot of doctors are taking far more than they are trained to do. Ideally, every doctor should stay in their own area of specialisation, because it helps both the doctor and the patient. For us here, we try as much as possible to stay within our area of specialisation, which is women and children. Anything outside of that, we invite specialists or refer.

It is said that gynaecologists are often tempted to have affairs with women because of your exposure to them. Is that true?

There are laid down rules and regulations on how doctors deal with their patients. It is unethical for a doctor to have an affair with his patient. Abroad, we have colleagues who have had their licences revoked for having affairs with patients. And the earlier Nigerian patients know their rights, the better. Anybody that comes to you in the hospital is in a vulnerable situation, so you should not use your position as a doctor to take advantage of the patient. The second thing is that it is unethical for a male doctor to examine a female patient without a chaperon, especially when the patient is exposed. A lot of people are not aware of that. Thirdly, every doctor that indulges in such practice is always poor.

How do you relax?

I have time for relaxation. Like I told you, once you operate within your area of specialisation, you cannot experience stress. There is no emergency you cannot handle because you are tuned to anything. But the moment you go out of your area, you are constantly under pressure. You are not sure whether you are doing the right thing for the patient. I believe that any doctor who operates within his area of specialisation will make more money. But when you go out, you are likely to be constantly embarrassed and eventually the patient will know that you are applying trial and error method, and you will not have rest of mind.
SOURCE: THE PUNCH ONLINE

FG called to establish more hospitals

The Medical Director of Nisa Premier Hospital in Abuja, Dr Ibrahim Wada, has urged the Federal Government to further complement private initiative in the treatment of infertility among women.

Speaking in an interview with the News Agency of Nigeria (NAN), in Lagos recently, Wada said that the government could raise its participation in this regard by establishing more hospitals and improving the technology to treat infertility.`
`There is the need to increase more government hospitals to treat women with infertility as there are just only two of such hospitals involved in In-Vitro Fertilisation (IVF), treatment,'' he said.Wada said that it was also important to raise awareness on the use of IVF, particularly at the grassroots, to assist more women with reproduction. ``Doctors can also be trained to use the new technologies in assisting reproduction so that the cost can be reduced and more women have access to experts and the technology at all levels,'' he said.

Wada puts the success rate of women who embraced IVF in Nigeria at one out of every three women. ``This has been a consistent experience, the success rate becomes lower however if a woman is below age 38 or above,'' he added.He stated that the IVF was a working technology and that those who seek the assistance should do so early enough, stressing that age was an important factor for its success.The expert also called for more government interest on fertility-related issues, such as malaria, HIV/AIDS and other related health problems.