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