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.
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.
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.