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.