Renewed hope for motherhood through IVF

AGBENI Market is a popular market in Ibadan, Oyo State. It as a notorious market for adulterated or fake drugs such that the job of any helmsman at the National Agency for Food Drugs Administration and Control (NAFDAC), cannot be complete without close monitoring of this market. But that is not all about this market at the city centre, as it is home to other goods and services. The best place to visit for household utensils, toiletries and foodstuff, is still Agbeni.

You can then imagine the hustle and bustle going on in this market on a daily basis. Men, women, young and old are engaged in one transaction or the other at any point in time in the market. But tucked in the bowel of this market is 47 year old Muniat Oladipo.

On the outward, she could pass for a well to do trader. And that is what she is. But beyond the façade is an unhappy woman that has been denigrated and called names by her womenfolk in the market for a challenge that was not her creation. She is childless after many years in matrimony.

Indeed, life without a child for a woman of her age bracket is comparable to the taste of solution inside the gallbladder of a famished and dehydrated cow in the mouth of a thirsty marathoner.

Besides, like the Biblical Hannah who was repeatedly taunted by her rival Penninah for being childless in the house of Elkanah, Mutiat, had to painfully bear her “unfortunate condition” for 20years.

“The most painful thing then was listening to deliberate discussions of some women of child bearing age in my presence, of such issues as labour pains, ante natal care, immunization of babies, dentition experienced in baby growth and such other stuffs in an efforts aimed at making me feel as if I am not a complete woman.

“Some called me a witch, others said I had donated my ovaries to the occult world and therefore would not, for life,. be able to carry my own baby. We had visited too many spiritualist we thought should be potent enough to make me carry the seed of the womb to no avail. But throughout all these ordeals my greatest strength was the unwavering supports of my 62 year old husband, Asimiyu, who never, for once, left me in the lurch.”

Time was ticking for Muniat. Hope was giving way and despondency was setting in. Indeed, menopause was knocking at her door. But she was not willing to give up. And just at the nick of time miraculously, a lifeline came from the horizon. This time, through the support of improved technology, Muniat became a proud mother of a baby girl.

Muniat was the cynosure of all eyes at the University of Ilorin Teaching Hospital (UITH), recently when she was delivered of a baby girl through the hospital’s third successive Assisted Reproductive Technology (ART) thus terminating her experience of  20 years of marriage without a conception.

After the delivery via caesarian session at about 10:45 am by a team of Gynaecologists led by the Chief Medical Director of the UITH Professor Abdulwaheed Olatinwo, the mother gazing at the baby weighing 3.2kg said sobbing, “so I can be a mother at last.”

UITH is the third public hospital in Nigeria after National Hospital Abuja and University of Benin Teaching Hospital (UBTH) with the services of the ART unit.

According to Olatinwo, in whose tenure,the Renal unit of the hospital  had performed the first Kidney Transplant in a male patient, added that arrangement had been concluded for the first Open Heart Transplant (OHT) of the UITH by June this year.

The elated Olatinwo, a Professor of Gynaecology and Obstetrics, disclosed how the hospital had sponsored, to India on training, a team of Gynaecologists led by Dr Lukman Omokanye, to learn the  skills of the IVF.

Already, the IVF unit of the hospital, has become a much sought after centre by patients and their relatives just as it has equally become a financial autonomous section.

The CMD noted: “We don’t need to travel outside Ilorin for what can be done here. The IVF depending on its type can be done here with a paltry sum of about N600,000. We even give some rebate, through the hospital revolving funds, to some indigent patients.

“But we are canvassing more of private supports for the unit, especially in the area of adoption of some couples in need of its services. Today, we are training doctors from other hospitals on the IVF. Very soon, we shall be receiving patients from outside the country paying us hard currencies to strengthen the nation’s exchange rates capacity.”

According to the mother of the baby, “I had lost any hope of having my own baby in life. I had been to many hospitals, visited countless spiritualists to no avail. But today, looking at this baby, I know that there is nothing God can’t do. I thank God and all the health workers who took very good care of me here at the UITH.”

She was married to her husband some 20years ago. She recalled how she was diagnosed of Fibroid (Myomectomy) 12 years ago in a private hospital in Ibadan and the growth was also promptly removed.

When all efforts at conceiving failed even after the operation, the woman, now exhibiting knowledge of many medical terminology apparently due to her ordeal and frequent contacts with medical practitioners  said she was referred to the UITH for more investigations on her reproductive system. This according to her was five years after her last menstruation.

“The UITH doctors told me of the need to make my womb active because a woman of my age and who had last seen her menstrual period some five years ago would practically be having a dead womb.

“They commenced treatment by first placing me on medication. When it was time, they fertilised my eggs with the semen of my husband. On the third day, they transferred three embryos into my activated womb. After three weeks, they conducted a pregnancy test on me and it was positive.

“It was like a dream to me when the doctors asked me to commence ante natal at the sixth week of the pregnancy. My husband asked me to hide in Ilorin. I had to put up with my brother, Alhaji Ajibade Suleiman until I was delivered of this miracle baby. I never thought that a woman at menopause could still have a baby.”

Speaking with The Guardian on telephone from Ghana, the husband, said the day of the birth of the baby would remain indelible in his mind and a date that has taught him the greatest lesson that God is just and loving to those who diligently await his promise.

He added, “I am extremely happy today and will be eternally grateful to God and all the medical team at the UITH who assured us of the success of the IVF when we commenced the treatment with them.

“I must confess to you, I never thought it would work out well at the initial stage, but my wife was very optimistic of the positive outcome of it. She increased my faith on the IVF and today we are grateful to God and all those who stood by us in our sad moment of life.”

For Suleiman, the elder brother of the proud mother of a new born baby, the love of the husband of his sister remained the impetus that sustained the woman throughout her waiting period.

Suleiman said: “he did not just profess love to my sister, he showed what love is. Even though my sister is not his only wife, he showed her exceptional love and refused suggestions of a divorce common with many African men, including my humble self. Today, he has showed us the results of being patient.”

Speaking with The Guardian in Ilorin, Omokanye the Reproductive Medicine Clinician of the UITH advised couples with challenges of conception not to lose hope of a reversal of their conditions but with a caveat that early presentations of their cases would boost their chances under the IVF.

Besides, he praised the UITH management for the vision of the programme, just as he urged women already carrying the toga of barrenness to have faith in God and seek for more medical solutions to their challenges.

“We always emphasis the issue of age in IVF procedures, because early ages make women to have the ability to produce fertilisable  eggs. So women with this presentation should, apart from putting their trust in God, seek early medical solution towards boosting their chances.”

Although, two previous successes had been recorded before this feat at the hospital, Omakanye said the case of Oladipo was unique due to her menopausal stage when she presented at the hospital.

However, while medical experts said IVF is the best treatment for certain kinds of fertility problems, they are of the opinion that it can be demanding and doesn’t always result in pregnancy.

They suggested that if one is about to start a course of IVF, such person should find out as much as he can about the treatment, adding that knowing what to expect can make IVF easier to manage.

What is IVF?
When a couple conceives naturally, sperm from the man and the egg from the woman meet in the woman’s fallopian tubes. These are the tubes that join the ovaries to the uterus (womb). One sperm penetrates the egg and fertilises it.

In IVF, this process of fertilisation happens outside the woman’s body. A woman’s eggs are surgically removed and fertilised in a laboratory using sperm that has been given as a sperm sample.

Next, the fertilised egg, called an embryo, is surgically implanted into the woman’s womb.

Typically, one cycle of IVF takes between four and seven weeks.

What to expect of IVF treatment
IVF does not always result in pregnancy.

In the UK, around 20-25% of IVF treatment cycles result in a birth. In general, younger women have a higher chance of success. Success rates decrease dramatically in women over 40 .IVF can be a physically and emotionally demanding process. Some men and women have mental health or emotional problems such as anxiety or depression during or after IVF.

If you’re undergoing IVF, ask about counselling to help with the emotional impact of the process and its results.

IVF risks
There are health risks involved in IVF treatment. These include:

Multiple pregnancy
There is an increased chance of multiple pregnancy with IVF. Multiple pregnancy has health risks for both the mother and children as twins or triplets are more likely to be born prematurely and to be underweight at birth.
Ovarian hyperstimulation syndrome (OHSS).

Drugs used to stimulate the ovaries during IVF can lead to ovarian hyperstimulation syndrome (OHSS).

In OHSS, the ovaries enlarge and become painful, causing abdominal discomfort. More severe cases can lead to shortness of breath, fluid retention in the abdominal cavity and formation of blood clots. In these cases, you may need a stay in hospital.

Infection
When eggs are removed from the woman, a fine needle is passed through the vagina and into the ovaries. There is a risk of introducing infection into the body, though antibiotics and surgical hygiene ensure that this rarely occurs.

How IVF is performed 
The IVF technique was developed in the 1970s. It may differ slightly from clinic to clinic but a typical treatment is as follows.

For women
Step one: suppressing the natural monthly cycle
You are given a drug that will suppress your natural menstrual cycle. This is given either as a daily injection (which you’ll be taught to give yourself) or as a nasal spray. You continue this for about two weeks.

Step two: boosting the egg supply
Once your natural cycle is suppressed, you take a fertility hormone called FSH (follicle stimulating hormone). These fertility hormones are known as gonadotrophins. This is another daily injection  you give yourself, usually for about 10-12 days, but it can vary depending on your response.

FSH increases the number of eggs your ovaries produce. This means more eggs can be collected and fertilised. With more fertilised eggs, the clinic has a greater choice of embryos to use in your treatment.

Step three: checking on progress
The clinic will keep an eye on you throughout the drug treatment. You will have vaginal ultrasound scans to monitor your ovaries and, in some cases, blood tests. About 34-38 hours before your eggs are due to be collected, you’ll have a final hormone injection that helps your eggs to mature.

Step four: collecting the eggs
For the egg collection, you’ll be sedated and your eggs will be collected under ultrasound guidance. This involves a needle being inserted through the vagina and into each ovary. The eggs are then collected through the needle.

Some women experience cramps or a small amount of vaginal bleeding after the procedure.

Step five: fertilising the eggs
The collected eggs are mixed with your partner’s or the donor’s sperm in the laboratory. After 16-20 hours they’re checked to see if any have been fertilised.

If the sperm are few or weak, each egg may need to be injected individually with a single sperm. This is called intra-cytoplasmic sperm injection or ICSI (see below).

The fertilised eggs (embryos), continue to grow in the laboratory for one to five days before being transferred into the womb. The best one or two embryos will be chosen for transfer.

After egg collection, you will be given medicines, either progesterone or hCG (chorionic gonadotrophin), to help prepare the lining of the womb to receive the embryo. This is given either as a pessary (which is placed inside the vagina), an injection or a gel.

Step six: embryo transfer
The number of embryos to be replaced should have been discussed before treatment starts.

Women under 37 in their first IVF cycle should only have a single embryo transfer. In their second IVF cycle they should have a single embryo transfer if one or more top-quality embryos are available. Doctors should only consider using two embryos if no top-quality embryos are available. In the third IVF cycle, no more than two embryos should be transferred.

Women aged 37–39 years in the first and second full IVF cycles should also have single embryo transfer if there are one or more top-quality embryos, and double embryo transfer should only be considered if there are no top-quality embryos. In the third cycle, no more than two embryos should be transferred.