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.

Why assisted reproduction is inaccessible to childless couples — Experts

Experts, during a conference, predicted that Nigerian couples in need of assisted reproduction would increase. They, however, warned that the technique could remain unaffordable to many infertile couples.

John Idowu, a resident of Lagos, has been on wheel chair since 2004 when he was knocked down by a hit-and-run commercial bus. Idowu has accepted his fate and he is getting on with life.

But the concern of the 34-year-old man and his wife now is their childlessness. “I married in 2003 and was involved in the accident in 2004. Since then, I have not only lost the use of my legs, but also my erection. My wife would have left if not because she is a faithful woman. Doctors have told me that there is hope for me. According to them, we can have children through assisted reproduction techniques.”

As a result of the growing problem of infertility confronting many Nigerians, including Idowu, experts at the 2008 scientific conference of the Association of Resident Doctors, Lagos University Teaching Hospital, Idi-Araba last Wednesday, discussed the challenges of assisted reproduction in Nigeria.

The experts said that between 10 and 25 per cent of couples in developing countries, including Nigeria, were infertile. According to them, one out of five couples in Nigeria is infertile. A gynaecologist, Prof. Frank Giwa-Osagie, in a paper titled, “Assisted Reproductive Technique in West Africa and Nigeria-Its evolution and challenges,” said that infertility had grave consequences.

“Childbearing has a pivotal place in survival and flourishing of marriage and lineage. Infertility leads to social stigma, unhappiness and marital as well as sexual problems,” he said. The professor stated that despite the high rate of infertility, assisted reproductive techniques were still beyond the reach of million couples who were agonising because of infertility.
Also, the Medical Director of St. Ives IVF Centre, Ikeja, Lagos, Dr. Tunde Okewole, noted that the awareness about assisted reproduction was still low in Nigeria. Explaining the relationship between spinal cord injuries and male fertility, Okewole confirmed Idowu’s statement. He said that the physically challenged man could benefit from assisted reproductive techniques.

Okewole stated that men with spinal cord injury could find it difficult to achieve erection because the nerve that propelled erection in the lower part of the spine had been damaged. “Without erection, the sperm cannot be released. In in-vitro-fertilisation, the sperm is retrieved artificially and used to fertilise the egg,” he said.

IVF involves fertilisation outside the body in an artificial environment. It includes placing the sperm with an unfertilised egg in a Petri dish to achieve fertilisation. The embryo is then transferred into the uterus to begin a pregnancy or cryopreserved (frozen) for future use.

A cycle of IVF involves stimulation of the ovary to produce several fertilisable eggs; retrieval of the eggs from the ovary; fertilisation of the eggs and culture of the embryos in the IVF laboratory and placement of the embryos into the uterus for implantation, called embryo transfer (ET)
IVF was originally devised to permit women with damaged or absent fallopian tubes to have a baby. Normally a mature egg is released from the ovary, then enters the fallopian tube, and waits in the neck of the tube for a sperm to fertilise it. With defective Fallopian tubes, this is not possible. The first IVF baby, Louise Joy Brown, was born in England in 1978.

In Nigeria, assisted reproductive techniques were pioneered by Professors Frank Giwa-Osagie and Oladapo Asiru at LUTH in 1989. Currently, there are 14 IVF centres in Nigeria, leading Ghana that has four; Cameroun, two and Senegal two.

Giwa-Osagie said that about 3,000 cycles of IVF were done annually in Nigeria. According to him, the 14 IVF centres in Nigeria comprise 12 private and two public institutions. The two government hospitals that have IVF centres are the University of Benin and the National Hospital, Abuja.

The professor put the cost of IVF per cycle in Nigeria at between N350,000 and N900,000. From Giwa-Osagie’s presentation, it is clear that not all cycles of IVF succeeds. He explained that for standard IVF centres, the pregnancy rate is 15 to 33 per cent per embryo transfer. An embryo is an egg that has been fertilised by sperm in a Petri dish. The pregnancy rate in low cost IVF is 15 to 20 per cent.

Explaining challenges facing ART in Nigeria, Giwa-Osagie said that they included its high cost and absence of regulation. He stated that the procedure had not attracted government’s attention because of the high disease burden in the country. “In a country that official minimum wage is $80, it is unaffordable to many Nigerians,” he said.

The professor predicted that increasing number of HIV positive Nigerians would seek assisted reproductive techniques to prevent transmitting the disease to their children. According to him, in Uganda, assisted reproductive techniques are on a large scale among people living with HIV.
Calling for regulation of the procedures, Giwa-Osagie stated that there should be minimum standards. According to him, the right to health should include ART.

Another expert, Dr. Ibrahim Wada, said that to make IVF affordable to many Nigerians, more public hospitals should establish the centres. He stated that a funding mechanism should be devised for low and middle low groups.

SOURCE: punchng.com

Ajabor wants law on regulation of IVF delivery

Benin—A gynaecologist and obstetrician, Prof Linus Ajabor, has canvassed the enactment of a law by the National Assembly to regulate ethical services in the In-vitro Fertilization delivery in the country.

Insisting that the In-vitro Fertilization (IVF) service delivery has become elitist in the country, he said such a law, when enacted, would reduce the cost of IVF delivery and enable the poor to benefit from such service since infertility was an issue that affects both the poor and rich. Prof Ajabor, who is also the Medical Director of Saint Anita hospital, Benin, made the call at the 11th annual conference and scientific meeting of the Nigeria Fertility Society, which took place in Benin Noting that there has been a steady increase by couples who want children through the IVF delivery system.

He said that since the first baby was delivered by IVF in the University of Benin Teaching Hospital (UBTH) on April 28, 2008, 12 other babies have been delivered in the hospital through the same system and commended the management of the hospital for bringing its IVF services to the reach of the poor.

The acting Chief Medical Director of the hospital, Dr. Mike Ibadin, in his address, said that the hospital has reduce the cost of IVF treatment to about N350,000-N400,000 to enable poor couples benefit from such services.

LATE MARRIAGE CAN WORSEN INFERTILITY - NIGERIAN FERTILITY EXPERT

Late marriage can worsen infertility – Expert

The Medical Director of St. IVES Specialist Hospital, Ikeja, Lagos, Dr. Tunde Okewale, has attributed the increasing rate of infertility in Nigeria to stress, pollution and exposure to harmful chemicals.

He advised Nigerian women against late marriage. The expert warned that late marriage could worsen infertility, especially in women.
Okewale stated these while speaking with journalists in Lagos on Tuesday on the first invitrofertilisation baby delivered by the hospital. He put the rate of infertility in the country at 25 per cent.

The medical director disclosed that the IVF baby was conceived through the parents’ sperm and egg. He further said, “Two other women are due for delivery in July and August 2008. Eight others are in various stages of pregnancy at the IVF unit.”
He also blamed the problem of infertility on late marriage, particularly by women. The consultant added that fertility in women decreased with their ages.
“For example, the probability of a woman in her 20s getting pregnant is higher than the one in her late 30s,” the consultant said. The medical director also stated that a lot of women, because of educational pursuit and inability to find willing suitors, married late.
“While about 40 per cent of infertile couples will get pregnant by themselves through changes in their lifestyles and by standard gynaecological treatments, 60 per cent will require assisted conception techniques,” he added.

Okewale said the cost of IVF in the country could be reduced by cutting down a series of tests that would not affect the outcome of the procedure. In Nigeria, the cost of IVF ranges from N500,000 to N1m depending on the hospital.
He said, “Efforts, time and money should not be wasted by concentrating on a list of useless and fanciful tests and investigations that do not affect the treatment and the outcome of IVF.
“It is bad enough being infertile, but going through tests that add no value to the outcome of the procedure drains the couples emotionally and financially. Keeping the treatment complex helps some clinics to justify the abnormally high fees they charge.”

According to Okewale, IVF is used for women, whose fallopian tubes have been blocked due to surgery or infections. He added that it could also be used for a man with low sperm count or immotile sperm.
The expert explained, “IVF treatment involves the administration of fertility drugs, monitoring of the cycle, collection of eggs, mixing eggs and sperm together outside the woman’s body in a dish or a test tube. The resulting embryo are left to grow and the best embryo are then transferred into the woman’s womb.”

Advising women that want to get pregnant, he said they should avoid smoking and alcohol. He added that women that had just gone through embryo transfer in IVF should take folic acid, refrain from oven and avoid strenuous exercises.

Okewale also supported the call for regulation of assisted reproduction in Nigeria. “Before you establish an IVF clinic, there must be a regulation that will guide you,” he said.
Urging Nigerians to shun quacks, Okewale stated that infertility in some couples was worsened when they were treated by quacks.

Lagos hospital delivers first IVF baby

A LAGOS-BASED In-Vitro Fertilisation (IVF) & Fertility Unit, St. IVES, successfully delivered its first test tube baby at the weekend, 11 months after the Ikeja-based fertility clinic was set up.

The baby boy, Christian, weighing 3.0 kilogrammes and measuring 50 centimetres in length was delivered by 1 p.m. on June 7, 2008, after 37 weeks of pregnancy. The baby was brought forth through a Caesarean section after a comprehensive IVF treatment by a team of five doctors, including an obstetrician and gynaecologist and embryologists.

IVF is a technique in which egg cells are fertilised by sperm outside the woman's womb, in-vitro. It is a major treatment in infertility when other methods of assisted reproductive technology have failed. The process involves hormonally controlling the ovulatory process, removing ova (eggs) from the woman's ovaries and letting sperm fertilise them in a fluid medium. The fertilised egg (zygote) is then transferred to the patient's uterus with the intent to establish a successful pregnancy.

The medical team was led by the Head of the IVF Unit, Dr. Tunde Okewale, a consultant gynaecologist and fertility expert. Other experts on the team were Dr. O. Ogundimu; Dr. A. Obi; Dr. S. N. M. Onigbinde and Dr. H. Oguike.

The couple aged 30 (woman) and 40 (man) have been married since 2001. But five years after marriage, they could not conceive and they sought medical intervention. After medical investigation, it was discovered that the woman had a blocked tube and the man a very low sperm count. They were advised to go through IVF.

When The Guardian yesterday visited St. IVES, which was established in July 2007, the mother and baby were well and stable. The mother was still in a deep sleep. The father refused to speak to the press.

However, The Guardian learnt that the mother is a housewife and the father is a top executive in one of the leading financial institutions in the country.

Okewale said: "What could have been recorded as our first IVF baby in April 2008 ended in a premature still birth at 26 weeks in February 2008 because of severe pregnancy hypertension, which complicated the pregnancy. This particular woman was part of the first batch but she was not successful. But on second trial, she conceived and was due for delivery last week of this month. But she came in here yesterday with very high blood pressure and in order not to lose the baby, we opted for an emergency Caesarean section.

"Two other women from the unit are due for delivery in July and August 2008. Eight others are presently at various stages of pregnancy in the unit.

St. IVES, IVF & Fertility Unit is committed to providing state-of-the-art Assisted Reproductive Techniques (ART) such as IVF, Intra Cytoplasmic Sperm Injection (ICSI), Intra Uterine Insemination (IUI), Sperm & Embryo Freezing at an affordable cost and with high pregnancy rate, in a comfortable and informal atmosphere."

In Nigeria, it is estimated that about 25 per cent of couples in their fertile age group are infertile and studies have shown that the incidence of infertility in the country is on the rise because of urbanisation, pollution, stress, chemical exposure, carrier orientation, late settlement in life, among others.

It has also been shown that while about 40 per cent of infertile couples will get pregnant by themselves, by changes in their lifestyles and by the standard gynaecological treatments, up to 60 per cent will, however, require some form of assisted conception techniques such as IUI, IVF, ICSI among others to achieve pregnancy.

The first authenticated and documented live delivery of a baby by IVF - ET (embryo transfer-test tube baby) in Nigeria was in 1987 at the Lagos University Teaching Hospital by Prof. Oladapo Ashiru and Prof. Osato Giwa-Osagie.

However, the first IVF or rather, test tube baby - Louise Brown - was born in the United Kingdom in July 1976.

Source: Guardian newspaper. Article by Chukwuma Muanya

MEDICAL FEAT AT LAGOS HOSPITAL AS WOMAN GIVES BIRTH THROUGH PRE IVF FLUID INSTILLATION SONOHYSTEROGRAPHY

LAGOS-Hope has again been rekindled for childless couples in the country following the birth of a baby girl to a couple in their forties, through a novel assisted reproduction procedure termed Pre IVF fluid instillation sonohysterography (PIFIS) at the Medical Art Center, LOFOM House, Mobolaji Bank Anthony Way, Maryland, Lagos.

The medical feat which is already causing excitement within medical circles in the country, was made possible by a team of experts at the Center led by renowned fertility expert and endrocrinologist, Prof Oladapo Ashiru, who first reported the procedure of PIFIS and UGET at the International Symposium of Morphological Sciences in Budapest and at the First International Con-joint Conference on Fertility, Anatomy and Morphological Sciences in Lagos in August and September 2007 respectively.

Announcing the birth in Lagos, Ashiru, who is also Chief Medical Director of the Medical Art Center, said the latest birth was the second to be recorded through the pioneering assisted reproduction procedure at the health facility. His words: “The couples who are excited about the delivery of their daughter are in their forties. The wife, a forty-two year old lady has been married to her husband for over 12 years, and this is their first baby. The first IVF-ICSI was unsuccessful but following PIFIS in the second attempt she had 12 embryos and three were transferred. The remaining eight embryos were frozen and are stored for future frozen embryo transfer (FET).

“This brings to two deliveries out of the first series of five patients undergoing PIFIS procedure since 2007. This case is particularly interesting since the take home baby rate (delivery of baby following IVF) in patients over 40 years of age is very slim, global estimate is about 9 percent success rate.”

Further, Ashiru remarked: “The PIFIS procedure was performed the month before the IVF cycle, and followed by another procedure called Intracytoplasmic Sperm Injection (ICSI) and subsequent embryo culture and ultra sound guided embryo transfer (UGET). The healthy baby girl was delivered through caesarian section at a private hospital in Lagos on November 8th 2007.



ORIGINAL ABSTRACT

Improving the pregnancy rate in IVF with pre IVF fluid instillation sonohysterography (PIFIS) and ultrasound guided embryo transfer (UGET)O.A Ashiru*, A.A Adewusi, L.J Shittu, M Oladimeji, R Ojugbo -IVF Unit, Medical Art Center, Mobolaji Bank Anthony Way, Ikeja, Lagos, Nigeria.

Objective: A practical effort to improve pregnancy rate in in-vitro fertilization and embryo transfer by the instillation of a fluid cocktail of saline and antibiotics to artificially distend the uterine cavity in the cycle prior to IVF, and the use of ultrasound guided embryo transfer. Design: Prospective study. Setting: Private fertility clinic and Academic center. Patient(s): 5 patients undergoing IVF and ICSI (Intracytoplasmic sperm injection) treatment with prior failed IVF cycle with hydrosalpinx or sub mucous fibroid and had to go through sonohysterography to exclude uterine abnormalities or evaluation and location of sub mucous fibroid in the cycle prior to the IVF cycle. Intervention(s): A saline fluid containing antibiotics cocktails was instilled in the uterine cavity through a plastic intrauterine insemination catheter attached to a syringe. Transvaginal (3-dimensionnal) ultrasonography was performed concomitantly. After IVF and ICSI embryos were transferred with ultrasound guidance ensuring placement in upper uterine cavity. Main Outcome Measure: Clinical pregnancy. Result(s): One patient with severe hydrosalpinx distending into the uterine cavity got pregnant and delivered a baby boy, after prior failed attempt, another patient with sub mucous fibroid and prior failed IVF attempt is currently pregnant. Remaining three patients had ET done and are clinically pregnant. Conclusion: The use of PIFIS and UGET does appear to improve the pregnancy outcome in IVF. Support: supported by grants from OARS Foundation.*Corresponding author E-mail: denrele@tigger.uic.edu
--------------------------------------------------------------------------------
*Corresponding author
E-mail: halaszg@ana2.sote.hu

UNIBEN Teaching Hospital delivers first set of test tube babies

The authorities of the University of Benin Teaching Hospital (UBTH) have announced the delivery of two babies resulting from In-Vitro Fertilisation (IVF) or Human Sperm Retrieval and Embryo Transfer.

The announcement was jointly made by the Chief Medical Director (CMD), Professor Eugene Okpere, and the Programme Director, IVF Unit, Department of Obstetrics and Gynaecology, Professor A.A. Orhue, on Thursday in Benin City.

While presenting the second of the two babies delivered through the IVF process, popularly known as test-tube babies, the duo expressed joy at the delivery from the process which they described as unique.
Professor Okpere said the baby being publicly presented was a pregnancy resulting from August Batch of 20 couples from which eight pregnancies occurred.

He explained that the delivery followed an IVF treatment which took place at UBTH about 2:15 p.m. on April 28, 2008.

According to him, two of the women had miscarriage at two and three months, stating that the remaining six pregnancies had all attained viability and were now achieving delivery one after another.
Okpere added that the parents of the first baby reside outside Benin and were unable to be present at the occasion because they were only discharged on May 5.

He said the feat was the first ever achieved in UBTH in its 35 years of existence.

BABY AT LAST, 20 YEARS AFTER MARRIAGE

CLICK IN THE BRACKETS BELOW TO READ REALLY WONDERFUL BABY STORIES

(http://www.mybabytestimony.blogspot.com)

Mr. and Mrs. Michael Idiake in the last 20 years, waited on God to bless their marriage with a child. Last month their prayer was granted as they told Jibola Oyekunle

February 4, 2007 was another special day for Mr. and Mrs. Michael Idiake. It was singing and dancing galore at the Dominion Cathedral of the Redeemed Christian Church of God at Gowon Estate, Ipaja area of Lagos.

Idiake, 50, and his 41-year-old wife have had it quite rough in the last few years. But now, they have a special reason to be happy once again. Their joy was brought about by their baby, whom they had waited long to have for two decades. “We gave her many names which all have their various meanings,” said the excited father at the end of the dedication of their beloved baby to God.

“You can call her Osekweme, which means ‘ I am thanking God’ ; we also named her Osayande, meaning, ‘Season and time belong to God.’ The baby also shares the same name with her mother. “We also christened her Joy and Faith, which are also the names of her mother, my wife,” Idiake enthused.

He said further, “The word Joy, as the name implies, represents our happy mood. With her, God has brought permanent joy into our marriage. I personally chose her mother’s name for an obvious reason: it was my wife’s faith that kept us going at some difficult points in time when my mind became weak. In those periods, God made her to get stronger in faith and she kept reassuring me that we were close to God’s time, when He would answer our prayer and bless our marriage with a child.

“You know as a human being, it is natural to feel depressed when after waiting for so long a period of time, you find out that the situation still remains the same. Judging from experience, some similar situations that have broken up some marriage relationships were not as bad as our own. Yet, some couples have found it difficult to live through it. But I thank God for my life and that of my wife. Both of us happened to have known God closely before we got married. And after our marriage, we became stronger in faith. It has not been easy but our faith has really helped us.

How did the duo manage such pressure? Faith, Idiaka’s wife, who is a nurse by profession, responded: “Yes, there were pressures from my family and that of my husband. But apart from the faith we both have, there is a strong love between us. Two, my husband’s father loves me so much and throughout this long period that we had been waiting on God, he never allowed any of such pressure to outweigh the love my husband and I have for each other.”


*FOR CONTACT INFO ON IVF CLINICS IN NIGERIA, PLS CLICK ON THE FOLLOWING LINK: http://www.ivfnigeria.blogspot.com/

IVF SUCCESS STORY FROM MEDICAL ART CENTRE

Mrs. RD was a 45-year-old lady with primary infertility. One significant aspect of this case was that she had been in England for almost three years previous to coming to us. She had 7 IVF cycles with a pioneer IVF center and another 14 cycles with a private center making a total of 21 failed IVF attempts.

She was managed for some endocrine abnormalities that were discovered on examination. Mrs. RD was then given a preparatory treatment to enhance her fertility and prepare the uterotubal catheterization with special medication. She was to come for IVF cycle as soon as the period starts.

The period never came and she was found to be pregnant three weeks later. All she needed was endocrine management and the uterotubal preparation for rejection and enhancement of implantation. That was during her second month of consultation. She delivered a healthy baby girl.

(II)
Mrs. UG had infertility of 11 years standing. She had been to a clinic in England where the hope of pregnancy had been removed since the husband did not produce sperm. He had a congenital absence of the ejaculatory duct. She came to our center and evaluations confirm the findings from England. In addition we also discovered some endocrine abnormalities in the couple. They were both treated for the endocrine problem, and then prepared for IVF. The husband was sent to our colleague in Urology, Dr. Lawrence Rush and had Testicular Epididymal Sperm Aspiration (TESA). We were able to get a good amount of sperm cells that were stored frozen until the IVF cycle. The value of earlier hormonal treatment on sperm recovery cannot be overemphasized. At a later date the wife was then stimulated for IVF using the ICSI technique. Three of the four fertilized embryos were transferred to her. She became pregnant and delivered a baby boy.

IVF SUCCESS STORY FROM NISA PREMIER HOSPITAL

Nisa Premier Hospital was established in May 1996, with the vision of an International Centre of Excellence for Gynaecology and Infertility treatment.

A pioneering breakthrough in In Vitro Fertilization (IVF) was achieved and authenticated by the Federal Government in February 1998.
The hospital then achieved Nigeria’s first IVF Twins, Triplets and the first delivery from frozen embryos.

In April 2001, Nisa Premier Hospital teamed up with Nordica International of Denmark to jointly run, the “Nordica Fertility Centre", in Abuja.

The correct mix of manpower, standard equipment and environment has allowed us to sustain very good IVF, ICSI and IUI pregnancy rates which are similar to results obtained in top European centres. The overall success range is from 25-35% per attempt, but we have succeeded in more than 40% of women aged below 35 years.

IVF SUCCESS STORY FROM NATIONAL HOSPITAL ABUJA

National Hospital records six test tube babies in 2007

The National Hospital, Abuja on Thursday, said it had produced six test tube babies in 2007 through its newly consolidated In Vitro Fertilisation Centre.

It said the number of test tube babies was expected to quadruple in 2008.
The Assistant Director, Information Services of the hospital, Mallam Yahaya Sadiq, who spoke on behalf of the Chief Medical Director, disclosed this in Abuja.

Yahaya said that the centre, which was put in place last year by the government, had initial hiccups.

He however said that since its consolidation in 2007, the centre had produced babies for parents who could not ordinarily have children.
He said, “The most important achievement the National Hospital has recorded in 2007 has been the consolidation of the production of test tube babies in its new IVF Centre.

“More than six babies were produced in the first session, but in 2008, we expect the number to quadruple. Don’t forget that the National Hospital is the first government hospital to do this.

“In 2007, another significant achievement was the installation of the Magnetic Dissonance Imaging Machine, which is used to diagnose ailment in any part of the body.
“The hospital had also installed Gama Cameras for the easy and speedy diagnosis of cancer in the body.”

IVF is a technique in which egg cells are fertilised by sperm outside the woman‘s womb. It is a major treatment in infertility.It can also reduce the need for surgery on the fallopian tubes.

By Victor Sam, December 21, 2007

IVF SUCCESS STORY FROM ST IVES CLINIC LAGOS

FROM ST. IVES CLINIC LAGOS

Dr. Tunde Okewale, consultant obstetrician and Gynaecologist, St. Ives IVF and Fertility Unit speaks:

SUCCESS RATE: We calculate the success rate in two ways: the pregnancy and the take home babies. It is possible to have baby but not take home as in case of still birth. Our success rate so far is 50 per cent. We started the IVF unit in July (2007) and we have three on-going pregnancies. Since July, we have three cycles and the pregnancies are about 18 weeks, and we have new ones that have just tested positive, but until the pregnancies grow, we would not make any noise.

The success rate varies from hospital to hospital, some 25 per cent to 50 per cent. Over 60 per cent rate was recorded in India.

COST OF IVF: the more the number of people that offer themselves for IVF, the more there are clinics and the more the companies that produce the media will come into the country. At present there are none. We have to import all what we need and these cost more. For instance, in India and America there are many clinics and there is a lot of competition. All the disposables that we use are from India. But what we have in St. Ives, our cost is still the cheapest.

The reason is, part of the things that inflate the IVF cost are unnecessary investigations before IVF is finally arrived at. For most infertile couples, when they come to hospital, doctors would write down the list of investigations to conduct. Most of the investigations do not have anything to do with the success of the IVF. Most of the investigations would have been done by the patient somewhere else. But we still tell them to do it. You find out that infertile couples go around dong doing the same set of tests and everybody pretends they are doing something. All these add an extra cost. If you come to St. Ives and you have done some of the investigations in the last one year, we offer you direct, what is necessary for you in the procedure.

COMPARATIVE COST OF IVF: In the United Kingdom it is $4,000 to $6,000. In America $10,000 to $25,000. In St. Ives, excluding the cost of the drugs, it is N250,000. In other IVF clinics around, it costs about N500,000 to N600,000. The cost of drugs is from N70,000 depending on the drugs.

Culled from P.M.NEWS Thursday 8 November 2007

IVF SUCCESS STORY FROM RODING CLINIC, LAGOS

FROM RODING CLINIC, LAGOS

A COUPLE who had been childless for eight years have become beneficiaries of in-vitro fertilisation with the birth on December 29 2002 of test tube triplets.
The triplets, a boy and two girls, were born after 35.5 weeks of pregnancy to Mr. and Mrs. Emmanuel George, aged 38 and 32 years, at Roding Medical Centre, Lagos.
The boy who weighed 1.9 kg and the girls, 1.7kg and 1.5kg were delivered through caesarian section after a comprehensive IVF treatment by a team of five doctors.
The team led by a consultant obstetrician and gynaecologist, Dr. Faye Iketubosin, included Dr. Adewunmi Adeyemi-Bere, Dr. Fidelis Akabosun (both consultant obstetrician and gynaecologists); an embryologist from the United Kingdom, Mr. Bryan Woodward and a resident embryologist, Miss Omowunmi Taiwo.
Dr. Iketubosin disclosed that his team recorded 50 per cent success rate with the first set of couples it treated with the IVF procedure. FOR THE FULL DETAILS, PLEASE CLICK ON THE ADDRESS BELOWhttp://www.news.biafranigeriaworld.com/archive/ngguardian/2003/jan/17/article07.html

IVF SUCCESS STORY FROM OMNI FERTILITY CENTER

FROM OMNI FERTILITY CENTRE

With a little over N1million, a couple’s five-year search for the fruit of the womb has become history. Late last year, the couple smiled home with a bouncing baby boy delivered normally at the OMNI Advanced Medical Centre in Lagos.
A single lady in her 30s graciously carried the pregnancy at the cost of N200, 000, thus ending the couple’s nightmare.
The N200, 000 was compensation for the lady that carried the pregnancy, while the balance paid was for medical bills and cost of In vitro fertilization.
The lady that carried the pregnancy on behalf of the couple hails from the South Western part of the country and lives in Lagos, while the couple from the South East, reside in the east. But the hospital ensured anonymity between both parties.
The couple who were referred from the east had indicated their interest to have a baby through the procedure, following medical indication that the surrogate mother was unfit to carry a pregnancy to term. It took the hospital one year from the time the couple showed interest to secure a match for the contract.

In the last two years, over 20 couples have approached the hospital for the same purpose including three Nigerians resident abroad. However, only two have had their dreams actualized. Many were unable to continue because of the cost.

Leader of the medical team that performed the process, Professor Osato Giwa-Osagie tells the story:
“We have successfully performed a surrogate pregnancy. We have had two experiences during the last five years. One was through IVF while the other was through artificial insemination. The most recent was through IVF.”

Culled from Sunday Sun, March 5, 2006

IVF SUCCESS STORY FROM NORDICA, LAGOS

FROM NORDICA CLINIC LAGOS, NIGERIA

History was made on September 14, 2004 when the first successful IVF baby, Julian Oluchukwu (God’s work),the first baby conceived through a combined ART procedure of IVF/ICSI at Nordica Lagos, was successfully delivered through a Caesarean Section.

The parents, Emmanuel Onwudijo and his wife Francesca have been married since July 1999.
Emmanuel Onwudijo, 37, indigene of Asaba, Delta State, and staff of Nigerian Breweries says, “Since we got married in July 1999, we have run from pillar to post, been in and out of hospitals and undergone so many tests than we can remember. We tried so many things, went to several hospitals, herbal homes and churches, but nothing worked until we came to Nordica Fertility Center in January of this year and there was a transfer that resulted in the birth of this our baby.
If I had known something like this could be so readily achieved, I probably would have done it during the first year of my marriage, but then I always thought I couldn’t afford it and was actually planning to save for it, but eventually it was my wife who took up courage and convinced me to do it. She saw the advertisement on the internet and we went down to the hospital for the procedure.
Francesca Onwudijo, 33, indigene of Ibuzor, Delta State and Confidential Secretary with African Petroleum (AP) : “…I would like to advise women battling infertility to try this assisted reproductive procedure. Although I’ll admit that most women are not aware of its existence or capabilities. I believe doctors and perhaps the media should reach out to Nigerian women, churches, hospitals and other relevant organizations to educate them about assisted conception.”

Culled from ‘Nordica News’

IVF SUCCESS STORY FROM HOPE VALLEY CLINIC

FROM HOPE VALLEY CLINIC, NIGERIA

“God has done it again! He made it possible one more time! My God has done it again! I feel elated and accomplished.”
These aren’t words of exhortation spewing from a Pentecostal pastor’s mouth. Rather, they are from a fertility specialist Dr. Olugbenga Ogunkoya, a gynaecologist and Managing Director of Hope Valley Clinic located on Etim Inyang Crescent, Victoria Island Extension, Lagos, excited at the successes recorded in his clinic in assisted reproduction.

Such successes are common occurrences at the clinic. But what is not very common are pregnancies in women who are over 42 years of age, even with the help of modern techniques such as in vitro-fertilisation. But this uncommon breakthrough has been achieved in a 45-year old lady through in vitro-fertilisation techniques, using her own eggs. It is probably the first such breakthrough in sub-Saharan Africa, using IVF technology at such an age.

Ogunkoya told The Guardian that through Assisted Reproductive Techniques, many couples in Nigeria have become surprised, happy parents.

And the techniques are varied. The one applied ina particular couple depends on their specific needs. However, each technique or the modalities used in applying it, must be of international standard. And success in the field, he says, depends mainly, if not solely, on two factors, namely equipment and expertise.

“Don’t waste money traveling abroad, Dr. Ogunkoya advises. “It is all here at home. We have brought the technology to your doorsteps at reduced cost and comparable success rate. They don’t have to travel abroad. They don’t have to pay airfare and accommodation fees overseas. But more importantly, they don’t have to leave work for weeks to travel abroad for treatment.”

Culled from the Guardian, Saturday February 25, 2006

IVF SUCCESS STORY FROM BRIDGE CLINIC

FROM THE BRIDGE CLINIC, NIGERIA

“Initially it was like a joke. My husband pleaded with me to see reason and believe in God, even though I was scared not knowing what the outcome would be. But the good Lord did for me and my family through this wonderful clinic. I am now six months and some weeks pregnant with three babies that are kicking, full and bubbling with life, and to tell you how wonderful it has been, I’ve not been admitted for any serious problem. The whole process has been natural.”

This is the testimony of a woman who recently benefited from the wonders of In-vitro Fertilization (IVF) or test tube baby technology. The woman in question – since safely delivered of her bundles of joy – along with her spouse, are amongst several scores of couples that have successfully overcome the problem of delayed childbearing, thanks to the commitment of a group of health professionals to fertility management at the Bridge Clinic Ltd., Lagos – Nigeria’s first, focused assisted conception clinic. Through comprehensive infertility evaluation, diagnosis, treatment and general provision of the best medical and scientific services currently available in the field anywhere in the world, and its bid to reduce the high rate of infertility in the country, the Bridge Clinic has been at the forefront of new developments within the field of infertility. It is credited with the first pregnancy in Nigeria attained with Intra Cytoplasmic Sperm Injection (ICSI) and Testicular Sperm procedure. The first pregnancy with ICSI and Ejaculated Sperm in addition to the first pregnancy by Gestational Surrogacy was achieved at the clinic.

Culled from Vanguard, Tuesday April 29, 2003

IVF SUCCESS TIPS AND HINTS

GENERAL IVF HINTS

The main IVF hint is to pamper yourself! An IVF cycle is a very stressful thing and anything that helps you through it without harming a potential baby is okay!
Decide ahead of time where and how you want to get news each day for how much medication to take, etc. This is especially important on the big days of finding out about fertilization and pregnancy test. Those days can be tough if things don't go well! You might want your partner or a good friend around!
Rest is very important, even before transfer. All those developing eggs are taking up a lot of space and energy.
Try to get to know the people who are treating you so you aren't just another patient.
It may help to make a friend or two who is at the clinic for IVF, too.
Bring a book, magazine, or hand-held game with you to appointments. You might be there for awhile.
Make sure they do a mock transfer prior to the actual embryo transfer. This is not fun, but it is necessary that they know the depth of your uterus so they know where to put the embryos.
Do whatever it is you need to do to make this manageable for you. (Naps, backrubs, favorite foods, etc. Be very good to yourself during this time.)
Small amounts of alcohol will probably not adversely affect you or your eggs, but caffeine has been shown to affect fertility, even in small amounts, so try to avoid it.
Buy a good, up-to-date fertility book and try to find out as much as you can about the IVF process beforehand. There are always new advances, so try to keep up with the changes in techniques.
Always ask your RE a lot of questions about your progress, what the numbers mean, etc. That is what they are there for! Also, you should be able to get copies of anything in your file (like your follicle growth and E2 test results and fertilization report). The more knowledgeable you are, the more likely they are to openly share information and take time to explain.
It can be very comforting to find someone, either in cyberspace or in person, that is in a similar situation (factor, cycle) that you can share stories and progress with.
Try to keep a very flexible schedule the week before the pregnancy test. Some people start their periods early and are stuck somewhere where they cannot just be alone and grieve.
Start taking a prenatal vitamin prior to your cycle. At the minimum, you should take 400mcg of folic acid daily for three months before conception to reduce neural tube defects such as spina bifida. The FDA suggests 800 mcg during pregnancy, so it is best to look for a prenatal with that amount.
Some clinics believe that a diet that is high in protein and low in salt and potassium can help you avoid hyperstimulation. Gatorade is a poor choice of fluid to drink to prevent/control hyperstimulation because it contains large quantities of salt. Water or Pedialyte is best, in quantities recommended by your RE. At a certain stage of OHSS, too much fluid can be detrimental.
Remember that some people get very uncomfortable and even have a lot of pain as the ovaries are stimulated. This may get worse as the follicles ripen. Loose clothing may help.
Don’t worry about your weight unless you are tracking it for hyperstimulation purposes. Unless you hyperstimulate, most of the weight gained during an IVF cycle usually disappears once your period starts and if you are lucky enough to get pregnant your weight won’t matter anyway!
If you are not taking birth control pills the cycle previous to your IVF, be sure to use birth control (no matter how ridiculous it may seem). Usually, you will start Lupron before you would know if you conceived or not and Lupron is very dangerous to a developing baby.

The extra fluid your developing follicles are taking up and being NPO before retrieval can sometimes cause constipation. Increasing your consumption of fiber and fluids as you approach egg retrieval may help alleviate this.
Don't talk to your partner too much about his role. This may cause him extra anxiety during an already stressful time and the extra stress can aggravate the performance anxiety that men suffer on the day of retrieval.
If this is your first IVF, be conservative about the number of blastocysts or embryos you transfer, especially if they are of very good quality. You may find that fertilization was your big hurdle and now that is complete you are on your way!
If you have had more than one failed IVF, consider changing clinics, especially if your doctor doesn’t have a change in protocol planned.
Remember that all cycles are not alike. Using the exact same protocol on another attempt even at the same clinic can lead to different results.
Some clinics use medications to prevent embryo rejection (low dose corticosteroids, etc.) which may help your chances of success. Check with your clinic to see if they think it would make a difference for you.
Always repeat the directions for medication to the nurse and get your E2 level. If something seems wrong or unclear, ask for clarification.Prior to the stimulation part of your cycle, make sure you and your partner discuss how many embryos or blastocysts you plan to transfer. (While remembering that your plan may have to change because of circumstances of the IVF!) If you think you will have extra embryos beyond what you want to transfer to avoid high order multiple risk, decide whether you will freeze them or discard them. Decide whether you would consider selective reduction. These are not things to discuss under pressure right before transfer!

POSITIVE THINKING AND DE-STRESSING HINTS
Try self-hypnosis tapes to keep your mind on warm and fuzzy thoughts.
Keep social contacts to a minimum.
Use the cycle as an opportunity to focus on yourself and on each other.
Try to relax and think positive.
For sanity sake, review the odds of success ahead of time. Some people try to stay as neutral as possible to avoid major ups and downs, others try to stay hopeful to help make all the procedures easier.
Try doing things to take your mind off the process. Visualization may just make the obsessing worse.Try to manage stress in whatever way works best for you. Some suggestions are relaxation or deep breathing exercises, yoga, or meditation.

EGG RETRIEVAL AND EMBRYO TRANSFER HINTS
You will probably need at least the day after your retrieval off of work. You may be in pain or you may just be tired and need the rest. Levels of pain post-retrieval vary from person to person. Some people may have little or no pain and others may have a lot of pain. Be prepared for both extremes.
Prior to retrieval, remind your partner (or the nurse if your partner isn’t there) to keep pressure on your IV site for you once it is removed (especially if you are taking baby aspirin or heparin). You will still be a bit woozy and may not remember.
Often the medication used for sedation for retrieval is one that causes amnesia, so don’t be worried if you cannot remember everything that happened. It is disconcerting, but not a problem. Remind your partner about this so that he doesn’t expect you to remember everything!
Some people have reported that the sedation used for retrieval can cause nightmares.
A heating pad on your belly may help with pain after egg retrieval.
If you are concerned about nausea during the retrieval, ask for something to stem nausea. A drug called Phenergan is a mild sedative and also will help keep you from vomiting or having nausea from other medications.
Have someone there to drive you back from retrieval and transfer.
Make sure that you tell them about any allergies. You may be given a narcotic pain killer afterwards. If you have problems with narcotic pain relievers, you can ask for a non-narcotic pain killer which may work just as well for you.
Eat a low fat diet for a few days before retrieval. Sometimes the embryos are stored in a vial of the mother’s blood, and they don't react well to fat (or is it lipids, or whatever), which can temporarily rise as a result of high dietary fat intake. (You can check with your clinic ahead of time to find out whether they use your blood or not.)
Some clinics suggest you avoid soaps, shampoos, and perfume on retrieval and transfer day as embryos can react poorly to odors.
Don’t wear fingernail polish to retrieval. Some clinics use a clip on your finger to read oxygen saturation levels during retrieval and fingernail polish will interfere with that.
Remember that not every follicle contains an egg, so don't be surprised if the number of eggs harvested is less or more than the number of follicles you've been watching develop.
If you have any significant pain within the first couple of days after retrieval, something may be wrong. LET YOUR CLINIC KNOW IMMEDIATELY! Some people have had a blood vessel nicked which led to internal bleeding so they had to go to the hospital for monitoring.
You may find it very hard to lay still for the required time after transfer (this varies some from clinic to clinic). You may want to bring extra pillows to make you comfortable, or some music to distract you.Many clinics aren't requiring *any* post-transfer rest, as recent studies indicate it has no impact in success rate. If it helps you feel like you are doing everything you can, rest as much as you feel necessary.Most clinics recommend you avoid the following after transfer: swimming, saunas, baths, intercourse, orgasms, lifting over 10 pounds, exercise that breaks out into a sweat. So, look forward to taking it easy!