Oladapo Ashiru is a professor of Anatomy and Reproductive Endocrinology and a specialist in Assisted Reproductive Technology (ART), of which Invitro Fertilisation (IVF) is a part. Ashiru who is
also the medical director, Medical Arts Center, Ikeja is an Adjunct professor at the University of Illinois, Chicago in the United States (U.S.) In this interview with APPOLONIA ADEYEMI, he highlights how scientific procedures used to tackle infertility in advanced world is now being embraced by Nigerians who need the services. Excerpts:
REcently, A 56 year old Nigerian woman gave birth in Lagos. Whether the reproductive process is through normal delivery or invitro fertilisation (IVF), which is the assisted method, is it appropriate for women in those age range to get pregnant and go through deliveries process ?
When Adam and Eve were in the Garden of Eden, everything was easy for them. They had children with ease. Conception was with ease. So, was pregnancy and delivery.
From the work I have done in comparative anatomy, the other animals have children so easily because they have no sin. Look at the rat, the rabbit, the pig, their reproductive system is so efficient, but when Eve went to the tree of knowledge and ate the apple, God told them that it is with difficulty that they will feed their family. So, man has to struggle to feed his family.
And then, it is said, ‘Even to conceive, it will be with difficulty. And beyond that, to even deliver, it will be with pain in labour.
However, because God always loves, due to his divine intervention, we are brought closer to him. That divine intervention and divine love has made it such that people are now able to have babies with ease. And some are able to have it with assistance.
However you may look at it, there is nothing that is happening in this world in the field of science that is not with the permission of the Almighty God.
Do doctors, have such beliefs?
I believe and you have to believe that even in this field (science) because when we go through this field, you will know that there is still the Almighty in his infinite mercy and power.
Why do I say that? When you look at this 56-year-old woman, irrespective of the age, if God wants to help, he will give the entire wherewithal to do it.
What I am telling you is that when we have 10 patients who go through IVF, and you give them the same type of treatment, and the uterus is very prepared, and you have embryos that are grade A embryos, and you put the embryo in each of them, the law of nature will just show.
In one particular person, there will be 10 eggs, and nine of them will fertilise and become good embryos.
In another, one, there may be 10 eggs and only two will fertilise. You have done the same treatment and in the same condition.
Beyond that, when you now put three embryos each in them, in one, all the three will grow into triplets. In another one, just two will grow into twin. In one, only one will grow and in another, there will be nothing.
Beyond that, you may have one embryo that grows and later it will split into two. That one is no longer science. That is nature. That is God in his infinite power.
Specifically, in science, is there age limit for women seeking IVF treatment?
There are some things you have to recognise. The age limit is the physical condition of the woman. If the woman is physically able to carry the pregnancy, she can carry it.
Some will go through using their own eggs and some will use donor eggs. There are things we can do to restore some egg reserve in a woman, that is to help to reactivate them before you can get some eggs from them.
You will worry when a woman at that age is getting into pregnancy. There is the possibility of abnormalities and pre-implantation genetics diagnosis helps to eliminate that.
If advancing age is a factor in IVF treatment, would it not be a risk for a woman in that age to go ahead and carry pregnancy?
In terms of carriage, what you need to do is to look at the physical condition of the woman. You look at the cardiovascular and the renal conditions and see whether they are fit. Somebody may be 42 years and may not be fit to carry pregnancy. Such a person can be advised to have a gestational host. This is what is called surrogacy.
Similarly, somebody may be 52 years and will be fit to carry pregnancy. So, it is for the doctor to look at it.
What are the risks elderly women who are not fit to carry pregnancy face?
They may end up with renal problems, high blood pressure or cardiac problems. All my patients, both the obstetricians in my facility and I monitor the pregnancies for them until the babies are delivered because high risk problem could be water and salt retention.
Pregnancy in elderly people has its own limitation, but with good medical care, most of our patients have been able to have babies in their late 40s and early 50s.
The risk involved has to do with aging. Usually, for those people who are coming this far, they have the financial resources to go through it. And then, because they have been going through this kind of process before, they are already accustomed to medical help. So, such people would have prevented any possible risk because already, they are people who care about their health.
Any risk in pregnancy will not show overnight. They could go into premature (early) delivery. So, you have to give them bed rest.
I have some patients in their late age and they are having twins and triplets. So, they are admitted into the hospital. Once we see the signs, we get them admitted as early as may be, 20 weeks. So, they are observed in that process. They are people that are very careful. The whole process may cause them money but if that is what they want, it is fine.
Most people who go for IVF treatment in our environment do so at an advanced age. Is it advisable to seek this service at earlier age?
Yes, you can come for IVF even at late 20’s. IVF is meant for a purpose, the original reason that IVF came into operation is for women who have blocked tubes. If the tubes are blocked, there’s no way the sperm can reach the egg to cause pregnancy. In the early days, they go and operate and repair that tube. That is almost being left aside, to just go in, get the eggs, fertilise them and put back the embryo into the tube.
The second reason IVF has come into play are for men that have low sperm and thereafter, other reasons come along the line.
The more IVF is into operation, the more perfect we are in it and the more efficient it is becoming in terms of predicting pregnancy. So, it is coming to a point were a woman may even chose IVF and get out of it.
In our center here, when we see young couples, we encourage them to try and have their pregnancy in the least invasive way like through the natural way. We counsel them to use some low tech procedures like giving them medication to ensure that they ovulate and the sperm increases, monitoring the time of ovulation and telling them to go and meet in their private time to have intercourse or getting the sperm and injecting it into the uterus or the tubes. Those are the low tech procedures. However, if the tubes are actually blocked, then, they go for high tech.
If they are approaching 40, we advise them to go straight for IVF.
Will you say IVF has come to stay in our environment?
It is. Those who need it, know they have no other option. The other option to IVF is to do nothing because if the sperm is low or the tubes are blocked, there is no way there is going to be pregnancy. If somebody is in her late 30’s or early 40’s and has tried all these things and it’s not working, she needs to go fast to IVF and the beauty of this is that at an early age the success of this is higher.
Many people in our environment who have children through IVF are secretive about it and some also belief children from this process are not normal. Are IVF babies normal children?
They are normal as any other kid. The first IVF baby, Luis brown has had her own baby and she had it naturally. There is nothing wrong with IVF.
It is only in Nigeria that we have this type of problem. In America, people let you know when they are sick. They tell you, ‘I have glaucoma. I have cancer of the colon. They tell you the type of medical condition they have. The only ailment Nigerians are able to say they have is headache, but beyond that, Nigerians are not willing to communicate and it is not helping.
Some religious and pro-life groups do not agree that God has a hand in IVF. What is your take on this?
I don’t want to get into any religious argument, but if you look at the Catholic Church, they do not believe in contraceptives. If you look at the aspect of going to the moon, did they believe God has a hand in it? Those trips that were made to space have enabled us to use cell phones that every body is using including religious groups.
Any science advance is meant to help mankind. For example, this IVF technology is now going to be used for people who have some serious diseases. It’s all part of divine love and divine help.
What are the challenges professionals in the field of IVF face?
I think the major challenge we have is that we need the support of government.
The other day, I brought in a media equipment for IVF, which is used to wash sperm. It is not for human consumption and somebody from the National Agency for Food and Drug Administration and Control (NAFDAC) seized it. The patients were going to go into the procedure the next day. It had already been delayed due to the delay in air travel because of the volcanic ash. Somebody there asked us to bring N40,000 for something we bought for $600, which is about N40,000. I could not go to iron it out with them because the patients were already waiting to use the material and I was in the cycle of (an operation).
These are the kind of assistance we need. We need more co-operation and more understanding from the government.
What is number of IVF babies globally to date?
I think it should be approaching three million worlds wide, as at 2006. I am sure we should be approaching four million by now. IVF started in 1978 and we had our first IVF baby in Nigeria in 1989.