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When IVF Fails, Other Therapies Can Help

Friday, December 13, 2013

REGULATING IVF TREATMENT IN NIGERIA


InVitro Fertilisation (IVF) is increasingly becoming a
method of bringing joy and laughter to fertility challenged couples all over the world. According to recent reports over one million babies have been conceived through the test-tube method globally with 40,000 taking place in Nigeria.

Many marriages which had hitherto hit the rock in Nigeria due to the problem of childlessness have been restored. So, it’s all kudos to the technology and the experts who have been involved in the service, particularly in Nigeria.

However, for us to continue to enjoy the benefits of the life giving  technology, it is important, doctors and other stakeholders look into some disturbing practices that have crept into the scene. There seems to be no regulatory measures concerning the practice as a result of which incompetent and unethical methods are now the order of the day.

I recently heard a story of how a donor egg was used for a couple without their consent. Fortunately, the woman had a little knowledge of IVF procedure and was able to detect that something was wrong. She knew that for an embryo to be produced, a woman’s egg should be collected and fertilized with a man’s sperm.
But in their own case, her husband’s sperm was collected after which she was asked to come to the clinic for embryo transfer. She was surprised and wanted to know how the embryo came about without her egg. What followed was accusations and counter accusations between the couple, the doctor and his staff which eventually ended at the police station.

A lot of other cases of unethical practices abroad. Practitioners do all kinds of things to convince couples that they are the best and live them to their clinics, just to make money.

In 2012, the Association for Fertility and Reproductive Health (AFRH) of Nigeria, approved minimum standards for clinics offering Assisted Reproductive Technology (ART)/IVF in Nigeria.

The guidelines which focused on the type of personnel that can operate in an IVF Clinic, the qualification, and experience necessary for such clinic operations also outlined the number of embryos that can be transferred in a treatment cycle. It recommended a maximum of two embryos for patients less than 30 years old, three for 31-38 years old, and not more than four for those above 38 years. It also required and mandated all IVF centres to keep records of procedures and have informed consent.

Unfortunately, accounts of couples who have undergone IVF treatment show that what obtains in many clinics is far from the recommendations of AFRH. In some cases, like the one I narrated earlier, the details of the procedure are known only to the doctor. Capitalising on the ignorance of some couples and their desperation to have their own children, the doctors manipulate the procedure, throwing all ethical guideline over board to achieve results. Many of them insert up to seven fertilized eggs instead of the recommended numbers inspite of the dangers it poses to the mother and the baby.

What about quacks who have hijacked the technology. At a public event recently, the Chief Medical Director, The Bridge Clinic, Dr Richard Ajayi, lamented that more than 60 per cent of people offering IVF service in the country do not have the facilities and qualified personnel for it, but have continued to do so in order to get money from patients.

He said that due to the perceived financial benefits and patronage, doctors and health workers who know little or nothing about IVF have continued to take advantage of couples in need by offering services they lack the right infrastructure to offer.

We all know that IVF treatment is very expensive. Infact, to go through one treatment cycle, some couples have to sell their properties or borrow money from different sources. It will therefore, be intensity of those  in authority to allow these couples to be ripped off by doctors, both the qualified and unqualified ones. The  procedure for IVF and the cost should be standardised.

Strict regulation and monitoring of IVF activities in the country is the only way to protect the patients and eliminate quacks from the system. It will also serve as a check for medical practitioners who have been making false claims to draw more patients. As Professor Osato Giwa-Osagie, co-pioneer of IVF  in Nigeria advised, “we must regulate how many embryos should be transferred. We must determine what qualifies you to operate an IVF clinic and what should be the qualification of doctors who offer infertility treatments.”

In addition; couples opting for IVF should be educated properly on the procedures for the treatment. Ignorance, can be very dangerous to the mother, the baby and can lead to continuous waste of money and emotional trauma.

 

By Calista Ezeaku

Wednesday, December 11, 2013

EXPERTS CALL FOR REGULATION OF IVF PRACTICE


IVF experts in the country have raised the alarm that due to lack of regulation, childless couples are being exploited in fertility clinics.

Invitrofertilisation (IVF), a method of conception for couples that cannot have their own babies, is becoming increasingly popular nowadays. So far, over one million babies have been conceived through the test-tube method globally.

Even in Nigeria, where many couples who have fertility challenges are yet to access IVF, over 40,000 babies have been born through the procedure.

Infertility among women and men is on the rise, hence the growing popularity of this procedure.

However, experts have raised the alarm that due to lack of regulation from government, fertility treatment in Nigeria is being infiltrated by quacks.

According to the Chief Medical Director, The Bridge Clinic, Dr. Richard Ajayi, more than 60 per cent of people offering IVF service in the country do not have the facilities and qualified personnel for it, but they continue to do so in order to get money from patients.

Ajayi said that due to the perceived financial benefits and patronage, doctors and health workers who know little or nothing about IVF have continued to take advantage of couples in need by offering services they lack the right infrastructure to offer.

The procedure is not cheap and it depends on one’s location in the country. A round of IVF goes for between N 500,000 and  N900,000.

He said that in addition to knowledge, the state of medical equipment and facilities in an IVF clinic could determine the success of an IVF procedure.

He said, “If you claim to be an IVF expert and you don’t have the right equipment to check if the sperm you have collected from the husband is fertile or the eggs you have collected from the woman are good, then you have offered a sub-standard service.

“If you do not have the right incubator or freezers to ensure that the eggs you collected are properly preserved and stored, then you have exploited your patient.

“If you do not have the machine to ensure that you transferred the right embryo into the womb, then how do you know that it would survive? For a round of IVF to be successful, a clinic must have the right laboratory.

“How many IVF clinics have the personnel and equipment for this? How many women even know this?”

Ajayi noted that because government is yet to see infertility as a public health concern, it has also failed to regulate IVF treatment.

He added, “Some doctors and even nurses claim to be doing IVF. And because it is not regulated, we cannot police or prosecute anybody. So patients are just paying for services that are not rendered.

It is so bad that some doctors even offer money-back-guarantee for IVF. They are marketing it, knowing well that it is not every woman who is infertile that needs  IVF.”

Ajayi stated that this infiltration of quacks in fertility treatment has increased the number of Nigerians travelling abroad for IVF treatments that is available in the country.

He said, “We cannot allow this to continue. Many women have lost millions of naira to quacks in the name of IVF. They are now confused as to where to go because they have done it in one or two clinics in Nigeria and it failed.

“So, it is those who can afford it that can even travel to the United Kingdom for treatment. It is another form of medical tourism that should be discouraged.

“Government must regulate it to protect Nigerians and also stop the millions of naira they spend in foreign hospitals on IVF when it can be done here.”

Professor of Gyneacology and Obstetrics at the Lagos University Teaching Hospital, Idi-Araba and co-pioneer of IVF in Nigeria, Osato Giwa-Osagie,  agrees with Ajayi that lack of regulation has also encouraged unethical practices, such as the transfer of multiple embryos in spite of the dangers it poses to both mother and child.

Giwa-Osagie said that though the ideal practice was the transfer of a single embryo to reduce complications and health risks, many fertility clinics in the country continue to transfer more than two embryos.

According to him, multiple pregnancies has an increased chance of resulting in miscarriage, premature birth and  the mothers often experience a lot of complications including high blood pressure, especially in Nigeria where there is poor maternal health care.

Giwa-Osagie said,“ Multiple transfers are also more likely to result in premature birth  and premature babies are more likely to have congenital problems like cerebral palsy or birth asphyxia. But the practice now is that women who have conceived through IVF have twins, triplets and even quadruplets.

“These doctors endanger the lives of the mother and the babies because when you transfer more than two embryos, you may have more than two babies. When you have three, four babies or more, the complications for the mother and babies are much higher than when you have one.

“In exceptional circumstances, the people who are over 40 may take three because their fertility rate is low. But people should not transfer more than two.”

While canvassing the regulation of the procedure, he noted that such would serve as a check for practitioners who have been making false claims to lure fertility challenged couples to their clinics.

Giwa-Osagie said, “Many claim that they have 60 per cent pregnancy rate when in actual fact it is 25, just to entice women to patronise their clinics. But if it is regulated, we can verify such claims by the number of babies that are born and it will form a basis for licensing of practitioners.

“We must regulate how many embryos should be transferred. We must determine what qualifies you to operate an IVF clinic and what should be the qualification of doctors who offer infertility treatments”
 
by Bukola Adebayo

Tuesday, December 10, 2013

CHANGING IVF’S ELITIST VENEER


Tunde Okewale was writing his school certificate when the first test-tube baby was born. So it seemed fitting he would aspire to be a gynaecologist. There is an equally-compelling tale about Okewale, medical director of Lagos-based St. Ives Specialist Hospital. He runs a programme that makes the otherwise expensive fertility treatment accessible to couples for whom that alternative may have been shut. Lanre Odukoya writes


Speaking on the vision that has kept him in business, the chief medical director of Ives Hospital, Okewale said: “First of all, I’m an obstetrician and a gynaecologist. The job of a gynaecologist is basically women’s health; that’s what I was trained for. I was trained at the Royal College of Obstetrics and Gynaecology in the United Kingdom before I came to Nigeria. When I returned to Nigeria, I had a choice of floating a general clinic but I decided to focus on the area of my strength.

So, we started the hospital by just being a women’s hospital. Over time, the women started bringing their children, so we brought in the pediatricians and it became a women and children hospital and that’s our core area of practice. But along the line, the women would also bring their husbands; that’s where the family healthcare side of it evolved. Over the years, we found out that reproduction is a very big part of a family survival. We saw so many couples coming to the hospital for cases of reproduction, so it became a charity part of our practice. We treat women with fertility problems up to the stage of IVF at present.”


He recounted the story of a 53-year-old woman who recently benefitted from his intervention at no cost at all. “Fortunately for the woman, at the time she came here, we were doing our annual half-discounted price promo for IVF. We have an NGO arm, Ives Medicare Foundation. At a specific month of the year, our partner would subsidize the cost of IVF for those who want to do it in that particular month. The reason for that is that quite a sizeable number of women who require IVF cannot access it because of the cost. So, increasingly in our environment it was becoming an elitist kind of intervention. I guess it’s quite expensive to do IVF and that’s the reason for this intervention once a year. But in participating in the promo, they still pay us our money, but as far as the patients are concerned, they’re paying half price.


“Basically, what the foundation is telling us is that, treat this people and come to us for the bills. So, there’s that program in place and last September when that particular one was being done, a woman came along but couldn’t even come up with the half price that was advertised for IVF then. In a practice like this, most of the times, you rarely come on a one-on-one contact with the chief medical director until the last minute; you would have probably seen the other doctors or nurses. She was very fortunate that I was the first person to see her when she came that fateful day. When I listened to her story and after proper counseling because of her age - she was 53 - we decided that the foundation should pay half of the price and we as an organization will pay the rest. That was what kind of intervention we gave to her. IVF is not hundred percent certain but I think God just honoured her by making success of that story.”


Like many fertility experts, Okewale offers a grim prognosis on the gynaecological situation in Nigeria. “About 50 percent of all gynaecological consultations in Nigeria now have to do with infertility. There are other issues like fibroids and the rest of them, but even the bottom line of the fibroid, what people are saying in effect is that they cannot have children. So, infertility has suddenly assumed big proportion of all gynaecological consultations for obvious reasons. The society starts counting the months for every couple that gets married and when pregnancy is not seen after a short while, they put the couple under tremendous pressure. The pressures come from the family members, friends, acquaintances and so on.”


But he adds that many causes of infertility which inadvertently give rise to the need for IVF are preventable. “The first thing is that if you understand why infertility occurred, then it’s easy to prevent those causes. Generally speaking, there are five basic requirements for women to get pregnant: the first requirement is that the man must have adequate sperm of good quality and quantity. At least the cells in the sperm must be a minimum of twenty million. The second requirement is for a couple to know when their fertile period is, that is the time the woman is ovulating. The third is that the inside of the woman’s womb must be able to accept and keep the pregnancy. So, there must not be any problem inside the womb that will disturb the pregnancy. This is where the issue of fibroids comes in. The fourth is that the woman’s fallopian tubes must be open so that the eggs can enter it and meet with the sperm. It’s like a conduit pipe that connects the woman’s eggs and the sperm. Finally, the woman must produce quality eggs every month.”


About how long a woman should monitor these developments before she comes for consultations, the demure physician said: “Ideally, if a woman comes for any gynaecological consultation within a one month cycle, all those five requirements could be known. From the day she begins her period till when the period ends, the test to check out those five things would have shown results. And a solution would be proffered straight away. The mistake in Nigeria is that people think the same solution applies to all cases of infertility. But if you look at those five requirements, you’d realize that they’re different. At the end of every investigation of infertility, the treatment you give to a woman who is not producing eggs is different from the one for the woman whose tubes are blocked. So, IVF is not suitable for every woman who is trying to get pregnant.

There are indications specifically in the history that will say, your own best solution is IVF, like the case where the two tubes are blocked, IVF is the perfect solution. If the sperm count is low and it’s about five million, IVF is the best. The minimum sperm count here is twenty million, but if you have about eighteen to nineteen million, drugs can work at that level.”
As promising as it always seems though, there are reported failures in IVF procedures. In the event that all these conditions are met and a woman still cannot conceive, he explained: “In about 10 percent of women who come for fertility test, at the end of the month when you check those five things, there may be nothing wrong.

In such situations, we’d say they have what we call unexplained infertility and there’s a treatment for that. Basically, what unexplained infertility means is that the sperm and the eggs are not meeting for some reasons. It could be that the mucus in the cervix is blocking the sperm and so on. And there are specific treatments for that. Unexplained infertility is a well recognized situation which affects up to about 10 percent of the married couple. Another problem in our environment is stress. A lot of couples are not even making love at the right time to even allow for pregnancy because of their work schedule. Maybe they had been living in Nigeria and it’s been all work; they would go on holidays for a few weeks and when they return, they are pregnant. So, change of environment especially if there’s no problem, can aid the healing process.”


In-Vitro Fertilization essentially is fertilization that occurs outside as opposed to the more traditional In-Vivo Fertilization which occurs inside. “What we do is that we bring out the woman’s eggs into a separate dish in the lab. We treat the eggs and when the man produces the sperm, we treat the sperm by separating the good from the bad ones. And we use that sperm to fertilize the eggs in the lab when the fertilized eggs have started growing in the lab. Then we place the embryo back into the woman’s womb. When this is done, you bypass the tubes totally because you don’t need them now,” he said.  


“In IVF, the last frontier that has not been cracked is that if you interview some people, they would tell you their IVF failed and that it never worked until the third attempt. You can place four embryos that look equally good inside a woman’s body while the body would accept one and reject the three or accept two and reject two sometimes or accept all the four and sometimes not accept any. It’s still a mystery. And this is what everyone is working on the world over. Any doctor who predicts a hundred percent success of any IVF procedure is obviously lying.”


Okewale grew up at a time when, as he recalls, “people were complaining of austerity in the late 1970s”.  But he notes nonetheless that things were more organized. “My father was a broadcaster with WNTV then Ogun Radio in those days and I have a sister, Toun Okewale, who’s into broadcasting too. My mother was a teacher and a trader and life was good. I’m the second child. Growing up, the only thing I thought about was becoming a broadcaster because it was the earliest influence over my life”


He may be a fertility expert, but he’s not at sea on matters of fashion and style. “Sometimes I wear my tie, suit and the white coat to the office, but today is more or less not a very busy one for me. I use the gym to stay fit. I patronize local designers but mostly wear ready-made stuff because I don’t trust people cutting and measuring me before they go and sew. I’d rather enter a shop, see what I like, if I put it on and it’s my size, I’d just buy it. What I’m wearing today is a product of Vans Kere. I love the good things of life, I socialize, I go on holidays and do regular things men do. I drink occasionally. I would only take a Cabernet Sauvignon, I’m normally not a beer person,” he said on this sunny Wednesday.
 
By Lanre Odukoya

SOURCE: THISDAYONLINE

Monday, December 9, 2013

EXPLORING IVF TREATMENT IN NIGERIA


Infertility is not something people choose, yet one in every four couples in developing countries has been found to be affected, and more people are getting infertile. In view of this, Uche Uduma spoke with some fertility experts, in a bid to find out the procedure for fertility treatments in Nigeria.

In-vitro fertilisation is a conventionally assisted fertility technology whereby, an embryo is created outside the womb and then transferred back into the woman’s womb after fertilisation has occurred.

Before now, couples trying to have babies through IVF travelled abroad for treatment. However, in the past few years, fertility clinics have sprung up in different parts of the country. And this innovation has changed the prospect of thousands of couples that were unable to have children. For Maryam (surname withheld), a civil servant based in Abuja, the option of IVF treatment came up when she couldn’t conceive after 11 years of marriage.

According to her, “I opted for IVF with my husband after we had tried to have a baby without success. Three years ago, my husband suggested we try IVF. I wanted it abroad but my husband insisted we should do it in Nigeria. Both of us went through investigative laparoscopy to find the cause of the infertility, then we began the treatment. The whole IVF cycle took us about six weeks after which I was able to conceive.

However, the treatment failed after I had a miscarriage. I must tell you it was really painful because that was the first time I ever got pregnant and it was coming 11 years after we got married.  We gave it another shot, the second ,time it was easy. I knew what to expect and my husband too was very supportive. We went through the whole process together till I conceived again, this time it was successful. I am still thanking God”.

How In-Vitro Fertilisation Works

The Chief Embryologist, Nisa Premier Hospital, Abuja, Dr Rabi Ahmed-Odia who spoke with LEADERSHIP Sunday explained the procedure for conventional IVF.

According to her, “In vitro fertilisation means creating embryo and fertilising it outside the body while In-vivo means inside, that is when the sperm and the eggs come together in natural conception, everything takes place inside . But what we call conventional IVF means, mixing the sperms and the eggs together in a dish, and the following morning, one could check for fertilisation. 

In that case, within the maximum of 18 hours, one would see signs of fertilisation. Then we transfer it back into the patient. It basically means, creating embryos outside the womb. But if you do what we call Intracytoplasmic Sperm Injection (ICSI) where we assist the sperm and inject it into the egg, then you can see signs of fertilisation in 13 hours.”

Available Range Of Fertility Treatment In Nigeria

Conventional fertility treatment in Nigeria today offers wide range of treatment options available anywhere around the world. 

The Chairman and Founder of Nisa Premier Hospital, Dr Ibahim Wada, who spoke with LEADERSHIP Sunday, stated that all the procedures that are available anywhere in the world are now available in Nigeria.

 “I can’t think of any procedure that is available anywhere in the world that is not available here in Nisa Premier Hospital. We do In-Vitro Fertilisation (IVF), Intracytoplasmic Sperm Injection (ICSI), Intra-Uterine Insemination (IUI),  sperm storage, Pre-implantation Genetic Diagnosis (PGD) as well as blastocyst culture. We have facilities for vitrification and offer all the services that any fertility centre can provide.

Dr Wada further revealed that medication and operation are conventional methods used in treating infertility.

According to him, “on woman’s side, we have conventional treatment, one of which  is to give tablets to the patient so that she can ovulate because her problem is that she cannot produce eggs. Another one is sometimes to operate the patient,usually with blocked tubes. The tube is where the egg and the sperm meet so if it becomes blocked you are infertile.

Therefore, there is a conventional treatment of operating on the fallopian tube to try to open it up or removing fibroid that has been distorting the womb and making it difficult for the woman to conceive.

“On the man’s side, there are also conventional methods; a man with low sperm count will benefit from some drugs depending on why he has low sperm count. A man could have low sperm count from what is called varicocele. In such case, operation could be done to correct the varicocele.

Cost of IVF

The Chief Embryologist, Nisa Premier Hospital, Abuja, Dr Ahmed-Odia, explained that the cost of IVF treatment largely depends on the patient’s age as it affects the cost. “The cost of drugs can range between N300,000 to N1million, if the woman is a lot older. But if the woman is younger, it will be cheaper in  terms of the amount of money for the drugs, usually between N250,000 to N300,000. Everything that we use is imported which means, with technical fees, everything will be about N850,000. So, it is based on the patient’s age and the type of procedure.”

Factors That Determine IVF Success Rate

The Chairman and Founder of Nisa Premier Hospital, Dr Ibrahim Wada, also stated that the success in IVF treatment include quality of the sperm, quality of the eggs and the patient’s age.

“The older a woman gets, the less the quality of her eggs and the less quality of the embryo that comes from those eggs.  Most importantly, the womb lining has to be receptive to the embryos. Success rate varies from centre to centre, most importantly according the patient’s age. Here if one is under 30, the success rate is over 60 per cent. If 30 to 35 years,  the success is about 50 per cent and if 35 to 40, it is about 40 per cent. If the patient is over 40 years, it is about 33 per ent. But here in Abuja, I’m glad to tell you that our own range is 40 to 60 per cent which is the result you expect from any of the best centres in the world.

So, in my view, the success rate compared to that of UK is very good. We started this journey in Abuja 15 years ago and at the last count, we have had over 15,000 babies.”

Risk Associated With IVF

Dr Wada, disclosed that the most common risk associated with IVF is Ovarian Hyperstimulation Syndrome (OHSS). “When we give the drugs to a woman so that she can produce many eggs, some over react.

Though the dose maybe low, their body might be sensitive. In particular, these are women with polycystic ovaries; they produce more than 15-20 eggs at a time so the ovary gets tired and it starts loosing fluid into the abdomen. The abdomen can become swollen and painful. They are very mild cases and the women don’t need treatment to recover.”
by Uche Uduma

Friday, February 15, 2013

Eko Hospital records first quadruplet delivery through IVF


A 30-year-old woman, Mrs Funmi Oguanigie, on Friday gave birth to quadruplets at the Eko Hospital in Lagos.

The delivery is the first in a single delivery in the hospital in 25 years.

Oguanigie, a resident of Anthony Village in Lagos State, was delivered of two boys and two girls at about 3 p.m. by a team of doctors, led by a Chief Consultant Gynaecologist and
Obstetrician at the hospital, Dr Adegbite Ogunmokun.

The babies, who weighed 2.22kg, 2.29kg, 2.24kg and 1.94kg respectively, were delivered through caesarian section.

Speaking with NAN shortly after the delivery, Ogunmokun said that mother and children were in stable condition.

He said that the babies were conceived through In-Vitro- Fertilisation (IVF), carried out by the hospital.

The doctor said that this was the first time such number of multiple babies would be delivered at the hospital since the hospital was established in 1988.

The gynaecologist expressed delight over the feat, advising couples desiring babies to seek medical help early.

“ We encourage them to report their cases early. There is help out there; every problem has a solution. We give God all the Glory,’’ he said.

Ogunmokun said that the IVF process would take between six and eight weeks, costing about N750,000 which patients could pay installmentally at the hospital.

 

Source: reporters365.com