Infertility remains a source of social, mental and emotional distress and especially some Sub Saharan Africa where a high premise is placed on child-bearing. The treatment of infertility has advanced and a lot of hope has been brought to many families who hitherto might not have had any chance of child bearing with the advent of Assisted Reproductive Technology, ART.

Nigeria has made history in this regard. Good Health Weekly spoke to co-pioneer of IVF in Nigeria, Prof. Osato Giwa – Osagie during an International Conference on Improving IVF Pregnancy rates in Nigeria, organised by the Association for Fertility and Reproductive Health, AFRH.

Giwa-Osagie who is President, AFRH spoke on a wide range of issues from the genesis of IVF in Nigeria, to factors affecting the rates of IVF pregnancy among other challenges. Excerpts:

By Chioma Obinna

_FACTORS that determine IVF pregnancy rates

The rates of pregnancy vary from about 15-40 percent. Every clinic here or abroad has seasons of very high pregnancy rate. Some get as high as 50 percent particularly for egg donation and cycles for older women. They have also had circles when the results are poor it can be as low as 15 percent as a result of the drugs they were also given. All these are local factors that affect results.

Secondly, almost all the requirements for IVF are all imported including water. They are all imported and used once only. Some of the centres have two or three pieces of equipment to do the same thing because of issues of maintenance locally. When you go there, you will find three – four scan machines, everything is duplicated and these are at a cost.

Thirdly, our women, as you know are prone to fibroids. We are the fibroids headquarters of the whole world. And fibroids reduce pregnancy rates. Infections in women not only damage the tubes, but could damage the uterus itself. This could also reduce pregnancy rates. These are the local peculiarities we come across.

One is getting the appropriately trained and qualified personal, nurses, counsellors, the embryologists and the clinicians. You need all these people in an IVF clinic. The job cannot be done by just one man. Quite often you find a gynaecologist who is in-charge of patients. Stimulate them, recover the eggs etc, somebody else has to now do the culturing of the eggs, and that is the embryologist, the laboratory people.

Challenges in IVF practice

Many times the success of your effort depends on the laboratory rather than the clinicians. You must look at both sides of the practice and put both sides upwards all the time. You have to also have the logistics arranged properly. There are clinics ready to lend things to each other such as oxygen or media.

Those relationships exist because we are all importing all these things. From time to time, our importation process runs into problems at the airport. At one time, NAFDAC was saying everything must be tried in Nigeria and proven before it can be used.

That means, you will bring the media from Sweden or whereever you are importing it from, you will now use it in Nigeria maybe on a bunch of mice and report to NAFDAC and they will say you can now use it. That didn’t make sense because you cannot by any stretch of imagination equate the standards of our science with that of Sweden, Germany, England, US or Canada.

If it is good enough for those countries to be used on their own people then it is safe enough for us to use on our people. We do not have the money to do all those tests. I think they found a solution to that because if they enforced that regulation all the IVF clinics will grind to a halt including the ones in the public hospitals. We have lost batches of reagents to this sort of thing because by the time it is held for more than about 72 hours, it is gone. Thousands of dollars down the drain.

Lack of regulation

Regulation is very important in Nigeria. For people who watch television you find some doctors talking about what is a gynaecological disease. He or she is not a medical doctor but will be talking about endometriosis, fibroids and how he has a solution that dissolves fibroids. And now if such charlatans are allowed to get to the field of IVF, then I feel sorry for the women of this country. There are no standards to convey them to.

In Nigeria, when these people are operating and you talk, people will say doctors are jealous that is why it is very important we put in place some guidelines and regulations.

We have been saying this for the last 10 years or more and nobody is listening to us. We shall keep saying it. If we have enough funds we are going to publish it in a newspaper as paid advertisement so that everybody will see it that a group of people who are experts in this field are saying this is the way this thing should be regulated and these are the guidelines.

If we don’t do that somebody will get up one day and said they want to regulate. They will just pick some of their friends to be on some committee. They will write the regulations processes for IVF in Nigeria. When the experts start complaining, they will say they are complaining maybe their income is threatened. So that is why we are concerned that there should be a proper regulation for training and practice. As far as I know, no country in West Africa has regulation. Ghana was trying to put one in place; South Africa was writing theirs about three years ago I was hoping to find out from them.

We will have our own guidelines and we will now try and implement it ourselves whenever the government is ready, we prefer to have both regulations in place.

Evolution of IVF in Nigeria

When we started IVF, in LUTH, we were three, Prof. Ashiru, Dr. Akin Abisogu and myself. The original work to allow us to start human work was done by Prof Abisogun who was still doing a Master of Science anatomy and looking at IVF in mice. The supervisor was Prof. Ashiru. And I was watching them if they would succeeded we will transfer to human. So when they succeeded we now said we are ready for human work.

I went to Conakry in Australia to learn human IVF and Prof. Ashiru went to America. That is how we started. Our laboratory was Anatomy Department of the College of Medicine at Idi Araba, and all our work was done in one of the theatres at the LUTH. It was very much experimental. There was no mechanism in place for the patients to be charged.

Today, IVF is charged. We were doing it as research and grants from reagent donated from friends abroad. We recorded our first pregnancy in 1984, a young lady from Ibadan. We then had another pregnancy in 1985 and 86 through a technique called GIFT.

First IVF baby

In 1985, Dr Olatubosun and his team from St. Nicholas reported a delivery of a baby from Gamete Intra Fallopian Transfer (GIFT). We reported the first delivery of a baby through IVF in LUTH by 1989. The success was reported and published widely both at national and international fora. I am talking of about 30 years ago. There was no funding and we could not charge patients so it was not sustained. After we succeeded we decided to say these things should be set up properly. The Federal Government said IVF was not a priority for Nigeria.

I decided to stay in Nigeria rather than moving to Saudi Arabia or anywhere in the world. I moved my IVF practice to private practice and that is how IVF came to private practice. Then Prof. Ashiru went on sabbatical, leave of absence in Chicago. By the time he came back, they were now the younger ones in the field talking publicly about IVF successes.

Nobody is being reported anymore to the medical council like they did to us then. When you were reported to the medical council you felt a kind of knife dangling over your head. So many things happen these days and people are getting away with it. Right now it is very easy to practice IVF. A that time, it was only Nigeria, Egypt and South Africa that succeeded in IVF. The rest of Africa was not doing it.