OVER the past decade and a half, Consultant Obstetrician/Gynaecologist and Managing Director/CEO, Nordica Fertility Centre, Lagos, Asaba and Abuja, Dr. Abayomi Ajayi, has been living his childhood dream of helping Nigerians to overcome the challenge of infertility and completing their families through Assisted Reproductive Techniques, ART, such as IVF.
However, despite the successes in this direction, Ajayi remains worried about the high number of babies that die before birth or are born with genetically transferred disorders. In this chat with SOLA OGUNDIPE, he speaks about the development and steps being taken to tackle it. Excerpts:
Eliminating sex-linked diseases
We can help eliminate sex linked disorders such as sickle cell disease, albinism, blindness, etc. There is some form of congenital deafness that runs in families that we can also screen for. New technology has made it possible for us to identify embryos that can bear some diseases such as cancers in life, so we can easily identify and select the embryos that are free from diseases.
We call it Pre-implantation Genetic Diagnosis, PGD. It is the process of removing a cell from an in vitro fertilization embryo for genetic testing before transferring the embryo to the uterus. Pre-implantation Genetic Screening, PGS, is the process of testing for overall chromosomal normalcy in embryos.
We know that we all have 23 pairs of chromosomes in our cell nuclei. The last pair is the sex chromosomes, so one of the things you also get from that is you can tell the gender of the embryo from that when you can see these 23 pairs of chromosomes.
Before a few years ago, we could only see about five pairs of chromosomes, but now with technology we can see all the 23 pairs, so apart from gender we can look at every disease that the embryo can be predisposed to.
In screening we are looking at the number of chromosomes and their arrangement because we have seen that the greatest reason why IVF fails is because there are problems in the arrangement of the chromosomes. We now know that 70-80 percent of embryos produced in our labs can never become babies because of this problem that increases with age of the woman and this is one of the reasons why we say older women are so worse with IVF and with reproduction generally.
We have seen why it is so now, especially with the structural or numerical errors in the arrangement of chromosomes, so you are able to pick out the ones that cannot become babies to start with. There are about 600 diseases that we have been able to see what their profile looks like, so we can identify such and we do not use such embryos.
New areas in 2017: In 2017, we are going to be at the forefront of anything that is new. What we are doing now is an offshoot of Compatibility Genetic Testing in the sense that we have started to screen our donors for genetic diseases.
We know we have had so many babies using donor eggs, we don’t have any complaints yet, but we don’t know how many of them are out there. The problem with genetic diseases is this.
We all have gene mutations, every normal person carries 3-5 mutations, but it is normal. The problem only comes when we marry somebody who has the same mutations like we do, so we turn from being carriers into exhibiting the disease. This is what we are now looking out for in people that are using donor eggs now.
Somebody could be a healthy donor who is carrying mutations in her genes. She is normal and healthy, but the problem only comes if the husband of the person who wants to use that egg carries the same mutation.
Then the baby they are going to have will be born with the disease, this explains why two black people can give birth to an albino, because they both carry the albino gene even though they are not manifesting as albinos.
This is what we now want to start doing. We will screen our egg donors and husbands of the recipients. We have had instances like this. A couple brought the baby to one of our parties and we were also surprised but we saw the way they were handling the baby, but the couples did not complain and that’s what made me to be interested.
Inspiration: Then we had an experience of a woman that got pregnant and went to the US to deliver.
Everything appeared okay until she did some tests and it was discovered that the baby was not doing well and they decided to section her that day. Afterwards it was found that the baby had multiple congenital problems that were not compatible with life. The woman had to wait for the baby to die.
So that made me to start to ask questions. It fired up my interest in PGD and I began to ask how can we prevent this kind of thing?
We asked her a few questions later on and learned that she had had a baby that had died before, but the diagnosis was never made that the baby had congenital abnormalities. This made me realise that we probably have missed so many congenital abnormalities in Nigeria. So it is better for us to start investigating.
Investigating why babies die
In Nigeria we do not investigate why babies die. This is a significant problem. Some babies have congenital abnormalities, they blame doctors, and we do not investigate enough why the baby has died one thing that is one of the things we need to bring into our practice. Why did this baby die? The way we treat the death of babies leaves much to be desired.
I recall an incident in Asaba, a patient did PGS and lost the baby at about 14 weeks. That should not really happen. We told the woman that when the baby was expelled we needed to take a sample from the placenta for testing, but she blatantly refused. But these are things that a white person would do willingly. So it is difficult to understand some of these things, and until we start looking at why we keep losing babies, we will not learn.
The assumption now is that congenital abnormalities are not common in Nigeria, but I beg to differ. Human beings are the same. If something is common somewhere, it should be common everywhere, except if it is environmentally linked. Congenital abnormalities are usually errors in nature, so why is error occurring in Europe and not here. I do not agree, these are some of the things we need to start doing so that we can answer some of the questions.
Problem is Society: The problem is even beyond the doctors, the problem is society. Let us look at the baby that dies in-utero. What is the normal reaction of the patient? The common reaction is often that the doctor is not skilled, but people need to know that babies die. We need to differentiate the ones that die as a result of negligence, we should start asking questions about why babies die. That will also differentiate the ones that die due to negligence and the ones we cannot do anything about.
When people lose pregnancies in the first trimester they blame everybody, yet 50-70 percent of the time babies that are lost in the 1st trimester are congenitally abnormal and there is nothing any doctor can do. There are congenitally abnormal babies most of the time. So when things happen, let us grieve from point of knowledge. Let us begin to educate the public about these things.