Many challenges of IVF babies, practitioners in Nigeria 

• Experts decry stigmatisation of infertility, babies born through assisted reproductive technology
• Say centres still importing all equipment, drugs, laboratory supplies that create bottlenecks

As the global community commemorates In Vitro Fertilisation (IVF) Day also known as World Embryologist Day, celebrated on July 25 every year, fertility experts have narrated the many challenges of babies born through the process and that of the practitioners.

They also decried stigmatisation of infertility and babies born through any form of assisted reproductive technology. The experts lamented that IVF clinics are still importing all equipment, drugs and laboratory supplies, thus creating bottlenecks in terms of delivery and increased cost of operations.

The fertility experts/IVF practitioners include the Joint Pioneer of IVF in Nigeria and the Secretary-General of the International Federation of Fertility Societies (IFFS), Prof. Oladapo Ashiru; President of the Association of Fertility and Reproductive Health (AFRH), Dr. Preye Fiebai; Medical Director, Origene Fertility, Dr. Babatunde Ogunkinle; and a Social and Behaviour Change specialist, Ms. Adeola Olunloyo.

On what have been the challenges and breakthroughs in the practice, Ashiru lamented that the industry is still importing all the equipment, drugs, and the laboratory supplies.

He said such development creates bottlenecks on delivery and high cost of operations. Ashiru, however, explained that in a few African countries, the pharmaceutical companies manufacture the products locally, thereby creating a lower cost of operation.

World IVF Day marks the birthdate of the first baby that was conceived and successfully birthed through IVF.

Louise Joy Brown born on July 25, 1978 was the first baby born through the IVF procedure. From this day onwards, IVF was recognised for being a reliable reproductive technology to conceive babies.

The three pioneers of IVF were embryologists Patrick Steptoe, Bob Edwards and Adam Burnley. They led the procedures for the first successful IVF treatment. Since then, they are recognised for their achievements in this field.

Ashiru, who is also the President of African Fertility Society (AFS) and Medical Director of Medical Art Centre (MART) Maryland-Ikeja, Lagos, said: “Baby Olusola was the first IVF born in 1989 through the work of Ashiru and Giwa-Osagie. It was published in The Guardian Newspaper and LUTH Mirror.

“Today, over 10 million babies have been born through IVF worldwide. The figure for Nigeria is an estimate close to 15,000 from well over 130 IVF Clinics. Babies are not that easy to showcase. But many clinics display such pictures in the clinics. I believe it has to do with our reserved culture and protection of children. Beyond this is the continuous need to de-stigmatise infertility or babies born through any form of assisted reproductive technology.”

Can we meet them with photographs? “If you visit our clinic at the Medical Art Centre, you will see pictures of babies, singletons, twins, triplets, quadruplets, and two quintuplets born over the years. But they are not for public consumption. Many couples bring such pictures as an encouragement to new patients, and not for publicity,” Ashiru said.

On the cost of a session of IVF and how many sessions one needs to get pregnant, he said it depends on several factors such as age, the clinical factors, sperm factors, and more.

“It ranges from N1.8 million up to N5 million or more in cases like surrogacy. Globally, the cost of IVF ranges from $4,000 to $20,000 (N15.84 million). It is for this reason that we are witnessing a lot of medical tourism in IVF in Nigeria with patients coming from America, Britain, and Europe to save cost,” Ashiru said.

He said the success rate of IVF has improved over the years due to significant advances in assisted reproductive technology.

Ashiru said the success rate at the beginning of IVF in the early 80s was between 10-15 per cent, but today it is between 45-70 per cent because there has been tremendous development in the clinical protocols, patient selection, minimal invasive egg recovery with ultrasound guidance. He said the area that has witnessed the most advanced cutting-edge development is the embryo laboratory with sophisticated microscopes, incubator, culture media, and air purification system.

Ashiru said the human capital development in IVF is phenomenal and there are several opportunities for training highly skilled staff.

“One of my colleagues in the USA spoke recently at a joint paper presentation between their centre in Chicago and our Medical Art Centre. He was full of praise at the embryo biopsy sample coming from our centre as one of the best reaching their centre”, he added.

Ashiru said it is predicted that with the current rate of technological development, IVF success rate could reach as high as 95 per cent per cycle in 10 years. He said the figure is far higher than the 25 per cent that occurs in nature every month.

On whether claims about IVF successes from many centres are true, Ashiru said: “If a clinic displays that it is registered by AFRH and in Lagos in particular by Health Facilities Monitoring and Accreditation Agency (HEFAMAA)-IVF Monitoring unit, I can believe the claim. The public needs to look out for such accreditations, so as not to be deceived.”

On why IVF has become a very big issue in Nigeria that even young couples in their thirties are going for it, Ashiru said: “It is not peculiar to Nigeria. The technology is now easy and straightforward, so some opt for it. The advice I would give is that for young women who are not yet thinking of childbearing, it is better to harvest some eggs and freeze them. So, they are stored in the egg Bank. It is because as women age unlike men, the fertility decreases and by 36 years, their fertility rate drops to 15 per cent from 25 per cent at age 22. By age 40, the fertility is just above 10 per cent.”

On recommendations on how to make the process more accessible and affordable, Ashiru said: “Taken together, Nigeria has done very well among the global players in ART. What needs to be done is for the public and the government to assist those that require the technique to conceive but cannot afford it. There are currently about six foundations that support IVF treatment, and about five IVF centres in public institutions. We can improve on this number.”

Fiebai said Nigeria through the Association has played a significant role in IVF globally, adding that it was through their activities that Prof. Ashiru got elected as the current Secretary-General of the International Federation of Fertility Societies.

“We have produced guidelines to self-regulate the practice of IVF since 2012. We have also worked with the Lagos State House of Assembly, and the National Assembly to ensure legislation on ART. The bills have gone through the final stage at the Lagos State Assembly, and the Senate bill is nearly done after the second hearing. We will be making a presentation on the legislation of IVF at the upcoming World Fertility Congress in Athens on September 10-13, 2023,” he said.

Ogunkinle described IVF as the most efficacious solution to infertility problems.
Speaking at an event held to mark World IVF Day in Lagos, he noted that babies born through IVF are normal babies.

The theme of the event organised by Origene was “Parenthood: A Journey of Hopes and Tubes.”

“It has been shown that IVF is a treatment option that has been used to solve infertility problems. This technology has provided happiness and joy to many homes and it has continued to provide hope for many families with infertility challenges. Nigerians must take advantage of the technology,” Ogunkile said.

He added that IVF has grown beyond solving fertility problems, saying it is also used to solve some genetic conditions that can be transmitted in offspring.

He further explained that egg freezing is the storage of a woman’s egg for future use to have her child.

“Every human being has a right to the enjoyment of the highest attainable standard of physical and mental health. Addressing infertility is therefore an important part of realising the right of individuals and couples to found a family. Fertility care encompasses the prevention, diagnosis and treatment of infertility,” Ogunkile said.

Olunloyo, who is also an advocate for social change to improve the sexual and reproductive health and rights of people, said equal and equitable access to fertility care remains a challenge in most countries; particularly in low and middle-income countries. She said fertility care is rarely prioritised in national universal health coverage benefit packages.

Olunloyo said inequities and disparities in access to fertility care services adversely affect the poor, unmarried, uneducated, unemployed and other marginalized populations.