Monday, December 21, 2015
Etomi allegedly collected the money from the victims with a promise to make them have twins through In-Vitro Fertilisation (IVF).
Her crimes were exposed after she collected N900,000 from a family to treat their daughter who is blind and has malignant brain tumour.
The suspect, according to the police, told her victims that she worked for a British owned hospital based in Ondo State.
Police said the victims reported the incident after they discovered that they were not responding to treatment.
The suspect was nabbed at her hideout in Saint Saviour Street, Benin City, Edo State.
She was said to have asked the victims to name the number and sex of children they want and some of the victims mentioned twins, triplets and quadruplets.
Sunday, October 11, 2015
I will cover some of them in the next series of publications. The first one I want to touch now is the use of ART to test for abnormalities in human chromosomes by testing the embryos.
Medical Art Centre, in an earlier publication, discussed the effectiveness of PGT as a technology used in the selection of embryos with genetic defects and chromosomal abnormalities.
This technique was first introduced at the centre in 2009 and has yielded healthy babies that are sickle cell anaemia free and/or have accurate chromosome number. Recently, a new technique which yields better result with the PGT process was introduced by the centre. The following example would be considered for a better understanding of the new technique.
What is PGT?
PGT is an acronym for pre-implantation genetic testing. This involves techniques used to test embryos for genetic defects or chromosomal abnormalities prior to transferring them to the uterus. These embryos are usually created via In-Vitro Fertilisation. PGD and PGS are examples of PGT.
PGD versus PGS
Pre-implantation genetic diagnosis specifically refers to testing for specific gene defects in the DNA code. For example, PGD can be done on embryos from a couple where both partners are known carriers of a specific genetic disorder such as sickle cell anaemia, cystic fibrosis etc. On the other hand, Pre-Implantation Genetic Screening refers to testing that investigates the chromosome number abnormalities (aneuploidy testing) or the sex of the embryo.
In order for this diagnosis to be carried out, cell(s) must be taken out of the embryo. The process of taking out these cells is called biopsy. Before now, biopsy was usually performed on cleavage-stage embryos on the third day.
Embryo biopsy is traumatic and lowers the embryo’s ability to implant. With the advent of trophectoderm biopsy technique, cell removal can be performed on a blastocyst – stage embryo on the fifth or sixth day after fertilisation.
Trophectoderm biopsy involves the removal of the trophectoderm component (cells that form the placenta) of the blastocyst embryo. This is less traumatic and the blastocyst cells which are quite resilient recover quickly. Since the embryo has many more cells at the blastocyst stage (about 100 cells) than at the cleavage stage (6-10), we can remove about four-five cells from a blastocyst with little or no impact on its developmental potential.
How is trophectoderm biopsy done?
The story of a couple below will be used to illustrate the process.
“Eric and I have been together for several years without a baby. We were introduced to Medical Art Center by a close friend and we immediately started screening and management for infertility. After undergoing the IVF process, I got pregnant and delivered a baby girl three years ago. In order to balance our family, we opted for another round of IVF but this time around with the PGS option.
“We were particular about screening our embryos for chromosomal abnormalities since I am advanced in age and we also desired to have a male child. During the counselling process, we were advised to screen our embryos using array comparative genomic hybridisation (aCGH) which screens all 24 chromosomes.
“The consulting doctor explained to us that the clinic had just introduced a new biopsy technique which would increase our chances of having results for all our embryos. This technique will reduce the incidence of embryo testing showing no signals or no results after diagnosis because usually four- five cells are available for testing after trophectoderm biopsy.
“We were told that we would be the first couple to use this technique for PGS at the clinic. The doctor went ahead to inform us that our embryos would be frozen via a technique called vitrification and would be transferred in a new cycle. That meant that we would not be having a fresh embryo transfer but, instead, a frozen-thawed embryo transfer. The doctor also assured us of the effectiveness of the vitrification process, hence calming our fears of fresh embryos being more viable than the frozen embryos.
We trusted the advice of the doctor and signed the written consents for the procedure. We underwent the IVF process, our embryos were cultured for five days and then biopsy was performed.
First, the embryo had to show a distinct inner cell mass (ICM) and trophectoderm. ICM forms the embryo proper and must be avoided during the biopsy process. A very small hole was made in the outer shell of the embryo using a laser. Then the trophectoderm cells were allowed to come out of the expanded blastocyst. Using a pipette and more laser beams, herniating trophectoderm cells were detached and used for diagnosis. At the blastocyst stage, the embryo is ready to implant and cannot be left to continue growing in the incubator, hence the need for embryo freezing. Our biopsied embryos were immediately frozen.
“At every stage of the process, we were updated on the progress of our embryos, from number of eggs retrieved to number fertilised then the number of embryos biopsied and frozen. Once the results were ready, we were called in for a consult. We were given a copy of the PGS report and the genetic counsellor explained our report. We were told explicitly the number of embryos that were chromosomally normal (euploid) and asked to decide what we wanted at transfer.
Two top quality euploid embryos were transferred in a subsequent cycle, pregnancy was confirmed two weeks later and we had our healthy baby boy in August 2015.”
Friday, October 2, 2015
Pray, is In vitro fertilisation otherwise known as IVF now an exception to the Medical and Dental Council of Nigeria’s rule against advertising among doctors? One of the clinics in selling itself over its “competitors” said “some clinics claim to do IVF whereas they only do the conventional IVF.”
Another clinic touted “in our 10 years of existence, we have been able to assist in the conception of hundreds of babies and we are still counting.” Still, another said “we are committed to delivering optimum customer satisfaction beyond expectations.”
It’s not lost on me that among the owners of the mentioned fertility centres is a renowned professor in the field of fertility in Nigeria. But as the article itself said, there are still quacks in the field. Every time you read anything on fertility centres, they mostly create an impression that it is a one-stop shop for “all” problems concerning infertility.
Medical science has done great things for humans, but with assisted reproductive technologies, medical science fails far more often than is generally believed. The European Society of Human Reproduction and Embryology reports that on the average, out of the 1.5 million assisted reproductive cycles done worldwide, only 350,000 resulted in the couple having a child. That puts it as a 77 per cent failure rate worldwide. Even in the United States, the Centres for Disease Control and Prevention gave the failure rate as nearing 70 per cent. As Miriam Zoll and Pamela Tsigdinos put it, “Behind those failed cycles are millions of women and men who have engaged in a debilitating, Sisyphus-like battle with themselves and their infertility, involving daily injections, drugs, hormones, countless blood tests and other procedures.”
Almost 37 years after scientists in Britain gave the world its first “test-tube baby,” assisted reproduction is now worth about $4bn a year. But the story is different in Israel where it costs almost nothing. There, until recently when a cap was fixed on the number of cycles a woman could have, it was limitless.
Yet, you can’t miss the marketing aspect of fertility clinics that reminds you it is still a business venture. IVF costs a fortune in Nigeria and many parts of the world. Fertility centres deal with customers who are desperate and vulnerable. “Once inside the surreal world of reproductive medicine, there is no obvious off-ramp; you keep at it as long as your bank account, health insurance or sanity hold out.”
Many couples are in debt because of fertility clinics, and despite many failures are still hoping for the elusive breakthrough. With the journey of infertility, anyone who stops is regarded as a failure in the race. To a childless couple, one out of a million chances means “I still have a chance.” It does not help that our culture sees having children as the purpose of marriage.
Even up till today, no one can say for sure the long term risks of all the invasive procedures and experimental interventions. Zoll and Tsigdinos say, “Ending our treatments was one of the bravest decisions we ever made, and we did it to preserve what little remained of our shattered selves, our strained relationships and our depleted bank accounts. No longer under the spell of the industry’s seductive powers, we study its marketing tactics with eagle’s eyes, and understand how, like McDonald’s, the fertility industry works to keep people coming back for more.” Of course, there will be lucky couples. But no one hears the other side of the story, where clients who refused to give up became addictive, with cycles of debilitating trauma.
Even with all this, in an unfair world as ours, every year it is estimated that 42 million women with unintended pregnancies abort those pregnancies. That is why a little girl who hawks oranges gets pregnant and gets beaten by her parents, while those who want it don’t get it. Much as science can claim to aid conception, ultimately children are from God.
He gives them out how He so chooses. We cannot query Him. If He says He created you to be barren, in that situation, as in all situations, give Him thanks. God ordained marriage for companionship, and not mainly to have children.
Children are only additions to it. You might get them. You might not get them. It does not mean God loves you any less. Nevertheless, for childless couples seeking God’s mercy, it is not a time to ask God “why me?” As a couple, say prayers of agreement, telling God you accept His will, with or without a child. That way, the anxiety is removed. For some women, it is just the stress of childlessness that perpetuates their infertility. Babies will not want to live in a body in constant agitation. They want a peaceful abode. If you want children, don’t be “crazy about kids.”
It is an ironical world where what we don’t want is what we get! I have encountered couples of many years’ infertility, who after counselling them to get their mind off children and put their mind and trust in God, for good or for bad, come back to tell me the “good news.” Of course, with infertility, there will be those couples whose infertility has clear causes, who will need medical intervention. But for a good number you cannot find any clear cause. Even women who have delivered a child before, it does not mean the second child will come automatically.
As a woman ages, her fertility reduces. There could still be other factors. Many, without any medical intervention, but with a large dose of patience, will still conceive.
Those who are running fertility clinics must not raise false hopes. Their clients have a right to know about the risks to their health, the social downsides, and the documented high failure rates even in the best of centres. Clients should be given proper and unbiased advice without thinking about the money to be raked in.
Monday, February 3, 2014
Thursday, December 20, 2012
What is the level of awareness of IVF in Nigeria?
The level of awareness has been tremendous and in Nigeria we have come a long way. In the early 1980s particularly in 1983-84 when we started IVF in humans it was difficult to get patients to accept it as a form of treatment. And even when they ac-cepted IVF as a form of treatment, it was taking them a significant time to even know that they wanted to come.
And when they came for IVF, they were not ready to reveal the type of treatment they were taking.
When you now look at it from that time till now, you will see that IVF has come a long way. By the 90s some people had come to terms with it and by the time it got to 2000, we had more landmarks and the awareness was increased. To-day, I think there is greater awareness about IVF as what people do regularly.
What happened in some countries about 20-30 years ago is now hap-pening in Nigeria. At present, many people are now feeling free to come out and testify that they have children through IVF. Considering the remark-able success of IVF, many people are now willing to have children through IVF because they now have better understanding that having children through IVF is not harmful.
Why is IVF treatment still ex-pensive in Nigeria?
It is expensive because of the ad-vancement and improvement in the technology. The old method has been disbanded. We are now using a new method which involves the use of dis-posable needles. The disposable nee-dles are very expensive and we have different companies manufacturing the equipment. The new innovations have really improved the success rate of IVF in Nigeria.
How has it improved IVF from what it used to be in the past?
It is those of us who pioneered in this field that can appreciate and recognize the level of improvement in the technology. For example, in those days in Lagos University Teaching Hospital (LUTH), for a patient to go through IVF she had to be admitted into the hospital; she would be in the ward a day or maybe two days be-fore the surgery.
We would be monitoring her and then she would be given all the homone injections and then we would go and retrieve her. When you do this you are supposed to give one of the injections called Human Chronic (HCU), when you do that you have to operate the patient within 34 – 36hours.
In those days we were in the theatre and people were not ready to go through the process. Today, the method has been refined to one single injection. So there is complete change in the procedure. The old three divisions have been upgraded into one single injection.
What is your view about the state of the Nige-rian health sector?
Health service in this country is not adequate. In fact we are lucky and fortunate that the private sector is re-inforcing the health services. If you take Abuja for ex-ample, health servicing is being helped by some of the private hospitals there. And in Lagos, the private sector is helping in some of the health services. I believe that the state of health in this country could be better than it is today.
With over 35 years in the medicine profession, what have been your saddest and happiest mo-ments?
My saddest day as a medical doctor was in 1984 when I was a Professor and Head of Department of the De-partment of Anatomy and also a consultant in the La-gos University Teaching Hospital (LUTH). During that period there was a doctors’ strike and all the teaching hospitals were shut.
As a result of the strike, the Fed-eral Government proscribed the Nigeria Medical Asso-ciation (NMA) and sacked all the doctors. Those of us who were in management were allowed to stay in the institution while others were sacked.
The Buhari/Idiagbon regime later set up a screening panel for doctors and we all packed out from the doc-tors’ quarters. I went to stay with my brother because some of us who were doctors then did not have any house. We probably felt then that we were in a profes-sion that would give us comfort till when we would re-tire at 65 years and some thought that may be along the line they would build their own house. I discovered that many Professors retired without building a house.
The government decided to bring back all the sacked doctors and they set up a military panel to screen us. Some of the doctors that screened us were younger than some of us. Some of them who were either Ma-jor or Colonel were in the panel and we all went to face the military panel.
When I got there they didn’t drill me so much knowing that I was the Head of De-partment. But I now saw some of the older people, in-cluding some of my teachers, who came there for the screening. I felt sad for them. Even the former Minister of Health, late Prof Olikoye Ransome-Kuti, was among those that were asked to face that panel. And many in his age group also lined up to face the panel.
My think-ing then was that they had to do it because they had no other option. When I came back home that day, my wife asked me what happened and I explained how we were humiliated. I saw it as humiliation because some of those who screened us were not as experienced as I was then, in fact one of them was my class mate in the secondary school and then I was smarter than him. I was not concerned about myself alone but those senior people.
And I felt that the next time something like this would happen if I had to be there, it won’t be because I had no job. I felt that the best thing in this country is to set up your own system and not to do government work.
That day I decided to go to my contractor to start work on my house that was then at the foundation level. I thought that I should be able to have a house of my own even though the house they gave me as a Professor of Anatomy was very large. I have the second largest house in LUTH, which I was staying then. I devoted a lot of efforts toward building my own house. With the help of God, we started in 1984 and by 1986 I was able to move into that house.
Was that what motivated you to go into private practice?
Absolutely! It was the experience and the fact that I was coming from the US. In America you don’t have to have a private practice if you are an academic physi-cian like us. You work as a lecturer in the university and also do your private practice in the university and you get your money from both practices.
Nigeria is the only country where the system is bad and terribly bad. We do not understand the difference between a produc-tive professor and an unproductive one.
Professors of Mathematics, Geography, Religious Studies, Cardiol-ogy, and Plastic Surgery get the same amount. It doesn’t matter whether one professor goes in at 8am, 9am or 10am and closes at 3pm, 6pm or 10pm. In America, an Associate Professor can get more salary than the Pro-fessor that is head of his department if he is bringing in much money in form of research grants.
When we were in LUTH, Professor Giwa-Osagie and I worked on Saturdays and Sundays to be able to see some patients because those were the only days we could get the egg from them and yet what did we even get from some of our colleagues? Some of them usually said, ‘What are they doing and why are they working so hard?
While working, others would be in the staff club drinking. So you are not even rewarded for the work you are doing. There is a fault in our system. There is a structural problem that if you go to many of the teaching hospitals or general hospitals, you will see some consultants because they are very lively and their service is good their outside patients would be full and they would be working very hard to attend to people. But some people are hard and will not attend to so many people. At the end of the month the consul-tants would get the same salary.
Some consultants are always doing ward rounds to go and see their patients everyday while some will not.
Having worked in both public and private sec-tors, how would you compare the two?
It depends. The public sector is supposed to be better but the private sector can be better if you run it in a bet-ter way. I run my organisation like a teaching institute and that is why we are highly rated. We are training people and we are also current. If a private sector does that there would be development but if it just stays on one level, then you will see that the level of activity will reduce.
Do you have any regrets working in the public sector?
I don’t have any regrets because it is something I en-joyed doing.
Friday, October 12, 2012
At what point would you advise a couple to undergo IVF?
What the World Health Organisation says is that when you are 35 or below 35 years, you wait for one year before you go for test when there is no obvious reasons for you to go for it. For instance, if the husband has had a fall, or his testes have been compromised, you can do that earlier. If a woman is not menstruating regularly, you don’t need to wait for one year before you do that. Those are the obvious reasons. But if you are below 35, you wait for one year for investigations. If you are above 35, you wait for six months before you go for investigations. It is the investigation that will say whether you need IVF or not. We know that among infertile couples, it’s only about 10-15 per cent who will need IVF.
Considering the high technology involved in IVF procedure, it is still believed that its success rate is still low. What are the reasons?
The reality is that everywhere in the world, IVF is not a 100 per cent success rate. If somebody tells you that IVF success rate is 60 per cent, he or she is lying. You have to know the physiology of pregnancy. It’s like you take an organ from one person and put it in another person. The chances of rejection are high. For instance, when you take someone’s kidney and put it in another person’s body, chances of rejection are very high. That’s why people like that take drugs to suppress their immunity in order to encourage the body to accept it. Now, in pregnancy, you have two people coming together. Whether it’s IVF, whether it’s on the bed, you have two people coming together; they create a new creature and now, it’s in one person. The chances that one person will reject it is higher than for that person to accept it because that is simple immunology. That is the way the body protects itself. Once it sees a foreign body, it tries to kill it. Unlike the kidney transplant where you can give the patients drugs to reduce or suppress their immunity, however, you dare not try it in IVF. That is why we can brag and say that IVF babies are normal babies because they go through the same quality control system in the body. However, it’s that same quality control system that makes our success rate not to be 100 per cent, 60 or 70. But there is a lot of work because when IVF first started, the success rate was very poor, with about 10-15 per cent. But now, it’s going to 30-35 per cent and sometimes 40 per cent, without compromising the quality control system in the body. Probably in the future, with some things now being worked out, maybe we might be able to improve, but I don’t see us getting a 100 per cent.
How do you convince overly religious patients to undergo IVF?
It’s purely science. When people are resistant to things, most of the time, it is because they don’t have the knowledge. So, one of the things we need to do is to educate people; to make them know that IVF is natural because the only thing we do is to mix sperm and egg. Every other step is natural. Apart from educating clients, which is the most important thing, we can’t force anybody to accept the explanation. We equip people with the knowledge and allow them to make up their mind. We want people to know that there’s nothing diabolical about IVF. I’ve had the opportunity of educating a pastor on IVF, after which he said he was going to organise a seminar for me to lecture his congregation on the efficacy of IVF.
How much does it cost to undergo IVF?
It is difficult to put a price because it depends on what the problem is with the couple. Two friends may come and they might have different bills because it depends on what the problems are. But I can give a range. That is why I am so comfortable saying that if you can buy a second-hand car, you can do IVF.
Would you say that infertility is on the increase in Nigeria?
It looks like it’s on the increase, but one needs to be careful. We can only rely on figures from outside Nigeria because we don’t keep figures in Nigeria. The figures we have from outside show that infertility might definitely be on the increase. There was a study that was conducted two years ago in Denmark, which showed that sperm count was decreasing. Those are the things that we can lay claim to; and in Nigeria, there is no doubt that we are seeing more infertility cases. However, that is among those that report because people now know that it is possible to treat infertility. Once you can treat any disease, many more people will come forward because you can help them. That is why I say one must be careful about Nigeria because we don’t have accurate figures. But it definitely seems as if it’s on the increase.
How do you guard against transmittable diseases like HIV/AIDS?
HIV is not a disease that you inherit. We screen for HIV before we start treatment. If any of the partners has HIV, there are things that will be done to reduce transmission to the baby. But if there are genetic diseases, IVF has gone a little beyond that and we can even detect genetic diseases, which we can now prevent by not using the embryos that are affected by such genetic diseases. That is what we call pre-implantation genetic diagnosis.
How do you check abuse of the procedure among IVF practitioners?
We always advise couples to go to reputable fertility centres because we know a lot of things that happen when a woman is infertile. But those acts have their consequences and in a short while, quack IVF clinics will be in debt and consequently go out of business. In any case, we are regulated by quality control.
What is the life span of sperm in storage?
It does not have time limit; you can store it for a long period of time as long as the condition is maintained. The same thing with egg storage, which is a new thing.
Monday, October 1, 2012
Monday, February 20, 2012
Your clinic recently accomplished the feat of delivering of the 1,000th baby, to what will you attribute this? (July 2011)
1,000th baby! That was a milestone in our desire to provide quality healthcare to Nigerians. But that has come and gone and we are moving on. Permit me to say the feat is because of our determination and strict adherence to best medical practices obtainable anywhere in the world. In this clinic, we leave nothing to chances at all. We go all out to use latest technological innovation to bring smiles to face. But like I said, we are moving on. We are upgrading our centre in Kaduna to a full-fledged IVF hospital to cater for increasing needs in that parts of the country. Our success rate has also increased tremendously and we are happy at this. As at the last three quarters, it was 34 per cent and it is getting better now.
Are there things people do that make them more susceptible to infertility?
Of course, you are right. Let’s take women for example. Every woman has two tubes through which egg can pass for fertilisation. Once the tubes are blocked, there is nothing anybody can do about it naturally. So, any factor that will contribute to blocking the tubes will constitute an impediment to fertility. For instance, it is common knowledge that there is too much teenage pregnancy around and these girls will resort to abortion. That can block or damage their tubes if not handled well. This can be reduced by vigorous health education in our schools and public institution. So, those who have had abortion are very susceptible to infertility if it was not handled well. There is also the issue of multiple sexual partners…
…That causes infertility too?
Sure, it does. One could contact sexually transmitted diseases that may affect the chances of conceiving naturally. Once there is serious infection the tubes that translate sperms outside become blocked. Then, there is also the challenge of women who decide to get married late because of educational or professional pursuit. The end result is that they settle down for marriages late when fertility is very much on the decline and we would rather advise our ladies to settle down to marry early.
Once they finish their university education is fine.
When it is late?
Late is relative because fertility does not end at a particular age. So the best is once you finish your university education, settle down and marry. The earlier you start the better. By early 30s, fertility is already on the decline. By 40s, you might be needing egg from a donor.
What about men?
Yes, in men, we would be looking at smoking. It is a major cause of infertility. It has terrible ingredients that can slow down the sperm from moving and reduce egg production permanently. So, it is advisable people stop smoking heavily or stop it altogether. It is the same with alcohol consumption. Some men also wear hot pants that prevent ventilation in their private region. Then those who work in hot environments like bakeries, manufacturing factories and the likes are also at risk. It is also true for long distance lorry drivers who sit on the wheels for hours. This exposes them to infertility. Anything that can expose the testicles to heat is harmful for fertility. Once these things are stopped, fertility increases. These are harmful habits that promote infertility.
How do people feel after they are assisted to achieve pregnancy?
Of course they feel elated. They are like is this happening to us? I have seen a lot of that. Many will hug me and jump over me. For me as a doctor, it is also fulfilling. You never can tell how much people go through when they cannot have pregnancy on their own. It is such a shameful, distressing thing. So, when this finally gets it, they feel they have emerged through an ordeal that it is really. We have had patients from overseas coming around and saying it is absolutely unbelievable. For me, it is just the wonder of technology.
But there is the feeling that the assistance you render is not natural. Some women may feel ashamed to embrace it, feeling they cannot conceive on their own
You know those who come here have tried some options before. They have been to religious and traditional homes, seeking help for years. So for them to come means they recognise they need to be assisted. So there is no shame or bad feeling about it. Besides, there is nothing unnatural or artificial with IVF. It is simply a scientific method of achieving pregnancy practised worldwide. We don’t introduce anything other than sperms and egg, which are produced by the couples together. We simply monitor the mixture and ensure it forms pregnancy with technological devices. I think awareness has been poor and this is why many people don’t know what it is about.
How about cultural and religious perceptions that seeking assisted-conception is out of place?
Essentially, it is a matter of ignorance. If you are not challenged, you can sneer at those who seek help. But when it is you, you wouldn’t help where it is available. There are pastors who will say only God gives children and I agree perfectly. But we have pastors attending our clinic, getting help. The only way we can continue to convince people is to continue to talk about it and make them realise the process is as natural as scientific. Babies who come naturally are not different from the ones that come through assisted-conception. You find that those who were born through IVF now have children of their own. The babies do well and are not any less. Scientists have measured the intelligence coefficient of IVF babies and found out they are not lacking in any way. So what we do for couples here is to offer customised services that will maximise their chances of conception. The clinic itself is just in a matter of 3-4 weeks.
Saturday, February 18, 2012
Several accolades have followed the announcement of Robert Geoffery Edwards as the 2010 winner of the Nobel prize for Medicine by the Nobel Assembly at Karolinska Institute, Stockholm on Monday.
Although the prize comes with about $1.5m reward in cash, the true reward for the British professor comes from the over four million babies that have been born through his innovation.
Mrs. Adeola Michaels is one of the beneficiaries of Edwards’ IVF. Narrating her ordeal, Micheals who was recently delivered of a bouncing baby girl at the age of 57 years, said that she nearly went through hell and came back during her waiting years in the hands of her in-laws.
Michaels said her parents-in-law banned her from their house for 30 years after her spouse and herself were discovered to be suffering from unexplained infertility.
“I was not accepted because my husband refused to marry another wife. My mother-in-law called me a witch on several occasions, saying I had bewitched my husband from getting married to other women who could give him children. But to God be the glory, I had my baby this year through IVF and we did the naming ceremony in their house,” she said.
Edwards’ research that led to IVF started in 1955 and later through 1968 when he collaborated with the late Patrick Steptoe ,a medical scientist, which led to the fertilisation of the human egg in his laboratory.
Edwards developed human culture media to allow the fertilisation and early embryo culture, while Steptoe utilised laparoscopy to recover ovocytes from patients with tubal infertility.
The birth of Louise Brown, the first “test tube baby” in July 1978 heralded the beginning of a new field of medicine. Because medical practitioners can now inject a single sperm into an egg, infertile men as well as infertile women can have children. With this advance, called Intracytoplasmic Sperm Injection, even men who harbour small numbers of sperm can father babies.
Edwards, who is also dubbed ”The Father of test-tube babies,” pioneered the development of human in-vitro fertilisation therapy as an option for fertility-challenged couples in the world.
”His achievements have made it possible to treat infertility, a medical condition afflicting a large proportion of humanity including more than 10 per cent of all couples worldwide,” the Nobel Institute said.
No doubt his discovery has touched millions of lives. As a result of his efforts, many babies have been born by parents who otherwise would have failed to conceive children as infertility is said to afflict more than 3.5 per cent of the world population.
IVF specialists in Nigeria who congratulated Edwards following Monday‘s declaration, said that the prize was the highest feat in medicine and would increase awareness on the safety, success and survival of IVF therapy.
The Chief Medical Director, Medical Art Center, Ikeja Lagos, Prof. Oladapo Ashiru, who co-pioneered IVF in the country, said that the Nobel prize would increase awareness of IVF as a process for having children when other options have failed especially in Nigeria.
”It is great news and we are very excited about the award. Through Edwards, we have used this technology to help mankind in terms of having children. Now we hope people especially in this part of the world can embrace IVF as another process of having children when other options fail,” Ashiru said.
The CMD of Bridge Fertility Clinic, Victoria Island, Lagos, Dr. Richard Ajayi, who has had 500 babies conceived through IVF in his clinic, said although it was a welcome development, the recognition of Edwards’ effort to mankind was long overdue.
” For a technology that brought more than four million babies into the world, it is coming a little late but it’s better late than never. Edward is very old now, Patrick Steptoe is late. But it is still a welcome development,” he said.
Even experts have identified social stigma and low awareness and acceptance as reasons for the delay generally.
Edwards and his colleague, Steptoe, who died in 1988, marched forward against tremendous opposition from churches, governments, and the media, as well as intense scepticism from scientific colleagues to initiate the IVF phenomenom.
In his comment, the CMD of St.Ives Specialist Hospital, Ikeja, Lagos, a fertility clinic, Dr. Tunde Okewale, where over 210 babies have been born through IVF, said that although many Nigerian mothers have benefitted from this technology, they still refuse to share their experience like others abroad for the fear of being stigmatised.
”IVF is well recognised as an assisted conception technique although its pioneers faced many social opposition from government and religious groups. People felt it was like playing God by playing with nature. It is now well-accepted in developed countries.
”However, it is still shrouded in secrecy and stigma in Nigeria due to misconception, ignorance and religious sentiments.”
Asked to comment on what efforts experts were making to educate Nigerians about the advantages of IVF, Okewale said that obstetrics and gynaecology doctors through ethical practices would continue to educate the public.
Ashiru, an adjunt Professor of Anatomy and Reproductive Endocrinology with the University of Illinios, Chicago, said challenges were reducing worldwide due to increased awareness. He added that the Nobel Prize in medicine was a proof of its gained popularity.
”Like all new things it takes time. I founded a reproductive health magazine that is well circulated for this purpose only. Parents of IVF babies in Nigeria are our best awareness.”
Also speaking on the success rate of the IVF therapy, they all said that it was age-dependent.
Okewale said that success rate was age-dependent as a woman‘s chances of conception reduces as she grows older.
“It is dependent on the woman, the success rate per one attempt ranges from zero per cent at 50 years old to about 70 per cent at 25 years for a woman,” he said.
Ashiru stated that at his centre, the success rate was 45 and 60 per cent for patients less than 35 years and about 20- 35 per cent for patients over 40 years.
Infertility is perceived to be a death sentence generally in Africa especially in Nigeria, where in spite of ever increasing population of over 140 million, childlessness is not tolerated either by society, individuals and most especially families.
Infertility, which could be caused by ovulation problems, presence of fibroids, blocked tubes in women,low sperm count in men and unexplained causes in both gender, has also increased cases of divorce, polygamy, adultery and domestic violence amongst many families in Nigeria.
Apart from social problems in Nigeria, IVF is said to be only for the rich. The cost of obtaining an IVF varies from N700,000 to N1m in Nigeria.
However, IVF specialists have said in addition to dearth of IVF personnel, the cost of maintaining an IVF facility is not cheap.
Ashiru said, “It is expensive, the drugs, the laboratory ware, the equipment, the whole process and the staffing all consume money, but providers are trying many methods to reduce cost. At MART, we are able to give one free cycle after three failed attempts with the help of OARS Foundation.”
Okewale,whose hospital is also presently offering 50 per cent discount on IVF therapy to infertile couples in the month of October in celebration of Nigeria‘s 50th anniversary said, “Normally, a cycle of IVF treatment costs N700,000. The cost of injection, drugs and treatment,but we did a promo that reduced it to N350,000 to give hope to infertile couple who will not take the IVF option due to the costs.”
They stated that to reduce the cost of obtaining IVF, government through meaningful interventions could subsidise the costs for affected couples.
According to him, incidence of infertility will continue to rise with increased rates of infection through sexually-transmitted diseases, urbanisation which leads to stress and hormonal imbalance affecting sperm count and late marriage on the part of women which reduces their fertility.
Okewale said, ” If government should recognise infertility as a social problem, then they can subsidise the cost. More people would be needing IVF due to increased cases of infertility.”
They however urged fertility-challenged couples to always consider IVF therapy as a fertility treatment option and not a last resort.
Ashiru said, ”Today there are almost three million babies born from IVF. Since my involvement in IVF from 1984 till date in different centers, the number of babies that came through my intervention is over 1,000. At the MART, the number of babies we have facilitated since 2004 is over 200. It is a viable option.”Ajayi also added, “There is no reason in spite of all challenges, why infertile couples should not do IVF. Edwards has helped us to discover a method where technology can assist nature in playing its natural role.”
Thursday, February 16, 2012
By Chioma OBINNA
INFERTILITY has not only destabilised couples’ self esteem but has distorted relationships leaving a social stigma.
At such times, counseling is required to ensure a stable emotional state. In the words of the Executive Director of Hope Valley Fertility Clinic, Dr. Michael Ogunkoya, counseling gives opportunity to explore thoughts and feelings and beliefs in order to come to an understanding of the emerging situation.
Incidentally, fertility consultation with focus on Invitro – fertility treatment differs significantly from other medical consultation in obstetrics and gynaecology clinics. It involves an invasive nature of tests and a great impact on the couple’s intimate life but an inevitable process to determine an appropriate treatment.
According to Ogunkoya, counseling forms a crucial component of care and emotional treatment in infertility services. This is why at Hope Valley Clinic, couples are allowed to express themselves to an understanding counsellor who encourages, reassures and supports them throughout the cycles of repeated diagnostics procedures, interventions and medical treatment that can be successfully but often are not.
“We have recorded high success rates. From our records, I think we are the best in the country using Assisted Reproductive Technique (ART) and among the best in the world not just in terms of rate of conception but the delivery of services to the couples.
To me, is far important because this is a highly emotional problem. Therefore patient needs to be handled with patient and that goes a long way in securing confidence of the patient in allaying their fears and anxieties. Our job is far more than that of somebody who sees a patient and give medications. A lot of counseling is involved even before you start treatment because you need to build the confidence of the patients in order to secure the best options of treatment for them”.
He said: “It is a peculiar task most times. By the grace of God, one has been doing this for nearly a decade now therefore you gain some experience dealing with issues. We have a counselling unit too, which is being handled by a professional counsellor and by my training too, I have a lot of counselling experience. So you need to calm the patient down, explain to them what they are into. Show them examples of those who have gone through it, answer their questions correctly without any reservation. When you deal with that properly, the medical side becomes simpler to approach.
IVF treatment in Nigeria
Ogunkoya stated that Nigerian practitioners are on course as the country has recorded some of the highest rates in the entire world. “Don’t forget, Assisted reproduction is not a Nigerian issue but a world health issue. Even things we use are not made or bought in Nigeria. We have high success rates and we can compete favourably well with our colleagues across the world”.
Rise in infertility problem
I don’t see any increase in infertility problems rather it is the awareness that is increasing. Increase in accessibility or acceptability of modern ways of treating the problems. More patients read about these things in the papers. That did not happen in the past. As a result of that, people get more aware of places they can go and get the problem solved.
That is more of the cause of apparent increase. Problems of infertility have always been there both in the male and female. Especially, there is a lot of misconception about infertility being common in the female. It is now being reversed because we know that men too have problems if not more than females and they are beginning to accept it too. This wasn’t happening in the past.
Other reasons which may fuel infertility is that there are more women who are going to school now than 30 years ago. Many of those who are going to school want to push their careers at the highest level and thereby delaying settling down into marriage and child bearing. These days, instead of marrying at 25, they get married at 35 or 36 years and by that time, the fertility clock is about winding up because a woman’s fertility begins to dwindle even right from the late 20s although, very slowly, until about 36 it slows down more sharply and by 40, it becomes a problem. By the age of 40 or 42, a woman will need donor egg to achieve pregnancy.
Many people are coming into the practice but unfortunately, many quacks appeared to have their way through the media. Many more doctors may be interested in obstetrics and gynaecology and fertility treatment, but the reality is that we need more. As long as such a centre is set up according to the acceptable standards. If you consider the population of this country, you will agree with me that we need more.
In London alone we have 72 assisted reproductive technique centres. But the standards have to be there. The unfortunate thing in Nigeria is that these things get abused. You will agree with me that have we lapses in all the system in Nigeria. Which of the sectors are being controlled by government today? Just mention it. This is a big problem in Nigeria. These lapses are not being tackled by the government.
Now, we, the practitioners are looking at ways of sanitising that particular aspect of medicine. We should have done it long time ago, but very soon all hands will be on deck towards that area. we are going to call a meeting of all interested parties to form a body and that body will elect officers, committees and sub committees that would address certain issues including registration of such professionals by certain standards, at least minimum standards that is required to establish an IVF laboratory to prevent patients from being ripped- off.
As it is, anybody can just set up an IVF unit today in Nigeria because there is no monitoring or control. Some who had already set up an IVF clinic are not even gynaecologists. I don’t know where their endocrinology knowledge will come from but is just a matter of copy, copy. I remember years ago when scan first came into this country, people who are not doctors owned scan. People who have never been trained on the use of scanning machine owned scan as long as they can move the probe and something click out of the screen, they will scream that is your baby. I personally experience that. So these are the issues, I hope that very soon, there will be standards established to take care of the situation.
Effect of activities of quacks in IVF practice
On the part of patient, you do not only talk about the money wasted, but the emotional torture. Somebody comes to a place to get his or her problems solved and at the end fell into a wrong hand that do not have any knowledge of what he is into. Certainly, the patient will not get pregnant, if she eventually does, she would have got pregnant anyway.
Let me tell you something, if you have 100 patients who are seeking to get pregnant, if you leave them alone untouched without any medication some of them will get pregnant in the next one year. That is statistics but most of them will not because they are not getting the right treatment from the quacks. But more important is that by the end of the day, their emotions would have been bastardised because their hope have been dashed. They no longer know where to go because they have given it their all as they think.
We have doctors in this country who are practising Invitro – Fertilisation Technique. We know them, we are not saying they cannot have the business established but they must get a gynaecologist, who is professionally trained to manage such clinic.
We are going to be pushing for a legislation to stop these problems at the National Assembly level. We have formed a body that would do this. The aim of doing this is not to excommunicate such people but we also want to help them if they are interested in practising that particular profession. We can train them. Those who are not gynaecologist who are practising it we can tell them what to do because we need more centres because the population is huge. The issue is not envy or unhealthy competition but sanitisation to ensure that the right thing is done and the right product is delivered to the patient. It is not just a matter of collecting money from patients and ripping them off.
Challenges of IVF practice in Nigeria
Talking about IVF, it is not a Nigeria thing. It is a technology that is based on science.
Science, we all know is very specific in its requirements. One plus one is equal to two that is the end of the story. You cannot afford not to do the right thing in science. In this business, we depend a lot on certain things. For instance power. Our colleagues in other part of the world don’t have to generate power by themselves because power is constant. But here we don’t only have to own generators, we have UPS, we have inverters with all the problems those ones will cause you not only money, noise and pollution, time wasting. Even to set up, we have to go abroad to get trained because we don’t have the man power here. We have to get the expatriates to train us for a couple of years.
Personnel is a heavy constraint. We don’t have ready-made personnel to do this for us. We have to train people and retrain them and sometimes import expatriates who will collaborate with us. This is another heavy constraint that requires a lot of foreign exchange. Even when you train Nigeria personnel they may not be as reliable as those of our colleagues abroad because for some reasons you cannot appreciate the issues involved in this type of society.
Other constraints have to do with cost. How many Nigerians can afford the treatment of IVF? We have battle all these issues and yet IVF is not a procedure that you can continue to cut down cost because many things we use are not what you manage. If you are to use certain things it has to be it. It is either you do that or forget about it. There are cultural issues too. But we can manage it by counselling. Can you imagine a woman being told by her in-laws that she should get pregnant before six months or she would be thrown out of her husband’s house? These are issues that constitute major constraints but we are fighting back. Unfortunately, about 80 to 90 percent of the patients are already constrained, bastardised, and resources are almost exhausted before they find their way to authentic fertility clinic.
I am afraid not much can be done to the high cost of IVF treatment for now because of what I have just told you. The technology is science. In science you must use the right things. There is not much one can do about the cost. On our part, we have done our possible best. What we charge here is half of what our colleagues charge abroad. You can go to the internet and find out. So can we do better than that no. We don’t want to lose the quality of what we offer. For instance, we have to ensure that the generator is on 24 hours because of what we keep in the refrigerators.
All these things have to do with cost. What we tell our patients is that when they are ready they can come over. Most times a lot of them think it is something they could do in bits. It is not so. Because we start the treatment when we have all we need so the treatment does not get truncated half way. We have tried our hands also on the cost of our involvement with patients, what can we do? We looked at the issue of telling those who sell us drugs to reduce their cost as well, we know their own constraints as well.
It could be injurious. We discussed this in our international conferences on how to establish low cost IVF treatment. There are some procedures we have tried in the past like the one we call Invitro – maturation. Instead of using several drugs to generate matured eggs, we use very few drugs to generate immature eggs and mature them outside the body but yet it has not gained world wide acceptance because of the results.
The issue is that Nigeria government is not doing anything about the issue. We have minister of health, we have commissioners of health. Any time you see them talk about anything is only for political propaganda and it dies there. We will continue to make noise. If the government were to be sincere about helping as they do in other countries to assist patient half way with their drugs, I believe many more Nigerians will have access to treatment.
Professionals playing God
I will put that question back to you. There is no basis to say anybody is playing God because the egg comes from the woman and the sperm still comes from the man. If you have a boil in your nose what will you do? You will remove it and may even take antibiotic. Will I now say you are playing God because you use antibiotic? That problem will never go on its own. So if a woman is not getting pregnant and we know that is the egg from her and she has no eggs, we will get it from somewhere else. A person who has no left limb from an accident and he wants to be productive, he will go for artificial limb. Will you say he was playing God? These are facts. If somebody is not getting pregnant and you take the egg and take the sperm put them together as normally it would have done inside her body then put them back into where they would have settled, I don’t think anybody is playing God in this situation. I would want to take this opportunity to tell Nigerians that the issue of playing God does not arise. We are just doing what science does and good knowledge God has given to us.
IVF baby and naturally conceived baby
People have a misconception about these things but where will be the difference when we already said that we achieve pregnancy by putting together the woman’s egg and the man’s sperm? There is no difference. Experience of over 30 years has proven clearly, that there is no difference at all in any of the parametres you are using to judge; child development, behavioural development, IQ, social interaction amongst others. The first IVF baby now has a baby and her baby is fine.
Hope Valley success rates
To the glory of God, we have over 1000 babies delivered through Assisted Reproductive Technique (ART). As I speak to you now some people are about to deliver. As at the last count, we have 1008 babies and we are still counting and we have to continue. We have four centres scattered all over the country. We have one in Abuja, Port Harcourt and Kaduna. We pride ourselves on high success rates which is probably due to the diligence we have here. Right from the beginning, we handle patients holistically and establish great confidence in them. Through proper counselling, and approach, give them to ask questions.
We have found that to be a very good instrument to this our trade, apart from the quality control measures. When you come to my clinic if it is not going to work, I will tell you the situation point blank. Most patients will be happy to be told the truth.
Quality control measures
The concept of quality control is to gain excellence and in so doing have the best result in any field. Quality control is about getting the right thing done and the way you achieve it. IVF is not an exception. There are bodies that certify it. There are many others who maintain high standard of quality control without being certified. It is just by doing the right thing. Right from the employment of staff you will train and retrain. In the procedure, you teach the patient on how to comply with the treatment. Set standards about record keeping so that you can have good records.
Hope for IVF patients
A lot of patients should be very careful. It is unfortunate, that our healthcare is not properly fine-tuned. A lot of patients have been man handled. Usually, when you asked them about their past you get all sorts of harrowing stories. A lot of patients’ vaginas have been burnt. Many of them were deceived that when they insert something into their Vagina, their fibroid will drop and this has led to so many of their vaginas being burnt seriously. At the end of the day, they will just destroy the anatomy of the place and sometimes, the cervix is burnt and not accessible and it touches the heart that such things do happen.
Like I said, apart from the money that they spend, they are emotionally bastardised and when such people now come to a place like Hope Valley and you listen to them, they get surprised that you gave them opportunity to express themselves. At Hope Valley clinic, we listen to them very well and get the best approach for their treatments. And this is a recipe for good results. However there is need to create more awareness about the treatment.
Patients should also find out about their problems and ask questions before they plunge into any treatment procedure. I advise that patients should go to their doctors and ask questions. Any doctor who does not answer your question, leave the doctor because he is supposed to serve you. Approach a gynaecologist, and if after one year or two years you are not breaking results request them to refer you to a fertility specialist. If they don’t, find your way.
Wednesday, February 15, 2012
He had his professional training both within and outside Nigeria and has worked with reputable hospitals in Nigeria and overseas. The Nigerian/British trained gynaecologist who has been practising since 1975 had returned to Nigeria from the United Kingdom in 1992 as gynaecologist and started a hospital in Dolphin, Ikoyi, Lagos, which he managed till 2001 when he decided to start off with the Hope Valley, an assisted conception unit.
The aim of the assisted conception treatment carried out by Hope Valley is to unite the sperm from the man and the egg from the woman to produce embryos in the laboratory. These embryos are then placed in the incubator for 48 hours and then transferred into the uterus to development a pregnancy.
It is about nine years now and Dr. Michael .O. Ogunkoya, a consultant gynaecologist and fertility specialist as well as the managing director, Hope Valley Female and Male Fertility Centre, an assisted conception unit, will soon celebrate the birth of a thousand babies that he has facilitated in the last few years at the fertility centre. He recalled that it has not been easy as in terms of looking back at when it all started. But today, the centre is reckoned as the best facility centre in Sub-Sahara Africa with a very impressive record of over 900 babies.
"We had to collaborate with some team from the United Kingdom (UK) as most centres in the world do in order to really acquire the skills-theoretical and practical aspects. Apart from that, there were the problems of finance and the fact that if you want to acquire technology from abroad, you are definitely going to cross some hurdles. We had to invite investors into the business because of huge amount of money involved at that time and luckily one was able to do that successfully, especially through friends.
"And so far, they have not been disappointed because not only have we been successful in what we do, but we have also been able to give them back some dividends. Of course, the investors would have been happier if they were given more because they were good people and could have put their money in the bank than investing it in a medical stuff," the doctor said.
However, in terms of the job he does, Ogunkoya is happy to serve the population as most doctors would, but he still has a lot of tasks at hand in terms of reaching out to his potential clients in the sense that many of them still do not know that this kind of facility at Hope Valley could exist in Africa, much less Nigeria. Another challenge for him is that even many of the few who know such facility exists in Nigeria, cannot afford it even when Ogunkoya claims his hospital charges far less than what it costs to get such treatment abroad.
"We spend a lot of money in trying to reach out and educate the population as well as creating the awareness. It has been my pleasure though because at the end of the day I get somebody pregnant; the couple is happy and we are happy as well," Ogunkoya said. He wants government to come in and assist couples having challenges in conception as it is done in other countries of the world. But that has not been the case as he bemoaned the lack of interest of government in couples that have such challenges. "We know the situation in this country; they have not been able to even help themselves not to talk of other people.
"But these are things that happen in other countries - government coming in to assist couples in purchase of drugs or pay part of the treatment fee. On our part at Hope Valley, we are charging below what we should be charging and that is our own contribution to the plights of couples who find themselves in this category", the gynecologist said.
He stressed that Hope Valley is very proud of what it is doing to have acquired the type of technology it did so far and to also have been able to produce the number of babies it has done within the little space of time. "This is something that is very pleasing to us, especially when we compare ourselves with other facility units in other parts of the world," Ogunkoya said with great satisfaction.
Explaining the process he goes through in getting numerous women pregnant at his unit, Ogunkoya said, "it is a very scientific procedure and that is the technical part of getting people to conceive". To this end, Ogunkoya most often do a lot of talking with the patients, most come to him with a pre-conceived idea of what it should be and bearing in mind that almost ninety per cent of them must have gone through all such of treatment modalities in past. Some going to the churches, native doctors and even having to go from pillar to post and therefore, when they come to a place like the Hope Valley, they are financially down, emotional drained and sometimes confuse, not knowing what to do and who to trust.
"So it is always very important for us to actually put them down to a resting phase. Here, they usually need a lot of counseling, so we talk a lot after which we introduce our scheme to them and explain it in very simple language. After all, what causes a baby is the combination of sperm and egg. It is as simple as that. We tell them simply that our job is to get the egg and the sperm, mix them together and then transfer the mixture back to the woman. Then we study scientifically what it takes to do so and we do that," the Doctor said. And as for the logic, he said it is much more than egg and sperm becoming embryo.
Ogunkoya, who has been helping women get pregnant since 1986 when he became a gynecologist, started the foremost technology about 19 years ago in Nigeria.
For him, nothing gives him pleasure and joy as getting women pregnant. "I am not only the one that is excited when we succeed in getting a physically and emotionally famished couple fruitful. The whole unit is usually happy and so excited, fulfilled and happy. The thing that really moves us is not the token we get as profit because that is quite small, but the fact that if you get these patients pregnant with the hassle and frustration that she came in with, it puts a smile on her frustrated face and so each success makes us so excited," he further explained.
On what stand out Hope Valley from other assisted facility centres in Nigeria.
He said, "How many units in Nigeria have been around for nine years and how many can boast of producing more than 900 babies?" That is probably an end result of a lot of other qualities like hard work, diligence, paying attention to details and having standard equipments that are used to produce good results as well as quality management".
To be able to move near the patients, Hope Valley has established satellite centres in all the geo-political zones in Nigeria. "By establishing satellite centres in other parts of Nigeria, we also try to help the doctors who refer them to learn from our technology as one of our aims is to teach the doctors and nurses coming behind us about what we do, so that they don't have to come to our head office in Lagos all the time for one explanation or the other. This also distinguishes us from other fertility centres in Nigeria because we are about the first and only fertility centre that has satellite centres in Nigeria as opposed to primary centres."
He has got lots of constraints on towing this line, but he has been able to surmount them taking one challenge at a time. "To become a doctor was very difficult to start with, especially for those of us that came from the village," Ogunkoya noted. To start off a unit like his, he said was very daunting. He said: "first, you need to have the interest that carried you along. You also need to have some form of contact with people who have done this kind of thing in the past. I was fortunate to have trained in England under somebody who is now a doyen of this profession in England, Prof. Kraft with who I did my intern back in 1981. So I picked my interest from there. You needed to have had such contact and having such contacts mean that you have been very hard working trying to proof a point.
"And having come back to establish it, finance, like I said earlier was an issue. It was quite difficult and because I did not have the kind of money expected to put up such a business, and so I had to call in some investors and if you know what that means, it is not easy too. Some will disappoint you, some will promise and turn you down at the end of the day and having crossed that hurdle, they needed money to go and buy the equipment.
"It is just like buying a car and you really need to know what car and what it's for. Then you need to go for the training. We needed to look for a collaborative team that is those who have been doing it successfully and that you can collaborate with so that you could be put through. And therefore we needed to get a team from abroad who would be coming here regularly to train and treat our patients," he said.
Apart from the financial problem faced by Ogunkoya initially before he eventually was able to stand on his own about six years ago, there were also the limitations that had to do with the patients. "Some patients are very good and would not give you any headache, while others will give you a lot of headaches. But they are patients and in terms of doctor-patient relationship, the patient is always right. But then you need to move near them, talk to them and finds out what is wrong even when the problem is not only medical. So some times the patients pose challenges that even adversely affect their medical challenges."
Ogunkoya was quick to advise couples that if they have been having unprotected sex for more than a year without conception, they should admit that there is something wrong and that a state of infertility should be considered. "Depending on the age of the couple, the frequency of intercourse, we believe that by the time you have tried for three years, one way or the other, and then you must definitely seek for assistance by way of assisted conception techniques."
At Hope Valley, he said each couple is given a customised medical service that suits their particular needs and it takes four to five weeks on the average to attain a success of conceiving. "Because there are so many technologies that we use, we try through consultations and tests to know which method of the technologies would suit each couple needs so that we can put a round ball in a round hole," the doctor emphasised.
Ogunkoya who craves to improve more on the success rate of the IVF in Nigeria, further revealed that the success rate of IVF throughout the world is not different from what is obtained in Nigeria, adding; "In fact some time we surpass that and I reckon that throughout the world, the success rate would further increase."