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.