Saturday, February 18, 2012

IVF therapy: Robert Edwards’ gift to humanity

Fifty-five years after Robert Geoffery Edwards began his research on in-vitro fertilisation, the Nobel Assembly of the Karolinka Institute gave him the 2010 Nobel Prize in Medicine on Monday. In this report, Bukola Adebayo examines the joy of beneficiaries of this innovation and what it holds for the future of the practice in Nigeria.

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.”

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