Nigeria records first birth following new technology in IVF

The Association for Fertility and Reproductive Health of Nigeria had its annual conference last week. They covered several topics from guidelines and regulation of the practice of assisted reproductive technologies to new techniques in the field.
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.”

HAWKING THE FERTILITY DREAM

On Monday, March 9, a leading national newspaper published as a “Supplement”

a two-page article, what it calls, a “Special focus on standard IVF clinics in Nigeria,” and entitled it, “Scourge of infertility: IVF as an option.” The article “advertised” fertility centres in Nigeria and those behind them. There were also telephone numbers where other clinics can get in touch with it so that they can also be “advertised.”
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.

 

source: medianigeria.com