Monday, February 20, 2012

Harmful Habits that lead to Infertility

Dr Michael Ogunkoya is a Gynaecologist and fertility specialist. He runs Hope Valley Clinic, Victoria Island Lagos, which has been helping people achieve conception with modern scientific inventions. He speaks with Sunday Oguntola on why many Nigerians are battling with infertility
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.
How 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

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.”

Thursday, February 16, 2012

In dealing with infertility, you manage emotions, says Dr. Ogunkoya

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.

Dr. Ogunkoya
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”.
Managing emotions
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.
Adequate legislation
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.
Government contribution
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

Nigeria: 'Making Women Pregnant Gives Me Pleasure'

Lagos — Dr. Michael Ogunkoya, a consultant gynaecologist and fertility specialist is the managing director, Hope Valley Female and Male Fertility Centre, an assisted conception unit. He has been able to get numerous women pregnant as a result of the state-of-the-art equipment at the centre. The hospital has been recognised as the best facility institution in Sub-Sahara Africa with a very impressive record of over 900 babies. He spoke with MARY EKAH.
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."

Tuesday, February 14, 2012

Experimenting The Scientific Baby Option

The introduction of invitro-fertilisation technology into the country has brought the desired succour to most couples despite its staggering cost. - The challenge of infertility among couples can be appreciated when one is faced with it than when one is told. This was the case with the Okafor family who lived with this through their 13 years of marriage.
Mrs. Mma Okafor, a middle aged housewife is today a proud mother of a set of triplets after undergoing invitro-fertilisation.

Mrs. Okafor like many Nigerians who are faced with the reality of infertility, is now singing songs of praise courtesy of the conception technology. She told Newsworld that her long awaited years of expectation was full of depression and isolation because of the rejection she suffered from friends, in-laws, family members and people around her.But today Mrs. Mma Okafor like many other women is basking in the euphoria of motherhood through the success of invitro-fertilisation.
The first lady of Oyo State, Mrs. Kemi Alao-Akala is also a beneficiary of invitro-fertilisation, IVF.
Invitro-fertilisation is basically fertilisation of the female eggs with the male sperm outside the body of the woman. This technology was originally planned for women with blocked tubes and those with ovulating disorders. The phenomenon simply means that the tubes are opened but the ovaries are not releasing the required eggs.
Medical experts say another problem is rearing its ugly head in the form of a sizeable proportion of males having abnormalities in the quality of semen they produce. This category of men suffers problems ranging from low sperm count to very low or even absence of sperm.
IVF also helps women without wombs to have children through surrogacy. This means that women who are over 60 years can have children through this technology.
The chief consultant of the invitro-fertilisation unit of the National Hospital, Abuja, Dr. Olubunmi Ladipo in a chat withNewsworld, said that though IVF is a new technology that assists conception, the success rate is not always 100 percent anywhere in the world. Basically, the success of the process is related to the age of the woman; the older the woman, the less the success. For those who want it, it is better to seek for assistance early in life, he pointed out. There are different types of IVF. The first is ‘programmed intercourse’ which entails giving drugs to the woman to produce egg and when it matures, the couple meet. There is Intrauterine Insemination, invitro-fertilisation and intracytoplasmic injection, ICSI.
Experts say in the country today, rampant infertility is giving rise to the use of IVF. And infertility in women is said to be caused by many factors like tube blockage, widely regarded as secondary infection, to sexually transmitted diseases, STDs, after either aortal infection or even after delivery in an unhygienic environment."All these are preventable because a good number of those who seek IVF are those who did not take preventive measures, otherwise they would not have any need for it," Dr. Ladipo emphasised.Corroborating Dr. Ladipo’s views, a fertility consultant at Dove Fertility and IVF Centre, Dr. Efena Egetie told this magazine that IVF also assists women who menstruate without releasing eggs. He stated that their eggs are harvested and mixed with the sperm scientifically to cause conception. The doctor who admitted that he has handled about 200 cases was quick to add that the success of IVF depends on the age of the patient and their hormonal profile. However, some medical experts have confirmed that IVF conception depends on luck because usually out of every 10 women who undergo this procedure, only two may become pregnant.Although this technology is putting smiles on the faces of average income infertile couples, the cost is such that most Nigerians cannot afford it. This is why it is considered as an elitist technology.
According to Dr. Efetie, in IVF pregnancies, after the third day, insemination becomes complete. He stressed that this accounts for the difficulty in differentiating between an IVF pregnancy from the normal one."But at the end of the full pregnancy period, most patients undergo caesarean operation to deliver their babies. Also, all babies born through this technology are normal like other naturally conceived humans," he further stated.

The National Hospital, since it commenced the IVF Unit in 2006 has handled about 500 cases at the cost of N300, 000 per patient.
At the Kings Care Hospital, Abuja, Dr. Madu Eghosa, an Embryologist at the Hospital’s IVF Unit told this reporter that the hospital has so far handled over 2,000 cases at the cost of N1.6 million for patients receiving treatment in batches and N2.1 million for individuals.According to the doctor, the inhibiting factors of IVF are finance and the African belief, which discourages people from seeking this help.Another inhibition identified is stigmatisation, which medical experts say contributes to people shying away from confessing openly that they conceived their babies through IVF technology.