Thursday, December 20, 2012

IVF has brought joy to many families

Prof. Oladapo Ashiru is reputed to be the brain behind the success of in-vitro fertilisation (IVF) in West Africa. In collaboration with another Nigerian expert, Professor Osato Ona Frank Giwa-Osagie, he pioneered the test tube baby procedure in Black Africa in 1984, and produced the first test tube baby in West Africa in 1989. Ashiru, former Acting Provost of College of Medicine, University of Lagos and the Chief Medical Director of the Medical Assisted Reproductive Therapy Centre, Maryland, Lagos in this interview with TEMITOPE OGUNBANKE and FUNMI SALOME JOHNSON, speaks on assisted reproduction and the state of health in Nigeria.

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.

Nigerian hospital pioneers novel IVF technique

A Nigerian specialist hospital, Nordica Fertility Centre, Lagos, has pioneered for the first time in West Africa, an In-vito Fertilisation, IVF, technique that doubles the chances of men with the problem of abnormally low sperm count and poor sperm motility to biologically father their own children.

The new technique, called Intra-Cytosplasmic Morphologically-Selected Sperm Injection, IMSI, enables the direct selection of good sperms from the man and then injecting into the woman’s egg to successfully achieve pregnancy.

Medical Director, Nordica Lagos, Dr. Abayomi Ajayi, told Vanguard that series of pregnancies had already been successfully achieved by the fertility centre from the pioneering initiative. “This is the first time it would be reported that a pregnancy would be achieved through this means in this part of the world,” he said.

He said the procedure which is described as a build up on treatment for male-factor infertility treatment procedure called Intra-Cytosplasmic Sperm Injection, ICSI, allows doctors to choose only those sperms with the best morphology for use in the assisted reproduction process, using a high resolution microscope that allows exploration at several thousand times magnification.

“In ICSI the sperm is magnified 200-400 times, but in IMSI, the sperm is magnified 6,600 times , so one is seeing the sperm completely and is able to select the good ones from the bad ones. This has been shown to produce better embryos, increased pregnacy rates and reduced abortion rates in men with low sperm count,” he said.

Those who will benefit most are men in who the sperm count is very low or even those with zero sperm count or those in who the motility is low. However it is ideal for men with sperm count below five million and/or sperm motility below 20 percent.

Other groups that can benefit include couples who have had cycles of failure of In-vitro Fertilisation,IVF, as well as couples with history of recurrent first trimester miscarriage.