Female and male infertility is a huge problem in many countries across the globe, including Nigeria. However, many families have opted for In Vitro Fertilisation to overcome the challenge. Dayo Ojerinde writes that in Nigeria, IVF is gradually gaining acceptance, but many people cannot afford the cost
Forty-nine-year-old Mrs Olufunke Oshofisan, a trader in Apapa, Lagos, has been married for 27 years. She had two stillbirths within the period after which she was unable to conceive. She said she later had to buy into the idea of going for In Vitro Fertilisation in 2017.
According to an online encyclopedia, wikipedia, In Vitro Fertilisation is a process of fertilisation where an egg is combined with sperm outside the body. The process involves monitoring and stimulating a woman’s ovulatory process; removing an ovum (egg) from the woman’s ovaries and letting sperm fertilise it in a liquid in a laboratory. After the fertilised egg (zygote) undergoes embryo culture for two to six days, it is implanted in the same or another woman’s uterus, with the intention of establishing a successful pregnancy.
In an interview with our correspondent, Oshofisan said her husband, who is a civil servant, was cooperative and never put her under pressure during the waiting period.
“My husband did not give me any problem, but I knew that his family members talked to him to find alternatives but they never said it in my presence.
“But he never considered taking another wife during the waiting period; till today I’m still his only wife.
“I did my IVF at the Lagos University Teaching Hospital in August 2017 and gave birth in April 2018. It cost us roughly N1m, but we were overwhelmed with joy as God gave us twins through the IVF. My husband could not hide his joy when the twins were born. The babies are doing very well; no health challenges, no issue since I gave birth to them,” Oshofisan said.
She said the first IVF she did resulted in a pregnancy, but she lost it as a result of stress and her eating habit.
“It came down before the end of the first trimester; after spending so much, when I had hope that I would soon become a mother. I didn’t know that a pregnant woman was not supposed to add potash to ewedu; the doctor said it was one of the reasons the pregnancy came down.
“When I went for the second IVF, the doctors told me not to stress myself and to avoid some foods that could affect the pregnancy. I abided by the rules and I was rewarded with a set of twins,” Oshofisan said.
Also, a 37-year-old mother who got pregnant twice via IVF and gave her name simply as Mrs Nwokocha told our correspondent that she had married for six years before going for the IVF when she could not conceive.
“I failed to conceive for years after I got married. Some of the doctors that I saw suggested IVF, but I was reluctant; the price was high. But my husband encouraged me and so in 2014 we decided to go for the IVF.
“I did the first one at Nordica Fertility Centre, Lagos, in 2014; six years after my marriage. The child is now four years. We paid N70,000 for registration and N150,000 for analysis, while we paid N1.7m for the IVF cycle,” Nwokocha said.
She said the second procedure she did was at the Lagos University Teaching Hospital in 2016 and she gave birth in 2017.
“LUTH’s price was just a miracle. I came to LUTH for another thing entirely. They mentioned that they were just starting their IVF centre and suggested that I buy into it. I wasn’t interested but they encouraged me and I went home and told my husband. He was skeptical because he doesn’t like dealing with government hospitals. But I told him that I would not bother him; that I would be the only one going for the appointments.
“When I got to LUTH, they were actually doing a promo. I paid only N400,000 for my treatment. It was a miracle,” Nwokocha said.
Nwokocha said she was lucky at her first attempt, adding that the second attempt failed while the third attempt succeeded.
“The pregnancies didn’t give me any challenge, they were just like normal pregnancies, and the babies are not different from any other baby.
“They are doing fine, if I don’t tell you that they were had through IVF you wouldn’t be curious because they are like any normal child. I even had cesarean operations for the two kids; we are living a normal life.
“After having my two kids, I wanted to create a blog to encourage other women to go for IVF and not wait, but my husband didn’t support the idea and that was why I dropped it,” Nwokocha said.
For 50-year-old Mrs Ronke Onadeko who resides in Ikoyi, Lagos, living with her partner for seven years without having a child was not satisfactory for her until she went for IVF at the Medical Art Centre, Maryland, Lagos.
“I tried having a child naturally but I had problem conceiving and that was why I considered the IVF option and it worked out.
“Before I did it at the Medical Centre in Maryland, I had done it several times in other centres, including outside the country, but they were not successful. When the pregnancy stayed in 2017, I had no issue at all; it was a perfect pregnancy; maybe because I exercised a lot and ate properly.
“Since I gave birth to my boy, he has had no health issue, there is no difference between a baby conceived naturally and the one conceived via IVF.
“I can’t even count the number of artificial insemination procedures that I have been put through; I even tried surrogacy and it didn’t work.
“I did more than 10 IVF cycles before finally succeeding and each of the cycles did not cost less than N1.2m. When the pregnancy later stayed, I was careful not to lose it, I didn’t have any pregnancy challenge and it was a sigh of relief carrying my own baby boy after the long wait,” Onadeko said.
Another IVF beneficiary, Mr Thomas Ozimede, a 50-year-old trado-medical practitioner who resides in Igando, Lagos, said his joy knew no bounds when his wife was delivered of a set of twins in 2015 after going for an IVF cycle in 2014.
“The pressure of not having a child after 23 years of marriage made me and my wife consider the IVF option. Though we spent more than N1m for the cycle that succeeded, I’m happy that the result came out positively, she gave birth to a boy and a girl.
“We did IVF six times, it failed five times and we succeeded at the sixth attempt.
“Aside IVF, as a trado-medical doctor, we tried all other traditional means, but they all didn’t work,” Ozimede said.
The cost of IVF in Nigeria
A professor of Anatomy and Consultant Reproductive Endocrinologist, Oladapo Ashiru, says the cost of IVF in Nigeria is between N1.2 m and N2m.
He said, “The price varies, people are confused now between IVF and Intrauterine Insemination; IUI is when you take the sperm from the man and inject it into the uterus of the woman, maybe because the sperm is low.
“The IUI cost between N200,000 and N500,000; that is not IVF. The IVF that involves stimulation can cost you over $10,000, which is about N3.6m.
“In Nigeria, because of low manpower and low cost of rent among others, the cost of proper IVF is between N1.2m and N2m if you go to a centre where they do the right thing. Once it is less than that, you have to be careful of what is going on,” Ashiru said.
He noted that the exchange rate had an effect on the cost of IFV in Nigeria.
“When the dollar exchange was lower, there was a time we used to charge N750,000,” he added.
Asked why the price changes with the exchange rate, Ashiru said, “Very simple; it is because we do not produce the drug we use in Nigeria and we also import the media for IVF culture, all those things are from abroad.
“In some countries where IVF is done, the equipment and the drug are produced in those countries; but despite that, it still costs between N1.5m and N1.8m. If those things are made in Nigeria, it will be cheaper.”
How IVF started in Nigeria
The first attempt at using in vitro fertilisation in Nigeria came as result of the research done by Ashiru in his Reproductive Endocrinology Laboratory at the College of Medicine, University of Lagos.
Ashiru and his postgraduate student, Dr Akin Abisogun, started the research in 1983 and this led to a successful IVF and pregnancy in rats. The result of the experimental work has been published and presented at several national and international conferences, such as the proceedings of the Anatomical Society of West Africa in 1984.
Ashiru, Prof Osato Giwa-Osagie of the Department of Obstetrics and Gynaecology of the Lagos University Teaching Hospital also started the process of Assisted Reproductive Technology in humans in the latter part of 1983, but the first pregnancy ended as a miscarriage in 1984.
Ashiru, in an interview with our correspondent, said, “We started preliminary work of IVF in humans in 1983. And by 1986, we had a pregnancy. In 1989, we had a pregnancy and the delivery of a woman of a baby from IVF. And because of my work, I have been publishing in international journals since 1984. So, that’s how it started.
“And when we became successful, the hospital decided to give us a position in the theatre to be able to do this specifically, and that increased our success rate. It continued until 1994 when I had to leave for the United States due to the instability in the country, as well as the fact that there was a new revolution in the field. There was new equipment and new techniques had been introduced. So I had to be in the US to be a part of that revolution, and that is the knowledge I have now brought back to Nigeria,” Ashiru said.
The IVF process
Ashiru said lifestyle changes were necessary for couples intending to go for IVF as such would make the body clean, free of pathogens and toxins which must have been in the body through food consumption or contacted from the environment.
“Such toxins are in foods like fish. In the fish, there are some metals like mercury that can stop a woman from getting pregnant. Those who work in the oil industry are at risk of picking up some toxins and contaminations that get into their body and prevent a woman from getting pregnant. We now know that if they detoxify, their body will be clean.
“Once that is done, you make enquiries; have interviews and discussions to know which centre is the best in terms of success rate, infrastructure and experience. Then you do your consultation.
“The next thing after all the examinations is to make sure that the uterus is clear; the sperm is available. They give the wife drugs to make sure that she can produce many eggs. When the follicles are ready, they remove those follicles, get the eggs, then the sperm; process them and get them together to fertilise. Three to five days later, they take it back into the uterus. And that is what leads to pregnancy. Ideally, if all the IVF processes are well done, there should be a success,” Ashiru said.
The professor of Medicine added that only about five per cent of those that could afford IVF stayed in the country in the 1980s, but presently, 95 per cent of the people who could afford it did it in the country.
He said, “Very few people go abroad for IVF today in Nigeria, as a matter of fact, many people are now coming from outside the country to do IVF in Nigeria.”
Even though IVF started at the Lagos University Teaching Hospital in Nigeria, a lot of centres have opened up in the country.
Some popular centres are Advanced Fertility Clinic, Lagos; Bridge Clinic, Lagos; Hope Valley Fertility Centre, Lagos; Kingscare Hospital, Abuja; Medical Art Centre, Lagos, National Hospital, Abuja; Nisa Premier Hospital, Abuja, University of Benin Teaching Hospital, Benin; and Nordica Fertility Centre, Lagos.
Govt, NGOs must help the poor access IVF
Dr Babatunde Okewale of the St. Ives Hospital, Abeokuta, Ogun State, said the government and non-governmental organisations could help the poor to access IVF by subsidising the cost for them.
“Government and NGOs must come together to help people with infertility, bearing in mind that it is a problem that affects the whole community. For instance, in our centre, we have an NGO that supports us; what they do is that twice a year for those who register at a particular time of the year, the patients pay 50 per cent of the charges while the NGO pays the remaining 50 per cent of the charges.
“Infertility is not a disease per se, it is not like having a heart problem, but it is the only disease that affects two people at the same time, the husband and the wife. In our society, giving birth to a child is very important, infertility could increase the incidence of extramarital affairs, it could cause a family breakup, divorce. It is a societal problem the government must look into.”
Okewale also urged the Federal Government to give importers of health care equipment a special exchange rate, as well as rebates on duty since most of the equipment and drugs were not manufactured in the country.
“Special exchange rate should be given to those importing drugs and health equipment that are not manufactured in the country; it will go a long way in improving the quality health care available to the people,” Okewale said.
He said about 98 per cent of IVF equipment and drugs were imported which was why the cost was high. Okewale, therefore, urged the government to encourage local producers to reduce the cost in the country.
When asked about the cost in his centre, Okewale said, “It varies because there are different types of IVF; we have the classical IVF and we have the Intracytoplasmic sperm injection, ICSI; we have IVF with a donor egg and surrogacy, among others.
“On the average, it ranges between N1m and N2m. The classical IVF basically involves taking the man’s sperm and mixing it with the woman’s egg in the laboratory.
“What happens in ICSI is that you take the sperm and inject it directly to the ovary of the woman using the ICSI machine. The machine is expansive and that explains why the ICSI is more expensive than the classical IVF. Some people might need a donor egg, surrogacy and the rest, that is an added cost,” Okewale said.
Over 180 million couples suffer infertility globally — WHO
According to data released by the World Health Organisation, the majority of people who suffer infertility are in developing countries.
WHO estimated that infertility affected up to 10.5 per cent of couples of reproductive age group globally and 20 per cent of couples of the same group in Nigeria.
Available statistics show that there are about 12 million infertile persons in Nigeria, which is almost 10 percent of the total population.
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