Speaks on the challenges of childless couples and IVF

By Sola Ogundipe

COUPLES often face hard decisions when experiencing infertility and harder choices when going through fertility treatments, and yet if they are successful, they face many other decisions as well. Thirty six years ago, on July 25, 1978, Lesley and John Brown faced such decisions prior to successfully undergoing a complicated and at that time, relatively unknown assisted reproductive procedure known as In Vitro Fertilisation, IVF.

The birth of their famous daughter, Louise Joy, at Oldham General Hospital, in the UK, ensured that the Browns will be forever remembered as the world’s pioneering IVF parents.

It is thanks to efforts of English scientist Robert Edwards, and his medical colleague Patrick Steptoe, that Louise, technically the world’s first “test tube baby” baby was created through the procedure of introducing fertilised eggs into a woman’s womb for a successful IVF pregnancy.

Julian-test-tubeMillions of couples all over the world challenged by infertility have since been inspired to toe the path of the Browns by adopting the revolutionary IVF intervention to become parents of their own biological children. To date more than five million IVF babies have been born.

On September 14, 2004, in Lagos, Nigeria, precisely 23 years after the historic birth of the world’s first IVF baby, Emmanuel and Francesca Onwudijo, joined the growing list of happy parents of perfectly healthy IVF children with the birth of their son, Julian Oluchukwu (God’s work).

Nobody knew for certain that Julian, who was conceived through a combined Assisted Reproduction Technique, ART, of IVF and Intracytosplasmic Sperm Injection, ICSI, was going to be the first IVF baby at Nordica fertility Centre, Lagos, until after his mother got pregnant at the first attempt.

Although separated by space and time, in several ways, the Browns and the Onwudijos had a lot in common. While the Browns had been trying to have a baby for the better part of a decade, the Onwudijos had been searching for the fruit of the womb for five agonising years.

Like all IVF babies, at birth, Louise and Julian were miracles to their parents. Louise, who is now a mother of two, marked her 36th birthday earlier in July, while Julian clocked 10 Sunday last week.

Like Lesley, he was successfully delivered through a Caesarean Section.
In a chat, Julian who loves Jollof rice and chicken, is currently in Basic 6, and  would like to be an engineer,  told Sunday Vanguard  that his mother told him about the origins of hid conception a long time ago and how, she and his father didn’t really have an option after going public to let other couples know how he was conceived and born.

Journey to motherhood
In a trip down memory lane, Julian’s mother, Francesca, recalled the long journey to motherhood. Unlike Louise’s mother, Lesley, whose fallopian tubes were blocked, Francesca recalled that she had no such impediment.

“I got married in July 1999 and had Julian in 2004 – that was five years interval.  I was taking treatment at Lagoon Hospital, but went to the internet to search for solution. You know when a woman is looking for the fruit of the womb, she would do anything and go anywhere. I was in the office and was just going through the internet when I saw the website of Nordica Fertility Centre, I took the address, at that time the clinic was at VGC, in Lekki. I went there and made enquires. That was how I met Dr. Abayomi Ajayi who I had known at Lagoon Hospital. I tried the first time and and to God be the glory, it was successful. There is never any harm trying.”

Francesca who said she has never had had to defend the fact that she gave birth to an IVF baby, had no problems about the issue of stigma.
“We went through the normal tests, there was nothing wrong, I was 24 or 25 then I could not wait to carry my baby rather than waiting and doing nothing. I was not intimidated by the cost. I had no fears or reservations at that time.

“I read a lot found out what the process was about. It was a kind of assisted process. I knew that. It wasn’t as if the baby was going to fall from heaven, it is a natural process, I made enquires and was satisfied. Julian wasn’t the first IVF baby in Nigeria. He was a normal baby and has grown into a normal child. He was perfect at birth and has been perfect in every way a baby should be. Julian has grown to be very intelligent, normal and smart just as babies from normal conception. I have not observed any abnormality whatsoever.”

Nothing to hide
Francesca, who had to rely on her trust in the church and has stood before congregations to talk about her experience, said she has never had to defend what she did or hidden it from anybody. “I had no problems about the issue of stigma. I have never hidden the fact that I did assisted reproduction. There is nothing to hide because he is my blood. It was my egg that was taken as well as my husband’s sperm. So there is nothing to hide. For those that are hiding, it is ignorance. They need to be better educated about the process”, she stated.

“The church I attend does not preach against IVF. I recall a few years ago, a doctor was invited from Abuja to lecture women on the IVF. He did with his team and educated women and asked the church to bring out three women to be given free IVF cycles. They did. Out of them, one was 54 years old; now she has two kids, twins – a boy and a girl. The husband was 69 last year. Another is carrying her baby now.

“If I were to be in a church that preaches against IVF, since I have gone through the process, I would try to educate women and let them know that it is not as if the baby is coming from another planet. It is an assisted procedure just to aid you to conceive. I can even go to the Pastor and use myself as example. My faith always works for me, I believe in God and so far he has not failed me. Why would you suffer in silence when you know there is an alternative? Why are you dying in pains? Children come from God. You just try the best you can”.

IVF and controversy
Almost since its inception, IVF has been a subject of ethical and controversy. Today some arguments once made against the process have fallen by the wayside, while others remain unchanged. Arguments in favour of IVF have remained fairly consistent over the years, notably the potential of allowing previously infertile couples to finally have children of their own. Prior to IVF, it was more or less the end of the line for infertile patients, but today, IVF is almost like the rule than the option for infertile couples.

Daily, babies are conceived and born throughout the world, but the percentage of those born with the help of assisted reproductive technologies doesn’t appear to matter. Rather, what matters is that the techniques available to infertile couples work.

It matters that wonderful doctors are helping people have a child, but it doesn’t matter how those children were conceived or born. What matters is that they are coming into the world at all. However, people ask if there is need to get wrapped up in the ethics of reproductive medicines, when the bottom line is to be helping a couple bring a normal, healthy child into the world.

Effective but expensive
Speaking on the birth of Julian, Medical Director/CEO, Nordica Fertility Centre, Lagos, Asaba and Abuja, Dr Abayomi Ajayi, said it represents a new beginning in the history of Nordica, a new hope for parenthood.

“Julian is like a son to us all here, our greatest achievement indeed. In view of our successes recorded, first with Julian our first baby and all those that came thereafter has necessitated the need for further advocacy by the parents in order to share the good news”, Ajayi said.

“Whilst we have achieved monumental growth in the number of babies conceived, we have equally not neglected our corporate social responsibility. Working in conjunction with the Fertility Treatment Support Foundation, FTSF, free fertility treatments have been made available to over 58 couples with diverse infertility challenges.  We also work with the ESGN, Endometriosis Support Group Nigeria, the only Foundation supporting this cause in West Africa”.

On IVF, he described it more as a necessity than an option for infertile couples.
“It is unfortunate that infertility is seen as a personal problem. We know it is a social problem. In Nigeria, unfortunately, the government is not and probably cannot for now sponsor fertility treatment. But government still needs to look at some of these things, and may be providing more centres that can cater for people who are might not be able to afford IVF.”

Noting that IVF treatment isn’t cheap anywhere in the world, Ajayi remarked that the way out is for government to help put the issue on the front burner.

“An experience I’ve seen i s that IVF treatment is not only taken up by the rich because we place a high premium on child bearing in this part of the world. And what people do is that it is like a family challenge. Once somebody has infertility in the family, I’ve seen people contribute money for people to have treatment. It is like a family challenge. Now that the government cannot measure up now, banks are coming up with initiatives that can make you pay in instalments. We know that there are companies beginning to take fertility treatment as part of their staff welfare. They are very few, but there is light down the tunnel and this is what we need to keep doing.”

The doctor, who maintained that IVF success rate is the same everywhere in the world, however, regrets the lack of nationwide data in Nigeria.

‘Success is age-dependent’
“The success rate is age-dependent. Julian’s mother had age in her side, because life comes primarily from the egg, so the younger the egg, when every other thing is normal, the better the success rate. This is why we tell people not to leave IVF as the last resort, because if you do you are actually compromising on success rate”, he said.

“We want people to report early so that there will be proper assessment and, if you need IVF, do it when chances are best, and the best can be done for you. For people above 35, we still have above 40 percent success rate; the problem in Nigeria is that a lot of people above 37 are doing IVF. But things are getting better.

“When we started 10 years ago, about 80 percent were above 37. The picture is getting better. The younger people should report early so that the success rate can be the best for everybody. It is not on even for us when we have to be doing this 4-5 times and asking people to be using donor eggs when they are not really prepared.

“Do proper assessment on time and if you need IVF, do it. It is age-dependent. If you are below 35, and you have tried for a year, and there is no pregnancy, see a gynaecologist. If you are above 35 and you have tried for a year without success, see a gynaecologist”.

Challenges with couples
According to Ajayi, sometimes there are couples that are seeing the traditional gynaecologist who is doing the assessment on them and everything is ok, but that is not so because the basic test can only identify a certain percentage of the problem.

“For somebody that is 45, the first thing to look at is the age. If we look at it from the point of view, you know we said it is the eggs that become babies. For such woman, even if she is still menstruating regularly, the problem lies with age which cannot be detected by regular tests. We are not going to look at whether she is ovulating or not, we are not looking at the stock ovaries, even then such person has normal function, we know it cannot be true. You have to interpret your tests holistically, so it is like a 60 year old woman now has an ovary function test that says normal, it cannot be. You have to look at the whole person to make your decision”, he stated.

Mrs Ranti Ajayi, the Clinic Manager, explains further. “When they come in and they are told they need donor eggs, they do not readily agree. Well it is a normal thing that every woman wants to have her own child biologically but when the reality on ground says it is not feasible, they just have to use donor eggs.

“Some will not accept, even when you give the options – to use donor eggs, adopt a child or buy one as they do now. With donor eggs, most of the time the child looks like the father. We look at the attributes of the mother before choosing a donor egg. Even then, other things are taken into consideration.”

Recalling how, in 2003, the vision of setting up Nordica Fertility Centre, Lagos was conceived, Ajayi said the primary aim was to courageously combat the plague of infertility by providing true “comfort centres” where the pain of childless couples could be soothed both emotionally and medically.

“Our first Centre opened on the 14th of April, 2003 at Victoria Garden City, Lekki Lagos. But owing to our desire to be close to our clients and the fact that we were also rapidly expanding, we moved to Ikoyi, Lagos in January 2008. The Yaba Clinic opened its doors in October 2003 and the our bid to make our clients the centre of their world, another Clinic opened in Asaba in November 2009 and the newest Centre in Asokoro Abuja was commissioned in November 2012.

“The lack of information about fertility options coupled with the stigmatisation associated with childlessness has contributed to the reason why a lot of people do not explore the possibility of assisted conception. This should not be seen as a taboo but seen as a means to an end. “In 11 or so years of existence, God helping us, we have been able to assist in the conception of several hundreds of babies and we are still counting,” Ajayi noted.

In its lifetime, Nordica Lagos has set a number of firsts.  With all modesty, it is the first IVF clinic to have a baby from laser assisted hatching and remains the only fertility clinic currently using the Intracytoplasmic Morphologically selected sperm Injection, IMSI, in addressing male related infertility issues. It is also one of the few clinics in Nigeria to utilise acupuncture for IVF treatment and to carry out Pre-Implantation Genetic Diagnosis and egg freezing”.

SOURCE: Vanguard Nigeria