As the field of fertility rapidly evolves, advancements in technology continue to offer new possibilities for those struggling to conceive. But along with these innovations, comes a host of challenges and concerns, including the issue of frauds posing as fertility experts. In this interview with Africa Health Report (AHR)’s Gom Mirian, the Managing Director of Nordica Fertility Centre, Dr. Abayomi Ajayi, spoke on these issues and other emerging trends.
Excerpts:
As an obstetrician and gynaecologist with decades of experience and pioneer of the Intracytoplasmic Morphologically Selected Injection (IMSI) in Nigeria, a founder of a clinic that specialises in In-Vitro Fertilization (IVF) and treatment of infertility, Nigeria’s representative of obgyn.net (a network of obstetricians and gynecologists all over the world), as well as member of many international professional associations including the global health council, what are some of the most promising innovations in the field of fertility treatment that you’ve seen recently?
We started with IVF at first. When the first child was born in 1978, it was a feminine issue at the time; mother Reese Brown had both tubes cut off due to an ectopic pregnancy. So, it was the first ground-breaking thing—the ability of a woman who was believed to be starre to have a child through the external fusion of sperm and eggs.
However, after that, we started to see that okay, we’ve solved this lead female problem, so to speak, but we were still getting poor results with those who had poor sperm count, until 1990 that the baby was born by ECE, a procedure whereby you take a single sperm and actually inject it into a single egg. At the time, that was unthinkable; it was science fiction.
After that, the treatment for fertility began to expand beyond those who had infertility to those who were trying to prevent diseases from being transmitted from the parents to the children. For example, sickle cell anemia in our environment, to wanting a particular gender. So, to determine the genes of the babies that we wanted, or to eliminate the ones that we didn’t want, we used a technique known as PGT.
There has been a lot of up fruit in that direction, but what I’m trying to say is that what is obtainable in good clinics in Nigeria are the things that you can do anywhere else in the world. So, services you can get in the United States or the United Kingdom are also available in some good fertility clinics in Nigeria. We are aware of surrogacy, of course. It’s also very much available in Nigeria. Almost all the services that you can get in top clinics all over the world can also be gotten in top clinics in Nigeria.
With these advanced technologies and treatments, do you see any emerging ethical concerns?
Oh, Of course, there are many ethical concerns, actually all over the world. Assisted conception is the greatest problem with ethical concerns. There are certain things you can do but are not allowed to do. For example, some countries claim they don’t use sex selection. There are certain countries that say they don’t do this or that.
But there are basic things like every doctor, every clinic that wants to practice these must have consent forms, which must be signed. You see some people doing surrogacy, there’s no consent, there is no contract. What are you really doing? And you also will go to such clinics? So, I think it is both ways. That’s why I’m saying that the most important thing to do is for the buyer to beware. You also need to be educated. At least, this is the barest minimum of what to expect when you’re going to an IVF clinic.
Are there laws/ regulations guiding fertility treatment in Nigeria or Africa as a whole?
Not yet, although I am aware that, for surrogacy specifically, Lagos State is working on one. Now that surrogacy has been bastardised in Nigeria, everyone is a surrogate agency and they are all engaging in a variety of activities. This is what Lagos State is attempting to regulate in the first place, and I believe that it will spread to other states as well. Some of us are arguing that instead of focusing only on surrogacy, let’s try to implement laws that will regulate the practice of assisted conception in Nigeria.
We have a body called the Association for Fertility and Reproductive Health, and we sat down to discuss the prerequisites for IVF and the rules for assisted reproduction in Nigeria. Of course, since it’s voluntary, we have no enforcement authority, so it’s like we are still depending on the church mind of members to carry out these guidelines, but that’s the situation at the moment.
Every country makes an effort to create its own laws. For instance, laws in the UK and America are not the same. South Africa has passed some laws, I believe Kenya tried to pass some laws, and Uganda took some actions, but there was some chaos that resulted from them. Each country should strive to make its home grown rather than importing laws from other countries and then copying them verbatim. You might discover, of course, that culture affects so many things.
Acceptability (is an issue) because when we’re talking about ethics, there’s no right or wrong. This is what is acceptable to you as a people so you cannot go and bring something from the UK and copy and paste what they’re using to regulate your own country. There’s going to be a lot of chaos. So that’s why sometimes, it is slow for you to get to that point, because all the stakeholders have to be involved if it’s going to be successful.
India just implemented its own laws, which I believe they were enacted between 2002 and 2001 December. They have been using IVF for a considerable amount of time. In order for regulation to be effective, stakeholders must be included and take active roles, so we can’t just say, “okay, this is how we’re going to regulate.”
What can be done to cushion the huge out of pocket burden on couples in accessing fertility treatment?
I have no knowledge of countries where the government really pays the cost, even in the UK. Don’t let us fool ourselves, technological treatments are expensive, and someone has to foot the bill.
Well, if you ask me, I believe the easiest thing for the government to do—if not entirely—will be for health insurance to be included. However, the government cannot afford to pay for IVF treatments. Let’s not kid ourselves. How many countries in the world provide services that are totally free? The answer is not many, and it’s not even close to being true, given our current population and economy.
I don’t think we are capable of doing that, but if we can get health insurance to be able to work properly and be able to take on things like that, then many more people will be able to access this.
Unfortunately, Nigeria does not currently have health insurance, therefore that is the issue we are now facing. I think we need to contextualise it by saying it is like an iPhone. Is it everybody who can really buy an iPhone? But if your uncle buys it and gives it to you, you can use it. So that’s one of the things that we’re seeing in Nigeria, Also, people are coming together, giving money to their wards and family members, trying to help them to contribute money, but someone has to pay if you’re going to get good quality healthcare.
One of the reasons we disagree with governments who play politics with healthcare is because someone has to pay for it and it is no longer an affordable option anywhere in the globe. So, in order to be able to pay for infertility treatment, we pray and hope that insurance companies would also include this.
What advice would you give to individuals and couples who are considering fertility treatment?
I think that’s a very key thing. One of the things I like to advise patients who want to get fertility treatment is, well, if you have the money, you can travel abroad, but there is no need for you to travel abroad right now in Nigeria, but you also need to do your due diligence.
One of the problems we have in Nigeria is we don’t like reading but we must read. If you are not going to fall into the hands of charlatans we must read, we must talk to doctors. But, most of the time, the way we talk to doctors in Nigeria is to say, ”do you know who I am?” That’s not the issue. The issue is that you must first of all educate yourself and then talk to the doctor and see whether this kind of doctor even knows what you know to be able to entrust yourself to such doctors.
I tell people that nobody has seen sperm or egg so actually our business is of faith. We are doing something that you cannot see and therefore, you must first of all establish the pedigree of the people who are looking after you and that’s why we are having a lot of funny clinics springing up now, because people who don’t do due diligence keep them in business.
Also, people need to talk more about IVF, about the challenges they face with infertility, rather than attacking when a patient enters your clinic and doesn’t get what he wants. He logs onto Facebook and makes a false statement. That type of behaviour is not what we want in Nigeria and is not going to be helpful. If anybody does anything that is unethical, call them out. If anybody does anything that is unconventional, call them out but not because you didn’t get pregnant, then you go ranting about it, especially when you know the success rate of the programme that you’re entering into and some of them, they tell you what the outcome is likely to be like.
So, what I’m trying to say is that although we shouldn’t attempt to undermine one another, we should make sure that we hold practitioners accountable as well. At the same time, let’s be fair to one another.
Are there other issues our readers need to know?
The only thing I want to leave with them is that there is hope when they are faced with infertility. They are not alone. Additionally, there are support organisations for them in Nigeria because, as I always say, education is the most essential thing.
What to anticipate from the therapy; when some individuals come, I tell them that they are asking for the impossible when they tell me what they want. I ask if they want me to build a flying automobile for them. We must also manage our expectations if we are aware of what to anticipate from technology. So, it’s a lot of education.
And that’s why you see me. I’m so much in the forefront of educating patients about what they need to know about technology. So, I think that’s basically what I will just leave with the readers.
About the Author
