By Okwuta Audu Managing Editor Kwararafa Reporters.
Dr Kenneth Egwuda is the consultant and founder of Gynaeville-ALPS AND Diagnostic specialist Hospital Jos.Egwuda, one of the pioneers of IVF test tube baby technology in Plateau state had a world record of making a 63-years-old African woman pregnant through IVF assisted reproductive technology in Jos. Dr. Egwuda in this interview with Kwararafa Reporters Managing Editor bares his mind on how age of Woman could no longer be a barrier to making her pregnant through IVF assisted reproduction technology. Excerpts:
Why should Nigerians believe in IVF assisted reproductive technology in raising children whenever the traditional approach of making Woman pregnant fails?
By the grace of God I was the Pioneer of IVF test tube baby technology in Jos and the doctor to the oldest African woman who got pregnant by assisted reproductive technology (IVF).
IVF means a technology that enables the gynecologist, or scientist to treat infertile couples. In this form of treatment, the egg is gotten from a woman and the sperm from the man and fertilised outside the womb, in a test tube after which the fertilised egg is transferred into the womb of the mother and she is able to achieve pregnancy by this means.
IVF is recommended for the following reasons; blocked fallopian tubes, advanced female age where there are no viable eggs, treatment of genetic diseases, low sperm count, infertility of undetermined causes etc.
How do you rate the success of the IVF technology since it came to Nigeria?
That is the first-time mom gave birth at the age of 63. The delivery was witnessed by the Plateau State commissioner of health. The baby, a girl became two years on May 8 this year.
You know, what we have noticed is, that IVF has developed in Nigeria so rapidly. It was predominant in Abuja, Lagos and Port Harcourt before now, but some of us who got our training partly in Nigeria, UK, Germany, Italy and India have decided to move into the deeper parts of Nigeria. That was why I was able to pioneer IVF in Jos and Kano state.
Talking about the success, when IVF started initially, it took several attempts to achieve the first success which was the birth of Louise Brown, delivered in 1978. You know, what we noticed is that technology of the drugs, equipment and even the modalities for treatment have gotten so improved, refined and advanced that success has become a common place with IVF.
The very first time we started in Jos, we got the oldest African IVF woman pregnant and currently we are looking at having a success rate of about sixty five percent, especially in the younger age group as at an advanced age, of 40 and above, success rate dwindles, coming as low as 10-15 percent. So, it has actually been nice, but the challenge we have noticed is that the need of people for IVF is increasing.
How do you address the rising cases of sex and gender selection of babies in the modern world?
Yes it is true that people now demand for gender balancing, wanting to select the sex of their offspring or even request for gestational surrogacy services.
You know, when a couple has five girls for instance, they begin to demand for a boy or two and when you have all boys, you begin to look for a girl or two. The reasons for that are cultural, religious, political, or economic or even due to inheritances.
So, we are beginning to get requests for sex selection, either because of disease condition or cultural reasons, and that has increased the depth of the technicalities that we need to apply in the practice of IVF.
By and large, we are meeting those demands and requests. Nigeria has not put forth an ethics of control of some of the excesses in IVF. But then, what controls the excesses is actually our association with the American association of reproductive medicine, the European society of Human Reproduction and Embryology. Those are the ethics that guides our practice. So the practice is controlled.
While we are grappling with the cost, we still find a way around the North central Region of Nigeria to bring IVF to a very minimal cost by doing things like the natural cycle IVF which is a little bit cheap as against the conventional IVF where so many drugs are consumed and very expensive .
How do you tackle the problem of late marriages among women and infertility?
Let me tell you that one of the interesting things you will like to know is the sexual revolution the world is going through now. Marriages do not come quite early , girls do not get married until they are old, and you know a woman’s reproductive life revolves around her age and time and the older she gets, the more difficult it is for her to get pregnant. Some people do not even get married until they are past forty, and at this stage, because of ignorance, they do not even know they do not have the capacity to achieve pregnancy quickly. But now, we see that with IVF, the woman can bank her eggs. You can imagine a woman has over seven hundred thousand eggs at birth, and when she gets old and wants to start using them, she sees none because she did not get married early. So we also started the process of freezing the female eggs. So the woman can freeze her eggs, take them up at a later time in life to achieve pregnancy and avoid using donated egg.
You know the world has also seen a lot of crises. We have a lot of military men or footballers who are married but do not cohabit with their wives, as they are either fighting for the country or on national assignments. In that process, their wives grow old without achieving pregnancy, so, their sperms can be frozen so they can achieve pregnancy any time with the husband’s consent.
How do you adopt science or technology in addressing male impotence?
Yes, impotence may mean that the man is not able to perform sexual activity, but does not necessarily mean he is infertile. A man can be impotent but still have sperms. We can surgically extract sperms from the testes and use them to the wife’s eggs. There is also the technology to use low sperm count in an ejaculated sperm to fertilise the woman’s eggs. That is one of the beauties of IVF.
Conventionally, before the man makes his wife pregnant, science has it that he should produce like fifteen to twenty million sperms in the ejaculate. But in IVF, we do not necessarily need that much. We also have many conditions today that make men unable to have sperms such as disease conditions, exposure to chemicals as seen in agriculturists, painters or those who work with all sorts of chemicals, their sperms are also affected by these lifestyles. So whether they have one million or two million sperms, we can use it to get the woman pregnant. Then of course, some may not even have at all. They may get donated sperm from anyone and can be used in treating their wives to achieve pregnancy. So the male factor now is very important as we can see now that the lifestyle of a man is also affecting his reproduction.
A man may have up to twenty million sperms, but because of his stressful lifestyle, the component of the DNA of his sperm may be affected. This is what we call the DNA fragmentation, so you see millions of sperms but not plenty to make a woman pregnant. IVF is also a means of addressing that.
Does IVF services have age limit?
There are age limits usually enforced in countries with strict ethics and regulations. For instance, in the UK, age limit is about fifty, and that is obtained in many European countries. But then, in medicine, there is what we call ethics. You can be older than fifty but judged by a doctor to be fit enough to conceive to bear a child. Nothing stops him from giving you that service because what governs the care we give to people these days is the patient’s autonomy.
The rights of the people are reproductive rights. For instance, an individual is free to access any reproductive care and benefit from scientific inventions. This is why we had a sixty three year old woman achieve pregnancy here in Jos. When that happened, we got calls from doctors from London saying why on earth did we have to make an old woman pregnant, knowing that life expectancy in Africa and Nigeria is very short. Who will take care of the baby when she dies? We told them that we are aware of that, but in medicine the intervention you give an individual depends on the person’s autonomy.
So you allow them make a choice, and make sure the intervention is beneficial.
We do no harm and we tell the truth. This woman’s desire was to achieve her dreams of carrying a baby in her life time that she can call her own and by the age of sixty three, with scientific ingenuity and the help of IVF or assisted reproduction technology, she was able to achieve it. While the world was criticising, the beneficiary was excited and happy that in her lifetime, she could carry a baby of her own. So, you see the balance. It is however important to note that at this age pregnancy may take its toll on her age.
But a woman may be as young as twenty years for instance, and you judge her unfit to carry a pregnancy because she may die from some heart condition that is incompatible with pregnancy. A woman in that condition may not be admitted by the physician to attempt the journey of pregnancy. Yes, there are age limits but the bottom line is let the health status of the individual determine what intervention is given.
At your ALPS Hospital and Diagnostics, what is the traffic of people coming for these services every day?
In my hospital where I work as head of the human reproduction unit, we see an average of four to six people who come to access these services daily. We treat them in batches of thirty to forty monthly, and the number is so because the people carrying the burden of infertility are enormous.
Over time, it appears that the quality of care we give people has been satisfactory and so they refer their friends to come access care here. More so, I think it is because the cost of the care here in Jos is cheaper compared to other regions. The cost of accommodation, transportation, and feeding are also lower. Cost of life generally is lower in Jos. So in a way, it brings down the cost of the IVF. Then more importantly, I am among few Africans that practice low cost IVF, which is the natural cycle IVF and that cuts off the cost of drugs that people spend and further breaks down the cost of treatment.
What are the disadvantages of going for IVF?
I will say there are no disadvantages, because people who have the problem have come for help. The most painful part that may be termed a disadvantage may be the failure of IVF. It is not every time that hundred per cent success is achieved by everybody. That is why I talked about the success rate. The failure may be as a result of social pressure, depression and frustration due to infertility. So for me, these are the disadvantages and the cost too, because no matter how low the costs of IVF, there are those who cannot afford it.
Can you carry out surgery without cutting the patient open under the current scientific dispensation?
That is actually called the minimal access surgery or keyhole surgery. Instead of cutting the patient open widely with your blade, you make only tiny holes in the abdomen or any cavity you intend to operate and introduce your gadgets as thin as one centimeter wide with your energy sources device and cut off what you want to cut. No matter how big there are devices that can cut them into bits and pieces and suck them out of the body.
You finish this type of operation as against keeping the patient in the hospital for several days as we see in conventional surgeries, the person can go back home same day or next day. That is minimal access surgery and it limits the injury inflicted during surgery and facilitates healing. Also, complications from this surgery are lesser if done successfully. People return to their normal lives easily and faster. You are able to return to work sooner when you undergo minimal access surgery
Yes, it is more expensive than the regular open surgery, reason being that the gadgets are costlier, the cost of training is extremely high and the length of time used in developing expertise is longer, and so, you can only expect it to be higher than conventional surgery.
IVF is believed to be relatively new in Nigeria and as such what would be your advice to the prospective Nigerian Couples.
My advice to Nigerian couples is to see the introduction of IVF assisted reproductive technology as a move design by God to help man through the advent of science. They should also play down culture. The fact that fertilisation is taking place outside does not mean that the doctor is creating eggs. The eggs were taken from the woman’s ovary and the sperm from the man. Just that they do not have a meeting point inside., but outside, but the baby develops inside the mother and is delivered by the mother. It stays the length of a conventional pregnancy. So they should take advantage of the innovation and advancement in science.
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