In-vitro Fertilisation (IVF) may have been shrouded in secrecy because of the stigma associated with it while the procedure is quite demanding. But the flood of testimonies from couples appears to be rubbishing the shame connected with it as Nigerians are now realising that a successful IVF is not only a scientific miracle but a breakthrough in itself. In this report, Isioma Madike, tells the story of those who became proud mothers through the assisted reproductive technology
On the outward, Mrs Elizabeth Nwaka, could pass for a well to do trader at the popular Mile 12 market in Lagos. But that could be a smokescreen. In actual fact, Nwaka is an unhappy woman that has been denigrated and called names by her in-laws for a challenge that was not her making. She was childless after many years in matrimony.
She said: “I was called a man by my in-laws, especially my mother-in-law, who saw no reason for two ‘men’ to be married. I was also branded a witch; while some of my sisters-in-law accused me of donating my ovaries to the occult world they believed I belong to.
“The most painful thing was listening to deliberate discussions of some women of child bearing age in my presence. They would deliberately discuss such issues as labour pains, antenatal care, immunisation and dentition experienced in baby growth and the likes. All these were aimed at mocking as well as making me feel incomplete as a woman.
“Fortunately, while I went through these humiliations, my husband stood by me. He just kind of developed a thick skin and deaf ear to all what his people were taking me through. He gave me strength and his unwavering supports were such that he never left me in the lurch. He was a rare breed. We visited spiritualists, white garment and Pentecostal pastors we thought should be potent enough to help my situation. But they all failed.”
Time, which is of essence, was ticking for Nwaka. Soon, hope gave way for hopelessness to set in. Menopause was knocking at her door. But she was not willing to give up. And just at the nick of time, miraculously, a lifeline came from the horizon. This time, through the support of improved technology, Nwaka became a proud mother of a baby boy.
Pathetic as Nwaka’s story may seem, hers was not an isolated case. Mrs. Bolanle Balogun also had fertility problems after signing the dotted lines with her husband many years ago. “I did so many things at different healing homes and hospitals. Despite my age, I never gave up on my dream of having a child. So, when a relative told me about a fertility centre in Lagos, I prayed and took my chance.
“I and my husband put our money together. Although we didn’t have much money but the doctors helped us. We went to the hospital and they gave us some treatment, and thank God it worked,” Balogun said.
She became a proud mother after undergoing In-Vitro fertilisation (IVF). But there was the issue of stigma, having conceived through Assisted Reproductive Technology (ART) or IVF? “That wasn’t an issue for me at the time; even now it’s still not an issue. From the day I was told I was pregnant, I called my mother and mother-in-law to tell them I was pregnant. My child is now two years old.
Mrs. Kate Adikwu’s case was not entirely different. She had her three children through IVF. Adikwu confessed that the problem of infertility in Nigeria can drive couples and families involved to the edge that at some point they will not care about the “how” of the conception of the children they so desperately want.
In her case, there was intense pressure and trials from worried members of the family after six years of wait. “At a point, the mothers-in-law want to see children and not how you got them, she said, adding, “I had two children through ART, but the third one, was a miracle sort of as he came naturally. My ART children look very much like me and my husband. This is because the sperm and eggs used are from us only that it was assisted conception. The genetic identities are so strong.
“Some people nonetheless accused me of going to one place or the other to conceive but i didn’t mind because I trusted God and they were eventually shamed after hearing my testimony. I want to encourage others going this ‘hell’ trying to conceive to try this technology. I bet they won’t regret it though it could be stressful but it’s worth the trouble.”
Aside these three, history was made in Abeokuta as another woman became Africa’s oldest IVF mother who delivered a baby boy at 67, a few years back. Mrs Ajibola Otunbusin was reported to have broken all known record in that respect in the process. Not only had she became the oldest Nigerian woman at the time to give birth through IVF, she was said to be the oldest African in recorded history to give birth to a baby, and the 2nd oldest mother in the world. The baby was delivered at Atoke Medical Centre, Abeokuta, on October 20, 2018.
The elated mother had undergone the IVF procedure at the St Ives IVF & Fertility centre. With her successful conception and delivery she became the latest in a long line of women who had benefited from the highly lauded IVF programme.
Speaking to Thelagostimes, Otunbusin narrated how her efforts to have a child had taken her to several specialist hospitals in Nigeria and India where she underwent numerous procedures without success.
“This might be hard to believe but I am 67 years old and I have been married for over 39 years. I have done several IVF both in India and in Nigeria that failed. At several points, I had said to myself: ‘So I will die without a child of my own?’ But I never gave up on God. I held on to the belief that at the appointed time, God will remember me. And my husband kept encouraging me. In 2018, I started the procedure with joy and I ended it with joy from above,” she said.
While glowing with the radiance that comes from a long mission finally accomplished, Otunbusin advised other women who are encountering challenges with childbearing not to lose hope. She urged them to remain positive and try all medical methods while also looking up to God for the fruit of the womb.
There have been other fascinating stories of those who waited for so long a time before experiencing what many call the joy of motherhood. One of such stories is on a woman who reportedly waited until her ripe age of 63, before becoming a mother, which many chose to call the Plateau miracle.
Mrs Margaret Davou did the unthinkable and was very happy when she struggled to breastfeed a baby for the first time in her life. Bes Hanny, as she called her, according to reports, looked fragile at birth though; she nonetheless was the cynosure of every eye that visited the Gynaeville Specialist Hospital along Old Airport Road in Jos, where she was delivered. She attracted numerous well-wishers, all eager to have a glimpse of a child whose arrival caused a retired civil servant to shed tears of joy.
Dr. Kenneth Egwuda, the IVF specialist and CEO of Gynaeville who helped performed the miracle, said that Davou underwent hormone replacement therapy to enable her uterus conceive. Through IVF, Davou’s fourth attempt and first in the hands of the Gynaeville staff, became successful.
With 12 years of experience in the field of assisted reproductive health, Egwuda had pioneered IVF in Plateau and Kano states. From the beginning, according to the doctor, the Davous knew they were in good hands and after proper evaluation, “we realised that the woman was in good health, aged but with no metabolic illnesses or other prominent ageing disease apart from hypertension.”
The woman was in a blissful mood after the delivery as she told Daily Trust: “I am fine, baby is fine, the Lord has done it.” The woman from Zawan in Jos South Local Government Area of Plateau State, had worked as an administrative staff with the Nigeria Television Authority (NTA) in Kano, Makurdi and eventually retired in 2012, two years after she was posted to the NTA Jos Network Centre. Before her delivery, she had been wary about talking to the press. However, a day after her baby arrived, she became a changed woman and beamed with smiles, thanking God and became more accommodating.
Her husband, 67-year-old Francis Davou, had also retired from the Nigerian Air Force in 2008 and reportedly said his joy was tenfold that of his wife. “It is because I am a man and so I have to control my emotions, but my joy is more than hers,” he said.
The Davous waited 38 long years to be called parents. Within those years, they had tried fertility treatments in other centres which failed; they had also used their resources to train children of relatives in the hope that someday, they will be blessed with their own offspring.
“I trained four of my brother’s children and they are all grown and married now,” said Francis. His eldest brother, Choji Davou, 78, also confirmed, according to Daily Trust that his younger brother had equally trained two of his children. He said: “We’re so happy that the Lord has answered our prayers and blesse them with their own child.”
The IVF testimonies is however, not restricted to the low and the average in the society; celebrities, the high and the mighty have had cause to also smile via the assisted pregnancy. One of the most remarkable of such stories was that of the celebrated singer and photographer, TY Bello.
She was said to have waited for nine good years that was characterised by tribulations before welcoming a set of twin boys in October 2014. She had to endure struggle with Endometriosis, IVF and ceaseless pressure from friends and family before she finally became a proud mother. She revealed going through IVF to conceive her boys, the journey Bello confirmed was a very intense one for her.
She said: “I had just been through the toughest nine years of trying to get pregnant, being confident that it would be a breeze since I had always known that I would make a great mother. It was quite humbling when it didn’t happen as I had envisioned it. It was grueling actually.”
There was also the charming story of Dr. Rachael Dickson, wife of the Bayelsa State Governor, Seriake Dickson, who gave birth to a set of quadruplets in the United States of America after reportedly undergoing fertility treatment at an IVF clinic. More than 10 years after the Bayelsa State first couple married they had no child of their own, and when the bundle of joy arrived in the form of quadruplets, it was said to be via IVF.
The first IVF baby, however, was born in 1978 but this procedure was not conducted in Nigeria until 1989 after which Ibadan joined the league whose IVF was done in July 2015 and delivered in March, 2016. That great feat gave hope to couples who had been battling with infertility without success.
That became the first successful birth of a baby conceived from frozen egg of a 44-year-old woman, who had suffered infertility for eight years. The feat made her the first in the country and West Africa. The baby, named Tiwatope, which is the 5001st in the world, were carried out by Nigerian fertility specialists at The Bridge Clinic, a Lagos-based fertility treatment centre, where the mother had her eggs frozen using the vitrification (flash-freezing) process.
Announcing the medical milestone, a fertility physician at The Bridge Clinic, Lagos, Dr Emmanuel Owie, said the birth of the baby on February 16, 2016, effectively puts Nigeria on the global map as regards the practice of oocyte (egg) freezing or cryopreservation, a new offering in the IVF space. He said prior to the birth of Tiwatope, the new practice seemed to be an exclusive preserve of the developed world of Europe and North America.
He said: “Tiwatope’s mother had her eggs frozen for two months, using the vitrification, also known as flash-freezing, process. This is the cutting edge technology in cryobiology, where the eggs or oocytes of a woman is dehydrated and the water content is replaced with ‘anti-freeze’ solution (cryoprotectants) before freezing. This will prevent the formation of ice crystals which could destroy the cell.”
Owie had also noted: “We fertilised the eggs using a standard technique known as intracytoplasmic sperm injection (ICSI) to overcome the egg shell which normally gets hardened with freezing. The fertilised egg was subsequently transferred into her womb, resulting in the pregnancy with Tiwa. She had her antenatal care in her family hospital and delivered the baby boy through Caesarian Section.
“At The Bridge Clinic, we celebrated Tiwa’s birth as it is a further demonstration of our coming of age in the practice of assisted reproductive technology. It is a show of the sum of our strengths — our people, our process and our infrastructure. It demonstrated our commitment to global best practices which ensured that our offerings are in tandem with what is obtainable in the developed world, both in variety and in quality.”
According to Wikipedia: “IVF is a process by which egg is fertilised by sperm outside the body: (in glass). The process involves monitoring and stimulating a woman’s ovulatory process, removing an ovum or ova (egg or eggs) from the woman’s ovaries and letting sperm fertilise them in a liquid in a laboratory. The techniques can be used in different types of situations. It is a technique of assisted reproductive technology for treatment of infertility.”
It is commonly known as Assisted Reproductive Technology, and the process is by manually combining an egg and sperm in a laboratory dish, and then transferring the embryo to the uterus. Other forms of ART include Gamete Intra-Fallopian Transfer (GIFT) and Zygote Intra-Fallopian Transfer (ZIFT).
Experts say that IVF is used to treat infertility in patients with blocked or damaged fallopian tubes, male factor infertility including decreased sperm count or sperm motility, women with ovulation disorders, premature ovarian failure, and uterine fibroids. Also, women who have had their fallopian tubes removed and individuals with a genetic disorder and unexplained infertility.
According to one fertility expert, “there are five basic steps involved in the IVF and embryo transfer process. Monitor and stimulate the development of healthy egg(s) in the ovaries. Collect the eggs and secure the sperm.
“Then, combine the eggs and sperm together in the laboratory and provide the appropriate environment for fertilisation and early embryo growth. In transferring embryos into the uterus, the following steps are taken: Fertility medications are prescribed to stimulate egg production. Multiple eggs are desired because some eggs will not develop or fertilize after retrieval. Transvaginal ultrasound is used to examine the ovaries, and blood test samples are taken to check hormone levels.
“Eggs are retrieved through a minor surgical procedure that uses ultrasound imaging to guide a hollow needle through the pelvic cavity to remove the eggs. Medication is provided to reduce and remove potential discomfort. The male is asked to produce a sample of sperm, which is prepared for combining with the eggs.
“In a process called insemination, the sperm and eggs are mixed together and stored in a laboratory to encourage fertilization. In some cases where there is a lower probability of fertilization, Intra Cytoplasmic Sperm Injection (ICSI) may be used. Through this procedure, a single sperm is injected directly into the egg in an attempt to achieve fertilization. The eggs are monitored to confirm that fertilization and cell division are taking place. Once this occurs, the fertilised eggs are considered embryos.
“The embryos are usually transferred into the woman’s uterus three to five days following egg retrieval and fertilisation. A catheter or small tube is inserted into the uterus to transfer the embryos. This procedure is painless for most women, although some may experience mild cramping. If the procedure is successful, implantation typically occurs around six to 10 days following egg retrieval,” he said.
For those who go through the IVF success stories in Nigeria, both the husband and the wife usually go through the struggles, disappointments, pains, and psychological traumas of being childless before their testimonies. Most men do that to dispel societal beliefs on infertility that totally blames the woman and frees the man.
Infertility, according to medical experts, is a couple thing. They defined it as the inability to achieve pregnancy within one year duration of regular (evenly spaced 48 hours interval) ejaculatory vaginal sexual intercourse without contraception between a man and woman in the reproductive age group. Infertility, the experts said, is caused by 40 per cent a male problem, female 40 per cent, and the remaining cause of 20 per cent is unknown.
However, one of the known obstacles to effective IVF success is what the health experts referred to as Polycystic Ovarian Syndrome (PCOS). PCOS, they said, is one of the commonest causes of infertility. They said that patients with the disorder usually have multiple small cysts in their ovaries that occur when the regular changes of a normal menstrual cycle are disrupted, leading to enlargement of the ovary and production of excessive amount of androgen and estrogenic hormones.
This, perhaps, may be what the Managing Director of Nordica Fertility Centre in Lagos, Dr Abayomi Ajayi, had in mind when he organised Failed IVF Cycle Open Forum. Ajayi used the occasion to emphasise that many couples do not prepare for treatment beyond the first IVF, thereby getting disappointed if the cycle is unsuccessful. He stated that the probability of attaining higher successes occurs when a plan for multiple cycles is put in place rather than the one off treatment.
He further explained that couples who have had a failed cycle should not give up, as there usually is a bright hope of another trial. According to him, “the more couples understand how IVF works, the easier it would be for them to understand what to do when a cycle fails. The role of the fertility centres and experts is to lay the foundation for a successful pregnancy, but when the sperm and egg have been fused, what happens within the next two weeks remains a mystery. The implantation at that time is like a black box. That is when pregnancy is determined.”
In implantation, he said, the embryo is placed like planting a seed and waiting for it to germinate. This is why the two weeks wait after IVF is observed. “At this window of time, IVF could fail for several reasons and it is often difficult for couples to understand why.”
Ajayi also said that embryo selection methods could contribute to a failed cycle, even as he added that embryologists select embryos for transfer based on cell stage, embryo grade and the rate of cell division and the surgical procedures themselves.
“The egg retrieval and the embryo transfer are very important to the success of an IVF cycle. Despite all the challenges, IVF remains extraordinarily successful. One of the reasons IVF often fail is because couples are unable to make the right decisions that IVF requires. They need to listen to their doctor and try to make right decisions. The work of a good IVF clinic remains to support couples in making right decisions,” he said.