As Nigeria celebrates the World Infertility Awareness Month in June, LARA ADEJORO speaks with the first black Secretary-General of the International Federation of Fertility Societies and President, Academy of Medicine Specialties of Nigeria, Prof Oladapo Ashiru, on the evolvement of ART and its regulations in Nigeria
There is currently no law that regulates fertility clinics in Nigeria, and demand for fertility services is on the increase. What is your take on this, and what is the way forward?
That is not precisely correct. We have guidelines that regulate the practice of fertility and assisted reproductive technology. In Nigeria, like in many other countries in the World, fertility clinics are directed by doctors guided by their fertility societies’ regulations. The Association for Fertility and Reproductive Health of Nigeria has had very robust guidelines for the practice of Assisted Reproductive Technology since 2012. The guidelines are comparable to those used by the American Society for Reproductive Medicine, the European Societies for Human Reproduction and Embryology, and the International Federation of Fertility Societies.
Furthermore, the discipline of doctors in all medical specialties, such as organ transplants, surgeries, infertility, cancer, and others, is within the Medical and Dental Council of Nigeria. What is needed further is that many countries provide a broad enabling law to empower the professionals to affect the operation of their guidelines. I understand a health reform bill in the house of assembly. However, the input of the medical professional has yet to be obtained. The Lagos Government took the bull by the horn and adopted the guidelines produced by the AFRH with further consultation with the Lagos ART guidelines. A monitoring committee was set up under the state ministry of health to help conduct IVF Clinics inspections and regulations in 2019. It has helped improve the quality and productivity of fertility clinics in Lagos State.
I have seen in many clinics that most people who visit fertility clinics are rich. Does this mean that accessing fertility treatment is only for the rich, and what is the hope of an average Nigerian in accessing fertility treatment?
Access to fertility clinics is not only for the rich. There are opportunities for the poor to obtain fertility treatment with the aid of grants from well-wishers, religious organisations, and foundations. The fact is that treatment of infertility at all levels is costly. Starting from the drugs used to cause ovulation, improving sperm count for low technology treatment, and buying the media, IVF-ET infrastructure, and supplies.
Unfortunately, none of these items are produced in Nigeria. Hence they are always affected by the devaluation of the Naira. When we started IVF-ET in the 1980s, it cost about $5000 for one IVF, which was about N3000. Today the average cost of IVF in the low-middle income countries is about $4000, which is about N2 million. It is far above the average income of the population. That is why many organisations come to the aid of those who have difficulties in meeting their financial obligations to ensure they are blessed with babies in their families.
In 2005, we started the OARS Foundation in collaboration with the Medical Art Centre to give the less privileged the opportunity to carry their babies. We are happy to say that we have been able to have several such babies annually.
There is a high fertility rate in the country. Why are infertility clinics booming?
I am not sure there is any data to support the high fertility rate in Nigeria. The fact is that infertility affects millions of people of reproductive age worldwide and impacts their families and communities. Estimates suggest that between 48 million couples and 186 million individuals live with infertility globally. An estimated 15% of couples will have trouble conceiving.
Even in developed countries where there is an abundance of health education and health promotion, about nine percent of men and 10% of women aged 15 to 44 reported infertility problems in the United States. One in four couples in developing countries is affected by infertility.
With the above, it is clear that we cannot over-emphasise the need for human capital and infrastructure development for fertility health. About 30 years ago, about 90% of couples who needed high-tech infertility treatment travelled to America, the UK, or other parts of the world, causing a lot of foreign exchange on medical expenses.
Today, virtually everyone needing high-tech infertility treatment can have it in Nigeria. Indeed Nigeria has now become a country for Medical tourism for infertility treatment. One must congratulate our Nigerian fertility practitioners and the AFRH.
Experts say things are changing on different alternatives for parenting. What are these changes, and what are the acceptability and views of Nigerians generally about this?
A lot has changed in opportunities for parenting. For example, June is now celebrated as World Infertility Awareness month. World Infertility Awareness Month is celebrated every June to increase awareness regarding numerous infertility issues faced by couples across the globe. It includes problems related to female as well as male fertility. Several myths regarding infertility are debunked during this month, and many options are brought forward to those who may want to conceive. The purpose of the month is to improve the lives of millions of people who fail to conceive due to a lack of scientific knowledge.
More so, in Africa to de-stigmatise infertility myths, yes, some causes of infertility can be overcome. All you need is a good doctor, a supportive family, and an open mind. Fertility education focusing on preventable causes such as sexually transmitted diseases, occupational hazards, environmental and climate changes, and nutritional and dietary causes would be highlighted. The International Federation of Fertility Societies, in Partnership with the MERCK Foundation, will celebrate the month with a World infertility Summit on June 24th for all who have an interest in fertility. The other changes involve the various options to address the different causes of infertility. They range from a simple understanding of the exact possible dates for conception, ovulation induction, sperm improvement regime, ART, including IVF-ET, Intracytoplasmic Sperm Injection, donor eggs and sperm, Gestational Surrogacy, and Pre-implantation genetic diagnosis with stem cell therapy. The research continues daily.
Infertility is a disease of the male or female reproductive system, but what is the infertility ratio between males and females in Nigeria?
The purpose of emphasis is that we now believe that the ratio is 50:50 between males and females, which means that 50% of infertility is caused by the male while the female causes another 50%. The import of this is that once couple try for one year of regular unprotected intercourse with any conception, they should visit a doctor. If the couple is over 35 years of age, they should not wait for one year but start to seek help after six months. Fertility typically declines with age, and the decrease becomes pronounced from 36 years to 43 years.
As a fertility expert and the first black Secretary-General of the IFFS, what infertility cases seem difficult to be handled and why?
As of today, almost all cases of infertility can be solved. The couples only need to be assessed in a customised fashion and be given the ideal option to resolve their issue and be granted the fruit of the womb. Although in Medicine, we say that we treat and the Almighty heals. So at the end of it, the Lord grants the babies.
What are the common problems that cause infertility in men and women?
The most typical cause of infertility in men and women is sexually transmitted disease, especially gonorrhea, followed by Chlamydia. These two infections scar the tubes that carry the eggs and the Sperm.
Unfortunately, the Chlamydia does not show signs early enough; hence by the time the person shows signs of discharge on the urinal passage, a lot of irreversible damage have been done. The following common cause is toxins in the environment or occupational. They include industrial hazards like paint, plastic wares, petrochemicals, oil and gas pollution, pesticides, and aerosol fumigations. Many of these affect the reproductive system and go up to the following two generations. Other causes are abnormalities of the organs, heavy metals from a diet like large fish, stockfish, and driving bear footed. For these reasons, it’s now recommended that couples ensure they get rid of years of accumulated toxins in their bodies before attempting conception.
Assisted reproduction technologies have been available for more than three decades; how many children have been born so far in Nigeria from ART interventions?
Nigeria started a data registry in 2014. Before then, we participated in the IFFS surveillance and the international monitoring team. The total number of babies born worldwide from ART interventions is about 12 million. The estimated number of babies in Nigeria should be about 12,000.
How old is too old to have a baby?
Scientifically, an adult womb can be made to carry an embryo and develop into a baby. The only limiting factor would be the physiological ability to go through all the nine months of stress in pregnancy, especially from age 55 years and above. However, there have been reports of people delivering babies after 60 years.
What do men and women need to avoid, preventing fertility issues?
Avoid STI, avoid environmental toxins such as paint, pesticides, insecticides, alcohol, smoking, substance abuse, large fish, and stockfish as they contain mercury heavy metal which is toxic to conception, ensure e rich nutritional diet, main regular exercise, and avoid putting poisonous cosmetics on the body.
What do people exposed to harmful things need to do?
It is not possible to live in this current world of ours without excessive exposure to toxins from the environment, occupation, industry, and climate change. These toxins can affect fertility, cause cancer, and premature death. Hence, yearly general body detoxification is mandatory for health, Fertility, good health, and long life.
Experts say detoxification is a way of making couples fertile. How is this so?
Detoxification, especially a very comprehensive one, would clean out our intestine, liver, kidney, and the lungs, remove heavy metals from the body, use advanced frequency wave technologies to chelate heavy metals, remove pathogens, and according to F.X. Mayr, no one goes through individualised detoxification cleansing, as done at Mart-life Detox Clinic, where a new modern Mayr medicine (precision Medline) is practiced that would not feel energised and youthful.
Once you clean out heavy metals, pathogens, toxins, and free radicals, the mitochondria are renewed, and the body is filled with more regeneration and is invigorated.