While Nigeria IVF market is seeing a boom, lack of regulation is creating room for quacks which endangers the sector, writes ANTHONIA OBOKOH.
When Ladi Okeowo was married at the age of 28, she thought she had plenty of time to start a family. After all, she said, “My parents had me after 17 years of marriage.”
When at 33 she and her husband decided to start a family, they discovered that nature refused to cooperate. Four physically exhausting I.V.F. cycles (and two attempted donor egg cycles) later, they remained childless.
“The success rate is consistently low, it is more of 20 percent success and 80 percent failure, she said. “My husband and I have invested millions in the effort. My happiness is, we can afford it and I believe I will have a baby to be called my own someday,” she added.
Ladi is fortunate her partner understands the situation and has been with her, but same cannot be said of Miriam who has not only experienced the griming pains coupled with infertility, but has been extorted from quack fertility centres.
“My husband and I went through IVF after we tried to conceive naturally for more than three years,” she says. “It was a long road of trying and losing before we explored IVF. We have run into quacks. Most of my pregnancies, we realise, failed,” Miriam recounts.
“I had to do plenty of research on clinics before moving forward with another IVF clinic. The one I ended up choosing did cycles and procedures according to when my body was ready and we had success with our second round. I’m currently pregnant with our first child,” she said.
This experience shows how more Nigerian families are turning to the In-Vitro Fertilization (IVF) procedure. More partners now agree that if they experience a delay in pregnancy, they can still have babies through I.V.F.
IVF is a complex series of procedures used to treat fertility or genetic problems and assist with the conception of a child. During IVF, mature eggs are collected (retrieved) from a woman’s ovaries and fertilized by sperm in a lab. Then the fertilized egg (embryo) or eggs are implanted in the uterus. One cycle of IVF takes about two weeks.
IVF techniques range from using ultrasound scans, blood and urine tests to accurately pinpoint if and when ovulation is occurring to the more complex Intra Cytoplasmic Sperm Injection (ICSI) where an egg is assisted to be fertilised by injecting a single sperm into each egg using a microscopic technique.
According to the World Health Organisation (WHO), a woman below 35 should be equipped to do at least two IVF cycles. Study confirms that women who are undergoing IVF do have a reasonable chance of getting pregnant, noting that rates of success are higher for younger women. The study says however that IVF can never guarantee a 100 per cent chance of success.
However, more Nigerian families are turning to the IVF procedure, a development that has led to a boom in a market valued at over N17 billion as improved awareness fuels greater patronage. But medical experts say that absence of efficient regulation has become a threat to the practice.
BusinessDay gathered that the cost of the procedure is competitive in Nigeria in comparison with other countries. A single cycle IVF treatment ranges between N870, 000 and N1, 760,000.
The complete cycle in clinics of comparable quality aboard indicates that the average cost in the United States of America $12,146 (N4.3million) Saudi Arabia $6,475 (N2.3million), and the United Kingdom $4,190 (N1.5million).
Kemi Ailoje, chief medical director of Lifelink Fertility Clinic explained that the cost of IVF treatment depends on the diagnosis. Some patients require the use of their own egg or sperm while others may benefit from donors and some may even need a surrogate.
Between 5,000 and 10,000 couples annually turn to the procedure, according to figures given by practitioners at the 7th International Conference on Fertility and Reproductive Health held in Lagos last year. The participants noted that Nigeria has both the technology and expertise to compete globally. At an average cost of N1, 706,000 for full a procedure and estimated 10,000 couples per year, the local IVF market has conservative value of N17 billion yearly.
Globally, the IVF market is expected to reach $27 billion by 2022, according to a report by Grand View Research, Inc, a U.S.-based market research and consulting company.
The number of couples seeking the procedure may have doubled according to observations by half a dozen doctors interviewed for this story. They warn however that without a regulator, many couples are turning to quacks who, at a lower costs offer poor service to couples concerned about the social stigma of childlessness in Nigeria.
“Increasingly, IVF treatment is becoming more acceptable and the market size is growing, but couples need to be discerning about who they turn to as no one is properly regulating it at the moment,” said Jide Ojo, chief executive officer, the Bridge Clinic, a fertility centre based in Lagos.
Ojo further said a new body, the Association for Fertility and Reproductive Health (AFRH), is working out regulations for operating clinics. This uptick in IVF procedure in Nigeria is attributed to a rise in the number of married couples suffering from infertility, owing to urbanisation, pollution, stress, and lifestyle patterns.
“Men are beginning to realise that infertility is not female issues alone, so they now submit themselves for treatment,” Ojo said.
Ailoje also believes that there is an increased level of awareness about IVF now in Nigeria with less stigmatisation “and the success rate has also increased which makes it a viable option in the field of infertility management.”
Ailoje also harped on the need to improve regulation, pointing out that in the last few years, the Lagos State government has had joint meetings with practitioners to ensure the policy is formulated and implemented by ART practitioners.
Abayomi Ajayi, the managing director, Nordica Fertility Centre, says better financing arrangement will reduce recourse to quacks. “In Nigeria, we pay out of pocket and majority of Nigerians may not afford multiple cycles, but one of the ways we have encouraged them is to have packages that they can afford. Apart from reducing the price, we also provide emotional support and give couples enough information before they even start to let them know the success rate,” he said.
“We also enlightened them that if the IVF fails, the best way to go about it is to embark on multiple cycles. The more the cycles that they do, the better their chances of success,” Ajayi added.
Advanced ART facilities in Nigeria, experts say, have reduced medical tourism for IVF purposes. Clinics in the country have introduced newer techniques, which can offer a better success rate at an affordable cost.
However, in as much as success and failure rates exist, it means there are also risks in carrying out IVF. One of such risks is that it increases the chance of multiple births if more than one embryo is implanted in the uterus. A pregnancy with multiple foetuses carries a higher risk of early labour and low-birth weight than a pregnancy with a single foetus does.
Another risk is that while the rate of miscarriage for women who conceive using IVF with fresh embryos is similar to that of women who conceive naturally — about 15 to 25 percent — the rate increases with maternal age. Use of frozen embryos during IVF, however, may slightly increase the risk of miscarriage.
Stress is another risk in the use of IVF as it can be financially, physically and emotionally draining. However, support from counsellors, family and friends can help couples through the ups and downs of infertility treatment.