IVF in Nigeria: ENDO SCRATCH & IMPLANTATION

NIGERIA RECORDS FIRST BABY FROM FROZEN EGG

Nigeria has recorded the first successful birth of a baby conceived from frozen egg of a 44 year-old woman, who had suffered infertility for eight years, making it the first in the country and West Africa. The birth and conception of the baby, named Tiwatope, which is the 5001st in the world, was 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. 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 in-vitro fertilization (IVF) process. Prior to the birth of Tiwatope, the new practice seemed to be the exclusive preserve of the developed world of Europe and North America.

1st Test Tube Baby in Black Africa is now 34 years old
On March 17, 1989 history was made at the Lagos University Teaching Hospital when the first test tube Baby in Black Africa (comprising of West, East and Central Africa), conceived through the delicate In-Vitro Fertilisation and Embryo Transfer (IVF-ET) method was born. The bouncing baby boy named, Olushina, Eghosa, Oluwaremilekun, is nature’s gift to the family of Mr & Mrs Pius Oni and the crowning glory of five years of painstaking research endeavours of Professors Osato Giwa-Osagie, an Obstetrician and Gynecologist and Oladapo Ashiru, an Endocrinologist, both of the Lagos University Teaching Hospital, LUTH Idiaraba, Surulere, Lagos.The lad then, thus, became the First TestTube Baby in East, West and Central Africa. Read more at: www.ivfhistorynigeria.blogspot.com

ENDO SCRATCH & IMPLANTATION

Dr. Abayomi Ajayi

Endometrial scratching is an out-patient procedure which is relatively painless (similar to a cervical smear test) and is defined as medically administered damage to the inner lining of the womb with the sole aim of improving implantation. It was first demonstrated as a beneficial procedure in reproductive medicine in 2003. A Cochrane Library systematic review published in 2012 concluded that the technique double the implantation rate.

Implantation remains the biggest hurdle in securing a pregnancy in assisted conception. When the microscopic embryo quality appears good and the development of the endometrium is satisfactory on ultrasound, it is not possible to easily explain why implantation does not occur. Embryo implantation into the womb may fail due to poor embryo quality or abnormal embryo genetics. It can also often fail due to poor ‘endometrial receptivity’. This is where the lining of the womb is not favourable for the embryo to implant.

Quite simply, to get pregnant you need to have a healthy genetically fit embryo and a good endometrial environment for it to implant into. So, when it is reasonably assumed that the reason for a (or recurrent)failed IVF cycle(s) is an implantation failure especially when the embryo is microscopically of good quality, then endometrial scratching might be employed in order to aid implantation and then IVF treatment success. This has been supported by recent studies.

How does endometrial scratching aid implantation?

The process of endometrial scratching as it relates to embryo implantation is not entirely understood and some questions still remain unanswered. Scientists involved in studies believe that there may be two reasons for the increased implantation rates:

•Increase of endometrial white blood cells. It appears that endometrial injury increases the production of white blood cells (leukocytes such as macrophages) which secrete so called growth factors and cytokines which in turn control embryo implantation.

•Gene switching within the endometrium. Scientists speculate that sometimes embryos fail to implant due to genetic switching related to endometrial receptivity. That is, genes responsible for implantation of embryos are not switched on during the time when embryos are supposed to implant. Endometrial scratching may increase expression of genes (switching of genes) thought to be responsible for preparation of endometrium for implantation.

Indications

•Recurrent implantation failures

•Atrophic endometrium

How is the procedure carried out?

The procedure which usually takes about 15 minutes or less is carried out in the luteal phase of the cycle (i.e. after ovulation) in the cycle preceding IVF treatment. Normally this is done between days 19 and 23, day- 21 of the cycle on the average and that is what we do at Nordica Fertility centre. It can also be performed under anesthesia during a hysteroscopy evaluation of the uterus.

An informed consent is taken and the client is administered oral analgesics about one or two hours prior to the procedure. A speculum will be passed to find the cervix which is then swabbed with a saline solution to clean it. A small disposable endometrial biopsy catheter (Pipelle) is then passed through the cervix into the uterine cavity. The catheter is then agitated in the uterine cavity and suction applied to lightly cause minimal injury to the endometrial lining. Antibiotics may be required after the procedure. It may be followed by some mild uterine cramping and/or slight bleeding per vaginum.

At Nordica, we have employed the use of endometrial scratching successfully for a couple of our clients with previous failed IVF cycle(s) despite good quality embryos in the past few years. Although the benefits of endometrial biopsy scratching are undeniable, the exact timing and the number of biopsies are still being debated by fertility specialists. Fertility doctors agree that the scratch biopsy needs to be done once or twice before embryo transfer.

The additional benefit this procedure offers is that it allows us to map the cervical canal, and since it’s very similar to a dummy embryo transfer, it makes the actual Embryo Transfer much easier.

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IVF IN OTHER CLIMES

Fertility Centre Now In Asaba

Couples with infertility conditions can now heave sighs of relief as one of nigeria’s leading fertility treatment centres, Nordica, will officially open its new facility on Erhuvwu Club Street, Asaba, Delta State, on November 3 2009.
The event will start with a week long programme, which includes for a for doctors and nurses, fertility walk and an open day for free discussions and checks.
Since inception Nordica Fertility Centre has helped many infertile couples to conceive and get delivered of over 300 babies.

'Infertility Is A Shared Responsibility Between Husband And Wife'...More at: http://www.ivfbabiesnigeria.blogspot.com

Worthy of Note:

· Birth of Nigeria’s very first IVF baby recorded by LUTH in 1989 through team including Profs. Osato Giwa-Osagie & Dapo Ashiru. LUTH’s IVF programme was not sustained. Birth of IVF baby Hannatu recorded 9 years later in February 1998 in Abuja.
· Nigeria’s oldest IVF clinic (1999): Bridge Clinic, Lagos. As at 2009, has produced about 923 babies. Also recorded nation’s 1st ICSI & TESA pregnancies.
· First & only so far, African IVF clinic to record successful pregnancy in 45 year-old woman using her own eggs: Hope Valley Clinic, Lagos.
· Only IVF facility currently offering PGD: Medical ART Centre, Lagos.
· First IVF clinic in West Africa to record pregnancy in woman with Turner’s Syndrome: Omni Advanced Fertility Centre, Lagos.
· Only Teaching Hospital in Nigeria currently offering IVF: University of Benin Teaching Hospital.

HOW TO IMPROVE IVF SUCCESS

There are a few factors you can influence in increasing your chances with IVF. Eat well, exercise, get enough sleep and reduce stress in your life among other things.

However, the most important factor to increase your IVF success is your decision in choosing a fertility clinic. Once you choose a fertility clinic, the outcome of your IVF treatment is mostly in the hands of the fertility doctor and his staff. They choose the IVF protocol, the medication with dosages and all the little details concerning timing, which you will follow exactly. That's why you should consider comparing their IVF success rates! It gives you an indication of a fertility clinic's skill and expertise. So, be good to your body and wise in your decision of your IVF doctor!

Hannatu is not Nigeria’s first IVF baby

We have observed that for some time now there have been series of reports by Dr. Ibrahim Wada in the dailies celebrating the 10th birthday anniversary of his first IVF baby.
In your publication of Saturday April 11, 2009, it was stated that Baby Hannatu, who was delivered by Dr Ibrahim Wada at Gwagwalada Specialist Hospital 10 years ago, is Nigeria’s First IVF Baby.

That statement is incorrect and very false. It attempts to reverse the course of history. About three years ago, another doctor reported having the first IVF baby in Lagos and we had to educate the newspaper that reported it. It is very important for our reporters to do some research, especially when reporting matters of national importance and history. It is also necessary that our professional colleague should give honour to whom it is due and not rewrite history.

At the gala night celebrating Baby Hannatu’s birthday at the Sheraton Hotel, Abuja in March 2009, Prof Giwa-Osagie informed the dignitaries at the occasion about the true chronology of IVF successes in Nigeria. Those present to hear him included Baby Hannatu, her parents, Dr Wada himself, the Minister of Women Affairs and General Momah who was the Minister of Science and Technology and had certified Baby Hannatu’s birth at the time, and two former chief justices of Nigeria.

IVF in Nigeria began with a team at the Lagos University Teaching Hospital (LUTH), comprising Prof Giwa-Osagie, Prof Ashiru, Dr Abisogun, Mr. Sanyaolu and Mr. Aro. They started IVF work in 1983 and had the first pregnancy from IVF in West and East Africa in 1984. That pregnancy was documented but miscarried. However in 1989, the team had delivery of a baby girl from its efforts. It is note worthy that most of the current actors in IVF at this point were resident doctors in training. The mother of Baby O had lost both her fallopian tubes from ectopic pregnancies in the UK and became pregnant at her first IVF attempt in Nigeria. The achievement was well documented and was carried prominently in the media at the time. LUTH even produced a special news magazine that had the baby and his parents’ pictures and details.

The journalists who carried the news included Lade Bonuola, Onajomo Orere from the Guardian newspaper, and Loiusa Aguiyi-Ironsi from Tell magazine. They are still alive and well for easy reference. After too much publicity, the family of Baby O later got their lawyer to write us stating that LUTH or we should not discuss the baby any further. We were also restrained by the Nigerian Medical and Dental Council tribunal, which alleged that we were advertising ourselves through undue publication of our work in IVF. We still have these documents.

It is important to state that about 90 per cent of women who have babies through IVF do not want it publicised, even up till now. If you visit our clinics, you will see pictures of babies born through IVF.

However, that is as far as most of these parents want to go public. We admire the parents of Hannatu for willing to go public, but that does not make Hannatu Nigeria’s first IVF baby.

Also, in the 1980s, there was no Ministry of Science and Technology, and there is still till no requirement for that ministry to authenticate any IVF delivery. In the 1980s, the Federal Ministry of Health set up two panels to evaluate the LUTH IVF work, under the late Prof Grillo and Prof Adeleye respectively. Both panels reported that the LUTH team’s work was genuine and correct.

The fact that Dr Wada got the Ministry of Science and Technology to authenticate his work at the time of his first IVF baby cannot invalidate prior major breakthrough in Nigerian IVF success.
Prof. Giwa-Osagie, OON and Prof. Oladapo Ashiru, OFR.

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NIGERIA RECORDS FIRST BABY FROM FROZEN EGG

ENDO SCRATCH & IMPLANTATION

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