Dr Abayomi Ajayi, the Chief Executive Officer of NORDICA Fertility Centre, in this interview with select journalists recently, explained the imperative of adequate screening as a pre-requisite for a success of In Vitro Fertilization (IVF), saying that society should be blamed on the rising congenital problems in Nigeria, among other salient issues. CHIOMA UMEHA was there. Excerpts:
Can you tell us what led you into PGD/ART/IVF business in the first place?
A long time ago, there was this woman that got pregnant and went to the US to deliver. Everything appeared okay until she did some tests and it was discovered that her baby was not doing well; they decided to separate her immediately. Later, it was found out that the baby had multiple congenital problems that were not compatible with life. The woman had to wait for the baby to die. So that made me to start to ask questions. It fired up my interest in PGD and I began to ask how can we prevent this kind of thing?
Are you saying that health experts should be asking why babies die?
The experience I had with the woman’s issues with her baby made me realise that we probably have missed so many to congenital abnormalities in Nigeria. So it is better for us to start investigating and asking questions on why babies die. This is a significant problem. Some babies have congenital abnormalities, they blame doctors, and we do not investigate enough why the baby has died. That is one of the things we need to bring into our practice. Why did this baby die? The way we treat the death of babies leaves much to be desired.
I recall an incident in Asaba; a patient did PGS and lost the baby at about 14 weeks. That should not really happen. We told the woman that when the baby was expelled, we needed to take a sample from the placenta for testing, but she blatantly refused. But, these are things that a white person would do willingly. So it is difficult to understand some of these things, and until we start looking at why we keep losing babies, we will not learn.
So, who in your own opinion should we blame for this?
We should look at the society at large because the problem is even beyond the doctors. Let us look at the baby that dies in-utero. What is the normal reaction of the patient? The common reaction is often that the doctor is not skilled, but people need to know that babies die.
We need to differentiate the ones that die as a result of negligence, we should start asking questions about why babies die. That will also differentiate the ones that die due to negligence and the ones we cannot do anything about.
When people lose pregnancies in the first trimester, they blame everybody, yet about 50 to 70 per cent of the time baby-lost in the first trimester is due to congenitally abnormality and there is nothing any doctor can do. There are congenitally abnormal babies most of the time. So when things happen, let us grieve from point of knowledge. Let us begin to educate the public about these things.
Can you tell us about some of these diseases that you identify and how they can be eradicated or controlled?
We can help eliminate sex related disorders such as sickle cell disease, albinism, blindness, etc. There is some form of congenital deafness that runs in families that we can also screen for. New technology has made it possible for us to identify embryos that can bear some diseases such as cancers in life, so we can easily identify and select the embryos that are free from diseases. We call it Pre-implantation Genetic Diagnosis (PGD). It is the process of removing a cell from an in vitro fertilization embryo for genetic testing before transferring the embryo to the uterus. Pre-implantation Genetic Screening (PGS) is the process of testing for overall chromosomal normalcy in embryos. We know that we all have 23 pairs of chromosomes in our cell nuclei. The last pair is the sex chromosomes, so one of the things you also get from that is you can tell the gender of the embryo from that when you can see these 23 pairs of chromosomes.
Before a few years ago, we could only see about five pairs of chromosomes, but now with technology we can see all the 23 pairs, so apart from gender we can look at every disease that the embryo can be predisposed to.
How can you assist people with SS genotype?
We cannot help people who are SS because they are already SS. But we can come in for two AS people because that is the problem when two carriers come together. Sickle cell is just one of the numerous problems; there are other ones. For example albinism, even blindness. There are some congenital blindness; there are some deafness that runs in a family.
Sickle cell disorder is just one amino acid replacing another one, so we can be able to see if that amino acid has a problem. But now, technology has made it possible for us to indentify embryos that can bear some cancers in life, or ones that can cause particular disease. We are able to identify them and select the ones that are free from such diseases.
Through technology, we can also see whether an embryo has Down Syndrome.
Why do you think IVF fails at times?
IVF fails because there are problems in the arrangement of the chromosomes. That is why we screen to know the number of chromosomes and how they are arranged.
We know that 70 to 80 per cent of embryos produced in our labs can never become babies because of this problem that increases with age of the woman and this is one of the reasons why we say older women are so worse with IVF and with reproduction generally.
We have seen why it is so now, especially with the structural or numerical errors in the arrangement of chromosomes, so you are able to pick out the ones that cannot become babies to start with. There are about 600 diseases that we have been able to see what their profile looks like, so we can identify such and we do not use such embryos.
Also, most Nigerians are very emotional people and they pretend to be religious. For it to succeed, couples need to make some important decisions. Some of them are not easy decisions. Take a 46 year old lady, for example. She walks to your clinic and she says she wants to do IVF and after all the tests, you tell her that she needs to use donor eggs. She will likely tell you ‘in Jesus name’ it will work, doctor join your faith with my faith.
The success rate of a 46-year-old lady using her own eggs is less than five per cent and then if you go on with the treatment, it is likely it will fail.
What is your IVF position on a lady that has attained such age?
The World Health Organization has said that if a lady is below 35 years, she should prepare to do two circles, if she is above 35 years; she should prepare to do three circles of IV to F because IVF is not that we kept the baby somewhere that we are going give to you.These are some of the things that people don’t want to listen to.
Couples could be lucky because we have seen people who have done four circles and they have four babies and we have some people who have done five circles and no baby because the husband and wife are actually what determine the success as it is what you give to us that we can work with. The quality of the eggs and the sperm contribute to the success
Can you tell us some of the challenges facing your job presently?
The major challenge is electricity. The good thing is that where we store embryo doesn’t require electricity. What is needed is liquid nitrogen. Though the liquid nitrogen is expensive but it is affordable.
Incubator is different from where we store; we don’t store in incubator but it serves for transferring. Power is the most predictable problem here. You may not have light everywhere here but there must be light in the laboratory. Everybody’s profit margin has gone down abysmally bad and we all are suffering the same situation in the country.
Even in your own industry, newspaper, you know how difficult it will be to publish now; some of us are still in business just to be in business and not because of whatever profit. It has been like that all these while.
What are we expecting from NORDICA Fertility Centre as the new year winds down?
Right now, we have started doing compatibility genetic testing, trying to screen our donors for nay traces of genetic disease. But I will assure you that we are still going to be in the forefront of any new fertility invention in Nigeria.
But one thing is sure and that is a challenge; everyone of us has gene mutation. As said earlier, every normal person carries about three to five mutations and that is a challenge. The problem comes when we marry somebody who has similar mutation like us. At that point, we stop from being carriers to manifesting that disease.
Nordica Fertility Clinic is trying to screen donors on that. So you can have a healthy donor who is carrying some mutation in her gene, she is normal and healthy, but the problem only comes if the husband of the person who wants to use her eggs carries the same mutation.