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.
