Ending Scourge Of Sickle Cell Disorder With Technology

By Chioma Umeha

When Bukola Ojo, a 28-year-old sickle cell patient was about to get married, she was worried. She strongly believed that she would give birth to children with sickle cell because her husband was living with the same health disorder. Her worries and anxiety ended when she made her fears known to a friend, who directed her to a fertility clinic that can assist her when she gets pregnant so that she will have baby free of the condition.

After her wedding, she and the husband Daniel, visited Nordica Fertility Centre somewhere in Lagos where her friend directed her to.

It was there they met   Dr. Ololade Oyetunji, a consultant in Obstetrics and Gynaecology, who attended to them.

He assured them that they would have a child free of sickle cell or any other inherited disorder. The couple believed all that he said and hoped to give birth to children free from sickle cell. They were also counseled on how they could be helped.

It was not long after that Bukola became pregnant. After nine months she gave birth to a set of twins, boy and a girl and both kids were free from sickle cell anaemia.

Both couple were indeed grateful to God and the centre considering the number of children that are born daily with deadly disorders such as sickle cell. Sadly, many of them die before getting to adulthood and that is after their parents have would have spent all they have on them.

Explaining how couples with sickle cell anaemia and other disorders such as stammering, blindness, deafness, ‘vitiligo’, Tuner syndrome, cancer, Down syndrome, among others, can be tackled before conception, Dr Abayomi Ajayi, the Medical Director/Chief Executive Officer (CEO), Nordica Fertility Clinic, said Nigeria has joined countries that can scientifically assist parents with the over 600 inherited diseases to avoid giving birth to babies susceptible or confirmed inherited diseases.

Speaking at a press conference in Lagos recently, the fertility expert said Nordica has moved into this phase to be able to help Nigerian couples achieve a much more desired result regarding giving birth to children with defects, adding that technology has made it possible to identify embryos that are much more healthy, while eliminating the ones that predispose to health challenges.

“Apart from the ones that have diseases, there are also some that cannot become babies. So you remove these categories, and then you are left with viable and healthy ones that can become babies. Only the healthy ones would then be used to achieve the maximum result.

“With the new technology, we can tell you before a child is born what disease he or she is prone to later in life, so that, that can also

help that child in making lifestyle choices.

“Angelina Jolie, the Hollywood actor, is a very good example, because her genetic profile was already known, she didn’t wait to generate any cancer before she prevented it through the removal of her breasts, because genetic screening had already shown that she was carrying the genes.”

The physician added: “We can tell whether someone has predisposition to diabetes and other non-communicable disease. But, the thing is, the fact that you are prone to diabetes doesn’t mean you will have it if you engage in lifestyle changes that minimises the risks.”

According to him, technology has now also made it possible to see all 23 chromosomes in an embryo, making it easier to screen. “We all have 23 pairs of chromosomes in a nucleus and the last pair is the sex chromosome. One of the things you also get from the technology is the fact that we can also tell the gender of the embryo.

“Few years ago, we could only see about five chromosomes, but now with technology we can see all 23. So apart from gender, we can see all the diseases the embryo may be disposed to. If you are screening, you are looking at the number of chromosomes and their arrangement. We have noticed that the greatest reason why IVF fail is that there are

problems in the arrangement of the chromosomes,” Ajayi added.

He said with technology, it was now known that about 70 to 80 per cent of embryos produced in the laboratory can never become babies because of this problem, adding that such problems increase with age of the woman.

He, therefore, emphasised that couples should present early for treatment as better results could be achieved with younger age. “That

is one of the reasons we say older women do worse with IVF generally,” he said.

Dr Oliver Ezechi, an obstetrician and gyneacologist and Deputy Director, Research, Nigerian Institute of Medical Research (NIMR) Yaba, Lagos, gave further explaination. “In pregnancy it is possible to screen for aneuploidy by means of amniocentesis where a sample of the amniotic fluid around the baby is removed for FISH (that is, a diagnostic tool) and karyotyping, and chorionic villus sampling where a small sample of tissue from the placenta is removed

for testing.

However there are a number of problems linked to such prenatal screening. These techniques are not without risk. Miscarriage can complicate these invasive tests and statistically when this shattering event happens, it is far more likely to be a normal

pregnancy that is lost than an affected one,” Ezechi said.

Both experts agreed that while pre-natal screening or pre-implantation genetic screening can detect those pregnancies affected by aneuploidy, PGD goes a step further by testing an embryo for specific inherited abnormalities/disorders.

According to Dr. Taiwo Orebamjo, an assisted reproductive health expert, “pre-implantation Genetic Screening (PGS) offer screening that avoid the transfer of embryos that have common chromosomal abnormalities.

Unlike PGD, PGS is not looking for a specific but PGD is a technology used in conjunction with IVF to screen embryos for genetic conditions prior to transfer, so as to remove a cell from a three-day old embryo fertilised in vitro or analyse cells for specific genetic or

chromosomal abnormalities.”

Dr. Ajayi explained further that some couples are at risk of having a child with a specific serious genetically inherited disease.

Such a disease, he sad may be due to an abnormality affecting the genes, chromosomes or tiny structures within the cell called

mitochondria, adding,“ couples may have become aware of this because there is a family history of a genetically inherited disease; you have a child with a genetically inherited disease; you have had terminations of pregnancy for a genetically inherited disease.

Until recently, pre-natal testing (amniocentesis and chorionic villus sampling) offered the only means of diagnosing serious genetic conditions affecting the baby. When found, the distressing option of having the pregnancy terminated could then be considered.

“But, PGD provides an alternative to prenatal screening as embryos can be tested for any one of over 50 serious inherited disorders. PGD checks the genetic makeup of embryos obtained through IVF so that only unaffected embryos are transferred. Through PGD, couples are able to avoid passing on the condition to their children,” explained Dr Ajayi.

Mrs. Tola Ajayi, Nordica’s Clinic Manager, explained that PGD offers a better chance to PGS because, “There are some genetic diseases inherited by children that are life threatening and can only be treated by using stem cells from a close member of the family. PGD

takes care of that. PGD involves a ultidisciplinary team, that include the clinic’s own reproductive medicine specialists, embryologists trained to carry out the necessary embryo biopsies, clinical genetics specialists, scientists and counsellors.” It is interesting to note that a Nigerian veteran stand-up comedian, Atunyota Akporobomerere, popularly known as Ali Baba, has promised to sponsor the treatment of 10 couples for Invitro fertilisation (IVF) at Nordica Fertility Centre, Lagos.

Stating this after watching and sharing a video of a patient of Nordica Fertility Clinic who was excited after being told she was pregnant, he said he would take care of the cost of treatment of the three lucky couples, so that they would also experience the joy of being fertile as was the case with the woman in the said video. Akporobomerere added that he hoped they would give birth before his next January 1 concert.

The video, which was shared on the Facebook wall of the fertility clinic, and has been viewed over 25,000 times, showed an excited woman after being told that her pregnancy test showed positive.

According to Mr. Kunle Oyebanjo, the Head of Marketing and Sales, Nordica Fertility Center, the 10 couples for the treatment will be selected after screening some numbers of patients, such that the ones with the highest possibility of achieving favourable results will be considered.

“We are not just about numbers. We will do a series of tests to ascertain the ones with high possibility of responding to the treatment, and the best ten will be selected from there,” he added.