Experts have explained that IVF babies are normal babies and not a taboo: “They feel sad, happy, love, hate, envy and fall sick just like every other kid.”
Despite over 11,000 babies estimated to have been delivered since March 17, 1989, when Professors Osato Giwa Osagie and Oladapo Ashiru pioneered in-vitro fertilization and embryo transfer (IVF-ET) at the Lagos University Teaching Hospital (LUTH), there are still myths, improper perceptions and stigmatisation of beneficiaries. IVF, commonly known as assisted reproductive technology (ART), is the process of fertilisation by manually fusing egg and sperm in a laboratory dish, and then transferring the embryo to the uterus of a woman. Other forms of ART include Gamete intra-fallopian transfer (GIFT) and Zygote intra-fallopian transfer (ZIFT).
The perceptions about this medical process are as complex as the profound moral questions they pose. Some people believe that babies born through IVF are not normal children and they are likely to have neural development disorders like autism and mental retardation. People also wonder if it is right for single parents to have babies through IVF as well as whether couples with the human immunodeficiency virus (HIV) should be allowed to have babies through IVF. Others also question the ethical correctness of pre-genetic diagnosis used in treatment for the purposes of sex selection as well as sperm or egg donation.
Specifically, the Roman Catholic Church is known to have rejected for a very long time any reproductive technology that manipulates human embryos. The church only condones procedures that ‘assist’ natural conception. This means that the egg and the sperm must meet on their own, within the biological mother’s natural reproductive system. Catholic teachings allow two types of reproductive assistance, intra-uterine insemination (IUI) and GIFT. The Catholic church approves both procedures as long as the method through which semen is collected is not through masturbation. The church forbids third-party reproduction, specifically egg donation and surrogacy, whether traditional or gestational.
In Jewish teachings, IVF, using the father and mother’s sperm and egg, is generally accepted, although with some debates.
But it requires rabbinical supervision to be considered in accordance with Jewish law. When considering donated eggs or sperm, there again is not a complete consensus. With respect to egg donation and surrogacy, there is debate as to whether the status of the child is based on the egg donor’s heritage, the woman carrying the child, or both. In response to this ambiguity, a law was passed in Israel that allows women to donate their eggs to infertile couples. The law provides that a baby born through IVF would be the legal child of the birth mother, rather than the egg donor. The egg donor’s identity is not disclosed, but a national database will allow recipients of egg donations to check the religion of the donor.
As reproductive technologies evolved so rapidly, modern Muslim jurists have found it necessary to research the subject of assisted reproduction as it relates to the Koran. They reached an Ijtihad, decision based on Islamic law, on IVF and determined that the practice was permissible, provided the semen and ovum are from a couple who are legally married and the fertilisation takes place during their marriage, not after divorce or the death of the husband.
The Sunni Muslim’s position on third-party reproduction states that no third party should interfere with the marital acts of sex and procreation. This means that a third- party donor is not allowed, whether he or she is providing sperm, eggs, embryos or a uterus. The use of a third party in any respect is considered adultery. All forms of surrogacy are forbidden. A Muslim woman may not serve as a donor or surrogate neither would a man serve as sperm donor.
Untying the knot
To address these concerns, the Association of Fertility and Reproductive Health Practitioners of Nigeria (AFRH), ethics committee, held a public discourse on the practice of ART. The aim was to draft ethical guidelines for the practitioners within medical, legal, religious and socio-cultural groups. Participants were drawn from various religious groups, including Catholic, Pentecostal and Islamic clerics, legal practitioners, medical professionals and the general public.
The panelists agreed that, under medical and legal provisions, it is right for single women to have children. But since religion opposes it, it becomes a matter of religious inclination. For HIV-positive couples, the human rights charter provides that everyone has the right to procreation, and it is medically ethical, as long as strict protocols and safety measures are taken.
The panelists agreed that pre-genetic diagnosis could be used in the screening of genetic or sex-linked diseases like sickle cell anamia, haemophilia and cystic fibrosis, among others. But, if the intention is for
sex selection, then a line should be drawn. For gamete donation, it was agreed that there is usually a medical indication for it. But religious clerics disagreed with its appropriateness, especially as there is some form of pecuniary compensation as motivation. They argued that there could be a possibility of incestuous relationships from inter-generation and inheritance that may arise in the future.
The importance of adequate counselling and information to the donors was deemed vital, informing them of the side effects of the medications and treatment so that they can make informed decisions. It was agreed that the consent of a partner in the use of donor gamete was mandatory and must be sought before treatment. And about surrogacy, clerics disagreed with having a different woman carry another’s baby to term.
Generally, the clerics advised strict adherence to religious tenets.
“Child-bearing brings joy but the fact that I want to feel the joy of child-bearing doesn’t mean that I must get it at all cost. I don’t have to become a pagan simply because I am looking for a child. If I truly believe in the God that I worship, faith will teach me patience, perseverance and trust in God. Like in the scripture, men have lived to their 90s before having their first child and women lived to their 80s before having children. So, ifIsayIamaChristianoraMuslimandI am looking for a child and technology offers itself, I do not have to close my eyes like a man who wants to be rich but does not have a job and then he gets human parts simply because he wants to be rich,” one of the clerics volunteered.
Experts have also explained clearly that IVF babies are normal babies and not a taboo: “They feel sad, happy, love, hate, envy and fall sick just like every other kid. They laugh and they cry. They are also as intelligent as other human beings.”
A beneficiary who wanted to be anonymous said wrong perceptions exist because of ignorance. She said that, usually, IVF was done with the couple’s egg and sperm, only that the fertilisation took place outside the woman. Otherwise, it was as natural as other births. She added that, because of ignorance, most women saved from the stigmatisation of childlessness choose to attribute their IVF births to miracles.
Louise Brown, who is happily married to Wesley Mullinder, was the first “test tube baby,” as IVF babies are sometimes called. Brown has been married since 2004 and now has two male children, who came through natural birth. In Nigeria, Hannatu Kupchi, the first test tube baby in the northern part of the country, is currently studying medicine in a Hungarian university.
According to Wikipedia, IVF-assisted couples show greater emotional involvement with their child and they enjoy parenthood more than parents by natural conception. Experts explain that the claim that test tube babies inherit infertility from their parents is untrue. They argue that even in natural babies, about 90 per cent of the causes of infertility is also inherited. So, it does not apply to test tube babies alone. It further shows IVF babies are as normal and have similar problems as children from natural conception.
As ART progresses and becomes more accessible to the larger population, as with most societal shift, it is likely that the disquiet surrounding the heated debates relating to religion will subside. Religion is one of the most powerful factors shaping the opinions of the public, and while the interpretation of the texts by religious leaders may not shift, as with many things, the more commonplace fertility treatment becomes, the more tolerant the public’s perspective may become, belief systems aside.
Fertility experts are, however, encouraging beneficiaries to speak up and share their success stories, as it is the best way to protect their babies from discrimination. The first test tube baby in Nigeria pioneered by professors is unknown till date due to
the parents’ fear of stigmatisation. A brand ambassador of the Association for the Prevention of Infertility and Promotion of Reproduction Health and Rights (ASPIRE), Ifeoma Emekwue, challenged the stigma associated with IVF treatments. She is encouraging women with fertility problems to consider IVF.
Removing the hood
Emekwue had fertility problems several years ago. But she became a proud mother after undergoing IVF. She said she was not afraid of stigma: “From the day I was told I was pregnant, I called my mother and my mother-in-law to tell them I was pregnant and they know they are products of ART.”
Mrs. Kpaje, a mother of five, who had her first four children through IVF, with the last child coming naturally, noted that the problem of infertility in Africa could drive couples and families involved to
the edge, where they would not care how the conception of the children they so desperately want happens.
Kpaje said: “At a point, the mothers-in- law want to see children and not how you got them. I had four children through ART and the last one came naturally. I have five children now. My first son looks like my husband. They resemble us because the sperm they used are from my husband and the eggs are from me, even though it was assisted conception.”
Another beneficiary of ART said: “When I conceived after some period of childlessness, people couldn’t believe it was real. They were confused. After I was delivered of the baby boy, he looked every inch like his father.
My son not only looks like his father in appearance, he also walks like him.”
Experts say that IVF is used to treat infertility in patients with blocked or damaged fallopian tubes and male factor infertility, including decreased sperm count or sperm motility, women with ovulation disorders, premature ovarian failure as well as uterine fibroids. It is also applied to women who have had their fallopian tubes removed, individuals with a genetic disorder as well as those with unexplained infertility.
“There are five basic steps involved in the IVF and embryo transfer process. They include monitoring and stimulating the development of healthy egg(s) in the ovaries as well as collecting the eggs and securing the sperm. Combining the eggs and sperm together in the laboratory and providing the appropriate environment for fertilization and early embryo growth.
“In transferring embryos into the uterus, the following steps are taken: Fertility medications are prescribed to stimulate egg production. Multiple eggs are desired because some eggs will not develop or fertilize after retrieval. Trans-vaginal ultrasound is used to examine the ovaries, and blood test samples are taken to check hormone levels. “Eggs are retrieved through a minor surgical procedure that uses ultrasound imaging to guide a hollow needle through the pelvic cavity to remove the eggs. Medication is provided to reduce and remove potential discomfort. The male is asked to produce a sample of sperm, which is prepared to be combined with the eggs.
“In a process called insemination, the sperm and eggs are mixed together and stored in a laboratory to encourage fertilization. In some cases where there is a lower probability of fertilization, Intra Cytoplasmic Sperm Injection (ICSI) may be used. Through this procedure, a single sperm is injected directly into the egg in an attempt to achieve fertilisation. The eggs are monitored to confirm that fertilization and cell division are taking place. Once this occurs, the fertilized eggs are considered embryos.
“The embryos are usually transferred into the woman’s uterus three to five days following egg retrieval and fertilization. A catheter or small tube is inserted into the uterus to transfer the embryos. This procedure is painless for most women, although some may experience mild cramping. If the procedure is successful, implantation typically occurs around six to 10 days following egg retrieval.”
According to a professor of obstetrics and gynecology at the University of Benin, Edo State, Friday Okonofua, the prevalence of infertility in Nigeria is about 25 per cent, compared to between 10 and 15 per cent in the United States of America and the United Kingdom. For this reason, IVF comes handy and has helped countless couples around the world, though it is often unavailable and unaffordable in many developing countries.
A professor of anthropology and international affairs at the Yale University, Marcia Inhorn, said that, in many developing nations, the greatest social burden of infertility rests on the shoulders of married women, who are expected to become pregnant. They can experience “social scrutiny and ostracism” if they don’t have children. “This is especially true in ‘high-fertility’ societies of sub-Saharan Africa, where infertile women suffer from ‘barrenness amidst plenty,’” explained Inhorn, who is co-author of Infertility Around the Globe.
She said that the social stigma associated with infertility seems to be worse when women are expected to have many children and can lead to depression, despair, and threats of divorce. She explained that in sub-Saharan Africa, many infertility problems in women are related to untreated or poorly treated reproductive tract infections, which could easily be prevented with early detection.
However, Inhorn said most of the world’s infertility cases involve male infertility, which is a “hidden” and neglected reproductive health problem. “Women often carry the burden of their husband’s infertility, even when they themselves are healthy and fertile,” she said.
Director of the Bridge Clinic, Lagos, Dr. Richard Ajayi, said that he had a vision of making the treatment easily accessible. “Where you have a marriage that’s not blessed with children, there’s a lot of stigmatisation. In fact, some people say infertility is a justifiable reason for divorce and a lot of marriages break up where there’s infertility,” he said.
Nigeria is Africa’s most populous nation with over 180 million people, but it has a large fertility problem. At the Bridge Clinic, which claims to have had 1,253 live births since 2000, treatment can cost up to $5,000. According to Ajayi, maintaining a professional standard in a country with lack of trained IVF staff is not cheap. Ajayi said healthcare was not about numbers.
“It’s not just about making money; it’s about actually doing something worthwhile and having a clear vision to solve a problem that the country needs solving and at the same time building an institution that outlives me,” he said.