Assisted Reproduction / I.V.F Unit
(A) I.V.F Services Provided:
1. In-Vitro Fertilization and Embryo transfer (I.V.F. and ET) commenced June 2007
2. Intra-uterine insemination (I.U.I.) commenced May 2008
3. Intracytoplasmic sperm injection (I.C.S.I.) commenced February 2008
4. Embryo Cryo Preservation commended March 2008
5. Embryo thawing and transfer commenced March 2008
Working Days & Hours:
8am - 4pm (Monday to Friday)
(B) Brief history of the H.R.R.P./I.V.F. Unit
The present H.R.R.P. /IVF Unit is one of the four academic units in the Department of Obstetric and Gynaecology; the other units being Family Planning Unit, Feto-maternal Unit and Oncology-Urogynae Unit. The unit is a dedicated programme for infertility research and services, established with the support of the W.H.O. in June 1989 to evolve into a centre for collaborative studies in Human Reproduction Research. Infertility as a reproductive health index is a major gynaecological problem and in Nigerian culture, the main reason for marriage is child bearing, the failure of which results in several marital problem including divorce and impoverishment of women. Hence the W.H.O. support to establish the H.R.R.P. at the onset and continuing collaboration.
For the over two decades of the studies in infertility at the HRRP. It has been found that about 60% of the couples have male and female factors which are intractable to the common infertility treatment method with drugs or surgery and its various combination. For these cases, Assisted Reproduction Technology (ART) is the most efficacious treatment; hence the only way to improve infertility treatment outcome at the HRRP was to scale up the capacity and capability for infertility management to include I.V.F., I.C.S.I. and other variants of ART as presently obtains at the programme. Management installed the most modern cutting edge equipment for I.V.F. and ICSI and in June 2007 ART research and services began at the programme. Since then till date IVF/CCST services are run at the programme in batches of about 40 couples about every 5-6 weeks for five batches per year. There are about 150 couples handled yearly with a pregnancy rate per embryo transfer of about 28% which compares with other IVF centres world wide.
Working Days and Hours
The programme is open all working days of the week from 8.00 Ė 4.00pm.
However, for about 3 week before any IVF/ICSI batch run, the working hours, run almost 24 hours including week ends and public holidays.
Further details of the IVF Service delivery in UBTH
How we achieved the test tube baby feat
Let us discuss the topic by examining it under some sub headings:
1. What is test tube baby Technology?
Test tube baby is the layman language for what in modern parlance is known as In
Vitro fertilization and Embryo transfer (IVF and ET). In deed IVF and ET entails the following steps.
(A) Administration of some powerful drugs (mainly in injection form) to the women to make her grow several Oocytes (eggs) to a pre define level of maturity: after which the Oocytes are removed with some sophisticated Needle sized telescopic instruments (without any operative incisions either on the abdomen or vagina through the vaginal route guided by tran virginal ultrasound probe.
(B) The Oocytes (eggs) are further especially prepared in the laboratory and incubated in test-tubes with the Husbandís semen which had been produced earlier and subjected to a potentiating and activating treatment in the laboratory to enhance the capacity to fertilize the Oocytes (eggs).
(C) The fertilization of the Oocytes by the sperm when it occurs will result in Embryo which are further incubated in the lab for another 48 hours by which time the Embryo (New Baby) will be 2 days old.
(D) As soon as the Oocytes (eggs) have been removed from the body as described above, the woman is next subjected to some other treatment regimen which are injections, tablets and vaginal pessaries whose aim is to prepare the uterus (womb) to be more receptive/accommodating to the Embryo (new baby) when it is eventually transferred on the second day of life; again through the virginal route using sophisticated gadgets. It is expected that the transferred embryo (New Baby) will successfully implant on the endometrium (womb) to initiate the pregnancy which hopefully by Godís special Grace will lead to eventual delivery.
(E) In the past there used to be several instances of failure of the sperm to fertilize the Oocytes. This problem, nowadays is easily solved by the use of a special machine called the intracytoplasmic sperm injection (I.C.S.I.) machine which aids such low quality and low capacity sperm to easily fertilize the Oocytes just like the way jacket will aid some one who cannot swim to stay afloat on water at sea/river.
Thus, with the test tube technology, the difficulties in the way of the sperm of the Husband not being able to meet and fertilize the eggs (Oocytes) from the wife is successfully by passed, when the perm and eggs are bought together in the test tube to initiate fertilization and eventually, pregnancy, hence the Name; In vitro fertilization. The process as explained above usually succeed highly in the young women who are 33 years or less with a pregnancy rate which is higher than the natural rate of pregnancy in any cycle of 25%. Yes, it is important to note that in a normal couple staying together with adequate coitus, the chances of a pregnancy occurring in any month is 25% and 75% failure rate to achieve a pregnancy. However, this 25% is repetitive every month hence normal couple would all have achieved a pregnancy within 1 year duration. Usually the best pregnancy rate for IVF treatment which equal this natural pregnancy rate per cycle of 25% occurs in the young women. Older women because of the aging Oocytes have much lower pregnancy rate per cycle. Similarly, the IVF cost is lowest for the young women who require minimal drugs to produce Oocyte (eggs) compared with the older women who require more drugs to produce Oocyte (eggs) compared with the older women who require more drugs to produce Oocytes which at times, are of poor quality for fertilization and implantation.
2. Why did we go into Test Tube Baby Technology?
The problem of failure to achieve pregnancy in a marriage context in Nigerian culture is a serious one, because child bearing is the main reason for marriage. Thus, infertility leads to divorce, polygamy, marginalization, of the women depressive illness, impoverishment and other destabilization of the society. It is because of this that there was created a dedicate programme for infertility management at the UBTH called the Human Reproduction Research Programme (HRRP). Experience of infertility management at the programme in almost 2 decades revealed that in almost 60% of cases, couples have as the cause of infertility, factors which cannot be treated with the usual and common method of operation; drug medications or a combination of the two methods. Hence, the only way to have improved results in infertility treatment at the programme, was to advance to the technique of IVF which is the most effective way to solve the problem in the majority of our infertility population. The present UBTH management accepted this as a way to improve on results from infertility treatment at the centre, and upgraded the centre into a centre of excellence in infertility research and management in Africa, South of the Sahara Desert.
3. How did we achieved and sustained the test tube baby feat
WE achieved the test tube baby feat based on 3 events.
A. UBTH Management decision to transform the hospital into a multiple centres of excellence in Health Care Delivery
Under this vision, the HRRP which had perfected infertility treatment utilizing the usual common methods of operation and drugs for almost 2 decades with poor results in 60% of cases was upgraded to a centre of excellence. Management acquired the most modern sets of requisite I.V.F. equipments including the ICSI machine and cutting edge investigative tools including operative hysteroscope, and laparoscope with full monitor. This is why we achieve good pregnancy rate outcome even from the initial start of the I.V.F. service delivery and currently our pregnancy rate is at par with most other IVF centres in Nigeria, Europe and America.
B. Evolution of the HRRP/IVF into a mega station for IVF Service Delivery
The HRRP is a dedicated programme for infertility research and management which from the initial concept and construction was purpose built and tailor made to accommodate IVF (test tube baby Technology) facilities at its foundation in 1988. After the requisite core equipment had been positioned in the appropriate sites in the unit and initial test run, we decided to effect the IVF service delivery in Batches (by which several couples are assembled and handled together in a single IVF run) rather than as the individual couples present. Thus, after the initial 3 couples in June 2007 we scaled up to 20 couples and later 30 couples in a single Batch. Presently we have maintained batches of 30-40 couples for over eight month. Batching as a strategy in IVF service delivery provides the essential volume of clients for teaching and research as is expected of a Public funded institution so as to spread the knowledge of IVF services. Above all, batching allows all infrastructure (light water etc.) other human and material resources to be made available to the unit during any IVF service periodically and for us, this often is for a 10 days duration only in every 5-5 weeks. This is how the HRRP/IVF Unit transformed into a truly mega station for IVF service and is the first of its kind in IVF service delivery in Nigeria.
C. Godís Grace that transformed all our efforts into Success with a pregnancy rate of 28% of which compares favourable with all other well established IVF Centre world wide. Although the HRRP began as an infertility dedicated programme 1st June 1989, it took until 2004 when the present management came on board for the cutting edge IVF equipment to be install and the programme was transformed into a centre with IVF capabilities.
Finally it was on the 22nd June 2007 that the 1st IVF technique was performed and by Monday 22nd May 2008 at 12.15pm the first IVF baby was delivery in UBTH after 35 years to the Glory of God. The journey of the HRRP as a dedicated infertility treatment programme to attaining the status of a centre of excellence in Health care service delivery which took 18 years was actualized 22nd May 2008, with the birth of the 1st IVF baby.
The test tube baby technology is the fulfillment of a vision to create a veritable centre of excellence in infertility management in UBTH as the first in all the first, generation tertiary level care centres in Nigeria. This vision was accomplished as a mission with the delivery of the 1st test tube baby at 12.15p.m. On 22nd May 2008.
The Programme Director
Professor A. A. E. Orhue