By Ekundayo Omogbehin
FRI 12 AUGUST 2016-Infertility is the inability of a couple to conceive after regular unprotected sex over a period of time, normally one year. Infertility is a global issue as all new couples, save a few, look forward to raising children from their unions. In Nigeria, however, the burden of infertility is a lot graver as our society tends to regard childbearing as the biggest index to measure the success or otherwise of every marriage. This social expectation is the genesis of the prejudice against couples dealing with challenges of infertility. The prejudice, on its own, drives these couples into trying out all options and recommendations as they try to beat this unsavoury bias, thence tends to make them no more than puns in the hands of fertility doctors in Nigeria.
Generally, many couples commence their fertility treatment with their family doctors, who are largely general physicians, through the consultant gynaecologists who are referred by the physicians, and to the fertility doctors who the gynaecologists refer. While some of the patients get their issues resolved between their general practitioners and the consultant gynaecologists, some drop off this route to some unorthodox practitioners like the traditional and herbal medical practitioners, and religious leaders. While all these people who deal with the issues pertaining to human health need to be effectively regulated, the focus of this article is to ensure the effective regulation of the orthodox practice of in-vitro fertilization (IVF) in Nigeria.
Also, many couples who are dealing with infertility challenges depend on the mass media, especially the new media, for information on fertility clinics in Nigeria. Any search engine click on the internet throws up millions of websites of fertility clinics and their various success claims. It also throws up various promotional offers they have put in place to “ease the couples’ access to treatment”. Many gullible Nigerians have fallen for these unsubstantiated claims and offers, and have thrown their resources – money, time and gametes – down the drain, in the name of failed IVF treatment cycle, and with nothing but regrets to show for it.
IVF is a specialist medical practice and should be practiced in accordance with strict codes of conduct and the effective watch of a regulator. IVF process is an intricate procedure with possible contraindications and side effects dotting the various stages, from medical investigation, which includes scanning, through egg collection procedure, in-vitro fertilization and embryo transfer, and leaving the practice to be self-regulated is tantamount to institutionalization of quackery, mediocrity and mass murder. For instance, during the scanning process, some infections from the vagina may be introduced into the uterus thus creating a medical condition that was non-existent prior to the process.So a quality IVF treatment is such that must ensure that the possibility of this kind of outcome is reduced to the barest minimum.
Humans are known to have the poorest fertility rates of all mammals, with a pregnancy rate of less than 30 percent. This is a ready excuse for fertility clinics to justify a failed IVF treatment cycle. It is also a reason government needs to step in with effective regulation of the practice to ensure that unsuspecting citizens do not fall prey to the antics of some mediocre practitioners.
Many IVF clinics in Nigeria make bogus claims that are hardly authenticated by any reputable auditing firms. These claims are used to attract patients, who are in some cases, left worse than they were on commencement of treatment, medically and financially. These individuals are entitled to quality medical attention as well as deserving of protection from practitioners.
It is not surprising that the Medical and Dental Council of Nigeria (MDCN) which is the regulatory agency for medical practitioners, like its counterpartsin most parts of the world, seems to have left fertility doctors to go on with their practice unregulated, sometimes, at the expense of couples who are in search of children. These fertility clinics, driven by their mercantilist disposition, promise more than they can deliver and then turn around and blame fate for non-delivery of promises. An industry regulator is needed to moderate and audit the claims of fertility clinics so as to ensure they do not fly wild cards and deceive unsuspecting clients.
In the UK, the Human Fertilisation and Embryology Authority (HFEA) is the specialist regulator for fertility practice. Not long ago, HFEA mandated clinics to “take a more responsible approach to patient information”, to ensure websites gave vulnerable couples a realistic assessment of their chances of having a child. This crackdown was to force private IVF clinics to stop making exaggerated claims about their success rates, in response to the growing complaints that some of these clinics have been misleading these patients, charging exorbitantly high fees and delivering suboptimal results.
In Nigeria, however, the best we see are a few clinics that have gone ahead to adopt particular protocols from foreign countries of their choice and regulate themselves using those standards. This is a good start but we need an external regulator to ensure independent and uniform standard for the whole country. This is even more especial in Nigeria, withmany regulatory agencies overseeing our medical practice but with less-than-desired effectiveness. Now and then, we hear of an impostor medical practitioner being arrested after several years or decades of illicit practice. A specialist IVF regulator will ensure that this kind of misnomer does not get to the practice in Nigeria.
A good regulatory regime for IVF practice will not only ensure that couples seeking intervention get the best care, but will also safeguard the practice from quackery and help protect practitioners in times of trouble. This regulator will set the standard, licence, train and retrain practitioners, as well as licence and supervise fertility clinics to enforce compliance to the established rules and regulations.
The month of June, globally celebrated as the World’s Infertility Month, affords us a golden opportunity to take a second look at the IVF practice in Nigeria, in general, and its regulation, in particular, to ensure that Nigerians obtain a better deal from IVF practitioners in the country.
Dr Omogbehin works with The Bridge Clinic, a fertility Clinic in La