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‘25% of couples in danger of infertility’

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Prof Ashiru

Professor Oladapo Ashiru was the first indigenous professor of Anatomy in the University of Lagos, brain behind the first In Vitro Fertilisation (IVF) operation in Nigeria and the Group Chief Medical Director of Mart Group, He reflects on critical issues surrounding infertility and challenges bedeviling the health sector in this interview by VICTOR OGUNYINKA.

Could you share with us what it felt like having the first IVF operation way back in 1986?
We have been involved with IVF procedure since 1983, but our first conception then became aborted at the early period of pregnancy, which is what is now termed early pregnancy loss, which is still common in IVF till date. At that time, IVF operation was carried out using laparoscope.
You have to go to the theatre, put the patient under the general anesthesia. Then, aspirate the follicles from the patient by three incisions on the abdomen. One incision is for the scope that is the camera to look into pelvis; the other incision is for the forceps to hold the structure you are looking at and the third incision is for the needle to aspirate the follicle. So, that was what it was then.
Today, you do not make any incision in the abdomen, you go with an ultrasound, through the vagina and with one single needle incision you can aspirate the follicles from the ovary.
Was it technology that happened or precaution?
Absolutely technology. The industry came to the help of the doctors; they looked at what we were doing and they devised means to make it simple for us such that the glassware that we use for test tube is now in form of plastic ware, which is disposable.

Would you say infertility is still a big problem in Nigeria?
Infertility continues to be a big problem. In a recent conference in Geneva at the World Health Organisation (WHO) headquarters, we had a meeting of about 50 experts talking on guidelines for infertility. We still recognised the fact that infertility occurs in a large percentage of people. In fact, it occurs in about 20 to 25 per cent of married couples.
For both male and female?
Yes, we have now stipulated the definition of infertility to be “occurring in or either the male and female”. So, infertility is now defined as the inability of a person to get pregnant after 12 months of regular unprotected s3xual intercourse, or after six months if the person is over 35 years of age.
Are there general causes or peculiar causes for both s3xes?
There are general and peculiar causes. The general causes are the endocrine related. Inability to ovulate in a woman or endocrine that causes sperm production not to occur efficiently in a man. So, these are the endocrine causes that can occur either from the level of the brain, or the lower level in the nervous system. Like the hypothalamus or the pituitary glands.
There are some people that claim they don’t eat a particular meal in their family. If they eventually eat those ‘forbidden’ meals, could it be a problem to their health?
Absolutely, there are two things involved. As the saying goes, the food of a fisherman is poison to a blacksmith. That means we all have different genetic compatibility. It is always good to know what food is compatible with one. And also, as a general rule, food that grows in your environment is most time, good for you. But food that you import, for instance, we import apples, grapes, milk and some vegetable oils; they could be a problem to our health.
Could you tell us briefly about the experience on your successful delivery of a set of quadruple, was that the first?
In our own hospital that was the first. We had had quintuplet that were conceived from our centres, but they went abroad to deliver. A 50-year-old couple came here because they lost their son, they wanted to have a baby and we transferred three embryos into her, which was what was recognised then. But two of the embryos split into two so, at the end, they ended up with five babies. At first, we saw three gestational sacs, which meant three embryos implanted but a week later, the three sacs became four, which means that one of them split into two and later on, we saw five. So, they first went to Lagos State University Teaching Hospital (LUTH) and they were there for a while, but during one of the strike actions, the couple had to move to India.
The second one was the same, they went to Edinburg in Britain to have babies. So, these were celebrated feat that we did in our centre. But because of this, we started our own maternity centre to demark medicare. When we now had a patient who had four babies, we made her stay here at the maternity to rest and she was delivered by caesarian section. One after the other and the four babies were taken out less than three minutes from the mother and at that time, we had incubators for each of the babies.
You said 50-years-old couple, how about the issue of menopause?
Menopause means menstrual period had ceased. But some could be restored back to activity while others might have to settle for alternative options like in donor case.
When is it not ideal to get pregnant?
The only time that is not ideal to get pregnant, regardless of your age is if your health system cannot hold it. This is when your kidney or heart is not functioning properly. Or if there is a medical condition that would not enable you go through the pregnancy.
The health sector has proven to have capable hands in getting a job done, but there seems to be a problem with the structure on ground, what is the problem?
The problems are many folds and I think since the days of late Professor Ransome Kuti, we have not had a health minister that is bold enough to take another direction with health. Before Prof Kuti, the health system was developing mainly in terms of having tertiary and then secondary health. So, people developed general hospitals and university teaching hospitals.
But he had this idea about primary health care, rightfully so, which used to be actually a community health, but he termed it primary health care and the philosophy was that we should be able to give basic health to people, correct some things and develop people that can handle this. During that period that he was health minister and subsequent jobs that followed, that was the main emphasis and thrust of government and in the process, they ignored the tertiary and secondary health care.
Consequently, some ministers that came thereafter, tried to do something to the tertiary care, but it was not in my own view a comprehensive method. Some will say they want to help the teaching hospitals and they would buy equipment and at the end of the day, nobody to use those equipment.
Nigeria is highly equipped with manpower enough to be a centre for medical tourism in the world. Today, we still hold substantial manpower even in the USA and Canada.
You are one of the earliest authorities in what you do; do you and other professors sometimes give recommendations to the Federal Government on the way forward in the health sector?
Yes, in my own little way, I do sometimes for every minister for health. I have always sent them e-mails and make my comment about what I think they should do. And then, I think the last minister, Professor Onyebuchi Chukwu, took a lot of recommendations from me. I wrote a paper in a national newspaper on ebola that we were only talking about it in other countries and not preparing… So, I always give recommendations to people, but I think that when we talk about health, the government can take a radical measure and really get it done aright.
And you know, when you assemble a team; you assemble them on merit, not just talk and talk. People must come up with ideas and come up with facts. I mean we just had some examples like that in WHO in Geneva, we are bringing ideas on regulations, control of infertility and management, experts came, you put your own fact down, we all look into it one after the other and we accept. By the end of the day, we have good compendium of what to use.
Have you spoken to the present government?
There is nobody there yet, we only have the president and the vice president.

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