Dr Ibrahim Wada is a chief consultant gynaecologist and renowned fertility expert. He is one of the pioneers of IVF breakthroughs in the country and led the birth of Baby Hannatu in 1998. Wada, who is also the founder of Nisa Premier Hospital and chairman of Garki Hospital, Abuja in this interview speaks on advances in infertility care in the country.

With the rate of infertility in the country many people (male and female alike) now buy fertility boosters from shops and pharmacies. What is your take on this?

People should please spend the little money they have in seeing a doctor when they have delay in conception or other problems. Secondly, stick to the best of knowledge from that doctor. If you are not satisfied, go to another doctor, maybe a doctor at a higher level than your doctor.

People should not resort to fertility this or that not prescribed by a doctor. That type of self-medication does not lead to the success they are looking for. There are all sorts of marketing gimmicks and products around so use your sense and go to your doctor and you would not be wrong.

There have been a lot of myths and misunderstanding about Invitro Fertilization (IVF) and assisted reproductive technology. What do you think is the level of acceptance about it today in Nigeria?

I have been practicing this technology since 1996. The first baby born from IVF was Hannatu in 1998, and since then thousands of couples have gone through the procedure.

I remember very well that it was difficult for people to accept it at the beginning because it was not common in Nigeria. People thought that for such advanced technology they have to go abroad.

Now we have arrived at a point in this country where the acceptability is almost as what is obtainable in other parts of the world. That is not to say IVF is totally acceptable in the country. There are still some ‘buts.’

The first ‘but’ is the religious, moral and ethical. Couples do not have problems with it. Almost all facets of the population in this country are at peace with it. Even though the cause of the acceptability is also related to cost, more people are of the view that Nigeria is offering the cheapest possible In-vitro Fertilization when you look at the global scale.

The other aspect where acceptability is difficult among Nigerians is where the assisted reproduction involves a third person. Majority of Nigerians don’t like that. They like to have as much confidentiality as possible. The third person here means when it involves surrogacy, or using donated eggs or sperms.

Many people prefer to go for adoption when faced with that option. Nevertheless, some do it and key their guidance from the Almighty, and pray for the best outcome.

Another aspect of IVF that has generated ethical debate is when an intending couple both have the genotype AS and their parents and the community are afraid that their children may have SS genotype or children with sickle cell disease.

The science of IVF being done in Nigeria today can lead to this couple at risk not having any SS children. The process is called Pre-implantation Genetic Diagnosis.

So while one is very happy about this development, some people may not be comfortable.

Couples who are madly in love for better or worse will accept this procedure when they both have AS genotype but others may see it as interfering with what God wants.

Does this also prevent mental health conditions in children?

It helps with all forms of inherited abnormalities too many to mention. Some people lose all their children quickly because there is a genetic problem with the heart, brain or something else.

The genetic screening and diagnoses can tell you the sex of the embryo, the genotype – AS AA or SS etc – and if it is carrying Down syndrome or other abnormalities, by identifying what could be wrong with an embryo. We are now doing this in Nigeria at our hospitals.

What is your advice on infertility in Nigeria?

Nigerians should be informed that advances in infertility and assisted reproductive technologies treatment in other parts of the world are also done in Nigeria.

I know many of my colleagues that are working very hard to solve infertility problems. By training people , we are expanding the availability of these technologies to as many Nigerians as possible.

Is there regulation for the practice of infertility and assisted reproductive technology in the country?

Yes, it is being regulated. The Association for Fertility and Reproductive Health (AFRH), the body of IVF practitioners, was set up almost 10 years ago. When the governmental regulation was stalled we now developed self-regulation with guidelines and booklet that all our members have access to.

It has minimum standard of practice, ethics and morality among others. The guidelines is being done in collaboration with the Medical and Dental Council of Nigeria to regulate the practice of doctors in the system to ensure that they are following all the required protocols so that the population does not suffer unnecessarily.

You recently trained some gynaecologists as sub-specialists in infertility, and assisted reproductive technology. What is the outcome?

Yes, they are the first batch of gynaecologists that have been trained as Sub-Specialists in infertility and Assisted Reproductive Technology. They have completed their one-year course and we did their graduation ceremony last week.

The training was conducted under the auspices of the West African College of Surgeons which is the certifying body of Postgraduate Medical degrees. It was hosted by Nisa Premier Hospital and Garki Hospitals. The training was coordinated by the Institute of Medical Sciences Africa (IMSA).

Before now, doctors travelled to India and other countries for only two to three weeks for the training without practical experiences because they were not licensed to practice in those countries.

Specialisation in assisted reproductive care is very important in Nigeria as thousands of people are suffering from infertility. So it is important to train people correctly on how best to handle the issues. Hitherto, doctors travel abroad to acquire knowledge in this area and because they are not supposed to practice in those places, they just read and return to unleash it on Nigerians.

These first set of gynaecologists were trained in a very structured manner for a year so that they can practice in our community.

The graduands were six gynaecologists who are already fellows of the College of Surgeons and of Gynaecology. They are certified consultants; five men and one woman.

We put them through a very structured and approved training programme which included theory sessions, practical demonstrations, practical supervision of their work and computer simulation.

They were exposed to so much knowledge and skills over a 12-month period and are as good as anybody else who has been trained outside the country in the field of infertility and assisted reproductive technology.

It was the first kind of programme not just in Nigeria but the whole of West Africa at postgraduate level. We have shown the way for other hospitals across the region to develop their own programme because there are millions of people across the region in need of Invitro Fertilisation and advanced fertility care.

Some people with the knowledge could be drawn to unethical and sharp practices and focus on money but our trainees were not just taught knowledge and skills but also taught the fear of God and to put country and the community first before themselves. So we are expecting the highest moral and ethical standard of practice from them, and they wouldn’t let us down.

The graduation ceremony was attended by the representatives of the Minister of Health, Secretary of Health of the Federal Capital Territory Administration (FCTA) and Chairman of the Faculty of Obstetrics and Gynaecology of the West African College of Surgeons, Professor J. Ikechebelu of the West African College of Surgeons, among others.

What are the plans for IMSA?

The Chairman of IMSA is Professor Joseph Otubu who is a renowned teacher and professor, and I am the founder and Chief Executive of IMSA. There are other professors involved in the IMSA programme.

The main plans are to make it more like a finishing school. After doctors, nurses, lab scientists and pharmacists have graduated, we can still polish them into best practices. It is called continuous professional development.

IMSA also targets research but the major arm is training of people so that they are much better than when they left school and apply it in their jobs.

Infertility