IVF: 5 step process,costs, risks, success rates and centres in Nigeria

What is the meaning of IVF?

The full meaning of IVF is in vitro fertilization which some people like to refer to as ”test tube baby” or ”IVF baby”  is a process by which fertilization takes place in the laboratory and the fertilized egg (called an embryo) is then transferred to the womb where it implants and is carried by the woman till the 9^th month when a baby is delivered.

The process usually begins with routine blood tests, ultrasound scans as well as seminal fluid analysis for the male partner. The objective of these initial tests is to find a cause of the infertility and offer treatment and to determine the best procedure and protocol to offer individual couples.

A couple is said to be infertile /sub fertile if the they have had adequate sexual unprotected intercourse (3-5 times/week) for at least one year or 6 months (if the female partner is greater than 35 years old) without achieving pregnancy. The shorter timed definition for female partners older than 35 years is because it is a well-known fact that egg quality and fertility in females reduces drastically from the age of thirty-five. Subfertility may be primary (if the woman has never been pregnant in her life) or secondary (if the woman has ever been pregnant whether or not the pregnancy was carried to term, miscarried or aborted)

There are various causes of infertility which may be managed with medications and or surgical procedures to achieve pregnancy. IVF is not the only process through which an infertile couple may get pregnant. Infertility first needs to be established, that means the couple must have met the criteria for infertility and neither of them is using any form of contraceptives knowingly or unknowingly.

This is because most normal couples without any medical condition will get pregnant within a year of regular unprotected sexual intercourse. Even for people who do not know how to calculate their fertile period, you are very unlikely to miss having intercourse during your fertile window for twelve consecutive months if you have been having sex at least three times in a week.

IVF definition

Assisted reproductive techniques

Usually, if a couple has a clean bill of health after investigations, processes like monitoring ovulation (using urine/blood test kits, ultrasound scans), stimulating ovulation, trigger shots (a hormonal injection is given towards the ovulation date to  ‘trigger’ the ovary to release already matured egg into the fallopian tube) etc. must have been tried before assisted reproductive techniques are offered.

For those who have male factor infertility (MFI), for instance low sperm count, poor sperm motility or morphology, azoospermia from varicocele, dietary/lifestyle modifications plus drugs and surgical treatment may be offered first. For female factors such as hormonal imbalance, Polycystic ovary syndrome (PCOS), blocked fallopian tubes, hydrosalpinx, endometriosis, uterine synechiae, etc. dietary/lifestyle modifications and/ or surgical treatment is offered first. Assisted reproductive techniques may be offered after the couple has failed to achieve pregnancy following these treatments.

• Intrauterine insemination (IUI)
• Invitro fertilization (IVF)
• Intracytoplasmic sperm injection (ICSI)

IVF vs IUI

Either of these procedures may be done using donor gametes (egg or sperm) although for IUI, only donor sperm may be used because fertilization is taking place in vivo (in human body) and not in vitro (in the laboratory).

IVF vs ICUI

The difference between IVF and ICSI is that in IVF ,numerous sperm cells are kept with the egg and so the sperm gets to the egg and fertilizes it while in ICSI, one sperm is directly injected into each egg to fertilize it.

Which couple may need assisted reproductive techniques?

A couple may need to be assisted if:

• They are unable to achieve pregnancy after one year of adequate UNPROTECTED sexual intercourse
• They are not living together
• Either of the partners has a medical condition that has limited their chances of natural conception

Usual body process

The normal process in human body is this: by the time a baby girl is born, she has all the eggs she will need in her lifetime. Unlike the men, women do not produce eggs every day, they only have a set of follicles growing to maturity every month with one or two eggs released during a cycle. The eggs must get to get big enough to be released. If none of the eggs get to that required diameter, there will be no egg released for that month.

At birth, a girl has about two million follicles which continue to reduce all through their life till menopause. during the course of every menstrual cycle, from the first day, a cohort or group of follicles begin to increase in size and at about the 14^th day (in a 28 day cycle), the largest egg is released while the rest of the follicles just stop growing and die off.

This release of egg from the ovary is what is called ovulation. The egg then starts moving from the fallopian tube towards the uterine cavity ,if sperm meets it within the 1^st 24 hours of release, it fertilizes it and the fertilized egg then moves through the tube to the womb where it attaches to the walls (implantation) and begins to grow into a baby.

The IVF process

The process of IVF involves

1. Sperm collection
2. ovulation stimulation and oocyte (egg) retrieval
3. fertilization of harvested eggs with sperm
4. Growing of fertilized eggs
5. transfer of the embryo

Sperm Collection

In IUI, sperm cells are extracted from the seminal fluid (the fluid released by a man during ejaculation) and injected into the uterus through the cervix. This process bypasses the vagina and improves chances of conception for women who may have a harsh vaginal mucous that is not conducive for sperm to survive.

Ovulation stimulation and Oocyte (egg) retrieval

Your ovaries must be stimulated before egg retrieval. In an ART cycle, the drugs are given to stimulate the follicles so much so that most of the follicles for that cycle grow large enough to release eggs. In IVF, all the mature eggs/oocytes are harvested from the ovary through the cervix. This is usually done in the theatre after the woman is put to sleep.

Fertilization of harvested eggs with sperm

The harvested eggs are immediately fertilized with sperm from the male partner (either freshly collected or frozen) or donor sperm.

Growing of fertilized eggs

This is then allowed to multiply in a conducive environment in the laboratory till it forms the blastocyst by day three to day five.

Embroyo transfer

This is then transferred to the uterus either on the third or fifth day depending on the policy of the fertility center. This is usually under ultrasound guidance. Most of the times, the number of fertilized eggs that grow to become embryos is usually less than the number of eggs retrieved.

IVF two weeks wait

After embryo transfer, the IVF process has ended, and the two weeks wait (“2WW”) begins before you can do a pregnancy test (urine or blood). You will be given medications to make your body receptive and make the womb conducive for implantation. It is often advised that one avoids strenuous exercises and sexual intercourse during the 2WW.

The IVF medication process

There are different IVF medication protocols that may be used. Some protocols are shorter than others however the whole process from commencement of injections to embryo transfer usually lasts between two to four weeks. Protocol to be used depends on the hospital policy and/or the individual patient’s situation or preferences.

The longer protocol

The longer protocol involves a down regulation time in which all the body’s reproductive hormone release is basically put on hold  i.e. ‘downregulated’ by the medications given and then an artificial cycle is started with another set of medications.

The shorter protocol

The shorter protocol allows the natural cycle to go on but its augmented by hormonal injections to get more follicles to mature. Each of these protocols have their own advantages and disadvantages therefore they are usually individualized. Your doctor will know what protocol is best for you.

Cost of IVF in Nigeria

IVF is an expensive process that is both financially and emotionally draining. It is imperative that you prepare your mind and body before the procedure in addition to preparing a budget according to the amount of money you have or are willing to spend on the process. The cost of a cycle of IVF in Nigeria ranges between #750,000 and 2.5 million (drugs, procedure, and test).  It is offered by various fertility centers all over Nigeria both government owned and private hospitals.

However, most of the private centers are concentrated in Lagos and Abuja. Some centers offer two or more cycles at a discounted price if you pay for all cycles at once. This means that if the first cycle fails, you can have one or two more cycles depending on the agreement without making additional payments. If the first cycle is successful, then you would not get a refund for the other cycles paid for.

IVF vs ICSI Cost

Both procedures are done in the laboratory but ICSI is more expensive because it involves more work for the embryologist. ICSI also has higher chances of success than IVF.

IVF success rate in Nigeria

The chances of getting a ‘big fat positive’ (BFP) pregnancy test result following ART varies based on the procedure. For IVF in Nigeria, the success rate ranges between 40 to 65 percent for most centers.

In vitro fertilization (IVF)/Fertility centres in Nigeria

Here is a list of in vitro fertilization (IVF)/Fertility centres in Nigeria.

Conclusion

In conclusion, even though assisted reproductive techniques (ART) offers a higher chance of achieving pregnancy in infertile couples, there are still chances of having a failed cycle. It is important that you understand this to manage your expectations properly. Some hospitals offer psychological support following a failed cycle while others do not. The onus lies on you to find a good support system or join an IVF support group online of offline even before you start the ART/IVF cycle.