IVF: Making the impossible possible for childless couples

 

Tears of joy roll down the faces of Martina Nakato and Matilda Babirye (not real names) as they thank the doctor who made it possible for them to be born. 

 

“Our parents are proud to have us and had it not been for you, this would not have happened,” the twins tell the doctor.

For long, their parents were taunted by their lack of a child in addition to their father being HIV-positive. “On top of being less fertile, I feared to infect my wife with HIV,” recalls John, the twins’ father. 

 

Their search for HIV-negative children led them to a fertility doctor. A family friend recommended a fertility specialist at the Fertility Endoscopy Clinic in Nakasero, Kampala.

 

The couple are now proud parents of four children, two of whom are twins. All the children were conceived through in vitro fertilisation (IVF). 

 

The twins, who are vibrant 19-year-old university students, are some of the many children that have come into existence through IVF. 

 

On the popularity of the procedure among Ugandan couples, Prakash says: “Many people seek the service, but not all get it. Some only need fertility treatment to boost their chances of getting pregnant naturally, while others need artificial fertilisation, which is one of the many treatments for infertility.”

 

Dr. Daniel Zaake, a gynaecologist/obstetrician at Life Sure Fertility Centre Mawanda Road in Kampala, adds that fertility treatment has been well-received because of the results obtained. Since the technology was introduced in Uganda in 2004, over 400 babies have been born through in vitro fertilisation. 

 

“It is an option, especially where couples cannot conceive naturally. The only barrier is the cost because the consumables are very expensive,” explains Zaake. 

 

He adds that the cost differs from one patient to another. Patients with severe complications may require more expensive treatment. However, Zaake says the cost ranges from sh10m to sh20m. 

 

Dr. Prakash Patel of the Fertility Endoscopy Clinic in Nakasero, Kampala, who has been a fertility specialist for over 18 years, says most couples who go for fertility treatment are in stable marriages, are discordant couples, searching for twins or seeking a particular sex. He has delivered hundreds of babies, who were conceived artificially with the oldest children being at university.

 

According to records at the Uganda Bureau of Statistics, 60% of all new HIV infections occur in HIV-discordant couples and in over 30% of marriages, where only one partner is HIV-positive. In addition, stigma, discrimination and non-disclosure fuel HIV transmission between partners, but also limit pregnant women’s access to prevention of mother-to-child transmission services. 

 

HIV-discordant couples who desire to have children risk infecting their spouse with HIV. Fortunately,  advanced medical technology makes it possible for even the less fertile or HIV-positive couples to have children, who are HIV-negative. 

 

Prakash explains that for HIV-discordant couples, where the male partner is positive and the woman is negative, a technique known as ‘‘sperm washing’’ further reduces the risk of transmitting the virus.

 

The technique, according to Prakash, involves the ‘‘washing’’ of semen to remove everything else and leave the spermatozoa. This means that the sperm is washed free of HIV before it is inserted into an ovum.  It is a way to help HIV-discordant couples not to infect each other or pass the virus from either parent to the child. 

 

Sperm washing appears to significantly decrease the risk of passing HIV infection from an HIV-positive man to an HIV-negative woman.

 

More recent studies have found sperm washing to be safe, as long as the washing is done by qualified medical personnel.

 

Zaake says a mother with HIV is treated like any other patient. The IVF process does not affect her in anyway except the medical staff has to safeguard against a mother transmitting the virus to the child.

 

One of the greatest risks of artificial fertilisation is the possibility of having triplets instead of the twins one had desired. “This although happens rarely, and comes about as a result of one of the embryos dividing into two.”

 

“Some men are, however, are not up for artificial fertilisation due to their strong cultural beliefs,” Zaake adds. In many cultures in Uganda, a man or a woman who cannot have children naturally is treated as an outcast. 

Anne Asiimwe, a counselling psychologist at Care Counselling Centre in Bukoto, Kampala, says: “First, a parent needs to know the reason why they would want to disclose such information to a child. Is there any benefit?”

 

Asiimwe says there is no need to disclose if the child has both parents. But in case the mother got the baby through sperm donation and does not know the father, then the issue becomes more complex.

 

Asiimwe says if a mother must tell the child, then it would require a lot of preparation both on their side and that of the child receiving the news. 

 

“It may be easy in the beginning when the child is still young, but the consequences may take a toll on the child in the long run as they desire to identify themselves with their relatives,” warns Ruth Matoya, a counselling psychologist specialising in child psychology.

 

Matoya adds that every child needs to know who their father is and the identity of both parents is very important to them.

 

Asiimwe says when considering disclosing to family members about opting for IVF, one should weigh the benefits; what do they want from relatives? Are they going to carry part of the expense burden like footing the medical bill? Although you might need to confide in a sister or mother, it is important that you look at the disadvantages, says Asiimwe. 

 

Matoya says if the relatives are supportive financially, then it is better you tell them, but in case they are not contributing, then disclosing might do more harm than good. 

 

Although disclosing is a personal decision, Asiimwe advises to keep such information a secret because something shared ceases to be a secret. In case one gets to hear of the news somewhere else, it would cause a lot of stigma both on side of the mother and the child. 

Dr. Romano Byaruhanga, the president of the Association of Obstetricians and Gynaecologists of Uganda, says Uganda does not have a law specifying who should get IVF, the different types and a policy protecting biological and surrogate parents (women who carry pregnancies for other women). 

 

Byaruhanga says such laws are not laid down although some centres try to follow laws from countries abroad. 

 

Zaake says the Ministry of Health together with the Association of Obstetricians and Gynaecologists of Uganda are in the process of formulating a policy. At the moment, there are four centres carrying out IVF.

 

 

 

In natural conception, a sperm and an ovum or egg meet in the woman’s fallopian tubes. The sperm penetrates the egg and fertilises it, resulting into an embryo, which develops into a baby.

 

In IVF, which is one of the treatments of infertility, fertilisation is done outside the woman’s body. A woman’s eggs are surgically removed and fertilised in a laboratory using her husband’s sperm.

 

The embryo is then surgically implanted into the woman’s womb.

 

The patient is first given drugs to stimulate the production of the eggs. The harvest of the eggs depends on the patient’s age. The younger the patient, the more the eggs harvested and the older the age the fewer the eggs harvested, says Dr. Daniel Zaake, a gynaecologist/obstetrician at Life Sure Fertility Centre Mawanda Road in Kampala.

 

The eggs and sperm are fused in a laboratory to form embryos, a process referred to as fertilisation. 

“We pick the best and transfer a maximum of three embryos because not all eggs are good,” says Zaake.

In case of a balance, Zaake says the remaining embryos are frozen for a back-up. 

 

However, the patient is expected to pay a fee of about sh2m for frozen transfer because she does not have to go through the treatment again.   

 

Zaake says there is no age bracket for receiving in vitro fertilisation (IVF) because it is not about age, but fertility complications. 

 

He says IVF is usually a last resort for people who cannot conceive naturally.

The technology is administered in two scenarios. The first scenario is when women cannot produce eggs, when the eggs cannot move down the fallopian tubes due to tubal blockage or where a woman has problems with the ovary and needs someone to donate an egg. 

 

Secondly, where a man cannot produce sufficient sperm to fertilise the egg naturally.

 

Treatment depends on protocol; procedure and the common one takes about 40 days, Zaake says. 

A quarter of babies born through IVF are usually twins and 5% are triplets.