As the practice of assisted reproduction technology continues to gain ground, with more Nigerians embracing the In-Vitro Fertilisation (IVF) treatment, SHEHU OLAYINKA beams his searchlight on a growing trend of young undergraduate girls engaging in indiscriminate donation of their reproductive eggs for money.
When Bimpe Adeola (not real name) saw the stress on her roommates’ face as she returned from the clinic, she promised herself not to ever engage in what they had just done.
“Though they were only sick for two days, we all just stopped talking about it and no one ever mentioned it again,” Bimpe recalls.
Bimpe is an undergraduate student in one of the leading government-owned universities in Southern Nigeria. Two of her course-mates had just exchanged their reproductive eggs for money.
“The egg-selling business is booming in my school; students are engaging in it and it is because of the money” she tells The Nation.
Bimpe got to know of the ‘new’ business when two of her classmates sold their reproductive eggs to a fertility clinic for One Hundred and Twenty Thousand Naira (N120,000).
However, when this reporter began discussing with Bimpe, showing her findings about egg sales, requirements and the mental/health implications, she expressed huge doubts about whether they were made known to them.
“They are not up to age 21. I don’t know how they did it, maybe they lied. I actually cannot say, but they are not up to 21 years of age,” she said emphatically, even more bewildered. This was after this reporter told her the minimum age requirement in most countries.
She said, “They were paid five thousand naira (N5,000) every day they went for the check-up, while the remaining One Hundred Thousand (N100,000) was paid to them in full immediately the donating process ended.
“Students in schools are engaging it for the money. But it should be noted that they are not being forced. I think they have a middleman or woman, who engages students while some get to hear about it from their friends who had gone through it.”
According to further findings, students and non-students, who donate, were enticed by the money, most of them having come from poor background and struggling with poverty.
A random check at a tertiary institution in Lagos revealed that the practice is also prevalent amongst the students.
A student, who spoke to our correspondent, said it is a known secret.
“It is something that is done here. A close friend to one of my friends has done it,” she said.
While no known recorded case of egg donation death has been reported in Nigeria, in 2014, a 26-year-old Indian woman, Yurma Sherpa, died after an egg donation procedure at a private fertility clinic.
She was reported to have sustained internal bleeding in her pelvic region and her ovaries were ‘hypertrophied after the clinic injected her to make her super-ovulate, or produce far more than the usual one egg during her menstrual cycle.’
According to a report by the Indian Express, the post-mortem found haematoma or clotting of blood in the peritoneum (stomach cavity), around her uterus and ovaries, indicating internal bleeding.
The Indian tragic case, however, gives an insight into how some IVF doctors, if left unchecked, try to bypass normal procedures in egg donation.
Also in August 2010, Sushma Pandey, a 17-year-old working in a scrap depot, died in a Mumbai hospital after severe abdominal pain, two days after she had donated eggs for the third time within 18 months.
For each session, according to reports, she had earned a little over $400.
In a normal reproductive cycle, a single egg matures during ovulation. Assisted reproductive technologies inject gonadotropin, a hormone, to produce multiple eggs. Since there is no standard protocol on gonadotropin dosage or limits on the number of eggs that should be retrieved, some doctors use a dangerously high dosage that allows them to harvest as many as 50 eggs in surgeries that require anesthesia, heightening the risk of the procedure.
Nigeria IVF industry
In-vitro fertilisation (IVF) is a rapidly growing part of the healthcare system in Nigeria.
In-vitro fertilisation involves removing eggs from a woman’s ovaries and mixing them with sperm outside the body, typically in a Petri dish; “in vitro” is Latin for “in glass.” Fertilised by this process, the eggs become embryos that can be placed in a woman’s uterus, where they can develop into a fetus and eventually a baby.
IVF, as it is commonly called, is a much sought-after procedure by infertile couples.
Pressures are on huge number of couples unable to have children after marriage in the country, increasing the number of people who are looking at the fertility medicine for child birth.
As stated in a paper published in 2011 by R.A. Ajayi and O. J. Dibosa-Osadolor, in the African Journal of Reproductive Health, studies in Nigeria have suggested that the prevalence of infertility is about 25% with 1 in 4 women of this age bracket experiencing delays in conception.
The study indicated that with a population in excess of 160 million, of which about 22% women are in the reproductive age group, Nigeria suffers a high prevalence of infertility.
Even though the country has a high case of infertility, it has a growing population. Estimation by the United Nations put it at over 190 million, highest on the African continent and projected to hit 397 million by 2050; making it the world’s third most populous country after China and India.
Also, in July 2018, the National Population Commission (NPC) said Nigeria has fertility rate of 5.5 percent, indicating an average of six children per Nigerian woman. Yet many Nigerians experience infertility.
Chelsea Polis of the Guttmacher Institute, a think-tank, and her colleagues in a 2018 Economist report, estimated that 31% of Nigerian couples fail to conceive a child after 12 months of unprotected sex—a rate at least as high as in the West.
So, with the premium placed on child-bearing in Nigeria, IVF clinics are proliferating across the country in efforts to address the problem; and being largely unregulated, it is fast giving rise to quacks, and some practitioners who go against prescribed rules.
Relief came campaigners’ way after years of fighting for rules governing IVF in Nigeria to be passed by the National Assembly was set in motion in October 2017, with Senator Barau Jibrin’s April 12, 2016 proposed bill on in-vitro fertilisation passing for a second reading.
The bill seeks for an Act for the regulation of In-Vitro Fertilisation, IVF, by establishing IVF authority to make provision in respect of children born of the process.
Senator Jibrin, who sponsored the bill, in his lead debate, noted that the bill sought to regulate IVF procedures and prohibit certain practices in connection with the procedure, adding that it would help in the establishment of IVF authority and make provision in relation to children born of the process.
According to him, though IVF is to help a woman become pregnant and it is used to treat many cases of infertility, including advanced maternal age, it has led to a lot of challenges. He added that “If the bill is passed into law, Nigeria will join countries like United States of America, United Kingdom, South Africa, Kenya and Australia, which already have legislative framework on IVF procedures.
Former Senate President, Bukola Saraki, during the passage of the bill, expressed optimism that it would protect those who undergo the process and referred the bill to the Committee on Health, to report back in four weeks.
But two years after being passed for second reading, nothing has been heard of the bill in the upper chamber.
While a federal bill on IVF has remained stagnant at the National Assembly, Lagos State on the 10th of May, unveiled new regulations and guidelines for the assisted reproductive technology (ART) practice.
The guidelines, according to the immediate past Commissioner for Health Dr. Jide Idris, will help to check quackery in the practice of Intro-Vitro-Fertilisation in Lagos State.
Origin of IVF
In 1977, Steptoe and Edwards successfully carried out a pioneering conception, which resulted in the birth of the world’s first baby to be conceived through IVF, Louise Brown, on 25 July 1978, in Oldham General Hospital, Greater Manchester, UK. In the same vein, in October 1978, it was reported that Subash Mukhopadyay, a relatively unknown physician from Kolkata, India, was performing experiments on his own with primitive instruments and a household refrigerator, which resulted in a test-tube baby, later named “Durga” (alias Kanupriya Agarwal), born on 3rd of October 1978.
In Nigeria, the first recorded successful IVF birth was recorded in 1989, after the success of the first test-tube baby pioneered by Professors Osato Giwa-Osagie and Oladapo Ashiru, conceived via in vitro fertilisation and embryo transfer (IVF-ET) at the Lagos University Teaching Hospital (LUTH).
Since then, there have seen a tremendous growth and acceptance of child birth through IVF in Nigeria.
According to a report by the European Society of Human Reproduction and Embryology, published on July 3, 2018, since the birth of Louise Brown in 1978, more than 8 million babies have been born using fertility treatments in which eggs or embryos were handled outside the body.
The most commonly used technology is in vitro fertilisation (IVF), where a woman’s eggs are removed, fertilised in a laboratory and then re-implanted into her body.
IVF can also involve a constellation of other technologies, including the use of donor eggs and/or sperm.
According to Dr. David Adamson, who was speaking at an IVF congress on behalf of the International Committee for Monitoring ART (ICMART): “Based on ICMART’s annual collection of global IVF data, it is estimated that since Louise Brown’s birth in 1978, over 8 million babies have been born from IVF around the world.”
The figure, calculated from data collected from regional registries from 1991 to 2014; represents another steep rise in the cumulative use of IVF in the treatment of infertility. Estimates show that more than half a million babies are now born each year from IVF and ICSI from more than 2 million treatment cycles performed.
While some countries have been able set guidelines for egg donation, with most countries setting the age for donation at 21, some countries and agencies accept egg donors at age 16 and 18.
A check on some countries shows that not only does the countries have guidelines overseeing IVF practises, fertility clinics, have also drawn up rules guiding their own activities.
A leading Chicago-based egg donation and gestational surrogacy agency founded in 1996 by Nazca Fontes, Conceive Abilities, on its website said donors are required to be at least 21 years old.
The information on the clinic website reads “we require donors to be at least 21 to protect their own reproductive health and to help ensure they are mature enough to understand the risks and emotional magnitude of donating eggs.”
In India, an egg donor age is between 18 and 35 years. Rules of acting for IVF centers and egg banks are still discussed in India.
The Assisted Reproductive Technology (ART) bill was drafted in 2010 to govern the grey area of infertility treatment. It has specific regulations on egg donation.
Though the bill failed to make it through parliament but it drafted guidelines for ART clinics and professionals.
The United Kingdom, which has a highly regulated IVF industry, in 1991, after concerns about the implications of Assisted Reproductive Technology (ART), established the Human Fertilisation and Embryology Authority (HFEA) controlled by the executive non-departmental public body and under the UK Department of Health, that regulates and inspects all In-vitro fertilization clinics.
The UK, HFEA guidelines for egg donors includes: aged between 18 and 35 years old, fit and healthy, being within normal limits of weight and height, having no history in the family of inherited diseases or genetic disorders, not having any serious mental health issues – either yourself or a history in the family.
It is on the backdrop of this that the absence of a regulatory law 30 years after the first successful IVF birth in Nigeria, calls for concern.
In 2016, joint pioneer of Nigeria IVF industry, Professor Osato Giwa-Osagie, at an occasion to mark 10 years of IVF at the National Hospital in Abuja, said there is a need for government to establish regulations and guidelines for IVF in Nigeria, so as to improve the success rates, and increase access for people.
He said there were more than 40 IVF units in Nigeria, stressing that this was more than three times the number of IVF centres in all other West African countries.
The former president of the Association for Fertility Health and owner of a Lagos based fertility clinic, George’s Memorial Medical Centre, Dr. Faye Iketubosin, in a workshop organised by the International Federation of Fertility Societies and the AFRH in May 2019, revealed that Nigeria has 70 IVF clinics, meaning that 30 new centres had been added in a space if two years.
He also disclosed that less than 500 doctors are involved in the process, revealing a gross shortage of manpower.
On the growing number of egg donation amongst teenagers, Dr. Iketubosin in an interview with The Nation at his office in Lekki, stated that the commonest group of people that would volunteer themselves for egg donation tend to be students in the universities.
Besides, he said most practitioners would tend to use girls who are in their twenties for egg donation.
“The IVF (intro-) as modalities of treatment is fast becoming one successful treatment of infertility in women. As every new treatment evolves, more and more practitioners get involved in offering the treatment because of the success its offers. Like every treatment dealing with human gambit, there have to be some rules and guidelines to how to practise safely, so that recipients of the treatment do not come to any harm. The practise in different countries and climes differ; you can have auto-regulations or self-regulations, which is where practitioners come together and draw their own guidelines. This is the way we should do things for the safety of our clients.
“Some aspects of the treatment require legislation action because there are children born into treatment and born into special circumstances. Eg surrogacy. A gambit of a couple being carried by a third party. Now the status of the child born in that situation needs to be defined in law as the child of the commissioning couple and not a child of the woman that delivered the baby.
“In respect to egg donation, it came about after it was discovered that some women who are depleted of their eggs early, go through menopause early; and once a woman has gone through menopause, she can no longer have a child naturally and it was then discovered that if eggs of a younger person were fertilised with such a woman’s partners and then replaced into the woman’s womb, she herself could get pregnant, hence the treatment of egg donation was born.”
“Now that there are guidelines as to who a donor is, donor has to be a young woman in good health. The reason being that age is a prognostic factor in pregnancy. The younger a woman, the higher her chances of getting pregnant because the higher her natural fertility. So donors tend to be young people.”
“Now most cut age is usually about 21. Even though the age of adult is 18, most practitioners would tend to use girls who are in their twenties; and all over the world, the commonest group of people that will volunteer themselves as egg donors tend to be students in the universities.”
A gynecologist, Dr. Dare Amos Akinade, who spoke to The Nation, said teenagers’ involve in egg donation is a form of abuse.
He said the danger involve in egg donations are such that they need to stimulate them with drugs so that they can shed the eggs before they harvest and sometimes over-stimulation takes place, which at times see some gain weight, some develop ovarian trait; and there is risk that they can become very bloated and have severe headaches. Sometimes, it also changes their mood, which means you see their depression go up.
“Some IVF experts have some set of girls that they give some money to actually harvest their eggs. It is usually a double-blind technique and within the ambiance of the law that exists and they have to sign an agreement.”
“Teenagers donating their eggs is an abuse. But it really doesn’t pose too much danger to their health because they have enough and not as if they are going to remove all their eggs…
“There is however something we call ovarian hyperstimulation syndrome. If they have ovarian hyperstimulation syn drome, which gives them the bloatedness, the headache, weight gain and water retention; to reverse it is more than that money they are making.”
“Some people, because they are young, they may give them drugs first, but if in the process, they develop cold feet and run away, and the eggs are not retrieved from them, they could become over stimulated, and it can result in side-effects.”
He however maintained that the temptation is high. “In South Africa, they can go as low $750; but in some countries, depending on where and how many eggs can be gotten from them, donors get as much as $8000, which is a lot of money.”
On enacting an IVF law in Nigeria, Dr. Dare said it hasn’t gotten to a stage where we begin to cry wolf. “You don’t just begin to enforce or restrict something by law when there is no obvious danger affecting a good number of people in a community.
“You don’t begin to cry wolf where there are none. Actually what we need are laws that can impact people and not many people are interested in IVF. Even for those who are interested, they don’t have the means; and because it is not a highly patronised thing yet, even the would-be donors can’t find a ready market.”