Female and Male Infertility is fast becoming a huge problem in Nigeria. Many families have their 3 must-come-true dreams that include building a happy home, having one or more children and living a happy life. However, Infertility makes these dreams impossible for many couples.
Many solutions have been proffered over the years and one of the commonest is surrogacy. A condition where another woman carries a pregnancy on behalf of the real mother. Research has also revealed that some women may not be able to produce reproductive eggs and therefore they are tagged barren by the society. Some religious faiths believe that no woman is allowed to be barren and new technologies in the fertility field have also proven this to be true for those who have lost hope.
Few weeks ago, City People’s DAMILARE SALAMI 08155134152 met Dr Abayomi Ajayi, a fertility expert and the Chief Medical Director of Nordica Fertility Center based in Lagos and other cities in Nigeria; who spoke extensively on how women without reproductive eggs can get pregnant and make their own babies.
Below are excerpts.
As a fertility expert, I would like you to describe what Recipient Cycle is and those that can make use of it.
Recipient cycle is when someone is donating eggs for another person to make babies. One of the problems we usually have in this part of the world is that so many people usually mistake it for Surrogacy and they don’t understand the difference between the two.
It is not unusual for you to be talking to someone about Recipient cycle and she’s thinking about Surrogacy. So I think this is a very good point that we need to emphasize that recipient cycle only involves you using another person’s egg; you are going to carry the pregnancy yourself, unlike surrogacy. But both are part of what we call third party reproduction in the sense that another person needs to help the family in the process of making a baby instead of the man and the woman alone. This third party reproduction can also include sperm donation too but now we are specifically talking about recipient cycle. The implication of this is that the baby or babies that might be born from this process will not have the genetic composition of the woman who is carrying the pregnancy because the embryo comes from the egg and the sperm. But the baby or babies will have the genetic composition of the man in the union (the sperm that was used) but we think that there are some knowledge coming up now; the baby might not have the DNA of the woman but there might be a transfer of RNA between the baby and the mother. But that is still something that some people are still looking at.
Who are those that will benefit from the recipient cycle? The commonest people are people who have stopped making their own babies either due to age or otherwise. So it not uncommon to see many women after 40, 45 or 50 years using a donor egg. The other group that is also common is when there are genetic diseases that people don’t want to transfer to their children but of course, now we can have a pre-implantation genetic diagnosis to identify some of those genetic diseases but it’s still one thing that can be done. And then also even in the early days of HIV, some people were using donor eggs to reduce the risk of infection but that was many years ago. Now we know that we can use the eggs of most of the women who have HIV. Then this nit having eggs could also be something that you are born with and not what you earned because of age. So some hormonal problems or genetic problems could cause it, for example, people who have what we call tornal syndrome people who have rudimentary ovaries so they don’t have eggs in their ovaries; they can also benefit from donor eggs. In a nutshell, those are the people that can benefit from donor eggs.
While you were talking, you mentioned that the baby made from donor eggs doesn’t share any DNA with the mother. As an intending mother, can I make use of my sibling or close relation so that my baby and I can share some DNA?
Ok, may be before that, let me explain a few things because sometimes, some of the things we force over are not really as important as we take them. I’m not saying DNA is not important but what we are really concerned about is how the baby will turn out in the future and that will really start answering some of your own questions too. We want the child to as much as possible really be like us, not to have some of the diseases that we don’t have. But the problem to really start with is that we don’t understand the genes. There are two things involved in bringing up anybody, there is nature and there is the nurture. Nature is what you have inherited, nature is the condition under which you have been brought up. If you have two children (identical twins) and you bring up one in let’s say London (for the sake of discussion) and bring up the other in Mushin. We can assume that they have near enough genes but you will discover that they will behave differently and that is the power of nurture. So sometimes, some of the things we force over are not very important. In fact, we don’t know what is more important between nature and nurture. For some diseases, nature might be very important because they can be inherited but if we are not talking about diseases, if we are talking about behaviours, nurture might give nature a good fight for its money. Some of those things we do not understand enough. And then, when you go and bring a sister, you know I was even saying that when you are a twin, you don’t have the same genetic composition, you might have near enough genes. So your sister might be carrying a disease that you are not carrying and vice versa because there are different means of inheritance. The more we know about genes, the more we realize that we don’t know but these are probably things that are psychological that everybody wants to have their own children even when they have diseases that can be inherited. Rather than say there is a technology to purify or make my genes better, it’s still good for me to have my own genetic children rather than bringing genes that are even more superior to mine to the family, that’s a psychological issue. So as much as possible, we don’t mind if you can bring your sister but sometimes things that are tied to it can make it very difficult. For example, is your sister married? What is the husband going to say to the things that you are asking your sister to do because I have seen families where that has become a major point of crisis. Because someone asked her sister to donate eggs to her and the husband says are you high on something very dangerous, why should your sister ask you to donate eggs to her? And you see siblings now fighting over such issues but that’s not even probably the main issue. The husband is probably only concerned about his own wife’s safety. Then you ask yourself again, these genes that you think you are preserving, are you really preserving them? The answer is I don’t think so because to start with, the two of you don’t really have the same genetic composition but those like I said are soft issues that we really don’t have a yes or no answer to and that’s why it’s important to take a lot of education before making this kind of decision.
About 90 to 95 per cent of our patients use unknown donor because you want to be able to manage information. By the time your sister tells her husband, we don’t know how many people her husband would have told, asking for opinions. If it becomes a quarrel, then that means probably their mum would also be involved and it becomes a family issue, what is supposed to be between you and your wife. So we need to manage some of these processes properly. Unknown donor means you don’t want to know the person donating and in some advance countries, you can choose a donor with some specific characteristics. Probably you want a medical student, you want blonde or other characteristics too but what we try to do in Nigeria is that we try to shield the identity of the recipient from the donor and vice versa for obvious reasons.
Are these unknown donors paid?
There are 2 kinds of donors, Some are altruistic. They just want to help, (you have to give me their address in Nigeria. Laughs) while some are paid out a very huge amount. In other words, there are two kinds of donors; there is the known donor which the patient brings and who has to be screened properly to be sure that she is fit before going through the process and there is the unknown donor. Sometimes people bring donors that are not qualified to do the job so during the screening, we see that they are not qualified.
What’s the basis for their qualification?
Sometimes, their hormones are not good enough. Sometimes ago, somebody brought someone who is supposed to be a donor and then we discovered that she (the supposed donor) would also need a donor. And sometimes also, we discover that the donor is HIV positive because HIV is part of the screening. So such a person cannot be a donor.
Can hormonal imbalances lead to infertility?
When people say hormonal imbalance, it does not mean anything, I try to desist from using such words. It’s like somebody died and you asked what killed the person and they say death. It does not mean anything. When you say that somebody has a hormonal imbalance, that means one hormone is not balanced. Which hormone? Do you understand what I mean? Because there are different effects of hormones in the body, it is not all of them that will lead to infertility but there are some that will lead to infertility. So, if you want to talk about the hormones not being balanced, we need to be specific which hormone is not balanced. But if we want to use the broad term, hormonal imbalance can lead to infertility, of course, because there are some hormones that are concerned with infertility.
Does donating an egg have any harm on the donor and is there a particular number of eggs somebody can produce?
There is no procedure that is risk-free except that the risk is not very high especially in 2020, the risk is very low but there is still a risk. Most of the time, it is the fear of the unknown. It is not because she will run out of eggs because whether you do IVF or you don’t, the same number of eggs will go out every month. So it’s not because she’s going to run out of eggs but because of the procedure of IVF, there can be a small risk.
Is there any legal backing for either the known or donor action?
Very good question. There are many things involved in childbearing. Firstly, the donor is not giving the couple a child, neither is she giving the sperm that fertilizes the egg; she is only donating an egg. Secondly, there is a consent the donor would have signed which bars the donor from taking any funny action. However, that is why we preferred the unknown donor so that you don’t have that connection with the patient at all.
How safe are is recipient donor in Nigeria considering fertility centres?
The first donor treatment was done in either 1983 or 84 and we’ve been doing recipient cycle for about 16 or 17 years and we were not the first. You know there’s this hush hush thing about recipient cycle. People rarely talk about it, very rarely. I remember one of the first cases that we had, there was this lady who was referred to us by another doctor and after trying so many times in another clinic, I think we were only about 3 in Lagos then. So when the patient came to me and I said to her, don’t let us waste so much time, what you need to use is donor eggs, she went for about 5 months or so and then came back and we did just one treatment and she became pregnant and then she went back to the doctor that sent her in the first place to say that she was pregnant and while she was with the doctor, she snapped out of the room to call me that it was likely the doctor was going to reach me; I shouldn’t tell him that she used donor eggs. And I said it wasn’t the doctors business to know. When she delivered, I went to visit her at the clinic and she said to me again, don’t forget, don’t tell the doctor I used donor eggs. So people still do this hush hush about medical treatments in Nigeria. But to be fair, we have some people who talk about it in Nigeria now so I think it’s probably an individual thing.
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