•LAGOS Fertility Doctor, Prof OLADAPO ASHIRU Explains
On Wednesday 3rd October 2018, Prof. Oladapo Ashiru, a world renowned fertility doctor delivered the 6th Felix Oladejo Dosekun Memorial Lecture, in honour of late Prof. Felix Oladejo Dosekun, who was the 1st Vice-Dean of UNILAG Medical School, and Second Provost, College of Medicine, UNILAG.
Prof Oladapo A. Ashiru is the Chief Medical Director and CEO, Mart Group of Health Services, Medical Art Centre (Assisted Reproductive Technology); Mart Medicare (Maternity and Neonatal Services) Mart Diagnostic (Preimplantation Genetic Screening), and Mart-life Detox Clinic (first Modern Mayr Medicine Clinic in Africa); First Nigerian Professor of Anatomy, CMUL and Consultant Reproductive Endocrinologist, LUTH; President African Fertility Society and Member Board of Trustee Association for Fertility and Reproductive Health, Nigeria.
Below are excerpts of his lecture titled MAN KNOW THYSELF: And Healing power will be granted. In the lecture he revealed how medical science knowledge helps to achieve the fruit of the womb. The lecture was held at the Old Great Hall, College of Medicine, University of Lagos, Idi-Araba.
I am happy to give this lecture at the request of the Provost, Prof. Afolabi Lesi, on the first FOD lecture being given since his appointment as the Provost of the College of Medicine. I could not refuse him. He was one of my excellent students now performing to all our admiration.
In the words of Plato, those with knowledge must pass the torch. Dosekun passed the torch to many of us, and we have passed it unto many, including Afolabi Lesi. I have also heard some of his students and residents speak very well of him passing the torch. Furthermore, it gives me the opportunity to honour Prof.
Today it is my pleasure to present our work on our ability to help couple with Infertility to have their babies, those who are carriers of the sickle gene to have a healthy baby by the technique of Pre-Implantation Genetic Diagnosis (PGD) and those with various types of toxins standing in their way of conception have their bundles of joy.
The genesis of the above presentations started at the College of Medicine through excellent teaching by highly qualified and experienced teachers, and stimulating classmates. These teachers taught us with extreme devotion, dedication, dignity, discipline and they exhibited nobility, even in the classroom; particularly the person honoured by this memorial lecture.
Prof. Felix Oladejo Dosekun, was an erudite Professor with sartorial elegance. I cannot think of any of his students who did not have a great impression of this erudite and noble, gentleman. Many would remember the different colourful pipe he brought to his lectures! I mainly owe FOD, as we used to call him, a debt of gratitude. It was him who navigated my pathway into Anatomy as a specialty, for various reasons. Today I am happy that I can genuinely say the Latin expression veni vidi vici (I came, I saw and I conquered).
I trained in the College, became a lecturer, a Professor, started Postgraduate medical training in Anatomy in CMUL, brought in the first set of Sprague-Dawley albino rats for research throughout the College, and facilitated the elevation of many to Professorship level at CMUL, National and International places.
The title of this lecture was chosen as the 2nd piece to my inaugural lecture delivered at the University of Lagos on December 10, 1990, titled “Man Know Thyself: And You Shall Obtain The Healing Power”. Interestingly the University auditorium was packed full. Many had come from various organizations looking for how to obtain the power to heal. Although I have no such power, The Guardian newspaper reported that “Despite the Medical Science presented I held the audience
Assisted Reproductive Technology (ART) refers to conception requiring the complex handling or manipulation of both the male and female gametes in-vitro to facilitate pregnancy. Techniques that involve processing of only the male gamete cannot be referred to as ART but instead assisted conception. In the USA, for effective running of the ART program, it was mandated that every embryology laboratory should be headed by an on-site or visiting Laboratory Director. Consequently, in 2006, it became mandatory that new laboratory directors must have High-complexity Clinical Laboratory Director (HCLD) or Embryology Laboratory Director (ELD) certifications awarded’ by the American Board of Bioanalysis (ABB).
The history of ART dates back to 1969 when Yanagimachi and Chang reported capacitation for in-vitro fertilization of hamster eggs.
Capacitation, a term used to describe hyperactivated motility of the sperm, is required for fertilization to take place. Following this, in 1977, Andrew Schally, Roger Guillemin, and Rosalyn Yalow were awarded the Nobel Prize in Medicine and Physiology for their work in the isolation of LHRH from the hypothalamus.
In 1978, Ashiru and Blake also reported FSH positive feedback mechanism on the pituitary. These and many others have been the bedrock for the achievement of the first live birth via In Vitro Fertilization (IVF), Louis Brown, popularly called the first ‘test-tube’ baby in 1979. This groundbreaking success was achieved by Steptoe and Edward in London, and Robert Edwards was subsequently awarded the Nobel Prize in Medicine in 2010.
Other countries reported their successes, Australia by Carl Woods in 1980, 5 USA by Howard & Georgeanna Jones in 1982 6 and Nigeria by Oladapo Ashiru, Osato Giwa-Osagie in 1984 and the delivery of a baby through IVF in 1989.
WHAT IS IVF?
IVF means fertilization achieved outside of the body. It involves ovulation induction, oocyte retrieval, sperm preparation, oocyte denudation (removal of the outer covering- the cumulous), insemination and fertilization in a culture dish and finally embryo transfer.
Oocyte retrieval and embryo transfer processes are usually done under ultrasound guidance. Also, it is essential to know that gamete handling is generally done under strict temperature control. Without the development of IVF, pre-implantation genetic diagnosis (PGD) would not have been possible.
WHAT IS PGD?
PGD, as the name implies, involves testing for specific genetic defects in the DNA code before embryo implantation. Usually, there is a targeted examination of a known genetic abnormality in the couple. Since 2018 the terminology was changed to PGT meaning Pre-Implantation Genetic Testing.
Preimplantation Genetic Testing (PGT) is a diagnosis of a genetic condition before achievement of a pregnancy. PGT was first performed in the early 1990’s as a way for couples to prevent the pregnancy of a child with a genetic disease. Currently, at the Medical Art Center in Lagos, we are able to offer PGT testing for genetic conditions including sickle cell anaemia and chromosome aneuploidies. We work in collaboration with Genesis Genetics, a world-renowned genetics institute. They pioneered PGD testing of embryos for inherited genetic abnormalities.
DOES PGD REPLACE PRENATAL TESTING?
No, PGT does not replace prenatal testing such as Chorionic Villus Sampling (CVS) or amniocentesis. PGT is a research-based test allowing for a similar diagnosis to those available by prenatal testing. However, prenatal testing is still recommended as these widely used and well accepted prenatal tests remain the gold-standard of modem obstetrics and are necessary for this setting should a pregnancy ensue.
OTHERS ART PROCEDURES
There are other procedures used to assist conception. They include donor gametes, sperm aspiration from the testes, and surrogacy for different types of infertility. United Nations declaration is that having a baby is a human right issue.
Today over 8 million babies have been born through ART worldwide. Our success rate for normal IVF ICSI has been between 35 and 45% based on age. The older coup le has a lower success rate. We have produced over a thousand babies through this procedure in our hand. PGT for various abnormalities has provided close to 100 babies. In PGT for sickle cell, we have been able to bring into the world for couples with sickle cell carrier several babies. These babies are all sickle cell free. In all, we have singleton, twins, triplet, and quadruplet and I dire say tow quintuplet.
These have made us reduce the number of babies that we transfer to our patient to two. To our surprise, 3 embryos can split to produce quadruplet and quintuplet.
CLEAR AND PRESENT DANGERS IN OUR ENVIRONMENT
We now know that the environment constitutes a great danger to man. Environmental toxins from various occupational industries like Oil and Gas, petrochemical, agriculture, and different eating habits cause serious health hazards. We have reported the clinical success of Modern Mayr therapy type of detoxification in a fertility practice that uses detoxification as a complementary treatment.
Today in Nigeria and West Africa, IVF is now available in almost 70 clinics. About 25 of the clinics perform IVF/CSI and about 4 now perform PGT. It is possible to say that virtually any family will be able to have a baby with all the technologies in our hands. In 1984 when we started IVF program in CMUL/LUTH over 95% of Nigerian did ART overseas causing a lot of foreign exchange spending.
Today less than 5% of Nigerians travel abroad for ART treatment. In fact we now have many people coming for IVF treatment in our various centers from abroad. Our sickle cell carrier couples can now smile as we now can screen their embryos before conception thereby avoiding a sickle cell baby. The cost of this process even though quite high, compensates for all the stress of dealing with sickle cell babies. It is hoped that various groups including the government can come to the aid of couples in need of this technique but cannot afford it. In the long run, it will save a lot of money on the health management of complications of this disease.
Future research is needed to improve the speed of diagnosis and make it less expensive. Another major area that deserves research and if possible a Noble prize-level research is the study of the understanding of the window of implantation. The reason is that this is the only significant gap in knowledge for us to achieve close to 95% success in IVF. Jacques Cohen during his plenary lecture at a conference of PGT society in Kent, England in 2014 predicted that by 2025 the success rate of IVF should approach 90% if more research is conducted in this field.
Finally, in our experience, we have preliminary evidence to suggest that environmental toxins and diet play a significant role in reducing fertility and possible IVF success. Most of these stem from my earlier basic research in reproductive toxicology. The use of Mayr therapy to detoxify the body and get rid of toxins such as heavy metals like mercury, arsenic, antimony, lead and others, as well as such virus and allergies from horrible eating, have in general enhanced our success in IVF and PGT.
Thefuture of Nigeria is in the hands of Nigerians. We must redefine our values andstrategy for growth. No foreign country can save us but ourselves. They preferto continue the process of Neo-colonization. If we had not made efforts, theywould have preferred all ART patients to go overseas for treatment. We metstiff opposition in developing ART over 40 years ago. The same goes for manyindustries. We need to do our best and in the words of Beethoven a 17th Centurycomposer “I recognize no superiority in mankind other than goodness.” Also asearlier famous men like Prof. Oladejo Dosekun, let us all work to make thisCollege, University, and Nigeria better for future generations.