Lagos — CAN you tell us about the concept of the Bridge Clinics?

Medicine is evolving and a lot of things that we used to we share developed better ways of doing them. For example, we all have heard of obstetricians, gynecologists, that is people who look after women who are pregnant. Women, who are trying to get pregnant traditionally will go to a gynecologist. But gynecology is evolving. And the field is getting larger. And within gynecology there is gynecological ontology, that looks after people with cancer. There is genealogical urilogist, who looks after people who have urinal problems.

There is reproductive gynaecology and infertility which look after people who are trying to get pregnant. So the Bridge Clinic is a focus that looks after people who are trying to get pregnant. That is all we do. And this allows us to build competencies and become very focused and develop all the competencies that are required to be good at looking after women who are trying to achieve pregnancies. So we don't do anything else, we don't deliver pregnant women. We don't remove fibroid. Although we have the ability to advise those who have fibroid where they should go and remove them. Whether they should remove them or not. But we focus on doing assisted conception.

What are the causes of infertility in our society?

Where a couple is trying to achieve pregnancy it is usually because either the woman is not producing her eggs every month or the man's sperm are not up to the job. Or the sperm and the egg are not able to meet because there is a blockage of the tube. Occasionally, you may have fibroids within the uterus that is stopping the implantation.

So, within these four groups we have all the causes of infertility. When a woman is not producing egg every month it is not very difficult to treat because there are drugs. Any doctor who understands physiology can treat these patients.

If they do not succeed with these simple drugs then they need more complicated treatment. If you have a sperm problem, I know a lot of people try a lot of drugs but the reality of it from the scientific point of view is that there is really no treatment for poor sperm. Growing tubal blockage. Tubal flushing and all these thing that people do, occasionally, may work especially if the tubal blockages are very mild. But for more people with advanced tubal blockade it is very difficult to operate on them and so they need In Vitro Fertilization (IVF). So IVF, which is the service we offer (In Vitro Fertilization), is really the main treatment of infertility. So everything comes back to IVF.

How reliable Is IVF. And what is the percentage of success?

IVF is extremely reliable. Where a couple is in a bedroom without any problem they have a 25 per cent chance every month of achieving a pregnancy. IVF does the same. It gives the couple 25 per cent chance, when the take the treatment, of achieving a pregnancy. But the reality of IVF is that it can do what nature can do. Set is fun, it doesn't cost money. If it does not work this month you try next month. That is exactly how IVF works. But unfortunately IVF is expensive. It is not fun. It is not to be 100 per cent. But the result are still good.

What is the cost of IVF treatment?

IVF has never been affordable to the average man on the street. And this is one of the problems with IVF. Abroad, as we sit here there is a major debate raging in the United Kingdom (UK) about access to IVF treatment because IVF requires a lot of technology. And these technologies are expensive. So the average man, even abroad, does not have access to IVF treatment. IVF is expensive. If it is to be made available to everybody the government needs to subsidise it. This is a private institution where we raise money to provide these services . But if the government carries and provides some sort of grants, of course, it will be available to everybody.

How long does the treatment take before conception?

Well, the average treatment cycle takes about six week. The first stage is for the patient, woman, to take some infections to switch over her ovaries. She now takes other infection that lend the ovary to produce eggs. These eggs are collected, fertilized with the husband's sperm and transferred back into her uterus where, by the grace of God, it would develop into a pregnancy.

What is the rate of infertility between men and women?

Actually, male infertility is more common than female infertility because the issue, at the end of the day, is that the woman's involvement in infertility is obvious. Is her belly getting bigger? So we tend to look at the woman. We don't look at the man. And from that point of view we tend to assume that men do not have infertility problems.

Male infact is actually more common but the textbooks always talk about 40 per cent infertility in female, 40 per cent to the male, and 20 per cent on extreme.

What are the causes of male infertility in our society?

Well all causes of male infertility tend to be poor sperm count. You know the man may have no sperm cell to ejaculate. The most common cause of it is actually that men are born, it is a genetic thing. Men are just born with poor sperm. If you look at a lot of men who have poor sperm they have chromosomal problem, emission at the tip of the while chromosomes. And that the way nature designed them. That is why it is difficult to cure this problem. It is very difficult to cure it.

Yes, infections, such as you have mumps as a child- that can cause inflammation of the tests which can lead to poor sperm production in later life. If you have undescended testes, where a testes doesn't come down after you are born. You may have infections, such as chronic infections, if you have chronic genital infection like gonortec that is untreated, that can cause the ducts to block, in which case you get poor sperm production.

What is the response of Nigerians to IVF?

The response has been very good. I mean, the treatment works. And when you do want to have a baby and you have been around the place there is no other treatment but this treatment. So most people once they realise that this is what they need, they come for treatment. The response has been very good indeed.

Who really comes out for the treatment. Is it the woman alone or they come as a couple?

We don't get that often. Most of our patients have been support of their husbands. And indeed it is very difficult to treat a woman by herself. It is a couple problem. And we normally treat both the man and the woman.

What are the cultural barriers that you face in the course of your mission?

Well, the cultural barriers are many. You alluded to one, mean the perception of infertility. We are a very superstitions society. So a lot of time people describe infertility to witchcraft. Somebody doing something against them. Spiritual theories. And where you have that belief, it becomes very difficult for you to see science as the way out. I have had people coming and making requests that they need to go to the village where something is laying their genitals up behind somewhere.

And that will be the only way to cure the problem. So we have a lot of issues like that. But I think there are enough enlightened Nigerians and also we have people come through. And when we explained to them that most infertility is a scientific problem. If we can define the problem. With the appropriate level of sophisticated investigation, we can define the problem. Once we do that we are able to carry them along. It is also very difficult sometimes to treat them because of the financial involvement. To get fertility is expensive, especially as said earlier the treatment has one in four chances.

This treatment needs money. Because as we always say what value do you place to your child. What do we exist? We exist because you want to have children and leave something behind. And the money we are talking about is not even up to the cost of a tokunbo car. This is the question of what value you place to these things.

In terms of naira and kobo what is the least amount that one needs for this treatment?

Oh, I mean, we always quote between N250,000 and N400,000.

Tell us your experience and rate of success at your Lagos clinic?

We have been very lucky. I think God has been with us in the programme. We started up in 1999. The first baby was born in January 2000. I think at the moment the Bridge Clinic club has 237 babies. We have singles, we have twins and we have triplets. We have boys. We have girls. Every year we have an annual baby party. We had one last year and all our babies came. And it was glorious. It is nice to see all these children.

We were the first to introduce intra osteoplastic sperm injection (ICSI) to Nigeria. It was a revolutionary technique because it allows men with very very poor sperm to have their own children. We were the first to achieved pregnancy with that. We were the first to achieved a pregnancy where a man is not producing any sperm cell when he ejacelated. We have to go to his tests to do surgical sperm collection. We were the first to achieved pregnancy with that in Nigeria as well. We are also the first to achieved pregnancy with IVF surrogacy-where you have a woman during labour she bled so much an he baby died. They have to take her uterus out to save her life. So she had her ovaries but she had no uterus. So we have to do IVF to collect the eggs, fertilised the eggs with her husband sperm and then have a sumogate to carry the pregnancy and give them their baby.

Surrogacy is extremely complicated. We had to use our ethnic committee. We have very good ethics committee at the Bridge clinic who were able to help us indeed. The surrogacy birth was an editorial comment in one of these national papers because of the way we used the UK laws to guide us in the treatment.

We are also the first to achieved a pregnancy with microsoft sex selection. A company in America called microsoft that devised the technology to separate sperm. We were able to ship the sperm to a bank in the United States, separate the sperms and used the preferred sex to treat the couple and get what they wanted that in Nigeria as well. So there are a lot of first attached to us. Beaning in line with our mission of ourselves we believe that we want to be the standard for reproductive healthcare in Africa. And we are doing everything in our power to achieve that. So we are doing a lot of publications. We do a lot of research.

What are the challenges you have faced?

There are major challenges. But the first challenge is raising the capital to start. Once we achieved that there is the challenge of getting credibility problem. A big credibility issue with the Assisted conception method most of the patients have been around the block. They've been bashed and battered. And they do not trust anybody. So they do not subscribe to treatment. So that is very difficult.

The other challenge is really trying to empower Nigerians to really be good in what they are doing. To drive it. So there are issues in oganisational growth, dedication, responsibility.

All in all in the challenges we have God has been awesome. We have overcome.

Why do you choose Port Harcourt for your second clinic in Nigeria?

We looked at our date in Lagos and found that we had a lot of patients coming from this area for treatment. And when you look at the nature of IVF. It is extremely psychologically tasking the reason we set up in Lagos was wen I was working in UK I saw a lot of Nigerians coming over to the UK for treatment.

It was very stressful, leaving your environment, leaving your support to come and take IVF. So we came to Lagos to provide succour. But then we found out that a lot of patients were coming from Port Harcourt. They were still getting very stressed. And the cost of treatment was a lot higher for them. So we decided we have the man power to provide the facility here in Port Harcourt.