Boosting odds of pregnancy with IVF

A cozy lounge with velvety seats led to an in vitro fertilisation or IVF laboratory in a Nairobi clinic.

Inside the lab, it is a dreamlike territory where baby making is happening.

Over five hundred embryos lie in small dishes that mimic uteruses. The room is so sterile that the embryologist asks if I am wearing perfume, considered toxic.

For five to seven days, the embryos are nurtured to grow as couples wait expectantly to come back to the IVF clinic and pick the best that will produce a pregnancy.

Without new technology, this baby making process is like playing raffle. A couple may choose the healthy embryo to be transferred to the uterus or the embryologist will pick.

After the embryo has been implanted in the uterus, some may grow into a nine-month old baby while others will not, causing an IVF failure.

IVF failure is costly, both emotionally and financially. Couples will have to start the whole process of preparing the woman’s body to produce enough eggs from the ovary, retrieving the eggs, harvesting sperms and fertilising both in a small dish, which may set them back between Sh370,000 to Sh700,000.

IVF, a technology used in assisted reproduction, extending the promise of couples and single women of having babies, has gained acceptance in Kenya.

The number of Kenyans seeking IVF has increased with the clinics BD Life interviewed reporting seeing an average of 30 patients a month.

However, there is the hushed conversation of IVF failures. IVF does not guarantee a pregnancy. In some clinics, success rate maybe 40 percent to 50 percent, which is higher than developed countries.

“IVF is a harrowing procedure, therefore couples have to be emotionally and financially prepared, including being professionally counselled,” says Dr Charles Muteshi, a fertility specialist at Aga Khan University Hospital.

Success of the procedure is a combination of luck, age of the couple, conducive womb, hormonal imbalance, adequate good quality eggs and sperms.

Young women are more likely to have good quality eggs with a higher chance of getting pregnant through IVF compared to older women.

There is no specific number of cycles that should be done but Dr Muteshi says ideally after three repeated implantation failures then a couple and their doctor should re-evaluate the decision especially for older women whose chances for success decrease as the ovary reserve reduces.

“Ask yourself, ‘Is there anything that you can learn from the failed cycles? Sometimes doctors may not find anything wrong but it is important to ask yourself realistically what the chances of getting the baby are and tweak the approach to increase the odds,” he says.

Some of the causes of IVF failure include loose cervix, untimely transfer of the embryo, uterus wall that is thin or unnaturally thick and chromosome abnormalities of the egg or sperm or the embryo.

However, with advanced technology, screening of embryos before they are put in the womb helps identify the genetic defects, changing the ball game for Kenyan couples.

“Genetic screening of the embryos increases IVF success rates. It identifies defects that may cause miscarriage or failure of the embryo to implant,” says Dr Joshua Noreh, a medical director and fertility specialist at Nairobi IVF Centre, one of the pioneer clinics in Kenya.

In Nairobi, testing the embryo for abnormalities ranges from Sh100,000 to Sh300,000, an additional charge to IVF, and that is dependent on whether a couple wants the embryo tested for over 600 inherited diseases or just chromosome analysis.

Another advancement in the fertility industry is the availability of donor eggs, and embryos. Couples now have an option of sourcing online and importing donor sperms or eggs.

They part with an additional Sh30,000 to Sh200,000, depending on whether the sperms are imported or locally sourced.

Donor sperms in IVF are used when a male partner has no sperm in his semen or if attempts to retrieve the sperms surgically have failed.

“Couples can choose a donor sperm depending on their preferences. The portfolio has physical characteristics of the donor and we encourage couples to pick close matches who have similarities with them to avoid societal stigma,” says Dr Noreh.

However, before opting for donor sperms, fertility experts may use a technology called ICSI or intracytoplasmic sperm injection, to address male fertility issues and boost fertilisation.

To reduce costs, one could freeze the extra or spare embryos for future use if the IVF cycles fail. This can reduce the cost of a repeat embryo implantation to Sh330,000 or lower depending on the centre.

In most clinics, couples have to consent beforehand to use of the created embryos. In cases of divorce or death of one or both partners, the frozen embryos are donated to another couple, known or unknown, or to the wife or husband, depending on the legal documents signed at the clinic.

No one individual can use embryos without the partner’s consent or after withdrawal of consent.

The fertility business is booming. Not long ago, one could search IVF in Kenya and find one or two posts on the Internet. Now, a similar search brings many fertility clinics in Kenya.

Dr Wanjiru Ndegwa-Njuguna, a fertility specialist who founded Footsteps to Fertility Centre in Nairobi says IVF acceptance has risen. She attributes the high uptake to financially empowered couples, access to information and willingness to scour the world for solutions.

At her Nairobi clinic, she does about 1,800 IVF cycles a year compared to less than 500 cycles five years ago.

“Women with blocked Fallopian tubes, with few eggs in the ovaries and approaching 40 years or men with no or low quality sperms now know that they shouldn’t be waiting to get children naturally. IVF gives them hope,” she says.

“In some of these cases, even if a couple waits, they will not get a child normally,” Dr Muteshi adds.

“We are seeing more people coming for IVF, especially in their 30s and 40s, an age where they have made savings to be able to afford IVF. We do about eight IVF cycles a month yet we are relatively new,” says the fertility expert who came back from the UK a few months ago.

To date, Nairobi IVF Centre has seen 4,000 couples with its first children born though IVF, a donor egg and a donor sperm being 13 years old.

So, when do you opt for IVF?

Dr Muteshi says if a couple has been actively trying to conceive for more than four years, when a woman has blocked Fallopian tubes, no eggs in the ovaries and a man has no sperms then they can consider IVF.

Because IVF puts a strain to marriages, it is important to always keep in mind that, if it does not work, it is not an individual’s fault, Dr Muteishi advices.

In about 50 percent of the couples, the reasons for IVF failure is unknown. There are those who have tried for more than eight times and got pregnant.

“The number of IVF cycles depends on how financially endowed one is and how badly they want a child. I have seen couples who have succeeded after nine trials,” says Dr Ndegwa-Njuguna.

Another challenge for most couples is the number of embryos put back into the womb. Some ask the doctor to implant many to increase their chances of getting pregnant. Some clinics implant one to three embryos.

Dr Muteshi says specialists aim for IVF to produce a healthy pregnancy without complications or risks to the mother and child.

“We transfer one or two embryos into the womb. There is no evidence to show that putting more than two embryos increases the chance of getting pregnant in young women. But it increases the chance of getting high-risk multiple pregnancies of three, four or five children,” he says.

IVF may have value for money but couples have to weigh options, the experts say.

“There are case where IVF has no benefits over natural conception for example women with advanced age. Their chances of getting pregnant through IVF is as low as that of conceiving naturally. You have to look at individual cases,” Dr Muteshi says.

Most fertility specialists see patients in their 20s to early 50s but there is one who was approached by a 58-year-old woman seeking IVF.

Even as more Kenyans warm up to IVF, many wonder if a child conceived in a laboratory will be normal as a child born naturally. Others fear that there might be a mix-up of embryos.

Dr Muteshi says there is no difference. They are intelligent, play normally and fertile.

Infertility is one of those common yet deeply personal issues that many couples still do not feel comfortable talking about. With lack of a database of specialists, how do Kenyans choose an IVF doctor?

It is like a choosing a hotel in a new holiday destination. An ideal scenario would be for the government to have a database with prices, reviews where patients can choose IVF centres dependent on many factors besides successes such as how a patient is treated.

“For now, choosing a specialist is dependent on a doctor’s referral. Or relying on word of mouth and experience. There are also patient support groups that have reliable information,” Dr Muteshi says.