Insights from Treating Patients in Kenya
Many of us assume a “natural order” of events in our lives; grow up, get a job, find a partner, career, and eventually a family. It is such a predetermined course of events that makes infertility so tough to manage.
Many across the globe have hopes of starting a family, some right after their glamorous wedding, but there are those that end up trying on their own for some dreadful years without success – and this marks the onset of a heart-breaking journey with a desire for parenthood that never goes away.
When the familiar terrain of simple parenthood disappears, some patients, after much intervention and arduous decision making, take a deep sigh of resignation and adopt children. But such is not the same for all.
You will find these couples seated patiently, waiting for a turn for consultation or treatment in treatment facilities such as Fertility Point, in Upper Hill, Nairobi. Their first-hand experience of the grief of infertility has driven them to seek alternative ways of becoming parents at the clinic.
Luckily, their chances of being blessed with a child through In-Vitro Fertilization (IVF) are relatively easy, thanks to the facility’s team of experienced fertility experts and world-renowned embryologists led by Dr. Rajesh Chaudhary.
While the actual process of becoming a parent through IVF may even take some time for some couples, the investment, the forms filled, the home visits, and all the hurdles involved are worth it.
“That is the antithesis of fertility treatment – a glimmer of hope, an end goal in sight and for couples who have spent so long navigating the uncertainty that is having a child,” said Dr. Chaudhary in an interview.
Fertility Point is the world’s leading fertility treatment centre with outlets in 12 countries globally. Kenya is the only Fertility Point outlet in Africa –they offer IVF services as well as artificial insemination, laser assisted hatching, freezing programme like sperm and egg freezing. Additionally, they also have Surrogacy and donor egg/Sperm services.
The doctor who has interacted with many Kenyans have noticed a trend of women waiting until it is almost too late to have babies. Many women nowadays are opting to grow their careers and become financially independent before settling down to start a family.
According to the doctor, 8 out of 10 eggs harvested from patients who seek treatment at Fertility Point are usually genetically abnormal, and they mostly belong to women aged between over 35 years. According to the doctor, 8 out of 10 eggs harvested through IVF after the age of 40 are genetically abnormal. And this is the reason why healthy pregnancy in 40+ age is a bit difficult. We always encourage such couple to screen their embryos after IVF for any chromosomal abnormalities by advanced technology called Pre-Implantation Genetic Screening.
“The commonest problem a 35 plus women faces is a low ovarian reserve, that is, they have a limited number of eggs left to be pregnant. As such the late 20s and or early 30s make the best years to have a baby,” he adds.
Citing examples from the cases he has treated; Dr. Chaudhary advises women to go for fertility treatment after trying to get pregnant for a period of more than one year. The one of the ways is IVF, a process involving fertilization of woman’s eggs and a man’s sperm and woman’s egg outside the body in lab. The egg and the sperm are combined in a petri dish in a lab, and once an embryo forms, it is transferred into the woman’s womb for implantation.
What are the different IVF treatment options?
“The types of IVF treatment options depend on a patient’s situation, but there are four types. IVF can be done by harvesting the egg and the sperm from the couple, a woman’s eggs and donor sperms, donor eggs, and a spouse’s sperm, or with donor eggs and donor sperms,” says Dr. Chaudhary.
The method is one of the safest and the most effective fertility treatments with a high success rate, which currently sits at about 65 percent according to the stats from the Fertility Point clinic.
The chances of getting pregnant through IVF, however, are usually about 60 percent. Other studies, nonetheless, have pointed out that the IVF success rate in an African woman is around 30 percent.
The procedure is recommended for women with different conditions including blocked fallopian tubes, fibroids, ovulation disorders, and endometriosis.
Single women, those with premature ovarian failure, unexplained fertility problem, male infertility, and same-sex couples should also get IVF treatment.
Some of the contributing factors to infertility among many women are associated with age, infections in the oviduct or the uterus, and or blockage of the Fallopian tubes.
“About 10 to 15 percent of the adult population in Kenya are dealing with infertility issues. Of this number, a further 15 percent need IVF treatment,” Dr. Faith Muchira says.
After the egg is harvested, Dr Manju who is an embryologist handles the eggs and sperm for next 3-5 days till it grows to embryos. The embryos are loaded in a fine catheter which is then transferred to the womb lining. Dr Manju also performs the advanced procedures like embryo biopsy for gender selection and genetic screening, Egg and Sperm freezing. At Fertility Point, Sperm analysis and morphology testing are done by Computerized method called CASA (Computer Assisted Sperm Analysis). This CASA method of Sperm analysis is more informative and accurate, says Dr Manju.
How does the IVF process work?
All the couples or women visiting the Fertility Point clinic begin by booking an appointment then meeting a specialist who will guide them on the best treatment approach.
During the first visit, a patient may be required to undergo some blood tests or an ultrasound to determine the hormonal levels as well as establish whether the uterus and the ovaries are okay for the task.
If, however, a patient has done the tests before, they can submit the records to expedite the process. If a man is a problem, an analysis of the semen will be conducted depending on the medical history provided.
After all the necessary steps are completed, personalized treatment is prepared for the patient.
The first step to the IVF treatment will then begin with an ovarian stimulation which stimulates the growth of follicles in the ovaries to produce more eggs for retrieval.
“The more the eggs, the greater the chances of fertilization,” Dr Rajesh explains.
This procedure consists of putting an injection of follicle-stimulating hormone (FSH) and/or luteinizing hormone (LH), given usually 10 to 12 days after the end of the last period. The follicular growth is then monitored through ultrasound and blood tests until the desired number of eggs and size is achieved.
FSH injections maintain high FSH concentrations in the body, which make the ovaries more mature.
Once the patient has the optimum number and size of follicles ready, a human chorionic gonadotropin (HCG) shot is triggered for the final maturation of eggs.
After ovarian stimulation, but before ovulation, comes the egg retrieval phase of IVF.
The retrieval is done using a needle guided by ultrasound into the ovary. The need aspirated the follicular liquid containing the eggs from the ovarian follicle. The liquid is then checked to confirm if it indeed contains the eggs.
Once their presence is ascertained they are stored in a culture dish as it awaits the sperm for fertilization, after which it is then transferred to the patient.
“Between the third and the fifth day after fertilization, the most viable embryo with the highest implantation potential is selected for transfer,” explained Dr. Manju adding that, “We also have Time lapse incubator which will help in selection of best embryo based on their growth pattern.”
This stage also gives couples a chance to consider genetic screening to ensure zero chances of passing any genetic disorders. This is done through what is referred to as pre-implantation genetic diagnosis (PGD).
How much does IVF treatment cost?
For a patient, the process costs starts from Ksh. 450,000. This cost is dependent on the ovarian reserve. The pre-IVF assessment, scans, and blood tests.
What about IUI treatment?
The IUI procedure mainly involves the men since the process requires the depositing of sperm directly inside a woman’s uterus. It helps a healthy sperm get closer to the egg at the time of ovulation.
For this treatment, Dr. Chaudhary also needs a physical examination of the patients, which takes into account their medical history like in IVF. An analysis of semen can be considered to check any morphological and sperm motility abnormalities.
The sperm is prepared for insemination through a process called “sperm washing” that pulls out a concentrated amount of healthy sperm.
Once ready, the doctor slides a thin, flexible tube through a patient’s cervix into the uterus. A small syringe is used to insert the sperm through the tube directly into the womb. Pregnancy happens if sperm fertilizes an egg and the fertilized egg implants in the lining of the uterus. The IUI procedure is painless and takes about 20 minutes.
It is worth noting that Fertility Point handles more IVF cases than IUI simply because, in Kenya, it is mostly assumed that the responsibility of infertility falls upon women. In as much as both genders are equally responsible, men are more reluctant in going for check-ups.
“We understand that it is important to carry out research and treatment for male fertility to ensure we provide our patients with comprehensive care, leading to successful treatment outcomes. Our andrology laboratory is best equipped with the most advanced technologies for semen analysis and other sperm functional tests, so we provide the best diagnoses and treatments in all areas of a male factor-related infertility,” said Vishal Sharma, the Vice President of Marketing Operations at the fertility clinic.
He added that as infertility specialists, Fertility Point is always ready to help men diagnose the underlying issue and recommend the right treatments or procedures that will lead to conception.
Since its inception in Kenya in 2018, the clinic’s team of highly qualified and internationally trained IVF consultants and senior embryologist have undertaken over 1000 cycles of IVF and helped more than 1000 patients become parents.
The COVID-19 impact
With the coronavirus being a relatively new phenomenon, the exact extent to which it affects fertility has not been established. The clinic says that they are still exploring the effects of the disease on male and female fertility.
“Latest recent research has hinted that Covid-19 may adversely affect the quality of sperm and reduce male fertility. The extent of this disease is dependent on its severity, as it is connected to the reproduction function in male Covid-9 patients with changes in seminal biomarkers,” noted the clinic.
Fertility Point sentiments are supported by a study that stated that there is lower Covid-19-related morbidity and mortality infection among females compared to males.
It further posited that men not only die double the rate women do, but over 80 percent of severe cases of Covid-19 occur in them. The ability of sex hormones to regulate the immune response differentially appears mainly to mediate this effect.