Evolution of Fertility Centers in Nigeria

Dr. Toyin Ajayi

In the industrial age, fertility rates began to decline worldwide. Between 1870 and 1920, fertility rates fell by 30 to 50 percent in Western Europe and the United States. Orthodox treatments were limited in scope and efficacy; and in many cases spiritual and other alternative means were employed by desperate would-be parents with varying outcomes.

In 1978, Drs. Patrick Steptoe and Robert Edwards of Oldham General Hospital, in Odham, England, after over two decades of research, performed the world’s first successful IVF (In vitro fertilization) procedure which led to the birth of Baby Louise Brown, the world’s first ‘test tube’ baby on July 25, 1978 in Oldham, England. In vitro fertilization is a medical procedure in which an egg is removed from the woman’s ovaries and fertilized with sperm in a laboratory. The fertilized egg, now called an embryo, is returned to the woman’s womb to develop.

This revolutionary feat led to a surge in the establishment of fertility centers as well as the development of more sophisticated techniques such as IUI (inter uterine insemination) and ICSI (Intracytoplasmic Sperm Injection).

In the United States of America, the first IVF baby was born in 1981; in France, 1982; Italy 1984; and Germany,1982. The first successful IVF procedure in Africa was in 1984 in South Africa.

Stringent guidelines and regulations were quickly set up to control the proliferation of sub- standard facilities in most of the developed world, but Africa has lagged behind. In Nigeria, at present, there are no regulations in place to specifically control the activities of fertility clinics.

The first claim to a successful IVF birth in Nigeria was made by Professors Giwa Osagie and Ashiru at the Lagos University Teaching Hospital in 1986. Dr. Ibrahim Wada of Nisa Premier Hospital reported an IVF birth in 1999. Many unverifiable claims of successful IVF procedures have been made since then.

To meet the ever-increasing demand for fertility treatment, many fertility centers have been established in Nigeria. However, the relatively high cost associated with treatments as well as the general lack of awareness in the populace has forced many would-be parents to turn to spiritual and traditional healers in their search for a child. The absence of a regulatory framework has encouraged the proliferation of quacks who often do more harm than good.

Bridge Clinic was set up as the first focused fertility center in Nigeria in 1999 and reported the birth of the first ICSI babies in Nigeria in 2000. This remarkable achievement was followed up by it’s becoming the first fertility clinic in Nigeria, nay West Africa to be awarded the coveted ISO 9001 Quality Management Certification in 2004 by TUV Austria.

As there were no accredited embryologists in the country at the time, Bridge Clinic began operations with technical support from a team from King’s College, London, led by Dr. John Parsons who had been on the pioneering team that performed the world’s first successful IVF procedure in 1978. This support greatly facilitated the rapid transfer of technology to Nigeria.   

Bridge Clinic’s focus on staff training and collaboration with international experts has had a positive multiplier effect on the fertility landscape as many of their alumni hold key positions in fertility clinics, both locally and in the diaspora. It plays a key role in advancing medical education and provides opportunities for healthcare professionals to receive specialized training in the field of reproductive medicine, contributing to the development of a skilled workforce in this critical area of healthcare.

In an interview with Dr Toyin Ajayi, The Medical Director of Bridge Clinic, she revealed that there were several obstacles that had to be overcome in fulfilment of their mission. Infrastructural, financial and technical challenges had to be overcome. Accurate laboratory testing, essential to the operations of a fertility clinic, was also lacking in the country. This led to the formation of Pathcare Ltd, a laboratory and medical logistics firm, as a necessary adjunct to the operations of Bridge Clinic.

As demand for IVF continues to expand, there has been an uncontrolled proliferation of fertility clinics to meet this need. Exploitation of desperate would-be parents is rife as unscrupulous and unethical operators take advantage of their distress. This phenomenon is not restricted to Nigeria but in more developed countries, stringent licensing systems control the deployment and assure the quality of the procedures carried out by fertility clinics.

In the United Kingdom for example, for a fertility center to begin operations, three regulatory licences are required: Human Fertilization and Embryology Authority (HFEA); Care Quality Commission (CQC); and the Home Office Controlled Drugs licence. Although these regulatory requirements are not yet in place in Nigeria, the Bridge Clinic operates according to these standards to ensure consistent and effective service delivery.

What’s the future? The fertility sector is expected to grow in Nigeria like in other parts of the world due to the global decline in fertility rate. The sector players in Nigeria need to acquire emerging cutting-edge technologies like the use of AI in embryo selection amongst others. According to Dr Toyin Ajayi, one of the values at Bridge Clinic is “Innovation.” The Clinic is always at the forefront in the adoption of new technologies that improve treatment outcomes. 

On the part of the government, there is need to set up a legal and regulatory framework to oversee fertility centers. The Lagos State government is already in the forefront of this as some papers are in the works. But the need for an oversight at the federal level cannot be overemphasized. The barrier to entry needs to be raised to avoid the incursion of quacks. Fertility treatment is based on trust and ethics, and that must be upheld all the time. 

*Dr. Ajayi is the medical director of Bridge Clinic.