ANY WOMAN WHO GETS PREGNANT AT THE AGE OF 42 IS MOSTLY THROUGH IVF, SAYS DR. MICHAEL OGUNKOYA, WHILE SPEAKING ON SEX SELECTION: BETWEEN DESIRE AND NECESSITY

Dr. Michael Ogunkoya, MD, The Hope Valley Fertility Clinic

“GOD gave us choice so we have the right to choose!” Henrietta was telling John, her husband why they needed to have a girl third time around. The couple already had two boys, Kenneth and Kevin who were 5 and 3 respectively. Now Henrietta was pregnant again and her belief was that baby No. 3 should be a girl. But John was being more practical. “Let’s not tempt God. It doesn’t matter whether this child turns out to be a boy or girl. If God wanted us to be choosing, He would have asked Adam and Eve to choose,” he argued.

 

According to John, God didn’t give Adam and Eve choice for their children’s gender, rather, in His wisdom, He gave them Cain and Abel, both boys. We should be thankful that we even have children that are healthy and normal. Children are the same after all. But Henrietta would have none of that. “Children are not the same because there are boys and there are girls. They are different and we should have both. We already have two sons and that is enough. I want a daughter and I am willing to do whatever is necessary to get one,” she said with finality.

 

The argument continued. The Abahs had a similar challenge. Like every other couple in this part of the world, Josephine and Joseph Abah looked forward to having children with a balanced gender bias. Eleven months after their wedding vows, their first child arrived. It was a boy. Their joy knew no bounds, more so when they live in a parochial society where male children are given preference. But this joy was short lived. Few months later, it was discovered that the baby boy had Haemophilia, an abnormal blood clotting condition more common in males. The Abahs were devastated.

 

They tried again for the second child. The second baby also turned out to be a boy. Alas, he also came down with the same disease condition. Neither Josephine nor Joseph could explain their predicament. The search for treatment began. During one hospital visit, they met a doctor who explained more about the condition and possible treatment. They were told the disease is sex-linked and prevalent in the family, and that a way out is to try sex selection principles through assisted reproduction to reduce chances of having another male child with such condition.

 

Josephine said, “It dawned on us that even though we are capable of making children naturally, we can only have healthier children through In-Vitro Fertilisation, IVF. We went to a very good fertility treatment centre in Lagos. We did it and we were able to select the preferred sex for our baby.” However, gender balancing or gender selection has remained an issue, especially in Nigeria. Many homes have been broken but with the advent of science of gender selection many homes will be saved. The Hope Valley Fertility Clinic is a major player in the technique. Thanks to the technique, Josphine now has a baby girl.

 

Toyin Odoh also benefited from the wonders of IVF. Diagnosed with Turner ’s syndrome, a condition that results from a missing or incomplete sex chromosome. For Toyin and her hubby, Ben, it was like there was not going to be normal children. After two years of unsuccessful attempts, they turned to fertility clinics. Although, they were in London, Toyin returned to Nigeria for treatment. The couple’s testimony was moving.

 

“I was diagnosed with Turner syndrome and this means I cannot conceive normally. We have been married for two years and we wish to have our own children. At first, I read an interview of Dr. Michael Ogunkoya of The Hope Valley Fertility Clinic, Lekki, Lagos. I called him from London, explained my condition and he invited me over. I came to Nigeria in April 2009 and he placed me on medication for IVF and one month later to God’s glory, it was successful. After all my treatments abroad, it was at The Hope Valley Fertility Clinic, I was treated and conceived. I thank God for putting smiles in my home and family,” she noted.

 

Sex selection fact and myth

A Consultant Gynaecologist & Fertility Specialist, Dr. Michael Ogunkoya, who successfully handled the cases enumerated above gave insight into the many issues surrounding sex selection, as well as increased reports on male infertility and why multiple births are occurring in older women. An experienced physician of international and local standing, he explained: “Sex selection has always been on the agenda for many homes in Africa before now. Even the old Chinese believed that the male sperm comes from left testis. There have been other efforts around the world to influence sex of babies. In Nigeria for instance, some people believe that if some people use some back of trees or leaves they will have male children.”

 

Dr. Ogunkoya, who stressed that there have been so many tales and myths that are completely not true about sex selection, said: “Sex selection is not all about balancing sex rather the main aim of sex selection is to reduce and prevent abnormalities.” The fertility specialist who stated that many IVF babies have been delivered at The Hope Valley Fertility Clinics said sex selection has also been successfully achieved. “Apart from gender balancing, there are other reasons, one of such is to avoid sex link disorders that are prevalence in some families like colour blindness, haemophilia and acute haemophilia. Sex selection allows such families who are prevalent to such disease conditions to decide the gender that suits their family.  Like in the case of Josephine, the couple was able to decide whether to have a male child or a female child,” he said.

 

Sperm sorting

Dr. Ogunkoya noted that the only clinically proven method of sex selection was the MicroSort Sperm Sorting Theory. “The MicroSort principle is a clinical technique used to sort and separate the two different types of sperm, X and Y, that is the female and the male sperm. Once the sperm is sorted out, it can be artificially inseminated (IUI). In this case you, would need the sperm sorting to be done on the day of ovulation.”

 

Although it said that sperm cannot be sorted into the two types 100 per cent accurately, clinical examination has shown success rates for girls is 90 per cent while male chances of success fall around 75 per cent. According to him, “For a Nigerian couple that needs the procedure, we are living in a parochial society where there are much desire for male children. Here, if somebody has good sperm and wants a male child we collect sperm from him and freeze it and send to MicroSort abroad in a special container and when it gets there, they separate the male sperm and female. So separation has always been on our agenda but it attracts extra cost.”

 

Explaining how the separation is done he said: “The principle of MicroSort is based on the fact that the female sperm has a bigger DNA and attracts more dye to the DNA, when you now put the sperm on a conveyor belt, on either side you will now put an anti- dye which will now attract DNA. The anti-dye will therefore attract the sperm that has more dye to the female sperm to the side. So female sperm tends to aggregates more to the side of the conveyor belt while the male sperm remains at the centre. The sperm has a head, neck and a tail. This head is where the DNA is. The female sperm DNA is fatter, and sluggish in movement, and because the female sperm is fatter the DNA is more and that of the male sperm is slimmer but faster.”

 

Male sperm vs female sperm

“When the sperm is poured on the conveyor belt, and the anti-dye, on either side, you put an anti-dye; the dye will stain the head of the DNA because the DNA attracts the dye. So the head of the female will attract more dye because it is a bigger DNA. The sperm is moving along the conveyor belt and the anti-dye both sides will sort of, attract the dye like a magnet and iron. If you put a magnet here and an iron is moving there, it will attract the iron because the magnet is there. If you put the sperm with the dye on their head and an anti-dye on the same axis, but all along the conveyor belt, you find more dye by the side than the centre. And because of the dye on the head of the sperm, it will attract more dye.

 

“At the edge of the conveyor belt you find more female sperm at the periphery while the anti-dye is at the centre where you find the male sperm. They have used the mere fact that the male sperm contained less DNA and less dye than the female sperm which contained more DNA and more dye in separating them since the anti-dye attract and the female sperm to the side. So the principle is therefore separating the female sperm and male sperm. At a distance, you discover that many of the sperm at the side will be female and many of the sperm at the centre will be male. And it is the only objective demonstrating method of sex selection known. It is still under research. It is still not available. So for some reasons when you separate such sperms, the person who wants female will take and the person who also wants the female will use the female”

 

However, due to extra costs, most clients opt for another method of sex selection which is a bit more scientific. “It is the fact that some people make love around the time of their ovulation. This involves timing of intercourse. The idea is based on the fact that female sperm are larger and slower and Male sperm is faster but more fragile. So a few days before ovulation favours the larger but slower female sperm while sex at the time of ovulation favours the faster male sperm.” However, Dr. Ogunkoya counseled that this method requires careful counting and ovulation testing to determine exactly when the ovulation will occur.  The fertility expert who noted that the recipe for success is not just simple but a combination of so many factors which includes diligence, hard work and transparency to patients emphasized on factors such as regular updating of equipment, training and retraining of staff.

 

Desire for male children

According to Dr. Ogunkoya, “There is more desire for male babies, but statistically most IVF babies tend to be male a ratio of about 8 to 2 or 4 to 1. We cannot tell you precisely the basis for that. In our practice, we have sort of noted that there must be a factor within the concept of Assisted Reproduction which imposes that. We are yet to find out the science behind it. Somehow, the process of IVF relies on the fact that sperm should be able to fertilise the egg to make embryo. It is usually that the sperm that is moving faster to get to the eggs should make the embryo. We still don’t know. A lot of efforts have to be put into it. May be we should start marking sperm to know which one makes the embryo. It is also possible to actively influence sex by selecting them”

 

Explaining the advent of multiple births in old women, he notes; “During the process of IVF we normally transfer more than three embryos back to the woman’s womb although these days, you only need to transfer less than three embryos. In some cases one and the idea is that most European communities rather not have multiple pregnancies and deliveries because of the social preferences. In Africa, we like multiple births and in fact we celebrate them. The tendency therefore is that if you go to such countries today, if you have 10 embryos, the highest they can transfer is two. And if you probably have twins before and you do IVF again, and the eggs are beautiful, they will probably transfer only one egg. There is the advocacy for two embryo transfer or one in some countries. But in Nigeria we still transfer up four embryos for reasons that we welcome triplets. If the three or four embryos are implanted properly that may result to triplets or quadruplets. So there is propondence of multiple births in Assisted Reproduction than in non-assisted births.”

 

Male infertility

“Yes as a woman gets older, the eggs become older as in fewer quality and quantity because as she gets older at age 13, the eggs that are being released are of a better quality than the eggs later in life. That is the law of natural selection. But to a man is the same but that of a man is to a lesser extent because the sperm of a man of 20 years is definitely better than that of a man of 30 years. As a man’s age advances, the sperm gets poorer. It is easy to say that more men are getting problems of infertility but all is enough awareness. The apparent increase of male problems is created out of increase awareness. If there is any increase at all, it could be traced to environmental problems and nutrition. Increase awareness, a lot of people now know where to go for their problems, there is no true increase in male infertility it is increase in awareness. Women are now being encouraged to come forward and the women are also being encouraged to bring their husbands along for necessary tests.

 

Multiple births

In Africa people do not talk about their pregnancy and a lot of people do not talk about achieving pregnancy through IVF. They prefer to keep it secret. Anybody who gets pregnant at the age of 42 is mostly through IVF but I am not saying that at 42 women cannot get pregnant on their own. But in reality, after age 45, it is really difficult for women to get pregnant on their own apart from assisted reproductive system. If they introduce two to three eggs and most times the result came out to be multiple births and for somebody at that age, will want to have three or more children at a time and forget about having more.