Fibroids usually do not pose any long-term dangers to a woman. However,
they could cause the following:

Heavy menstrual flow could lead to blood loss and low blood levels.
In some cases, the lady may need a blood transfusion.

Dysmenorrhea. Painful menses could affect the quality of life of the
client by causing severe pains during menses.

RISK FACTORS
As many as 4 in 10 women may have fibroids in any population, and by
age 50 years about 70 – 80 % of women will be found to have fibroids.
Several factors may increase a woman's risk of developing fibroids. They
include:

Genetic factors
Fibroids tend to run in families and are common in families where a
mother or aunt is found to have fibroids. It is also commoner in black
women.

Obesity
Fibroids are more common in obese women because of the conversion
of fat to estrogen. Fibroids feed on estrogen for their growth.

SYMPTOMS
Most persons with fibroids have no symptoms. When symptoms occur, the
client complains of:

Shifting abdominal mass. Most women describe it as regular
movements within the abdomen.
Heavy menses with the use of additional pads
Abdominal pains during menses.
Difficulty urinating [if the fibroid is compressing on the lower part of
the urinary bladder].

LOCATION OF FIBROIDS

The location of a fibroid could determine if a fibroid would cause symptoms.
The different locations include:

Intramural fibroids
They are located in the muscular walls of the fibroid and may enlarge
inwards or outwards. Small intramural fibroids generally do not cause
symptoms.

Subserosal fibroids

They are located on the external surface of the uterus.

Pedunculated fibroids

These are fibroids that grow outside the surface of the uterus and
develop a stalk.

Cervical fibroids

They are located in the wall of the cervix (neck of the uterus).

Parasitic fibroids

These fibroids are usually pedunculated and then develop blood vessels
from other structures

Submucosal fibroids

These are protrusions of fibroid into the uterine cavity thus distorting it
and increasing its surface area for bleeding. They usually cause heavy
bleeds.

FIBROID AND INFERTILITY

Fibroids rarely are a cause of infertility except in rare cases when it
occludes both fallopian tubes.
They could lead to pregnancy losses if a pregnancy implants on a
submucous fibroid. it could lead to pregnancy loss.
Women who get pregnant with fibroids could be at risk of:

Pains during the 2 nd trimester of pregnancy [when the fibroid
undergoes degeneration]
Poor growth of the developing baby, a term called intrauterine growth
restriction
Preterm delivery
Heavy bleeding after delivery

PREVENTION

There are no ways of preventing uterine fibroids as most cases have a
genetic potential. However, you may be able to reduce your risk slightly by
maintaining a normal weight.
Regular check-ups with your gynecologist are necessary if you have been
diagnosed with uterine fibroids to monitor their growth.

DIAGNOSIS

Diagnosis of uterine fibroid usually begins with a history of abdominal
swelling or heavy menses. However, in many cases, it is picked up during a
routine pelvic examination or an ultrasound scan for another medical
condition.

Laboratory tests may be required and examination done may include:

Full blood count. This checks for the presence of anemia [low blood
level], and the platelet count. It could assist in detecting blood
disorders.

Clotting profile. It helps to check for problems with blood clotting.
A 3D ultrasound scan will help confirm the diagnosis including the
numbers of fibroids and their location.

In some cases, an MRI may be indicated when planning for treatment or
surgery for women with large fibroids to get more details about the sizes
and locations of the fibroids, to ascertain that they are not cancerous.

TREATMENT

When a doctor makes a diagnosis of uterine fibroid, the plan to treat will be
determined by the symptoms. Modalities of treatment include:

1. Expectant management
Women without symptoms usually do not require any treatment. They are
counseled to have regular checkups.

2. Medical Treatment
Medications are used for the treatment of some of the symptoms of fibroids
or to temporarily reduce the size of the fibroids. They include:

NSAIDs. These drugs are used to relieve painful menses. Examples
are Ibuprofen, Brustan, Cataflam.

Mefenamic acid. Used to reduce the amount of bleeding during
menses.

Oral contraceptive pills. They are used to reduce the amount of
menstrual flow.

Mirena [progesterone IUD]. This is an insert implanted into the
uterus to reduce menstrual blood flow.

GnRH agonist. They are injections used to induce a state of
reversible menopause in a woman thus temporarily shrinking the
fibroids and reducing blood flow. They are used for a maximum of 6
months. They are also used to make fibroids smaller before a
planned surgery.

Uterine Artery Embolization [UAE]
This procedure is used for women who do not desire to get pregnant. UAE
involves inserting some gel into the uterine artery through a catheter to
block the uterine artery blood flow to the uterus. The fibroids will shrink over
months following the procedure.

3. Surgery

Myomectomy
This involves the removal of fibroids in women who still desire to
have babies in the future. Fibroids could be removed through:

Laparoscopic myomectomy
Laparoscopy is the preferred method for fibroid removal. It is done by
inserting a camera through a pinhole and the instruments for surgery are
inserted through small holes in the abdomen. The fibroids are removed
by morcellation [a procedure which cuts it into smaller pieces so it can
be pulled out of the small incisions]

Hysteroscopic myomectomy
For submucous fibroids, removal can be carried out successfully through
the vaginal route without making any incisions on the abdomen.

Laparotomy or abdominal myomectomy
This is the traditional method of removing fibroids. It is used for large
fibroids or multiple fibroids when laparoscopic removal is not feasible.

The normal ovarian function is to produce hormones [estrogen,
progesterone, and androgens] and release eggs [ovulation] from the
follicles every month. Ovulation occurs in response to stimulation by the
hypothalamus and pituitary glands.

TYPES OF OVARIAN FAILURE

1. PRIMARY OVARIAN INSUFFICIENCY
This occurs when the ovary fails to function normally in response to
appropriate gonadotropin stimulation provided by the higher centers
[hypothalamus and pituitary]. Hence, there is a primary problem with
the ovaries.
Causes include:

idiopathic causes [ cause not known]
Genetic disorders such as Fragile X syndrome and Turner syndrome.
A low number of follicles.
Autoimmune diseases, including thyroiditis and Addison disease.
Chemotherapy or radiation therapy to treat cancers.
Metabolic disorders.
Toxins, such as cigarette smoke, chemicals, and pesticides.

2. SECONDARY OVARIAN INSUFFICIENCY
This occurs when the hypothalamus and pituitary fail to provide
appropriate gonadotropin stimulation. Hence, the problem is with the
higher centers
Causes include:

Weight loss from eating disorders, chronic disease, and extreme
exercise
Drugs used in cancer treatment [The three most commonly used
drugs, cyclophosphamide, cisplatin and doxorubicin]

Tumors in the Pituitary glands which secrete hormones

Pituitary necrosis where all the pituitary hormones are extremely low
(Sheehan syndrome)

Hypothalamic tumor which causes a dysfunction of the organ
The risk of POF is higher in persons with a family history of the same and
surgeries involving the ovary.

SYMPTOMS
A lady with ovarian insufficiency may have no initial symptoms at the initial
stage.
The earliest symptom noticeable is short or irregular menses. This could
occur following the use of oral contraceptive pills. Other symptoms are
similar to those of menopause and include:
Night sweats
Hot flushes
Poor memory
Vaginal dryness
Mood swings
Inability getting pregnant

PREVENTION
If the cause of the ovarian failure is known the client can be counseled to
avoid factors that could trigger the condition such as weight gain, reducing
exercises and avoiding medications which could lead to it.

LONG TERM CHALLENGES
It is important to make an early diagnosis of premature ovarian failure to
avoid severe health challenges in this group of women. Apart from
Infertility, a client with POF present with:

Increased risk of bone fracture.
This is caused by low estrogen levels, thereby leading to weak bones
which can fracture easily.

Increased risk of heart disease
Estrogen protects the heart from heart diseases. Early loss of
estrogen predisposes women to heart problems

DIAGNOSIS
Diagnosing POF usually begins with a history of the above symptoms:
menstrual irregularity, chronic illness, drug use, exercise, poor eating
habits or disorders.

1. Laboratory tests
Hormonal assay to assess the level of serum Follicle-Stimulating
Hormone [FSH], Luteinizing Hormone [LH] and Estradiol on day 3 of
menses.
Level of Anti-Mullerian Hormone [AMH] which checks for the level of
remaining follicles. These levels are low.

2. An ultrasound scan of the ovary may reveal small, shrunken ovaries.

3. MRI of the brain [hypothalamus and pituitary] may be useful where a
tumor of the pituitary gland is suspected.

TREATMENT
There is usually no treatment available to restore ovarian function when
the challenge is a primary ovarian failure with the challenge at the level of
the ovaries.
For secondary ovarian failure, it may be possible to reverse the challenge
depending on the cause of the problem.

1. Lifestyle changes

Women are counseled to perform weight-bearing exercises and take
calcium supplements because of the risk of bone fractures.
For those interested in having children, options such as the use of donor
eggs, and adoption should be discussed with them. However, about 5 % of
these women may get pregnant spontaneously.

2. Medical Treatment

Women benefit from estrogen therapy to help protect the heart from
diseases and the bones from fractures.
Progesterone medications can be given also to help the client menstruate
each month, thus preventing endometrial hyperplasia and reducing the risk
of endometrial cancers.

1. ASSESSMENT OF OVARIAN RESERVE

This test is done to assess the quality and quantity of eggs in your ovaries.
A woman needs a good amount of high-quality eggs to get pregnant. Both
the quality and quantity of eggs reduce rapidly after age 35.
Different Tests to assess the ovarian reserve include:
Anti-Mullerian Hormone [AMH]
This is a hormone present in women of reproductive age that gives us an
idea of the number of follicles in your ovaries and the chances of a
pregnancy occurring. The test can be carried out at any time of the
woman’s cycle and involves a blood sample.

Normal value:             1.0 – 4.0 ng/ml
Reduced value:           Less than 1.0 ng/ml
Elevated value:           More than 4.0 ng/ml [risk of polycystic ovary]

Hormonal Profile
A blood sample is taken on the 3 rd  day of menses to assess for Follicle
Stimulating Hormone [FSH] and Estradiol. An elevated FSH level indicates
a reduction in the number of eggs. An elevation In prolactin levels indicates
hyperprolactinemia which needs to be treated.

Antral Follicle Count [AFC]
The doctor will perform a transvaginal ultrasound scan on day 3 of the
cycle. This procedure checks for the number of follicles available just after
the menses. It gives an idea of the fertility potential of the woman. 6 – 10
follicles per ovary are considered normal. If the follicles are less than 6, the ovarian reserve is considered low. These follicles usually vary in size from
2-10 mm.

2. ASSESSMENT OF FALLOPIAN TUBES

These tests are done to determine the patency of the fallopian tube and the
status of the uterine cavity to ensure the fertilized egg can implant in it and
thrive. A woman must have one or both tubes patent for the sperm to reach
the eggs after intercourse. If the tubes are blocked pregnancy will not occur
naturally.
Tests to assess this include:

Hysterosalpingogram [HSG]
This is an X-ray test in which a radio-opaque dye is injected into the uterus
to outline the endometrial cavity and the fallopian tube. The test is carried
out within the first 5 days after menses.

Saline Sonohysterogram
This is an imaging study of the uterus using a transvaginal scan to view the
uterine cavity and the fallopian tube while inserting fluid into the uterus via
the cervix.  It picks up conditions like endometrial polyps and endometrial
fibroids.

Laparoscopy and Dye Test
A laparoscopy and dye test is an operative procedure to look at your
internal organs usually the fallopian tube using a telescope and a monitor.
A blue dye is pushed through the vaginal and the fallopian tube to check if
the fluid flowing out through the other end of the tube. It is usually the gold
standard test for checking if the fallopian tubes are open.

Ovulation induction is relatively cheap, and not time-consuming as you do not
have to make frequent visits to the clinic, not invasive and it’s the first
treatment for suitably selected women.
The procedure involves using drugs to increase the number of
eggs released at the time of ovulation from the ovaries and hence
improve the chances of pregnancy occurring.

These drugs act by causing an increased release of hormones such as
follicle-stimulating hormone (FSH) and luteinizing hormone (LH) which
stimulates the growth and maturation of multiple ovarian follicles. While
taking the medications, one or two ultrasound scans will be carried out
to check for the development of the follicles. When the follicles are large
enough, another drug called HCG is given to cause the final maturation
of the eggs and the couple is counselled to have intercourse 36-40
hours later, which will coincide with the time of ovulation.

WOMEN WHO BENEFIT FROM OVULATION INDUCTION

Ovulation induction is recommended for women less than 35 years with:
Polycystic ovarian syndrome (PCOS)
Anovulatory cycles [not ovulating]
Hormonal imbalance
Unexplained infertility where the cause is not known
Irregular menstrual pattern

It can be combined with any of the procedures such as IUI, IVF and
ICSI.
Up to 75 % of women with irregular menstrual flow will ovulate with
about 50% pregnancy rates within 6 months.

MEDICATIONS FOR OVULATION INDUCTION

Several medications can be used to stimulate the ovaries to develop
multiple follicles. They include:

1. CLOMIPHENE CITRATE [CLOMID]

This is the most commonly used among women. It is an anti-estrogen
medication that acts by increasing the levels of FSH and stimulating the
development of follicles.
It is taken by mouth usually for five days starting from day 3 – 5 of the
menses. The dosage is 50 -100 mg daily. It is preferably taken at night
to reduce its unwanted effects.
Common unwanted effects include- headaches, hot flushes, visual
changes, ovulation pains, and mood changes.

2. LETROZOLE [FEMARA]

This is an aromatase inhibitor that helps to suppress estrogen
production leading to an increase in FSH. FSH increase stimulates the
ovaries to produce multiple follicles thus increasing the chances of
pregnancy.
It is taken by mouth usually for five days starting from day 3 – 5 of the
menses. The dosage is 2.5 -5 mg daily. It is preferably taken at night to
reduce its unwanted effects.
Common unwanted effects include- headaches, hot flushes, muscle
aches, diarrhea, dizziness, ovulation pains, and mood changes.

3. GONADOTROPINS

These are Injectable drugs that cause the ovaries to produce multiple
follicles and eggs. They are usually given daily from the 2nd or 3rd day of
commencement of menses and are stopped when the eggs are large
enough for ovulation to occur. They are administered subcutaneously,
under the skin.
Several types of gonadotropins are available and include:

FSH only [Gonal F and Bravelle]

Human Menopausal Gonadotropin, a combination of FSH and LH
[Menopur]

Common unwanted effects include- weight gain, leg swelling, nausea
and vomiting, and severe lower abdominal pains.

4. HUMAN CHORIONIC GONADOTROPINS [PREGNYL]

These are Injectable drugs that cause the ovaries to release the eggs
and cause ovulation to occur. They are similar in action to LH. They are
given when the size of the follicles containing the eggs is large enough
for ovulation to occur. After administration of HCG, ovulation occurs in
36 – 40 hours.
Common unwanted effects include-, headaches, irritability, leg swelling,
depression, pain at the injection site, and restlessness.

It is usually carried out in conjunction with medications [Clomid or
gonadotrophin] to increase the chances of ovulation occurring. In a few
cases, the client’s natural cycle is used and the IUI procedure is carried out
when natural ovulation occurs.
IUI aims to increase the number of motile sperm that reach the fallopian
tube and thus improve the chance of fertilization.

WOMEN WHO BENEFIT FROM IUI

IUI is recommended for couples with:
Mild male factor infertility
Couple with unexplained infertility
Women who have ovulation challenges
Teams who require sperm donation
Couples in a same-sex relationship

PREPARATION FOR IUI

IUI is an office procedure and couples are expected to be at the clinic 1
-2 hours before the scheduled time. The client would have had
ovulation induction before this and HCG injection.
While the procedure lasts a few minutes, sperm production and
preparation could last more than 1 hour. The semen is produced by the
male partner and handed over to the health personnel at the clinic for
sperm washing. In cases of male factor infertility where the male
semen is not suitable for use, donor sperm cells are used. The woman
should ensure she takes her HCG injection before coming to the clinic.
The IUI procedure occurs 34 – 36 hours after the HCG
injection.

PROCEDURE FOR IUI

A Cusco speculum is inserted into the vagina and the vagina is
cleaned with saline. The washed sperm is aspirated into a small plastic
IUI catheter is introduced through your cervix into your uterus. The
sperm is pushed and deposited gently into the uterus. The procedure
lasts only a few minutes.

COMPLICATIONS OF IUI TREATMENT

Ovarian hyperstimulation

Because drugs are used to stimulate the production of more follicles,
there is the risk of overstimulation of the ovaries by the gonadotropins
forming large cysts. Ovarian hyper-stimulation is very common in clients
with polycystic ovaries.
These cysts could rupture and leak out excessive fluid into the
peritoneal cavity of the abdomen resulting in weight gain, abdominal
pains and swelling, the passage of a small quantity of urine and
occasionally difficulty breathing. This problem usually occurs within one
week of HCG injection and in most cases resolves within 3 weeks.
This condition could be avoided by using a low dose of the medications
and monitoring the growth of the follicles in the ovaries during
stimulation with the transvaginal ultrasound scan. Despite this
precaution, some women still go ahead and develop ovarian
hyperstimulation.

Mild to moderate forms of the condition could be managed at home with
your doctor prescribing pain relief medications and encouraging you to
drink lots of fluid. Follow-up in the clinic is advised. Severe forms of
hyperstimulation may need drainage of some of the excess fluid that
collects inside the abdominal cavity to reduce the bloating and pain. It
usually allows the condition to resolve quicker and usually improves your
symptoms. In some cases, you may need to be hospitalized for proper
care and monitoring.

Multiple Pregnancies

Fertility treatment has increased the number of multiple pregnancies
including twins, triplets, quadruplets and so on. Clients who get
pregnant with more than one fetus at a time run an increased risk in
the pregnancies for both mother and babies.
These risks include:

 Fetal Challenges

1. Risk of miscarriage in any of the trimesters
2. Premature birth before 37 completed weeks
3. Birth defects in one or more babies

 Maternal Challenges

1. Pregnancy-induced hypertension
2. Pregnancy-induced Diabetes
3. Risk of having a cesarean section
4. Antepartum or postpartum haemorrhage

FOLLOW-UP

2 weeks after the IUI procedure you will be expected to come in for a
serum pregnancy check.
However, we note some women will commence their menses before
this time indicating the procedure was not a success.
One week after the HCG administration, you may be instructed to visit
the physician for an " ovary check." This is to ensure that the ovaries
have not over-responded. This visit is not always necessary.
Women who get pregnant are counseled to see their healthcare personnel
for further advice and counseling.

For a man to impregnate a woman, his sperm count needs to be over 15
million/ml in a single ejaculation. Men with sperm count less than 15
million/ml will have challenges with natural conception. With counts below 5
million/ml, even IVF may not assist couples in achieving a pregnancy.

ICSI is a revolutionary treatment for treating male infertility. In the normal
IVF, over 50,000 motile sperm cells are placed by the egg in a dish and
one of the sperm cells will penetrate the egg and fertilize it.

The ICSI procedure utilizes a microscope fitted with a micromanipulator to
inject a single sperm into a matured egg to help achieve fertilization, unlike
IVF which requires millions of sperm cells. It carries a higher fertilization
rate and birth rate than traditional IVF. Hence, it improves the success rates of
IVF in men with male factor infertility.

This procedure has brought hope to men who would not have been able to
have children despite using the IVF procedure. ICSI programs ensure
couples with low sperm count have the best chances of achieving a
pregnancy with the male partner’s sperm.

BENEFICIARIES OF ICSI

ICSI is a treatment for male infertility and may be offered when:
The sperm count is too low
The sperm cells cannot swim properly
After a previously failed IVF where there was no fertilization
Where the sperm cells had to be removed from the testicle using a
surgical procedure in men who cannot ejaculate
Retrograde ejaculation (semen flows backward into the bladder).
Where traditional IVF has failed

The ICSI procedure involves the following steps:

1. Ovulation induction
The woman is given daily injections called gonadotropins to stimulate the
growth of multiple eggs. Normally, every woman produces one egg at the
time of ovulation; however, the drug aims to help produce many eggs to
increase the chances of a pregnancy.
The injections are administered for about 9 to 12 days. While taking the
injections, several times Ultrasound scans are carried out to monitor the
growth of the ovaries and response to the treatment.

When the doctor decides that your eggs are large enough, Human
Chorionic Gonadotropin [HCG] will be administered to cause the final
maturation of the follicles.

2. Retrieval of the eggs
The eggs will be expected to mature 36 hours after the HCG injection and
be ready for retrieval from the ovaries. Egg retrieval involves the removal of
the eggs from the ovaries using a long ovum pick-up needle attached to a
transvaginal ultrasound probe. The procedure is carried out under some
anesthesia to ensure you do not feel the pain of the needle prick. A few
hours after the procedure you should be able to go home.
The client is given a progesterone suppository to insert into her vagina after
the procedure. Progesterone helps prepare the lining of the uterus for the
implantation of the embryo.

3. ICSI
On the day of your egg retrieval, the male partner is expected to provide a
fresh semen sample to the laboratory. He could produce the sample at
home or in the hospital. Fertilization occurs by injecting a single sperm into
the egg using a special microscope called a micromanipulator.
Following the injection, they will be placed in an incubator to enable
development.
For the next 3 – 5 days, the embryologist will monitor the growth of the
embryo, assessing their growth and quality, and deciding which ones are
best for transfer.
The client will be updated on the progress of the embryo during this period.
Clients do not need to present to the hospital; however, the woman is
counseled to continue her progesterone insertion as recommended.

4. Embryo transfer
Embryo transfer is usually done on day 3 or 5 days after the retrieval of the
eggs depending on the clinic protocol. Day 5 transfer is more popular.

For the transfer, the best-quality embryos are used. Your doctor will
discuss with you the number of viable embryos to transfer into the womb. In
most cases, 2 – 3 embryos are transferred back into the uterus. In
countries like the UK, single embryo transfer is done to reduce the
risk of multiple pregnancies.

The transfer which is a painless procedure involves loading the embryo into
a special catheter and under ultrasound guidance depositing it gently into
the uterus.

You will be advised to remain in bed for about an hour after the procedure
and then you can go home and resume normal activities.

5. Embryo freezing
After the transfer of the best-looking embryos, there may still be some
excess embryos remaining. Any unused high-quality embryos may be frozen
to allow the option of future implantation. Your doctor will need your
consent to freeze these embryos and the terms of freezing would have
been discussed with you during your initial consultation.

6. Follow up
After embryo transfer, you will continue your progesterone insertions at
home. You will be advised not to engage in any strenuous activities outside
your routine.
Two weeks after the procedure, you will receive a call to present at the
clinic for a blood pregnancy test.
If the pregnancy test is positive, you will continue the progesterone until
you are about 11 weeks when your placenta begins to produce enough of
the hormone to support the pregnancy.
An ultrasound scan will be done in the 6 th week to check for fetal heart
activity.
If the pregnancy test is negative, your health team will discuss with you the
possible reasons why this occurred and you may choose to have another
IVF cycle.

The ability to remove eggs from a woman and fertilize them outside her
body, and subsequently place the fertilized eggs back into the woman
opened up a world of opportunity for women with challenges carrying their
pregnancies for a variety of reasons. They simply get help to carry the
pregnancy and nurture it.

TYPES OF SURROGACY

I. Traditional Surrogacy
In this procedure, the surrogate's egg is fertilized by the intended father's or
a donor’s sperm.
The surrogate can get pregnant through sex with the intended father or by
artificial insemination. In many cases, the intended father's sperm is used
in the insemination resulting in a child who is genetically related to both the
intended father and the surrogate.
If a donor’s semen is used, the child born will not have any genetic
relationship with his/her parents.
It was a common practice before the evolution of IVF and was practiced in
the bible. It is not commonly practiced anymore.

COUPLES WHO BENEFIT FROM SURROGACY

It is beneficial for:

For couples who want a genetic linkage with the baby and plan to use a
relative.
If the intended parents are a single male or a couple where the woman is
not capable of using her eggs, traditional surrogacy may give them the
the genetic link they desire.
For couples who cannot find an egg donor of their choice or want a donor
they know.
For couples who want to reduce the cost of their surrogacy.

II. Gestational Surrogacy
Here, the parents create an embryo using their egg and sperm or using a
donated egg or sperm and the surrogate agrees to have the embryo
implanted in her uterus. Her womb is simply borrowed to nurture the
embryo and after delivery, the baby is reunited with the couple who will be
the rearing parents.

COUPLES WHO BENEFIT FROM SURROGACY

It is beneficial by:
Allowing mothers to have a genetic linkage with their babies
Allowing couples who have frozen embryos from previous IVF treatments
could use them in gestational surrogacy.

It is important to note that the baby delivered has the genetic components
of the parents from whom the egg and sperm were taken.
The surrogacy program involves carrying out the IVF procedure on the
couple and then transferring the embryo to the surrogate after preparing
the uterine lining of the surrogate to receive the embryo. The surrogate
undergoes several tests before being used to carry the embryo. Couples
could choose their surrogate of choice or the clinic could arrange to make
one available. The process of getting a surrogate involves legal
documentation to prevent the surrogate from absconding with the child.

COUPLES WHO BENEFIT FROM SURROGACY

Women with no uterus
Cases of recurrent IVF failure
Recurrent miscarriage
Severe heart and kidney disease in a woman

SURROGACY COMES WITH ITS CHALLENGES

Couples who plan to have babies through surrogacy need a lot of
counseling and support all through. It is:
More expensive than traditional IVF
There could be emotional turmoil knowing someone else is carrying
your baby
In our environment, people ascribe the pregnancy to the one who
carries it
The surrogate may bond to the baby and decide not to hand over the
baby after delivery.

Surrogacy has a lot of ethical questions with some religious groups viewing
it as immoral and a means of exploiting poor women for commercial
purposes.

Whatever the case, surrogacy provides a means of childbearing for
thousands of couples hoping to commence their reproductive journey.

In Nigeria, only Nigerians or those with Nigerian citizenship are allowed
legally to adopt a child. Adoptions are usually guided by the Nigerian Child
Rights Law of 1965, however, the laws may differ depending on the state
you decide to adopt a child from.
Adoption is meant for couples who have tried IVF and have not been
successful.
Couples without funds for IVF can adopt a baby.

General Criteria for Persons Who Can Adopt

1. The parents-to-be must be Nigerian residing in Nigeria. Each state
determines how long it takes to establish a bond between the
prospective parents and the child. This process may last up to 24
months.

2. Married couples and single individuals can adopt children. However,
a single individual can only adopt a child of the same sex as him or
her. Married couples must adopt together and must be Nigerian
citizens. Individuals adopting must be at least 25 years and 21 years
older than the child.

Criteria for a Child to be Adopted
Abandoned children or those less than 17 years can be adopted.
Both adoptive parents and adopted child must live together for at
least 3 months before an adoption decree can be passed.

Adoption Procedure

1. Choose a service provider to help you with the adoption process.

2. The service provider will find out if you are eligible to adopt a child

3. If you are eligible to adopt a child, a referral will be provided for you
and you will decide if you can meet the demands of providing a home
for the child. The child for adoption must also meet the criteria for
adoption.

4. The social welfare in that region will apply for custody of the child and
submit it to the registrar of the court. The procedure can take up to 2
years.

Documents that needed from the adoptive parents
Birth certificates
Marriage certificate
Proof of Nigerian citizenship
Financial assets
Police reports
Additional documents if required

5. Finalize the adoption procedure.
6. Bring the child home

Benefits of Adoption
Adoption is an alternative for couples who can’t have their biological
children. It could bring joy to the family in the process of raising a child in
your own home.
The adopted child gets better attention and a stable home to live in.

Risks of Adoption

There is still some stigma in families where children are not the
biological offspring of the parents.

Despite the fact we are coming to terms with accepting the practice of
adoption, it still poses some challenges in our setting. Many see the
family as comprising a father, mother, and biological children.

In several families, harboring adopted kids many still view the
children as not part of the ‘home’. Some persons still feel adopted
children are more prone to drug and medical problems and that they
may not adjust well in the homes they are brought into.

However, some people view adopted kids as lucky individuals who are
showered with so much love and a home to begin life anew.
It is important to note that adoption is a lifelong process that shapes
children and their families. Parents and the adopted child or children
need to communicate effectively and be patient with themselves to
ensure a happy family.

These women may find it difficult or impossible to have children using their
eggs.

An option for these women to have babies is to undergo egg donation.
Egg donation is a process whereby eggs/oocytes produced in another
woman’s ovary are fertilized by the husband’s sperm and transferred to the
recipient mother’s uterus.

The egg donor is a young woman preferably in her early 20s. The
the procedure typically involves a doctor giving the egg donor injections to stimulate the production of many eggs, removing the eggs from the donor when they are matured fertilizing in a laboratory with sperm from the
recipient’s partner, and then transferring the resulting embryos into the
recipient’s uterus for implantation and the establishment of pregnancy.
Following the delivery of the baby, the recipient will be the rearing parent of
the offspring. Doctors do this through a procedure called In-Vitro
Fertilization (IVF).

In the majority of cases of egg donation, the donor and the recipient are not
aware of their identity and the clinic keeps this a secret. In a few cases, the
recipient may decide to provide an egg donor after proper counseling on
the future possible challenges of such a decision.

CRITERIA TO BE USED AS AN EGG DONOR

Before a woman is accepted as an egg donor, she has to meet certain
criteria which include:

1. She has to be between 20 and 35 years of age. In our practice, we
utilize donors less than 25 years of age because they tend to respond
better than fertility medications thus increasing the chances of a healthy
pregnancy

2. They should be free of infectious diseases such as HIV, Hepatitis B,
C, and Syphilis.

3. Their genotype has to be AA to prevent them from passing the sickle
cell trait to the offspring

4. Women who have given birth or successfully donated eggs which
resulted in a pregnancy in the past are preferable

5. Women with a family history devoid of genetic diseases [this may
pose challenges because some persons may not have details of their
family history or may choose to keep such information secret

TESTS FOR EGG DONORS

When a client has been chosen for the egg donation program, she will
undergo:

Physical examinations to document their weight, height, and
complexion, and document other physical parameters.

Drug testing to ensure she is not on any recreational drugs

Ultrasound scan to examine the uterus and ovaries

AMH is carried out to document her ovarian reserve

Medical history is noted

Psychological history and counseling to ensure the donor is mentally
fit to undergo the procedure

Up to 50% or more of women using donor eggs will experience pregnancy.
The success rate depends on the age of the eggs, stimulation protocol, and
process of egg retrieval amongst other factors.
Egg donors are counselled on the legal implications of the procedure and a
a contract document will be signed informing her that she has no
responsibilities or legal rights to any children born via the donor eggs.
Egg donors may or may not be paid for the donation of the eggs; they may
receive compensation for their efforts in assisting another family to have
children.

Discuss with your fertility doctor if you think you will benefit from the egg
donation program.