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Infertility: As More Nigerians Embrace Surrogacy

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In the past, it was a taboo for a Nigerian woman to contemplates surrogacy  but now  it is becoming a norm, ODIRI UCHENUNU-IBEH writes.

The pursuit of education, career, wealth and the search for “Mr and Miss right” have made many delay parenthood, yet the natural clock doesn’t stop ticking.

Research has shown that infertility is on the rise with evidence indicating that in women, fertility peaks in mid 20s and starts a steep decline in mid 30s.

However, a recent report from the European Society of Human Reproduction and Embryology (ESHRE) has shown that more women are delaying childbearing at the present time than previously, leading to an increase in infertility rate globally.

Although many women are healthier in later life and may well take better care of themselves, this does not stop the natural age-related decline in fertility. This trend is expected to cause a corresponding rise in the mean age at which women record infertility.

According to the CEO, Lifelink Fertility Clinic, Dr. Kemi Ailoje, women in their 20s for instance, have a 20 to 25 per cent chance of achieving pregnancy during their ovulation period and this drops to 15 to 20 per cent for women between the ages of 31 years and 35 years and to less than 10 per cent for women ages 35 years and older.

By 40 years, Ailoje said, women typically only have a five per cent and by 45 to 49 years, a one per cent chance of becoming pregnant and this age group of women can be advised to go for surrogacy, as their eggs are no longer viable.

When then is surrogacy necessary? The fertility expert said surrogates or gestational carriers are needed when there is no viable womb available to gestate a foetus.

She said there has been an increase in surrogacy practice in Nigeria as more people are now exposed and awareness has improved.

“Acceptability is better now especially since people have successfully undergone surrogacy and are able to share with others the success story of surrogate delivery of their children unlike in time past when the discussion was a taboo with its attendant discrimination in Nigeria,” she noted.

The prevalence rate of surrogacy in Nigeria in the last two years has gone up, according to Ailoje as statistics revealed that surrogates who are under 35 years can be nearly up to 60 per cent.

“These success rates however begin to decrease as the age of the surrogate increases. However, the results are satisfactory and the incidence of major ethical / legal cases have been limited,” she added.

In Lifelink Fertility Clinic, the CEO said, “We use gestational carriers who are just hosts and do not have any genetic link to the babies. We have quite a number of them who have successfully completed cycles for patients most for medical reasons, and have successfully handed over children to their intending /genetic parents.”

Indeed, awareness and the pressing need to have babies may have led to more Nigerians embracing surrogacy fuelling the calls for legislation so as to effectively regulate the practice in the country.

But are there no laws guiding surrogacy? Ailoje said there is no federal law on surrogacy practice in Nigeria so parental rights are not fully guaranteed.

However, surrogacy is legal in Nigeria and its contracts are enforceable in Nigerian courts, says Ailoje, adding that in some states, there are approved  guidelines for the practice of third party reproduction such as surrogacy, use of donor eggs and sperm, regulated by the  main fertility body, Association For Reproductive Health (AFRH).

The fertility expert however advised couples who want to go into surrogacy to carry out investigations, adding that the use of Donor Eggs in a Recepient cycle may be recommended with the patients consent.

Understandably, stakeholders have harped on the need to further create awareness so as to promote the practice of surrogacy in Nigeria.

“There is the need for stakeholders, including the media to increase awareness by educating and enlightening the public about the medical reasons and benefits of surrogacy as an option to successful parenthood, while differentiating clearly the difference between a traditional surrogate and a gestational host/carrier”, Nnenna Nwobu, a retired nurse, said.

Emphasising the efficacy of surrogacy, Ailoje  said, “This method  of reproduction no doubt remains a viable method of having children by intending parents and has been done successfully over the years in Assisted Reproductive Technology (ART)/ Assisted Conception processes, and couples who require these services need to access them after proper counselling with appropriate legal backing.”

Why will a woman opt for surrogacy?  Medical Director, Nordica Fertility Centre, Lagos, Dr. Abayomi Ajayi said the main reason why a woman will opt for surrogacy is because she doesn’t have a uterus or doesn’t appear to work properly.

Ajayi whose centre has branches in Abuja and Asaba listed other reasons to include: “When a woman who may not have a diagnosed uterine issue but who has failed to become pregnant after several embryo transfers and woman who has history of miscarriages or pre-term birth thought to be due to factors other than egg/sperm quality or genetics (i.e. uterine or cervix issues).

The medical doctor said when faced with infertility, couples are introduced to many treatment modalities, terminologies and abbreviations, especially when ART is required. Some of these are confusing and not fully understood.

“One patient described it as “going through a maze” and one of these modalities/terminologies is Surrogacy, which is a form of third (3rd) party reproduction”, he said.

In retrospect, the medical revolution known as surrogacy is made possible by the scientific revolution known as in-vitro fertilization (IVF) and egg donation. It is thanks to these landmarks that women who have no uterus can still bear their own biological children, assuming their ovaries are still functional.

However, giving insights into the procedure of surrogacy, Ajayi, explained that  there are basically two types— natural (traditional surrogates) or IVF surrogate mother (gestational surrogate).

He said a natural surrogate mother is genetically related to the child, apart from carrying the child she has also gone through the procedure of insemination, with the use or her own eggs.

“On the other hand however, an IVF surrogate is not genetically related to the child. She carries a pregnancy, created by the egg and sperm of the commissioning couple. Ideally the surrogate should be under the age of 38 years, married or in a stable relationship. She should also preferably at least have previous live birth without complications,” he added.

Further, he noted that a prospective surrogate must be thoroughly counseled; such person should not have medical disorders, such as diabetes or blood group incompatibilities and shouldn’t smoke, drink or abuse drugs.

Ajayi observed that success rates for traditional surrogacy are approximately 10 to 20 per cent per cycle if intrauterine insemination is done but with IVF, the chances depend on the age of the surrogate and for IVF surrogacy, live birth rates are in the range of 35-l to 40 per cent per cycle.

With the increasing  rate of infertility occasioned by so many factors, there is the need for stakeholders, including the media to create more awareness on surrogacy, as a lot of people can  have a complete family through that process.

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