Nigeria’s renown IVF specialist and the MD of Nordica Fertility Centre,Lagos, Dr Abayomi Ajayi in this interview with RALIAT AHMED- YUSUF sheds more light on NIFTY,a pre-natal testing that can detect chromosomal abnormalities in pregnancy and even some genetic cancers.
What is NIFTY ?
NIFTY is a form of non invasive pre-natal testing.It is non invasive in the sense that you just need the woman’s blood to be able to detect the DNA of the baby.This was first done in 2010 in the University of Hong Kong and since then it has sort of transformed the way we do prenatal testing.It has not completely eliminated invasive prenatal testing but it has reduced its use to ten percent.
How did this come about?
We suddenly understood that you can detect the fetal DNA in the maternal blood from about 10 weeks and since the DNA determines the diseases we are prone to, especially chromosomal diseases.The chromosomes are in the nucleus of our cells and there are 23 sets of chromosomes that we human beings have – one set from the father and another set from the mother and the 23rd chromosome is the last and sex chromosomes which bears the genes.
What this test can look for now are the chromosomes not the genes. So anything that has to do with chromosomal disorder this test is able to detect it.
Before now we used to think congenital abnormality is not common in Africa but it’s not true- congenital abnormalities occur the same rate in whites and blacks provided you are a human being because these are errors that happen in nature.
How does NIFTY work?
There are some chromosomes that are associated with some diseases. For instance down syndrome is associated with chromosome 21 and so you can see whether a baby has Down Syndrome from looking at chromosome 21. Chromosome 13 is associated with Patau Syndrome while chromosome 18 is associated with Edwards Syndrome. These are the commonest syndromes that this test can detect. These chromosomal abnormalities are not compatible with life. Sometimes the baby dies while still in the uterus and people always blame the doctors but the baby has a problem that is not compatible with life and eventually the baby is going to die but it is not the doctor’s fault. You have the advantage at 10weeks of pregnancy to have such information. If the test comes out positive you can make your decision whether to continue the pregnancy or not.
How accurate is this test and how aware are people of this procedure?
The sensitivity of this test is about 99.9%.It’s pretty very accurate . On awareness – we wait for opportunities such as this workshop. But I can only talk to a few people and so we need to collaborate with media because the media has a wider reach.
If a pregnant woman tests positive to the test what happens?Do you just advice the person to get rid of the pregnancy right away?
That is why we do a lot of counselling. Before you do the test, you need to know the implications and once the result comes it is your decision to make -nobody is going to force you. Why it is much easier is that if you want to do a termination, it is done before there are bones because once there are bones it becomes a difficult termination to do.
If in the case of a positive test the woman decides to terminate the pregnancy what is the assurance that the next test would be negative in subsequent pregnancies?
It all depends on what we find. We might have to advice the couples to do Pre implantation Genetic Diagnosis(PGD) in their next pregnancy if it’s something that can reoccur. We test from the embryonic stage to see which embryo is affected.For instance, some people have congenital blindness. Another thing this test can also look out for are some genetic cancers and it can be prevented so that it won’t be transmitted to off springs.
Let’s talk about IVF. How much have Nigerians accepted the procedure compared to the past?
Its quite acceptable but the problem we have is access in terms of finance.Many people need it but cannot afford it unfortunately and that is why everybody is trying to do their own a little bit to make it more affordable but at the same time if you want quality there a limit to what you can do without compromising.Lack of knowledge is also another challenge.A lot of people don’t understand how IVF works. Some people just come and say I need a baby but it doesn’t work like that.
In Nigeria, people don’t pay attention to healthcare at all. They find it very boring but if we must live and live well we need to be aware of our health by doing things in moderation and that’s why there is a need to know about how to live a healthy life including reproductive health.
Some men also indulge in very unhealthy lifestyles such as excessive drinking and what have you. Male infertility is on the rise. We did a study recently and it is so shocking to know that out of the men that came to us 12% do not have sperm at all!
During an IVF procedure,how do you screen for some diseases/mental illnesses that could be transferred to the baby in a case where eggs/sperm donors are used?
Now we are able to screen for genetic diseases. It is not every mental issue that is a genetic disease. Substance abuse plays a big role in psychiatric problems so that you can’t screen for because it’s a social factor.For genetic diseases we are able to screen for them in donors.
In our centre for example,we have some donors that are already screened but the thing is that if you are going to use such donors then the husband must be screened because it’s the two gametes that are coming together and sometimes you might find problems in the man.The truth is that we all carry problems-they are called mutants.Some genes are mutated that can lead to diseases. Always remember the chromosomes. For instance if my chromosome 6 is not normal there’s no problem but if I marry somebody whose chromosome 6 too is not normal then chromosomes comes in our off springs.
Where do you see IVF in ten years from now?
We have not seen the end of new development in IVF because on a daily basis new things are being discovered.