Question: What specific services does Kingswill Specialist Hospital offer, and how does it respond to the fertility challenges Nigerian couples face today?
Answer: The hospital offers a wide range of fertility treatments, ranging from the simplest, such as simply counseling women on their fertile window, timed intercourse, ovulation induction, intrauterine insemination, and the more advanced in-vitro fertilization (IVF). We also provide pre-implantation genetic testing alongside IVF, including third-party assisted conceptions such as donor sperm/egg IVF and gestational surrogacy.
Question: With fertility treatment often perceived as expensive or elitist, how accessible are your services to the average Nigerian family?
Answer: Expensive is actually relative. In-vitro fertilization may seem expensive in relation to the Nigerian standard of living and minimum wage, as against western nations. The major reason for a reverse medical tourism with respect to IVF, whereby so many Nigerians in the diaspora return home for IVF, is because it is way cheaper than the cost overseas.
Question: Many Nigerians still see infertility as a woman’s problem, despite evidence to the contrary. How does your clinic work to change this harmful narrative?
Answer: This perception is the result of societal imbalance. Often, women come forward first for fertility evaluation, placing the onus on themselves even prior to evaluation. We discourage this by advising that couples attend the first consultation together. It also helps avoid the duplication of effort associated with individual fertility education and counselling. We also use fertility awareness campaigns, fertility enlightenment talks in churches and fertility-inclined NGO seminars to educate the public that infertility is a couple’s issue, not just a woman’s problem.
Question: Nigeria lacks a strong regulatory framework around fertility treatment, IVF, and surrogacy. What are your thoughts on this, and how does your clinic ensure ethical practices?
Answer: Regulatory framework in the form of guidelines exists, but enforcement is the challenge. For instance, Lagos State has adopted practice guidelines developed by the Association of Fertility and Reproductive Health, which serve to regulate fertility practice, and these are enforceable for IVF centres in Lagos. Inspections are conducted at least twice a year to ensure compliance with minimum standards. Other states’ health regulatory agencies need to adopt these guidelines to serve as regulations, avoid gaps and inconsistencies. To ensure ethical practices, our clinic has strict internal protocols, including requiring government-issued identification to prevent age falsification or identity fraud, prevent underage semen and oocyte/egg donors and also to prevent inadvertent incestuous treatment or close family members as gamete donors.
Question: Mental health is often overlooked in fertility clinic care. How are you addressing the emotional toll infertility takes on couples?
Answer: Many couples with fertility challenges are usually already burdened when they come. Psychologically, many of them have been weighed down based on how family, friends, and society treat them both in the guise of pity and contempt.
Fertility treatment as such requires empathy, and as such, the role of a counsellor is important. The counsellor has to be mature, knowledgeable and experienced in infertility and its challenges. Fertility counsellors can be in-house or visiting counsellors and in some cases such counsellors are health workers who had gone through similar challenges and treatment processes themselves. Counselling also helps prepare them ahead of the possible treatment outcomes, including both a successful treatment and a failed treatment.
Question: What’s your view on the level of public awareness around fertility as a medical issue in Nigeria, and what needs to change?
Answer: Awareness of infertility is not really the problem. If awareness was lacking, there would not be so much stigma and societal pressure on infertile couples. The major problem is awareness of infertility as a medical issue, the causes of infertility, the solutions to it, and where those solutions can be accessed.
A lot of people are aware that infertility is a problem, but they are not really aware of the causes. Some attribute the cause to spiritual matters or consequences of their past deeds or sins of prior generations, leading to seeking solutions in the wrong places, while fertility clinics and hospitals seem to be the last resort at a time when the harm might have been done by quacks.
Quacks often speak the language people understand, using vernacular, microphones, and fake testimonies, especially in rural areas, thereby making them more believable. With medical regulations not in favour of medical advertisement by physicians, quacks have publicity advantage. Hospitals seem to be the last resort for so many, and what should have been a straightforward IVF becomes complicated.
Fertility doctors now get involved actively in enlightenment programmes on social media, religious programmes and other family-oriented gatherings.
Question: Infertility is still a taboo topic in many communities. How does your clinic educate the public and reduce stigma, especially among men?
Answer: Fertility clinics and individual physicians these days engage in public enlightenment talks, podcasts, webinars, etc, all across electronic, print and social media as part of their social responsibilities. These are sometimes organised in partnership with religious bodies, NGOs, corporate bodies etc. The benefits of this often goes beyond enlightenment, with some of these organizations helping indigent couples with funding/grants or securing discounted fertility treatment rates with partner clinics.
Question: What are some of the most damaging misconceptions you’ve encountered about IVF, surrogacy, or fertility treatment? Some of which may prevent people from seeking the necessary services.
Answer: Misconceptions surrounding infertility, fertility, and IVF mostly stem from cultural and religious biases.
Some view all forms of assisted conception involving handling or manipulation of gametes (sperm and oocytes/eggs) as being against the order of nature. They forget that not all conceptions can take place in the comfort of the bedroom and as such assisted conception is needed when there is failure of such. The hospital or clinics are set up because there may be people who need assistance. They are not to be discriminated against as individuals may face medical challenges in one area or the other, and fertility challenge is one of such areas. This wrong mindset is responsible for late presentation for treatment. There are people who decline all forms of third-party assisted conception despite such being the logical treatment option for them. A major misconception is the wrong belief that IVF babies are not normal babies, that they won’t develop like every other child. But the truth is that IVF babies are just like any other babies. The special thing about such babies is the emotions and sentiments attached to the care of such pregnancies due to all that has gone into achieving such conception.
Another misconception is around surrogacy, where some think a child born via surrogacy will carry the genetic make-up of the surrogate, which is not the case, as the surrogate in gestational surrogacy contributes no genetic make-up to the offspring.
Question: Many patients face not just physical but also psychological pressure from family and society. What structures are in place at your clinic to support them holistically?
Answer: Pre-treatment counselling helps in this regard. Couples are to see infertility as a couple’s problem, not each individual’s problem. It is not about “my wife has a challenge” or “my husband has a challenge.” We encourage them to present it as ‘our fertility challenge’.
Involving ‘non-medical’ third-party acquaintances, such as relative,s in their fertility journey or visits, oftentimes adds more pressure.
Question: How do you ensure that clients from diverse cultural and religious backgrounds feel safe, respected, and understood?
Answer: We don’t discriminate against tribe, religion, or race. We also receive clients from the diasporas; Nigerians, Asians, and others. Each group has its own uniqueness and specific cultural or religious needs, and we respect all. When people make demands from a cultural basis that are against standard ethical practices, we decline such demands, for example, incestuous treatment. We recognise patients’ autonomy and, as such, respect their choice provided it is within acceptable ethical standards.
Question: Oocyte donation and surrogacy still remain a controversial topic in Nigeria. How do you engage donors and clients (couples who seek your services) to manage this subject matter?
Answer: Surrogacy and egg donation, despite being acceptable fertility treatment options, are controversial issues not just in Nigeria but in many societies. A few countries, like Italy and Germany, ban surrogacy completely. Others, like Australia, allow it only under certain conditions, such as when the surrogate is a relative. For many countries, it is an acceptable practice provided it is properly carried out ethically.
For oocyte donation, the key is to follow strict protocols and guidelines to avoid commodification. The motivation should be altruistic, not for financial gain on the part of the gamete donor. Any reimbursement should only be for potential wages lost due to the duration of treatment, time lost, or discomfort. Hence, it should not be seen as financially rewarding to keep the motive altruistic.
Like blood donation or any other tissue donation, gamete (semen and oocytes/eggs) donation in assisted conception is a standard worldwide practice. Gamete donation involves cells and tissues and is not illegal, and is less complex than organ donation, like in kidney donation.
Question: Can you share a patient success story (while respecting confidentiality) that illustrates the impact of your clinic? You may ignore if you don’t want to respond.
Answer: Every patient’s story is unique, and choosing one as outstanding would be unfair.
We have seen women born without a uterus who became mothers through surrogacy. We have seen those with uterine abnormalities or recurrent miscarriages finally carry live births. We have seen men with no sperm cells in their semen become biological fathers through sperm extraction from their testes directly.
Some couples have waited 25–30 years before becoming parents. To them, their story should stand out. Some have even published books about their journeys, while others prefer to keep it private because of stigma. So, every success story is unique in its own right.
Question: How is technology (like AI, telemedicine, or mobile apps) changing fertility care, and how is your clinic embracing this shift?
Answer: Technology is transforming fertility care. In Western countries this is already in use, and it will soon catch up globally. For example, AI is already being used to select the best embryos with the best chances of achieving conception and improving pregnancy rates.
Technology introduces standardization, reduces human error, and makes work faster. Telemedicine became especially important after COVID-19, allowing us to consult with patients abroad before they even arrive, reducing their time of stay.
Mobile apps now allow patients to input data, see results, and calculate chances before coming in for treatment. Patients are better informed and can ask more questions, which benefits everyone.
Question: Finally, what are your hopes for the future of fertility care in Nigeria, and how is your clinic working to be a part of that future?
Answer: I look forward to a time when everyone with fertility challenges can access quality care without falling victim to quacks. This requires individuals, clinics, and the government to all play their roles.
The government should make fertility care more affordable by reducing or removing import duties on medical equipment, consumables and drugs. Almost everything used in IVF is imported, so the cost rises with exchange rates. Waivers on medical imports would drive costs down and make IVF more accessible.
Government must also enforce regulations, ensuring that only accredited fertility centers with qualified physicians provide these services and quackery is eliminated. That way, patients know they are receiving real and quality care.
Question: Is there anything else that you would like to add?
Answer: The concerns about gamete (oocytes/eggs or semen) need to be demystified. Couples who need donor semen or donor eggs should not be condemned to childlessness. Donation is an acceptable practice worldwide, provided it is done ethically. Needing gamete donation should not be shameful. A woman may need oocyte donation because of being advanced in age, and she should not be denied the right to motherhood. If blood donation is acceptable, why not semen or egg donation? They are equally tissues and not even organs like the kidneys.
There are benefits that accrue to donation, such as free health screening. They get free tests for HIV, hepatitis, genotype, and other conditions. Some even discover health issues they never knew about and get linked to the right care, and in some cases, get free treatment and surgeries. For some, it serves as an opportunity to access their fertility potential. It can also serve as an opportunity for health counselling, career counselling and as an avenue for linkages to skill acquisition centres. The most important thing is the satisfaction that comes from the altruistic act of helping others.