Health
Why fertility clinics must stop transferring multiple embryos during IVF — AFRH president
Janet Ogundepo
The President of the Association for Fertility and Reproductive Health, Prof Preye Fiebai, has warned fertility clinics to desist from transferring multiple embryos during In Vitro Fertilisation procedures, asserting that the practice increases the possibility of higher-order multiple pregnancies, contributing to maternal and neonatal complications.
He decried the proliferation of quacks and the lack of nationwide regulation of assisted reproductive technology, stating that some clinics were transferring as many as six or seven embryos during IVF as measures to prevent a failure of the procedure.
The AFRH president called for legislation regulating ARTs and made it imperative that embryo transfers be strictly limited, ideally to one or at most two, per cycle.
Fiebai further called for the reclassification of a fertility drug, clomiphene citrate, being sold freely at pharmacies and chemists and purchased by women seeking multiple pregnancies without medical supervision, to be a prescription-only drug.
The professor demanded that only properly qualified specialists be authorised to provide assisted reproductive technology services in Nigeria.
PUNCH Healthwise earlier reported that the rising cases of higher-order multiple pregnancies and births in the country, including triplets, quadruplets and quintuplets, are attributed to the increasing use of ARTs and the misuse of fertility medications.
The report further showed that the increase in higher-order multiple pregnancies increased the risk of complications for both the mother and babies and worsened Nigeria’s already high maternal mortality rate.
PUNCH Healthwise reports that since the beginning of the year, five pregnant women who delivered higher-order multiple births died a few days after delivery.
Already, Nigeria accounts for 34 per cent of the global maternal mortality rate.
The AFRH president stressed that women who deliver triplets, quadruplets, or quintuplets face increased risk of complications and death after delivery.
Fiebai told PUNCH Healthwise, “The number of clinics providing ART services and the lack of regulation of the practice are most likely contributors.
“In other places, the recognition of the challenges with higher-order multiple births has resulted in regulation, and the trend now is towards single elective embryo transfer. But in Nigeria, you hear of cases of people transferring six, seven, and it is even celebrated. Something must be done about it,” he said.
The Consultant Obstetrician and Gynaecologist stressed that the pattern of sudden death after the delivery of women who had unregulated multiple embryo transfers, recorded in Nigeria and worldwide, made the regulation to limit the number of embryos transferred during IVF procedures compulsory.
The don further noted that the babies conceived through multiple embryo transfers were at risk of complications and death in utero and during delivery.
“Not only for the mother, but for the baby, because the chances of such babies surviving are extremely low, much lower than if you had one or two. The complications of pregnancy and the neonatal complications are more than three times higher in women who have twins. Not to talk of triplets or quadruplets. By the time you are talking about sextuplets and all, it’s much, much higher.
“A lot of women who die after their treatment, especially after they have had a caesarean section for higher-order multiples, there is rarely any indication that they would die. But suddenly, after a caesarean section, two or three days later, you suddenly find that they die. And this has been recorded worldwide.
“That is why we need to be extremely careful how we go about transferring embryos. And as much as possible, limit it to no more than two, unless the consequences are beyond our control,” he said.
Continuing, Fiebai said, “But ideally, I pray that we get to the stage where we have regulation that limits the number of embryos that you can actually transfer.
“And once there are consequences and people are held accountable, I guess this may help in the future.”
The fertility expert also raised concern about the widespread misuse of fertility drugs, specifically clomiphene citrate, which he said women were purchasing without prescriptions in an attempt to conceive multiples.
“Clomidine citrate should be prescribed as a prescription drug, and whoever is prescribing it needs to monitor patients to ensure they are properly treated while providing fertility services. For assisted reproductive technology, we have been struggling for many years to pursue legislation in Nigeria. Right now, there are two bills in the House of Representatives addressing surrogacy. But surrogacy is just one aspect of assisted reproductive technology. And if you do not address everything, you are going to create a monster,” he said.
He urged the government to regulate the sale of fertility medications and strengthen oversight of fertility clinics, stressing that only properly trained specialists should be allowed to provide assisted reproductive services.
“Government needs to look at the qualifications of those who are allowed to provide such treatment, and hopefully, with the Medical and Dental Council, you have to get the appropriate certification before you are allowed to do such things and that way we’ll hopefully start getting some order in the system,” he added.
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