LUTH MEDICAL FEAT AND ART ETHICS

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Fertility clinics should be strictly regulated On 18th April, the Lagos University Teaching Hospital (LUTH), Idi-Araba announced a successful delivery of a set of twins following an Assisted Reproductive Technology (ART). The mother is a 68 years old woman who had undergone fertility treatment in another hospital which enabled the pregnancy. Although the feat by LUTH drew wide commendation from several people and organisations, especially since it was the first time a Nigerian and African hospital would successfully nurse a woman of such age to delivery with the twin babies in good health, there are contending issues. In particular, the pregnancy has raised serious ethical concerns among health experts.

We are delighted that the woman and her babies are well, but she walked a thin line between life and death for that to happen. If the pregnancy had gone wrong, she would have been among the eighth in every 10 women of her age who unfortunately were unable to complete the rigour of the reproductive process without damage to themselves or/and their child. This is the risk that dissuades fertility centres from accepting IVF advances from women above 58 years. That explains why the Association for Fertility and Reproductive Health (AFRH) was quick to call into question the ethical decision of the IVF centre which facilitated the pregnancy process for the 68-year-old woman.

A statement by AFRH President, Dr. Wada Ibrahim said offering ART treatment for women over the age of 54 years violates its well-publicised practice guidelines. It added: “The key issues are: the risk that pregnancies pose to the health and well-being of women aged above 54 years; and the well-being of the children born to women over the age of 54 years, especially in terms of nurturing the children to adulthood. The AFRH has painstakingly put together a set of self-regulation rules aimed at ensuring good clinical, laboratory and ethical practice of ART in Nigeria. The Lagos State Government has accepted these Practice Guidelines and has gone on to set up an ART Monitoring Committee consisting of both Health Facility Monitoring and Accreditation Agency (HEFAMAA) officials and AFRH representatives.”

According to the World Health Organisation (WHO) guidelines, pregnancies above recommended age are prone to gestational diabetes, low or high birth weight, hypertension, abortion, possibility of the placenta partially or fully blocking the neck of the uterus, high possibility of caesarian delivery, as well as increased bleeding for the woman after delivery. In some other cases, it leads to the death of the mother or/and baby. Another ethical concern is on the side of the children. Apart from the possibility of the woman not being able to provide active care required of a mother at an advanced age, a research done by the University of Alberta in Canada shows that children born to older mothers may have more heart risks later in life, especially for male babies.

Despite these obvious risks associated with the practice, some fertility clinics in Nigeria are more interested in the income the reproductive technology will bring into their pockets as against advising older women of alternatives available to them which include adoption or surrogacy, among others. There is possibility the successful delivery by the 68-year-old woman was known because everything went well. What happens to so many other women who may have lost their lives or had life-threatening complications because their fertility doctors insisted on providing assisted pregnancies for them even when their ages pose health challenge?

It is therefore time such fertility hospitals were strictly regulated so they do not put mothers and babies into preventable health risks. The health of couples seeking fertility should be a priority before any other considerations.