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No respite for infertile couples as treatment cost skyrockets

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When Doris, a 30-year-old civil servant suffered series of successive pregnancy failures, she and her spouse were encouraged to seek specialized pregnancy care service.

Before then, the couple had tried to conceive for more than six years going from one doctor to another until a gynaecologist diagnosed Doris with incompetent (blocked) fallopian tubes and referred her to a fertility specialist.

After series of preliminary tests and investigations, the couple was advised to try Invitro Fertilisation, IVF, but was in for a shock to learn that it would cost between N1 million and N1.5 million for a single cycle of the procedure. This sum, it was gathered, excludes the cost of assessment, tests, drugs and other incidentals.

The couple’s anxiety escalated when it was made clear that for best results, patients undergoing IVF treatment are recommended to budget for a three-IVF cycle plan.

In Nigeria an estimated 90-95 per cent of IVF and other treatment costs are paid out-of-pocket with just a handful of patients having access to some form of financial support plan. Doris and her spouse belong to the out-of-pocket paying group.

The foregoing exemplifies the financial challenge of seeking assisted fertility treatment in Nigeria where raising children is already challenging under the prevailing economic downturn.

Though most infertile couples readily seek at least one type of fertility treatment, high cost is a major hindrance to achieving their dream of parenthood.

Reproductive health officials told Vanguard that for couples that require donor eggs, donor sperms, or donor embryos plus any additional form of third party intervention such as surrogacy or other technically specialized procedure, the cost is often several times more than that of a normal IVF cycle because there are additional charges to contend with.

Vanguard gathered that infertility treatment costs are not fixed across board, rather costs are usually personalised.

It was further learnt that major factors that determine the cost include the patients’ diagnosis, recommended procedure, as well as the location and sophistication of the treatment centre.

Most of the centres are based in Lagos in Ikeja, Surulere, Ikoyi, Victoria Island and the Lekki/Ajah axis. Several other centres are in the Federal Capital Territory, FCT, Abuja, Port Harcourt, and Asaba to mention a few.

Vanguard findings show that the cost of a routine diagnostic test for infertility ranges between N150,000 and N300,000. This may include semen analysis, blood tests for hormone levels, biopsy, genetic testing, etc.

A medical consultation along with an initial assessment may be offered at a one-time cost of around N100,000. A reassessment is often necessary after six months of the initial assessment at additional cost.

One of the ART consultants told Vanguard that the cost of a standard Intrauterine Insemination, IUI, cycle (including cost of drugs), ranges between N300,000 and N500,000 while subsequent/repeated IUI cycle goes for N250,000 and up to N450,000.

He explained that one of the key determinants of the cost is the location of the centre where the procedure is carried out.

Vanguard findings reveal that in Nigeria, the cost of a single IVF cycle in a decent centre or hospital begins from around N1.0 million up to N1.5 million excluding the cost of drugs. For a two-cycle plan, the cost is between N1.6 million and N2.6 million while a three-cycle plan is in the range of N2.1 million up to N3.6 million all excluding the cost of drugs.

If the cost of drugs is factored in, the overall cost could go up by at least an additional N1 million for each category.

Additional costs for other interventions

It was further disclosed by the practitioners that couples that require additional intervention pay extra.

For instance, the cost of opting for one cycle of a combination of IVF plus Intracytoplasmic Sperm Injection, ICSI, (a technically sophisticated procedure for addressing sperm related male-factor infertility) is between N2.0 million and N3.0 million.

Each subsequent cycle of IVF with ICSI combination is between N1.5 million and N2.5 million depending on the treatment centre.

For couples that require donor eggs, cost of a single IVF cycle is between N2.4 million and N3.1 million inclusive of screening of the donor but excluding the cost of drugs.

For two IVF cycles with donor eggs, couples pay from N4.8 million up to N6.0 million, while the cost of a three-cycle IVF plan with donor eggs goes between N5.5 million and N6.7 million inclusive of screening of the donor but excluding the cost of drugs.

Subsequent repeated cycles with donor eggs start from around N2.4 million per cycle with the cost of drugs adding at least N1 million extra to each category.

Vanguard learnt that if donor sperm is required for the IVF cycle, the costs vary, as sperm banks and fertility centres fix their own prices. The procedure per cycle is between N1.3 million and N1.8 million inclusive of insemination and screening of the donor but excludes the cost of drugs.

One frozen embryo transfer (FET) cycle including the cost of drugs ranges between N0.9 million and N1. 6 million depending on the centre and its location.

For couples that desire to preserve their embryos, the cost of embryo freezing per quarter (per embryo) at average of N100,000.

Other service charges

Endoscopy is an investigative /diagnostic procedure where a thin, lighted tube (endoscope) is inserted into the uterus to examine it for infections, diseases or any abnormalities.

The most frequently carried out gynecological endoscopy procedures are hysteroscopy and laparoscopy.

The cost of these procedures range from N300, 000 up to N3.0 million depending on the patient’s diagnosis/requirements and location of the fertility clinic or centre.

From findings, average cost of basic fertility treatment in Nigeria including consultation, investigation, counselling tests, drugs and follow up starts from a conservative N1.3 million.

Cost of surrogacy higher

If for any reason, a woman is unable to carry her own pregnancy, a surrogate can do it for her. Surrogacy is the involvement of a third party in the infertility treatment process. There are two types of surrogacy – traditional and gestational.

Traditional surrogacy uses the biological father’s sperm to artificially inseminate the surrogate mother who then carries the baby for the intended parents.

A traditional surrogate shares a genetic connection with the baby she carries.

For gestational surrogacy, IVF is utilised to create an embryo that is then carried by the surrogate, thus the surrogate has no genetic ties with the baby since her eggs are not used. This is the more commonly utilised method.

The average cost of gestational surrogacy varies and could range between N5.0 million and N8.0 million or more depending on whether or not it includes the IVF treatment fees, surrogate fee, diagnostic assessments, drugs, legal fees among other costs.

Overseas option still higher

Further investigation reveals that infertility treatment is even more expensive abroad. In the United Kingdom for instance, similar treatment procedures would attract around N3.0 million excluding the cost of visas, flight tickets, accommodation, feeding and other ancillary charges.

In the United Arab Emirates which has become the hub of medical tourism lately, the same treatment would attract up to N3.3 million; USA N5.5 million; South Africa N2.1 million; India N1.8 million; Germany N2.7 million; Spain N2.8 million; Denmark N2.6 million; Greece N2.3 million and Czech Republic N2.2 million

Practitioners explain the cost

Professor Osato Giwa –Osagie, renowned IVF specialist and Co-pioneer of IVF in Nigeria, says the high cost of IVF treatment in Nigeria is not unconnected with the poor state of the economy as well as infrastructural and manpower challenges in the health sector.

Giwa-Osagie encouraged the setting up of even more fertility centres as well as intensive financial support.

“Most of the things utilised in IVF are imported and some are consumables that are used just once and discarded.

“Getting appropriately trained and qualified personnel like the nurses, embryologists and clinicians is still a challenge.

“The equipment is expensive and most centres have to acquire more than one, sometimes two or even  three equipment of the same kind for just one procedure because of the issue of maintenance locally. All this adds to the cost.”

According to the “Biological and Social Aspects of Human Infertility: A Global Perspective” published in the Oxford Research Encyclopedia: “Progress for lower-cost state-of-the-art infertility treatment options is desirable.

“However, progress will depend on getting policies right, building health systems that work well and ensuring availability of enough trained medical staff.”

Nigeria’s health funding

For Nigeria, this would include an increase in per capita expenditure within the health system to meet WHO recommendation.

Nigeria has been far behind the recommendations and also behind peer group of nations in healthcare funding, a situation that has forced almost all infertility treatment to be on out-of-pocket expense.

In 2018, as stated by the latest available data by the World Bank, the per capita health expenditure for Nigeria was $84.

In comparison, figures for other developing countries are: Algeria $256, Brasil $848, Gabon $218, Ghana $78, India $73, Kenya $88, Mexico $520, Namibia $471, Pakistan $42, Rwanda $58, Senegal $59, South Africa $526, Tunisia $252, and Uganda $43.

Nigeria has never met the Abuja Declaration target of allocating at least 15 percent of the overall national budget to health.

The closest that the country has got to the target was in 2012 when N289, 770 billion or 6.23 percent of the N4, 648,849 billion federal budget was allocated.

In 2001 when the Abuja Declaration was made, the federal health budget was N41, 269 billion which was 4.46 percent of the N894, 214 billion overall federal budget.

The lowest percentage allocation to health since the Declaration was in 2010 when N185, 765 billion (4.20 percent) of the N4, 427,184 billion federal budget was allocated.

In 2021, the federal allocation to health is N604,191 billion, or 4.45 percent of the N13, 588, 027 billion federal 2021 budget.

This is lower than in 2020 when N575, 228 billion or 5.32 percent of the N10, 810.800 billion federal budget was allocated.

Vanguard News Nigeria

Health

Resident doctors threaten strike, gives FG two-week ultimatum 

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The Nigerian Association of Resident Doctors (NARD) has given the Federal Government a two-week ultimatum to implement the agreement reached on the welfare of its members.

The association gave the ultimatum after its national executive council meeting on Saturday in Lafia, Nasarawa State capital.
The association said should the FG fail to comply with its demands, it would embark on an industrial action.

The communique was signed by Dare Ishaya, NARD president; Suleiman Abiodun, the secretary-general, and Alfa Yusuf, publicity and social secretary.
“The NEC observed with dismay, the unnecessary delay in the implementation and payment of the new Hazard Allowance for over seven (7) months since its approval on 22nd December 2021 in a circular with reference No. SWC/S/04/S.218/11/406,” the communique reads.
“The NEC observed that the skipping arrears covering 2014, 2015 and 2016 have remained unpaid despite several negotiations with the Federal Government over the matter.”
The association alleged that years after the implementation of a new minimum wage, some of its members are yet to benefit from the adjustment.
NARD also expressed displeasure over the condition of its members in Imo, Ondo, Ekiti and Gombe states who are “owed 10, 5, 3 and 2 months respectively”.
The association urged the federal government to expedite action on the payment of the newly reviewed Medical Residency Training Fund (MRTF).
“The NEC demands the immediate implementation and payment of the new Hazard Allowance and arrears as contained in the circular from the National Salaries, Income and Wages Commission (NSIWC) dated 22nd December 2021 with reference number SWC/S/04/S.218/11/406 within two (2) weeks, ” the communique read.
“The NEC demands immediate payment of consequential adjustment of minimum wage to our members who have been deprived this benefit since it was implemented several years ago.
“The NEC demands an immediate review of the Consolidated Medical Salary Structure (CONMESS) and other related allowances given the current economic situation in the country, and also in line with the agreed terms from the previous Collective Bargaining Agreement (CBA) that it will be reviewed regularly.
“The NEC enjoins the Federal and all State Governments to look into the issue of assault on doctors and thoroughly investigate the ongoing cases and put measures in place to nip this menace in the bud to forestall future occurrences, as these inhumane acts have affected our members both physically and mentally.
“The NEC urges the Federal Government to take steps toward curtailing the brain drain in the health sector and find ways of eliminating all bureaucratic bottlenecks in the employment and replacement of the Resident Doctors leaving our institutions daily to seek greener pastures.”
The association said it will reconvene in two weeks to review the “progress made so far and take further actions for which nationwide industrial harmony may not be guaranteed.”

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NIMR Discovers New Severe Malaria Vector In Northern Nigeria

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The Nigeria Institute of Medical Research (NIMR) says it has discovered a new malaria vector named Anopheles stephensi in northern Nigeria.

According to Wikipedia, Anopheles stephensi is a primary mosquito vector of malaria in urban India and is included in the same subgenus as Anopheles gambiae, the primary malaria vector in Africa.

It is a highly competent vector of Plasmodium Falciparum and P. Vivax, considered an efficient vector of urban malaria.

The Anopheles stephensi mosquito has long since been considered an Asian malaria vector. It is native to parts of South-East Asia and parts of the Arabian Peninsula

Director General of the Institute, Professor Babatunde Salako, told newsmen in Lagos during his 63rd birthday ceremony on Monday night that the discovery was one of the institute’s recent research discoveries.

The vector, according to him, spreads malaria called plasmodium falciparum.

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He described the vector as a rugged one that is very difficult to eradicate.

“This has implication for malaria control in Nigeria because hitherto, the vector was known in West Africa sub-region,” he said.

Professor Salako further disclosed that the Institute is currently looking at vaccine development as a lot of studies have been done. According to him, the institute is working with five groups in a consortium to develop local vaccines in Nigeria.

He explained that development of vaccine, which the institute is into, is different from vaccine production.

The idea behind the vaccine development, he said, is to ensure that Nigerian researchers are able to learn the development process from the beginning to the end.

“This is important so that when we have a new epidemic or disease, known or unknown, it would be possible for Nigeria to develop its own vaccine,” Salako added.

He further disclosed that the institute is working on testing 2,000 people in Nigeria with a view to knowing whether the three COVID-19 vaccines evoked a response or not and also also to know how long it can be effective in their bodies.

“The essence of this is to know the effectiveness, side effects and responsiveness of human body to COVID-19 vaccines,” he said.

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Monkeypox common among gay men – WHO

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The monkeypox outbreak is prevalent among men who have sex with men, the World Health Organisation (WHO) has said.

The WHO Director-General, Tedros Ghebreyesus, said this on Saturday at a media briefing where he declared the multi-country monkeypox outbreak a public health emergency of global concern.

He said, “So, in short, we have an outbreak that has spread around the world rapidly, through new modes of transmission, about which we understand too little and which meets the criteria in the International Health Regulations.

“Although I am declaring a public health emergency of international concern, for the moment, this is an outbreak that is concentrated among men who have sex with men, especially those with multiple sexual partners.

 

“That means that this is an outbreak that can be stopped with the right strategies in the right groups.

“It’s therefore essential that all countries work closely with communities of men who have sex with men, to design and deliver effective information and services, and to adopt measures that protect both the health, human rights and dignity of affected communities.”

A study published on Thursday in the New England Journal of Medicine also revealed that cases of monkeypox are prevalent among men who have sex with  men.

According to the study, out of 528 infections diagnosed between April 27 and June 24, 2022, at 43 sites in 16 countries, 98 percent of the persons with infection were gay or bisexual men.

“These data point clearly to the fact that infections are so far almost exclusively occurring among men who have sex with men,” said Jennifer Nuzzo, an epidemiologist at Brown University.

“And the clinical presentation of these infections suggest that sexual transmission, not just close physical contact, may be helping spread the virus among this population.”

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