EXCLUSIVE: Why Surrogacy, IVF, other assisted reproductive technology techniques are gaining grounds in Nigeria – Medical Expert

A renowned medical professional with years of experience as a fertility consultant in both public and private practice in Nigeria, Dr Caleb Nwaneri has opened up on why expectant couples are exploring the assisted reproductive technology (ART) techniques to achieve their aims of becoming parents. 

Nwaneri in an exclusive interview with NewsClick Nigeria said Nigerian couples are exploring the options not because infertility is on the increase but because they (expectant couples) have more means people are more aware, and more educated.

According to him, the latest on the list of such exploration in ART is surrogacy. The others are In vitro fertilisation (IVF) and Intrauterine insemination (IUI).

“Surrogate is someone who helps another to achieve a purpose.  In medicine, especially fertility medicine, a surrogate is a young woman. Most times, it’s usually a younger woman who helps some older woman to carry pregnancy to fruition. This can be due to a number of factors including the older woman not having a womb  at all it could also be that she had a one but carrying  the pregnancy will be to the detriment of her health. But in essence it’s just a younger woman helping an older woman to carry pregnancy which in most cases,” Dr Nwaneri explained.

Surrogacy can be categorised into two types: traditional surrogacy and gestational surrogacy. Both are typically founded on the understanding that the child will be handed to the intended parents following delivery. When a woman becomes pregnant through traditional surrogacy, she donates her own egg, which is fertilised by artificial insemination, bears the embryo, and gives birth to a child on behalf of the intended parent. In this case, the surrogate mother contributes genetically to the conception, and is both the biological and gestational mother of the child.

Contrarily, in gestational surrogacy, also known as host surrogacy, a woman (the genetic mother) donates the egg, which is fertilised, and a different woman (the surrogate mother) bears the foetus and gives birth to the child. In this case, the surrogate mother merely serves as the gestational mother and does not contribute genetically to the conception of the child. Both methods of surrogacy are increasingly widespread in Nigeria, though traditional surrogacies are becoming the more popular option due to legal challenges such as the identity of the rightful mother often arising in gestational surrogacy.

 

Surge in surrogacy in Nigeria

On the recent surge in surrogacy in Nigeria, Dr Nwaneri said infertility numbers has not change but people are increasingly becoming more aware of the options available: “So I think the rate of infertility has not changed, I think it’s essentially been the same through the ages. But what has changed is the means. People have more means, they are more aware, and more educated. So information is more available to people. In those days, people make sacrifices or pray when they suffer infertility. So with the advancement of medicine people are more self aware that there are medical interventions, there are more expensive tests. So sometimes when we run these tests,  they do realize that maybe this person has blocked tube or a condition called Asherman’s syndrome where she may not be able to carry the pregnancy to term. If that is the case, there is a way out, get a younger woman, most times it’s preferable a relative, sometimes it will even be someone you do not know. Screen them and if they are healthy they carry the pregnancy. So yes, there is a surge, but not because infertility rates have changed. But because people are more aware or have more information, will have more access to treatments and people have more money for treatments,” he explained.

 

Other Trying To Conceive (TTC) options

“So, the most common for the reproductive treatment has to be IVF in vitro fertilization, which entails combining the male sex gamete and the female sex gamete which is the sperm and the egg, you put it back into the woman. So basically there is no surrogacy without IVF.  IVF is an artificial means of achieving pregnancy.  There is also what we call the IUI, intrauterine insemination, where maybe we’re dealing with the case of low sperm counts, so what we do is we get sperm, it undergoes a process called washing.  Even though count is low, the most active of that low count prepared,  and now inseminated so that they are in better position to live. If we don’t do that, that same person may not be able to achieve conception, he may not be able to impregnate his wife. The sperm may not be able to swim. But when you undergo that insemination, we’ve prepared them,  and we will push it deeper than the penis could get it in.

There are other reproductive treatments, there is the hormonal method. If the problem is hormonal imbalance, sometimes when the hormones are not balanced, the woman  just basically need some support. So to be able to achieve conception, hormones have to be in the right place. For such women we will continue to monitor, most times treat them with tablets and drugs till the hormones become balance. The commonest hormonal imbalance is Prolactin. This is the hormone responsible for reducing breast  milk. They are a number of women battling infertility who have prolactin. So the brain thinks they’re pregnant. But they’re not pregnant. The prolactin is exceptionally high, as high as it would have been if they were pregnant. So in that case, the brain thinks they’re pregnant and it will be difficult for them to get pregnant. Because when people are pregnant, they no longer ovulate so there is no egg production. That’s just few of them.”

 

How expensive is surrogacy in Nigeria?

“Well, I know it’s almost as expensive as the IVF procedure itself. So between two and five million naira, depending on what you want, and what the person want. People have different levels of greed. And you know that for someone that has agree to carry a pregnancy for nine months, it has to be because of the money.

It depends. On the average, what we’ve seen, it is between 2 or 3 million naira. You know a lot of things are involved, you’d have to get the services of a lawyer. Because there’s such a point between mother and child, most of these people begin to regret it and at the later stage, they no longer want to continue. Most times the surrogate and the family, they never get to know each other to avoid situations like I want my baby in the future. Although DNA will show that the surrogate is just like a nanny, she wont share the same DNA with the baby.

But there’s also what we call  the traditional surrogacy. Sometimes women in question doesn’t have womb, her ovaries are also tied or she just can’t produce eggs, they can go for traditional surrogacy which involves using the egg of the surrogate. This is more dicey and more expensive. legal frameworks would have to be more expensive too.”

 

Legal concerns

Nigeria is that kind of a country, I wouldn’t say lawless but we don’t really have law for it here in Nigeria. Unlike many other countries, Nigeria lags behind in surrogacy agreement regulation, which is disappointing considering the increasing number of surrogacy agreements entered into on a daily basis in the country. The closest Nigeria has come to regulation of surrogacy is the presentation of the Assistive Reproductive Technology (Regulation) Bill 2016.12 Regrettably, till date, that Bill has not been passed into law. Only Lagos State has passed guidelines on Assisted Reproductive Technology in 2019, the remaining 35 states in Nigeria and the Federal Capital Territory are yet to enact any legislation to regulate assisted fertility methods.

Despite this, surrogacy has not been criminalized in Nigeria, since it is not defined in any written law as an offence and no punishment is prescribed for it.15 As such, if a person engages in surrogate motherhood or enters into a surrogate contract in Nigeria, such a person cannot be said to have committed a crime.