In a move that is set to address catastrophic costs associated with accessing In vitro fertilisation (IFV) services, a team of Zimbabwean medical doctors is working with the government and the University of Zimbabwe (UZ) to establish a low cost IVF centre to run under the public sector healthcare system.
By Michael Gwarisa in Dubai
IVF is a process of fertilisation where an egg is combined with sperm in vitro. The process involves monitoring and stimulating a woman’s ovulatory process, removing an ovum or ova from her ovaries and letting sperm fertilise them in a culture medium in a laboratory.
While the burden of infertility has been on the increase in Zimbabwe owing to a plethora of factors ranging from dietary concerns, environmental issues and physiological issues, access to infertility treatment services such as IVF has been a thorn in the flesh for most couples owing to prohibitive costs as the service is currently being offered in the private healthcare sector.
According to a snap survey conducted by this publication, accessing IVF in the private sector costs between US$5000 and above, a situation that has forced most couples battling reversible infertility conditions not to access the service from the private sector.
However, once the low cost IVF centres open its doors to the public, prices of services will likely go range from US$500 to at least US$1,500 and even below.
In an interview with Health Times on the side-lines of the Merck Foundation Africa Asia Luminary 2022 in Dubai, Consultant Obstetrician, Dr Gerald Madziyire said the low cost IVF centre will try to take short cuts of other steps for conventional IVF so as to bring the overall cost of IVF down albeit cognisant of the need to maintain excellent quality of care.
For low cost IVF, we give less of hormones to stimulate their ovaries to produce more eggs. It is those hormones which push up the cost of IVF. If you are doing maximum dosing, you are likely to have the cost of stimulation being around US$1,300 so now we are just saying let’s stimulate minimally so that we reduce the cost to about US$500 for stimulation only,” said Dr Madziyire.
Laboratory costs also push the price of IVF up. However, the new public sector IVF centre will be handled by a government laboratory and this will reduce the embryology cost to around US$500. Embryology costs around US$1,400 at the moment in the private sector. As the service gets more numbers, the centre will be able to refine and cut down on the cost.
The University of Zimbabwe is the one funding construction of the IVF laboratory at the moment. The initiative is being pushed under the public sector and UZ and it will be housed in Harare. Dr Madziyire, Dr Tinovimba Mhlanga and Dr Mazhangara are currently the three medical doctors running with the project.
Dr Mhlanga was trained in various places, Dr Mazhangara trained in South Africa and Dr Madziyire is among the doctors from across Africa and Asia that have been trained by Merck Foundation. Merck Foundation has to date provided 1,470 scholarships to doctors in 50 countries.
“I was trained by Merck Foundation from November 2019 to February 2022 in India. I was trained in IVF and Reproductive endocrinology. I learnt how to evaluate infertility in patients, I learnt how to prepare them for IVF, taking them to theatre, stimulating them to produce eggs, harvesting the eggs and the whole process including fertilising.
“It’s a very technical aspect which I had not been exposed to. Further to that, through Merck’s Sponsorship again, I enrolled in the Diploma in Sexual Reproductive Health (SRH) and it was a very good Diploma which gave me a lot of theoretical background which is necessary for fertility work. What I acquired earlier on in India was doing scans which is essential for evaluating women with infertility.”
Dr Edem Hiadzi, President of the Fertility Society of Ghana (FERSOG) told Journalist during Media Training on the side-lines of the Merck Foundation Luminary that the World Health Organisation (WHO) is currently working on a low cost IVF plan for countries to ensure improved access to services for those in low and middle income settings.
“This low cost IVF will see citizens who can’t afford the service from various low resource settings actually accessing the service at very affordable rates. This will improve treatment outcomes for those with infertility. However, let us be cognisant of the fact that age is a factor in all this and I would advise those of reproductive age to take up IVF services. While it is a good thing to ensure everyone holds a child in their hands, I would advise those of advanced age to consider a number of issues before taking up IFV. For example, if you have a baby at the 70, the chances of you playing your parental role to that child are very slim,” said Dr Hiadzi.
Even though IVF services are on the pricey side, a number of Zimbabweans are embracing the technology and have had several babies delivered through the same channel. The in vitro (IVF) fertilisation programme which was reintroduced in Zimbabwe in 2016 by a team led by Dr Tinovimba Mhlanga has proved a great success with 197 live births recorded so far and more expected before the year ends.
With almost 500 treatment cycles having been performed this gives an overall average success rate of 39 percent, which compares favourably with the success rate in other countries. Dr Mhlanga pointed out, however, that the success rate varies with age.
“Women aged between 20 and 35 have the best chance of a successful outcome. Once you get to 40 years the success rate drops to 10 percent. At age 42 the odds diminish to five percent,” he said.
The success rate in the United Kingdom in 2019, according to the United Kingdom Human Fertilisation and Embryology Authority, was over 30 percent for women under 35, just over 25 percent for women aged 35 to 37, just under 20 percent for those aged 38 to 39, just over 10 percent at between the ages of 40 and 42 and just below five percent for those aged 43 to 44. The success rate rose steadily over the years to reach these levels.
Dr Mhlanga and his team began the in vitro fertilisation in 2016 in a laboratory attached to an operating theatre at a private clinic in Harare. They now have their own spacious IVF Zimbabwe Centre in Harare’s Belvedere suburb. The centre has consultation rooms, an ultrasound facility, pharmacy, general laboratory for chemistry, haematology and medical microbiology tests, operating theatre, recovery ward, the IVF Laboratory, maternity wards and labour ward.
“We have brought convenience to our patients. We are able to look after them and provide everything they need at the centre from the first consultation and tests to the birth of their baby,” Dr Mhlanga said.
“Because we are a specialist IVF centre, everyone here is trained to look after our sub-fertile patients with great care. This helps to destigmatise sub-fertility,” he added.
Dr Mhlanga rejects the notion of infertility preferring the term sub-fertility because, he says, infertile sounds final, when most people can become fertile with the help of modern medical procedures.
There is a special room at the centre for semen collection which is attached to the operating theatre. This allows men to produce semen in a comfortable environment, which has further helped men to come for tests and the actual IVF procedure.
In the ultrasound room there is a screen on the wall in front of the bed where the woman can see what the doctor sees on his screen beside the bed. In the operating theatre there is also a screen on the wall so that she and her partner can see the embryos that have been grown in the laboratory. This also allows them to see embryos being picked for embryo transfer. The embryo transfer is done under ultrasound scan guidance.
