Two of the least talked about methods of conception topics in Ghana; IVF Treatment and Surrogacy. Not only the least but itâ€™s almost like a taboo topic in most social circles and one most people will not comment on even on social media.
Despite these medical breakthroughs being an answered prayer for conception, some couples face stigmatization for choosing this route to have a child. Itâ€™s no wonder these couples keep their decision under wraps until the child is delivered and even then donâ€™t share their method of conception for fear of being shamed or criticized by family and friends.
Michelle Obama recently revealed how her two daughters were conceived via IVF in her bestselling book â€œ Becomingâ€ . I was surprised along with the millions of women who read that part. She also shared her miscarriage experience during an interview on ABCâ€™s Good Morning America “I think it’s the worst thing that we do to each other as women, not share the truth about our bodies and how they work.â€
Thereâ€™s a huge knowledge gap surrounding these available conception methods and I hope this interview with Dr. Owusu-Ansah a gynaecologist will shed more light and bridge that gap (hopefully).
NOQ: What is IVF?
Dr.Owusu-Ansah:Â IVF is short for in vitro fertilization. This is a conception method chosen by couples who are unable to conceive through natural or conventional interventions. In 1977, Steptoe and Edwards were the first doctors to successfully carry out a pioneering conception which led to the worldâ€™s first baby to be conceived by IVF. The first IVF baby is Louise Brown who was born on 25th July 1978, she turned 40 last year and has had babies of her own through natural means.
NOQ: Instead of an IVF what other methods are available for couples unable to conceive?
Dr. Owusu-Ansah:Â There are several. For conception to be possible the woman must be ovulating, her fallopian tubes must be open and this is done through a tube check. These are pre-requisites which must be in place. A couple must be also having sex at least every 48 hours or in adequate intervals. The man and woman are evaluated and based on the findings the best intervention is laid out for them. There are other options to stimulate ovulation in a woman and through natural intercourse a woman can get pregnant. Minor assisted conception techniques like IUI ( Intra uterine insemination) which is a fertility treatment that involves placing sperm inside a womanâ€™s uterus to facilitate fertilization and intra-cytoplasmic sperm injection (ICSI) a laboratory procedure where a single sperm is picked with a fine glass needle and is injected directly into each egg. IUI and ICSI were created for men with low sperm count
NOQ: Under what conditions is IVF done?
Dr. Owusu-Ansah:Â IVF is done when a womanâ€™s fallopian tube is confirmed to be blocked. So fertilization is required to be done outside the womanâ€™s body in an incubator and is brought back into the womb to implant. A womanâ€™s peak of fertility is around 22-24 years after which thereâ€™s a decline. After 38years of age, the eggs are not in a good shape and if this is discovered an IVF is suggested, also a womanâ€™s whose fertility age has declined will have her eggs examined to determine if she needs a donor egg ( a woman does not produce new eggs). A man with low sperm count will also be required to undergo assisted IVF, also in scenarios where the manâ€™s sperm and the womanâ€™s egg are not in good shape, both will require donor gametes ( donor sperm and donor egg). IVF is also required in cases where the woman is unable to physically carry the child which therefore means the use of a surrogate to implant donor gametes. If a couple want a specific gender after having other children with other genders, then they will be given the option to choose what gender they prefer through the IVF method but that comes at an extra cost.
If a woman has a medical condition which has been poorly controlled which prevents her from carrying then the IVF method will be indicated through surrogacy.
NOQ: How much does it cost to do an IVF treatment in Ghana?
Dr. Owusu-Ansah:Â It costs about an average of GHC 15,000 â€“ 40,000 for the spectrum of the treatment but this depends on whatâ€™s needed and that will be determined by the parameters you present after your medical history, after physical examination and a few investigations are conducted. This will ultimately determine the price involved for the treatment.
NOQ: What prevents the success of an IVF treatment?
Dr. Owusu-Ansah:Â Usually when thereâ€™s pre-existing medical conditions ( diabetes, hypertension, thyroid diseases etc, which arenâ€™t well controlled in the woman or man. The quality of the eggs and the sperm also contributes to the success of the treatment. The medications used during the treatment and the compliance of the patient can also be factors. The pre-existing medical conditions are treated before the treatment commences.
NOQ: What is the Success rate of an IVF treatment
Dr. Owusu-Ansah:Â the success rate is between 35-70%
NOQ: Are there sperm banks in Ghana? How does a man become a donor? Does he get paid?
Dr. Owusu-Ansah:Â Yes, there are sperm banks in Ghana, about 25 of them can be found across Ghana; Accra, Ho, Kumasi, Takoradi etc have IVF centres and these facilities have the capacity to freeze sperm that makes them potentially a sperm bank. To become a sperm donor, a man can walk in and get screened for infections and other genetic screening. Once you qualify, your sperm sample can be frozen for use. Sperm donors in Ghana do get paid but the amount varies from center to center.
NOQ: Can a woman decide to freeze her eggs until she’s ready to conceive?
Dr. Owusu-Ansah:Â Yes, a woman can decide to freeze her eggs until sheâ€™s ready to conceive or a man can also freeze his sperm for the same reasons. However, both have to bear in mind the cost associated with keeping either the egg or sperm in the cooler. The longer it stays in the more cost you bear and the cost can vary between $500-$1000 per year depending on quantity being stored. One thing to note is that you may not get back the same amount of eggs you froze in the initial stages, an example is if you freeze 10 eggs for a certain number of years, you may recover maybe 8 or 5 eggs which have satisfactory biological activity for fertilization. Freezing is not a 100% perfect process.
NOQ: What is surrogacy? What are the types?
Dr. Owusu-Ansah:Â Surrogacy is when someone carries a child for a woman who due to complications is unable to do so naturally. The child is carried till delivery. There are two types of surrogacy; traditional and gestational surrogacy. The traditional surrogacy is whereby the commissioning fatherâ€™s (commission parents are the couples who want the surrogate) sperm is used to fertilize the egg of the surrogate which makes the surrogate relate genetically to the baby. The other type; gestational surrogacy is when the surrogate is carrying a baby whose DNA sheâ€™s totally unrelated to. The commissioning father and motherâ€™s sperm and egg are put together in the lab, when the embryo forms itâ€™s placed in the womb of the surrogate for the 9-month period.
NOQ: How popular is surrogacy in Ghana?
Dr. Owusu-Ansah:Â Surrogacy in Ghana is on a slow rise in Ghana given our traditional conservative nature, but itâ€™s not very popular out there. It is also an expensive setup. Most IVF centres in Ghana have surrogates. Itâ€™s not an option that comes easily to most couples as most want to carry their own pregnancy.
Ghana doesnâ€™t have a clear-cut policy on surrogacy yet so the space/ landscape is prone to abuse as thereâ€™s no regulation. A few agencies run surrogacy services. The price involved in surrogacy is averagely GHC 150,000 for the whole process which includes IVF treatment, the screening test, C-section delivery and also compensation fee to the surrogate etc.
NOQ: Does surrogacy involve a written agreement since thereâ€™s no existing laws at the moment?
Dr. Owusu-Ansah:Â All proceedings are covered by a written agreement between all parties involved including medical staff, surrogate, commissioning parents etc.
NOQ: What are the steps involved in surrogacy as a method of conception?
Dr. Owusu-Ansah:Â Thereâ€™s an anonymous screening of the surrogate mother which includes psychological counselling, signing the consent form, delivery by C-Section and the baby given to the couple whilst the surrogate is compensated.
With regards to the commissioning mother, depending on her circumstances she may have to wear a fake pregnancy bump until the baby is delivered. This often happens due to the peculiar society she may belong to to create the impression of her â€˜pregnancyâ€™ and to avoid having to explain how she suddenly has a baby.
NOQ: Has there ever been a situation whereby a surrogate has refused to give up the child? How does this get resolved?
Dr. Owusu-Ansah:Â Some surrogates have been a bit resistant after delivery because they feel they havenâ€™t been adequately compensated or well treated during the 9-month period, whilst others feel an emotional bond to the child after delivery. Thatâ€™s why consent forms are signed before the process begins to prevent conflicts. If thereâ€™s any issue, discussions can be held to resolve any contentions.
NOQ: Is a child conceived via a surrogate completely disassociated from the surrogate’s genetic makeup?
Dr. Owusu-Ansah:Â We often discourage traditional surrogacy due to the emotional and genetic bond created between the surrogate and the baby.
NOQ: What are the associated risks in surrogacy?
Dr. Owusu-Ansah:Â The usual pregnancy complications can affect the surrogate, minor psychological issues may affect the surrogate especially after the child is taken away so she has to undergo counseling post-delivery. Most surrogates are taken away from their regular environment to a private place to avoid answering to people in her society which can be emotionally stressful.
NOQ: When the baby is to be born via a surrogate does the couple need to be present? What is their role during delivery?Â
Dr. Owusu-Ansah:Â The couple must be present during the delivery day but to avoid interacting with the surrogate arenâ€™t allowed in the delivery room but can be present in the building or close by the delivery ward.
With this in-depth knowledge about IVF and surrogacy in Ghana, I hope you have learnt something new and useful. We should be able to talk about infertility openly without fear or fear of being shamed. In a culture where couples are expected within a few months of getting married to conceive itâ€™s no wonder thereâ€™s secrecy and silence on the topic. Women/wives unfortunately are targeted by relatives, friends and even strangers when after a year of marriage a childâ€™s cry hasnâ€™t been heard in the household. The psychological stress on the woman is immeasurable in such a time. As we openly talk about miscarriages, infertility and other conception challenges, people will be better informed and learn to unlearn our attitude on such issues.