October 2, 2023

Dr. Abayomi Ajayi

Esther was 38 years old and her husband, Kunle, was 40 when they began investigating the cause of their infertility. They were married for four years and longing for a child when they finally opted to visit a fertility centre in Lagos.

Following a series of basic and routine tests, some issues were discovered that were preventing conception, so the couple was recommended to undergo in vitro fertilisation (IVF).

Under the supervision of their specialist, Esther had the IVF procedure. She was monitored and stimulated to produce eggs, as sperm collected from Kunle fertilised the eggs in a laboratory.

Two embryos were implanted in her uterus, and the other two were frozen. Unfortunately, the goal of establishing a successful pregnancy was not attained.

With the failure of IVF, the couple was advised to better pursue intra-cytoplasmic sperm injection (ICSI). In the ICSI process, a single sperm was injected into the centre of the egg. The fertilised egg (embryo) grew in the laboratory for up to five days before it was transferred to Esther’s uterus (womb), but surprisingly, there was no positive result the second time around. Esther and Kunle dumped that fertility clinic and changed their specialist.

At the new clinic, they went for a series of counselling and in the end, the IVF and ICSI process was repeated but with no success. The specialist carried out more laboratory tests and then recommended that Esther was to have new five-day embryo transfers. The couple agreed and proceeded with the recommended method, but that one too failed. Esther did not conceive.

Following the series of disappointments, the couple visited yet another fertility centre. They had a consultation with another specialist who investigated their history and advised that they did a comprehensive reassessment. After an investigation of all the clinical findings, another cycle of IVF/ICSI and embryo transfer was recommended. As soon as the eggs were recovered, they were fertilised with the appropriate sperms.

But this time, another procedure was introduced. After eight eggs were retrieved from Esther’s ovaries, then fertilised with fresh sperm from Kunle, six embryos were created. Two of the eggs did not fertilise.

The embryos divided and multiplied over five to six days to become blastocysts. In the cycle, the blastocysts developed in the laboratory, afterwards, the blastocysts were sent for a special test known as Pre-implantation Genetic Testing with Aneuploidy screening (PGT- A).

It was discovered that only two of the six embryos were genetically normal while the remaining four were abnormal. Normally, embryos that survive the blastocyst stage of development have a high implantation potential once transferred into the uterine cavity. However, all the embryos transferred during Esther’s previous IVF cycles had either not implanted successfully after the transfer or implanted and then aborted spontaneously shortly after that.

The physician explained that Pre-implantation Genetic Testing with Aneuploidy screening was a procedure that would enable the clinic and doctors to determine the chromosomal status of the embryos that she had produced through IVF by screening all 23 pairs of human chromosomes in each of the embryos. The couple was made to understand that only embryos with the correct number of chromosomes could implant successfully and develop into healthy baby.

Through the test, it was possible to identify the embryos that had chromosomal abnormalities and separate them from the embryos that were normal.

Thus the physicians were able to select the most normal embryos and transfer them for implantation — increasing the likelihood of pregnancy per transfer while reducing the risk of miscarriages. The two normal embryos were transferred.

Esther confessed that she felt pregnant as soon as the transfer was completed. This was confirmed by a pregnancy test and later ultrasonography. The pregnancy was uneventful. Nine months later, Esther gave birth to her beautiful daughter, Francesca.

It was a dream come true. This was about a year ago. The couple has since returned to the fertility clinic for another appointment to set up another IVF procedure. Esther is now expecting her second child. A scan has revealed that the unborn baby is a boy. The combination of IVF and PGT gave Esther and Kunle hope for starting and completing their family.

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