Infertility is a major public health issue in Nigeria and it is estimated that approximately 1 out of every 4 couples will experience some difficulty in achieving a pregnancy. The treatment of infertility is difficult and since the introduction of In Vitro Fertilization (IVF) in 1978, IVF has evolved to become the cornerstone of fertility treatment and all over the world and most couples experiencing delay with conception will require IVF (and Intra-cytoplasmic Sperm Injection) (ICSI) to achieve pregnancy.

The Bridge Clinic was set up to provide high quality fertility treatment including IVF (and ICSI) to Nigerians in Nigeria. Our Lagos clinic began operations in 1999 and our Port Harcourt Clinic in 2003. Since inception, we have completed over 4,000 IVF/ICSI treatment cycles with the birth of 923 babies as at January 2009 following treatment at both clinics.

It is a legal requirement in developed countries like the United Kingdom (UK) that all clinics carrying out fertility treatments that involve human gametes such as IVF are licensed by the Human fertilization and Embryology Authority (HFEA). Unfortunately there are no such regulatory authorities in Nigeria, but at The Bridge Clinic we recognize the importance of such regulation and we have always functioned as if we were one of the clinics regulated by the HFEA.

The HFEA advices that IVF clinics set up an ethics committee to supervise their activities and ensure that all these activities fall within the moral and ethical framework of the society. The Bridge Clinic set up an ethics committee in 1999 as one of the conditions for the involvement of our technical partners from Kings College Hospital, London. Our ethics committee has set up guidelines within which the activities of the clinic are regulated. For example, all clients requesting surrogacy arrangements must be presented to the ethics committee on case by case basis as are all single women requesting the use of donor sperms to name a few. We have found the ethics committee extremely useful over the years. Similarly, the HFEA mandates that independent counseling services be available to all clients attending the clinic to assist with the difficult decisions the couples have to make during fertility treatment. The Bridge Clinic implemented independent free counseling services as one of our service offerings to all our clients since 2000.

The European Tissue and Cells Directive (2006) mandates that all clinics carrying out IVF, implement a quality management program according to ISO 9001:2000 guidelines and most of the clinics in the United Kingdom are now getting certified as inspections starts in April 2007. The Bridge Clinic anticipated this initiative and we received international certification of our quality management system according to ISO 9001:2000 guidelines from TUV Austria as early as 2004 well ahead of most of the clinics in the United Kingdom.

The widely publicised problems with gamete mix up in two UK Clinics led the HFEA to mandate that all clinics carrying out IVF services introduce a witnessing program to control all activities that involve the handling of human gametes to eliminate the risk of gamete mix up. The Bridge Clinic introduced a witnessing program as an essential part of our treatment program in 2003.

The HFEA performs an annual audit of the results of treatment from all licensed clinics in the United Kingdom and publishes these results in the HFEA annual report which is available on the internet. We have always had informal audits from Dr Virginia Bolton formerly of Kings College Hospital now at St. Thomas Hospital, London, who is also an HFEA inspector, and Dr. John Parsons of Kings College Hospital, London but we have not published the results of these audits. These published results are an important guide to clients seeking IVF treatment and as part of our objectives of providing quality IVF services in Nigeria; we have invited the international audit firm of Akintola Williams Deloitte to carry out a verification exercise of the results of treatment at The Bridge Clinic.

The results show that by the end of 2006 we had carried out 3,180 cycles with one out of every couple having embryo transfer achieving a pregnancy. These results are comparable to the results obtained from clinics in the United Kingdom. A young couple trying to achieve pregnancy in their bedroom have a 25% or 1 in 4 chance of achieving a pregnancy every month. This is the same chance that IVF provides. However, natural conception does not cost money and if a pregnancy does not occur this month then we try for the next. Unfortunately, the level of financial and emotional involvement with IVF treatment is such that every client that subscribes for IVF treatment expects to achieve a pregnancy and this leads to unrealistic expectations about IVF treatment. Of course some people conceive in the first cycle but the reality of the treatment is that most couples must expect to carry out up to three or sometimes more cycles in order to conceive.

IVF treatment is frequently seen as a last resort to fertility management and most couples tend to present for treatment in their late 30's and early 40's. The Age analysis of the results shows that the pregnancy rates are better for the younger woman and women in their late 30's and early 40's have lower chances of conception with IVF treatment and a lot of these older women will require donated eggs from younger women to conceive. A more proactive approach to fertility management is encouraged and couples are advised to present for treatment earlier so as to achieve their desire of conceiving a pregnancy.

The Bridge clinic is absolutely committed to the provision of services that can rival that which is available any where else in the world. We believe that there is only one standard of healthcare and that standard is prescribed by international best practise. Our clients in Nigeria only have to get on an aeroplane to travel abroad to access that standard and if we want to remain relevant to them we must provide services that are comparable to international best practices. The fact that we operate in Nigeria with our economic and infrastructural difficulties does not absolve us of this responsibility. This philosophy underscores all that we stand for at the Bridge clinic.

Quality is expensive and it has been argued that we need to focus on the provision of low cost IVF services in Nigeria since most of the beneficiaries can not afford quality IVF services. We believe that quality is not negotiable in the provision of health services and we need to focus on strategies to provide low cost but quality IVF services to those that cannot afford it.

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