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Pregnancy without sex!


Uganda's first 'test-tube baby' is expected mid next month. Dr. Edward Tamale Ssali, the director of the Nordica Kampala Fertility and Gynaecological Centre, said he had fertilised eggs in a dish and implanted the embryos into several women.

At least two are now in advanced pregnancy. One of them has gone to deliver in Britain, while the other will deliver in Kampala, said Ssali. "I can only pray that this technology stays and we teach more Ugandan doctors how to do it," he said.

The treatment, Ssali said, was done to help couples who had failed to get babies naturally. Some men have too few sperms to cause a pregnancy naturally. A few have no sperms in their semen. Others fail to ejaculate. In women, the fallopian tubes might get blocked or the ovaries may not produce eggs normally or the uterus has a problem.

The process of producing a 'test tube baby' begins with the use of medicines that stimulate a woman's ovary to produce eggs. When the eggs mature, they are sucked out of the ovary and placed in a dish.

The team then collects sperms from the man by making him ejaculate or using a needle to suck sperms from the testis. They then inject a sperm cell into each egg to achieve fertilisation. The alternative method is to simply allow sperm cells to swim towards the egg and fertilise it.

Two to five days after fertilisation, the embryo is implanted into the uterus using a catheter passed through the cervix. Normally they fertilise several eggs at ago and store the surplus embryos so that if the first implantation fails, there are more embryos to implant.

The process is called in-vitro fertilisation (IVF). Laypeople coined the expression 'test tube babies' because they imagined it is done in a test tube.

Ssali said apart from helping infertile couples, IVF also enables an HIV negative woman to safely have a child with an HIV positive man. This is particularly recommended for HIV discordant couples where a man has HIV and his wife does not. Such couples are usually advised to use condoms. But if they want a child, the man's sperms can be washed and then used to fertilise the woman's egg.

"It is well known that HIV does not attack the sperm. It is only in seminal fluid. Before we inject the sperm we can test to make sure it does not have HIV," said Ssali.

Prof. Peter Platteau, an IVF expert at the Free University of Brussels, Belgium, cautioned that not every woman given IVF would successfully carry the pregnancy.

At the first trial, more than half the embryos will fail to settle in the uterus. The best chances of success with this treatment are among young women in their twenties.

The IVF technology, he said, also helps sickle cell carriers to produce babies who are not sicklers. Doctors fertilise the woman's eggs using her husband's sperms then test and select only the normal embryos.

It is also done for couples that want to select either a boy for medical reasons, say if all their male offspring would have a genetic abnormality. "We don't do it simply because you want to have a boy or girl," Platteau said.

Ssali said they were still working out the costs of doing IVF. It will be more than $2,500 (sh4.3m). Other factors like tests and drugs affect the cost.

While excited about the arrival of IVF in Uganda, Prof. Florence Mirembe, a senior consultant gynaecologist, said 70% of the infertility in Uganda is preventable. "If you look at the causes, they are mostly infections, abortions and delivering in unsafe places. If we make sure mothers come for antenatal services, deliver in safe places, don't get infections and don't abort, we will cut out all these," she said.

Test tube baby history

-First IVF baby born in 1978 in Manchester, UK.

-She now works as a nurse in UK.

-More than two million babies have been born through IVF

-17% of couples in UK who undergo IVF succeed in getting a baby


All articles are republished on AEGIS by permission. Material may not be redistributed, posted to any other location, published or used for broadcast without written authorization from Managing Director/Editor-in-chief, The New Vision, P.O. Box 9815, Kampala - Uganda, Tel/fax: 256-41-235221, E-mail: 

Information in this article was accurate in September 8, 2004. The state of the art may have changed since the publication date. This material is designed to support, not replace, the relationship that exists between you and your doctor. Always discuss treatment options with a doctor who specializes in treating HIV.