Botswana has a fertility clinic.
It is called Gaborone Fertility Clinic. It is a revolutionary facility with modern state-of-the-art technology to perform complex medical procedures. It also offers hitherto unheard of services such as In Vitro Fertilisation (IVF).
The clinic opened in April this year and is located somewhere in Gaborone. It is the brainchild of pioneering scientist, Dr. Vincent Molelekwa, a reproductive medicine specialist; endoscopic surgeon, obstetrician and gynaecologist among his many caps.
The mesotherapist and beauty consultant has also worked at Princess Marina Hospital as obstetrician and gynaecologist as well as Hospital Superintendent from March 2011 to February 2014 and as Head of Department from May 2016 to March 2017, where he worked as reproductive medicine specialist and endoscopic surgeon.
He also boasts administrative capabilities as former acting Deputy Permanent Secretary for Clinical Services in the Ministry of Health from March 2013 to February 2014.
On a hot Saturday afternoon Botswana Guardian reporter sat down for a chat with the jovial unassuming intellectual who graduated with Distinction in Medical Ethics at NUI Dublin, Ireland including Honours in Biology, Histology, Physics, Chemistry, Anatomy, Biochemistry, Physiology, Pharmacology, Microbiology and Pathology.But no place could prepare and fine-tune him for his current calling than the University of Stellenbosch in South Africa where under the supervision of Dr. Thabo Matsaseng, Prof. Igno Siebert and Prof. Thinus Kruger, he did his Fellowship Training in reproductive medicine from February 2014 to May 2016.
As we sat down for the interview, in his Clinic, we began by asking him what In Vitro Fertilisation is.“It is an assisted reproductive technology that is used to help couples that are unable to reproduce through the normal reproductive process to conceive,” is the unambiguous response of a confident scientist. Initially, he says, the technology was used in cases where the female patients had damaged tubes, where fertilisation cannot happen in the fallopian tubes.“Fertilisation happens in the fallopian tubes in the normal course of reproduction, so in cases where the patients had damaged tubes or blocked tubes or absent tubes, we then have to do that process in the lab, where the lab takes over the function of the tubes and then fertilisation happens there and then the baby is returned into the mother’s womb.”He says that the process of IVF can be understood in the context of what happens in nature because IVF aims at reproducing what actually happens in the normal process of fertilisation as it happens in the tubes.He says that in Nature what happens is that generally the brain through a gland called the Pituitary stimulates the ovary to produce eggs.
“Normally about eight to eleven (11) eggs are recruited and then in the normal course of events in the first half of the menstrual cycle, one of these eight eggs is selected and then the remaining ones die away and then one egg is ovulated.”
This ovulated egg is then picked up by the Fallopian tube, which he says should be understood as a hand. “It is an arm and hand. It captures this egg and since it (tube) has a hole in the middle, so this egg will basically start migrating towards the Uterus.
“In this segment of the tube there is a portion that is called the Ampulla. At this point it is a little bit narrow, it narrows rather quickly. The egg will spend around about 50 to 80 hours negotiating to enter into that narrow portion of the tube.
“This place is where the sperm will find the egg negotiating this passage. It is the place where fertilisation will happen.
“Now from this point following fertilisation the newly formed embryo, the zygote, will now start splitting into two, it is now no longer an egg, it is a new individual with a new chromosomal complement, so it splits into two, those two will grow to the original size of the egg then they break again into two. “And so this process continue happening along its journey towards the Uterus. What is important is that in the fallopian tube along this passage the fallopian tube will produce a particular kind of nutrients that are required by this newly-formed zygote.“The food within the fallopian tube is not the same as that in the Uterus, so it is specific. So as it divides it is fed with this food in the fallopian tube. It will reach the Uterus after three to five days. “During this process it would have undergone several divisions and these cells are forming into a ball. Around that time this egg will basically have about 32 to 64 cells. At that point the inside cells die away and leave a small hole, we call it a Morula, it is a blastocyst. “The egg therefore enters into the Uterus during that phase of its development called the Morula three to five days after fertilisation. Now at that point basically it buries itself into the Uterus, where it starts eating new kind of food.“The process of IVF mimics this entire process. It has two phases. The initial phase is the stimulation phase. Remember the Pituitary stimulates the ovary, so here, whereas the normal stimulation produces one egg, in IVF we aim at producing between eight and 15 eggs,” he said.
And during this phase the woman is injected with the same substances that are being released by the Pituitary gland in a process that usually takes 12 to 14 days.
“We recruit the eggs and we grow them until they are about two centimetres, this again mimicking the normal processes. At that point we then inject them with another hormone that is again produced from the Pituitary in the normal course of events, and this matures the eggs and prepares them for ovulation. “Within about 35 hours after injecting that hormone, the eggs will then start ovulating as it happens in the natural process. Because we want to harvest the eggs we then take the patient and harvest the eggs.”It is at this point that the male is introduced. “We also harvest the sperms from the male and then we can do one or two things. If the male sperm is normal we do conventional IVF that is the standard or traditional IVF. “We take the egg put it together with the sperm. We need about 500 000 sperms per egg. Then we incubate them.“Now from this point onwards IVF now happens in the lab. Remember IVF is in vitro fertilisation, in vitro means outside the body that is fertilisation happening outside the body, whereas fertilisation that happens inside the body is called in vivo fertilisation. “So after harvesting that’s when we now get into IVF, the fertilisations part. So we take this one egg and 500 000 sperms and incubate them. And then about 18 hours after you have put them together fertilisation happens.
“You’ll see evidence of fertilisation by seeing two little eyes in the egg, this would be the chromosomes coming from the mother and another package coming from the father, they start at a distance they’ll come together and fuse to create a new being, the zygote.
“At that point onwards you start giving them the appropriate food. Between day three and day five you can take the small embryo and put into the Uterus as normally happens in the normal process.“Now if the sperm is not normal, if there is a problem in the sperm either because the sperm number is low; or the mobility or movement of the sperm is compromised or it can be there is a problem with morphology (sperms not well formed, physically retarded) in this case you do a more specialised form of IVF.
“In this case you look under the microscope and select the best sperm and do fertilisation yourself that is you inject it into the egg, whereas in the natural course it’d do that itself, in this case you inject it, and from that point onwards 16 hours later with this form of IVF, fertilisation is confirmed.“Then further development from that point onwards is exactly the same as if you were doing conventional fertilisation, then you transfer the embryo back between three to five days into the mother’s womb. “That is basically IVF it’s as simple as that, nothing complicated!” Dr. Molelekwa says the expensive part of the technology is setting up of the IVF lab, which requires very specialised equipment.It requires three labs in one to do IVF. There is the Andrology Lab or Seminology Lab, where after the male gives his sperm it is assessed; cleaned and concentrated in a process that eliminates all debris (noise that impedes fertilisation), dead and immortal sperm and concentrate to give sperm that is more mobile and without debris.Then there is the actual IVF Lab itself where you need Lamina Flow cabinets; Microscopes and Incubators which will help in the process of incubating the baby and so forth.
If in this process there are embryos remaining after some have been transferred into the womb, then these embryos need to be frozen, hence the need for Freezing Lab where the embryos that remain after the IVF cycle are frozen. This eliminates the need for repeat stimulation in the case where the IVF process is not successful. This also saves the patient money because she will just unfreeze the frozen embryo and transfer them into the mother’s womb rather than start the whole process all over again.IVF also requires the right staff- the Embryologist. The scientists are extremely critical no IVF Unit can be run without them, they are highly specialised lab technicians and don’t come cheap they are paid like specialist doctors.The disposables, the materials, reagents are also required for the Clinic. They are not found locally, only sourced from Europe and America, thus making the technology out of reach for ordinary folks. It is very expensive, considering that medical aids don’t cover it neither does government subsidise it.Dr Molelekwa attributes his passion to rigorous training, which entails basically going back to school and being ‘cooked’ in sub-speciality training in fertility medicine.
As for enabling law in Botswana, Dr. Molelekwa says like anywhere in the world where IVF was first started, there is always a vacuum.
There is no law that enables or prohibits. The law eventually “catches up” with the practice.
Here at home this technology would be provided for under the Public Heath Act. In some cases Surrogacy (rent a womb) may also be required for assisted reproduction (IVF).
These conditions will ultimately require a change of law, for example to redefine who a mother is. Under the current dispensation, the law recognises the mother as one who gives birth to a child, so it may require amendment to provide for commissioning parents.