Infertility remains a growing concern for many couples in Uganda, with a significant number struggling to conceive naturally due to medical, hormonal and structural factors.
In this interview with Matooke Republic, Dr Ramin Tavakoli, an obstetrician and gynaecologist at UMC Victoria Hospital, explains what in vitro fertilisation (IVF) is, how the procedure works, who needs it, the costs involved, the risks and success factors, and what hope it offers to couples seeking to start a family.
What is IVF and how does it help couples who cannot conceive naturally?
In vitro fertilisation (IVF) means fertilisation outside the body. We use IVF for couples who have difficulty conceiving naturally. In Uganda, statistics vary, but about six to twenty per cent of couples may have difficulty, especially in the first year of trying.
In about sixty per cent of cases there may be a female factor, in about thirty per cent a male factor, and in about ten per cent the cause is unexplained.
Among the female factors, there may be abnormalities in the physical structures. For example, the fallopian tubes may be blocked or there may be abnormalities in the shape of the uterus. These can be congenital, such as a bicornuate uterus, or acquired, such as fibroids that distort the uterine cavity.
Apart from physical abnormalities, there may be hormonal problems that prevent ovulation. If ovulation does not occur, the egg is not released and conception cannot happen. One common condition is polycystic ovarian syndrome (PCOS), which makes regular ovulation difficult. Other causes include disorders of the hypothalamus or pituitary gland, excessive prolactin secretion from the anterior pituitary, or thyroid hormone imbalance. All these can lead to ovulatory failure and difficulty conceiving.
On the male side, there may be erectile dysfunction, low sperm concentration, abnormal sperm structure, or poor sperm motility.
These are the main reasons that may lead us to recommend IVF.
IVF involves giving the woman hormonal medication to stimulate the ovaries to produce follicles. The eggs (oocytes) mature within these follicles, and after about ten to fifteen days we harvest the mature eggs. At the same time, we obtain sperm from the partner. The eggs and sperm are then combined to form embryos. We then prepare the uterus and transfer selected embryos into it, supporting the process with hormonal medication to create a suitable environment for pregnancy.
Normally, an ejaculate contains about 120 million sperm. Sperm must travel from the cervix through the uterus into the fallopian tube to meet the egg. When the sperm count is low, many die along the way and the chance of pregnancy is very low. With IVF, we can select the available sperm and use them directly. Even if sperm are present but immotile, we can still retrieve and use them for the IVF process.
How long does the IVF process usually take from start to finish?
It takes around three months.
What are the main steps involved in an IVF procedure?
First, we identify a couple that requires IVF. Second, we carry out investigations and determine the most appropriate protocol. Third, we give hormonal medication to stimulate egg development in the ovaries. Once the eggs are mature, we harvest them, obtain the sperm, fertilise them to form embryos, and then transfer the embryos into the uterus.
What challenges do you face during the process?
It is a demanding process for the patient because it requires regular follow-up. Patients often need to come to the hospital daily for monitoring, including frequent ultrasound scans. This is a significant burden, and we must keep patients motivated to attend consistently and to accept the necessary tests. It is also an expensive process, and the cost is ultimately borne by the patient.
How do you ensure the safety of both the mother and the baby?
Through constant monitoring. We perform daily scans to assess follicle development. If the follicles grow too quickly, we reduce the medication dose; if the response is poor, we increase it. If there is discomfort, we provide pain relief.
We also use pre-implantation genetic testing. Once embryos form, we can remove a few cells and analyse them for genetic abnormalities. For couples at risk of conditions such as cystic fibrosis or sickle cell disease, this allows us to select and transfer healthy embryos. For example, if both partners are sickle cell carriers, there is a significant risk of having a child with the disease, so screening helps prevent this.
What factors determine whether IVF will be successful or not?
One of the main indicators is ovarian reserve. If a woman has a good number of healthy eggs, the chances of success are higher because more embryos can be formed and transferred. Healthier eggs produce stronger embryos, which are more likely to implant and sustain a pregnancy. Some embryos form but do not implant, resulting in an unsuccessful cycle.
Is IVF safe, and are there any risks patients should know about?
IVF is generally safe, but every procedure carries some risks. Patients may react to the hormonal medication with itching or pain at the injection site, and some may have allergic reactions requiring discontinuation.
There is also a risk of ovarian hyperstimulation syndrome, where the ovaries over-respond and produce too many follicles. Egg retrieval and embryo transfer are performed under anaesthesia, which also carries its own risks.
How affordable and accessible is IVF treatment for ordinary Ugandans?
IVF remains expensive because the hormonal medications are costly and the process involves many specialised professionals. Currently, our package costs about Shs 18 million.
Have you had any success stories?
We have had several. We started our programme a year ago and have already had babies, including twins. We also have patients who are currently pregnant and awaiting delivery.
What message do you have for couples who are struggling with infertility?
Couples should come to the hospital for assessment. Infertility is best treated early, and age is a major determinant of success. The older the patient, the lower the success rate.
