Department Of IVF

IN-VITRO FERTILIZATION UNIT

QUALITY OF CARE POLICY AND OPERATIONAL GUIDELINES

NHA/CD/QOCP/IVF/001

Dr. Korede Durojaiye W.

HEAD OF UNIT

1. Introduction:

Assisted Reproduction Technology (ART) services are a rapidly growing sub-specialty interest in Obstetrics and Gynaecology.  The demand for the service has increased over the years as the awareness of its potentials to alleviate the problem of infertility increases in the society.

IVF services commenced in 2006 at the National Hospital Abuja. It is the first sustained public sector IVF Centre in Nigeria.

The NHA IVF unit serves the following purposes –

1. Comprehensive management of infertility cases.

1. Vision Statement:

To be the most successful Assisted Reproductive Technology (ART) Centre in Nigeria

1. Mission Statement:

The IVF Unit, National Hospital Abuja is dedicated to enhance the reproductive potentials of the couple and ensure comprehensive management for infertility.

2.0 Quality assurance policy: 

            The Quality assurance policy ensures the following –

1. Development of guidelines for the various procedures in the unit
2. Provision of essential and up-date equipment for IVF services
3. Regular review of services and outcomes.
4. Regular training and retraining of staff

3.0 Strength of the Unit:

            The strength of the IVF Unit includes:

1. Based in a hospital providing comprehensive reproductive health care services.
2. Adequate number of trained staffs in the various units in the centre.

Services provided:

List of specialized services provided by IVF unit include the following:

1. Seminar fluid analysis(SFA)
2. Transvaginal ultrasound scan(TVS)
3. Invitro-fertilisation and Embryo transfer(IVF-ET)
4. Intra uterine insemination(IUI)
5. Intra-cytoplasmic sperm injection (ICSI)
6. Cryopreservation or freezing of gamete/embryos
7. Frozen embryo transfer
8. Surgical sperm retrievals including:
9. Percutaneous epididymal (PESA)
10. Testicular sperm aspiration (TESA)
11. Testicular sperm extraction (TESE)
12. Micro epididymal sperm aspiration (MESA)
13. Gamete donation services

4.0 Operational Guidelines:

Standard guidelines and protocols are in use for ovarian stimulation and for laboratory services. The main steps in standard IVF / ICSI services includes the following:

• Initial consultation and investigations at the Gynae clinic and/or private wing clinic.
• The investigations would include hormonal assay between day 2 and 5 of menses; Seminal fluid analysis after 3-5 days of abstinence; transvaginal ultrasound scan; HSG and /or hysteroscopy.
• Based on the findings, patient may benefit from in-vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), intra-uterine insemination (IUI) or timed intercourse (TI)
• IVF is the option if SFA is adequate while ICSI is the option when SFA is vey low.
• In the long protocol, treatment begins on day 21 from the date of last menses. Injection buserelin is given sub cute every day at about the same time for the first 13 days.
• Trans vaginal scan is done on the 14^th day to see the extent of down regulation. Hormonal assay may be repeated to be sure that down regulation has been achieved. Injection buserelin may continue for one week or as necessary
• Intramuscular injection (HMG) now commenced to stimulate ovaries, the dosage per patient is determined by factors such as age, FSH levels, body size (BMI) etc
• HMG is given daily for 7 days; scan is done on day 8 to determine the response of the patience. Dose is then adjusted if necessary.
• Scan now becomes more frequent, either daily or alternately to monitor follicular growth closely.
• When at least 3 follicles have reached about 18mm and above, injection HCG is given to mature follicles. This is usually between days 10 of stimulation to day 13 in rare cases.
• Egg collection or oocyte retrieval (OCR) is done at about 34hours from the time of HCG.
• Patient is allowed to go home the same day and commence some progesterone support and oral tablets to aid implantation.
• Embryo transfer is done between 48-72 hours after OCR and the patient goes home to continue bed rest for 2 weeks until pregnancy test. If positive, bed rest continues along with medications until cerclage is done at about 11-12 weeks of pregnancy.
• If pregnancy is negative, patient is counselled accordingly on the possible way forward
• After cerclage, patient is referred to the Gynae team for onward antenatal care till delivery.

5.0 WEEKLY ACTIVITIES AND SCHEDULE: 

The IVF sessions are run in batches. For each batch, patients that meet the required indication are recruited and counseled. The services are run throughout the week (Monday to Friday 8:00am – 4:00pm). The services include super-ovulation, pelvic scan, egg collection, sperm preparation, fertilization & embryo transfer.

 6.0 ORGANIZATIONAL CHART OF THE UNIT

7.0 Health and Safety Policy:

The health and safety policy of the hospital applies. 

8.0 Policy on Minimum Standard:

The IVF Unit in National Hospital is a member of the Association for Fertility and Reproductive Health (AFRH) of Nigeria. Its activities will be guided by the minimum standards to be promulgated by the National Assembly for the practice of ART in Nigeria.

9.0 List of Staff:

S/N	NAME	QUALIFICATION	POSITION
1.	Dr. Chris. O. Agboghoroma	MBBS, MA, MPH, MD, FICS, FWACS, FMCOG, PGA(ART)	Consultant Obs/Gynae & Head of Unit
2.	Dr. E. R. Efetie	MBBS, FWACS, FICS, FRCOG, PGCRE	ConsultantObs/Gynae
3.	Dr. R. Ibrahim	MBBS, FWACS,FICS,PGA(ART)	ConsultantObs/Gynae
4.	Dr. K. Durojaiye	MBBS, FWACS, FMCOG	ConsultantObs/Gynae
5.	Dr. S. Abubakar	MBBS, FWACS	ConsultantObs/Gynae
6.	Dr. I. O. Lawal	MBBS, FWACS	Consultant Urologist
7.	Gladys Ovuoraye	R/N, R/M, PPGD(HSSD), Fert Nursing(ESHRE), BNSC	Chief Nursing Officer (CNO)
8.	Ejura David-Mamuda	R/N, R/M, PPGD(HSSD), BNSC	Chief Nursing Officer (CNO)
9.	Loveth Gado	R/N, R/M, PPGD(HSSD), PPGD(SRH}	Asst Chief Nursing Officer (ACNO)
10.	Felicia Osimeh	R/N, R/M	Asst Chief Nursing Officer (ACNO)
11.	Sarah Musah	R/N, R/M, BNSC	Principal Nursing Officer (PNO)
12.	Rosemary Ofili	B.Sc, M.Sc	Asst Director (Embryologist)
13.	Funke Odeyemi	B.Sc, M.Sc	Chief Sci. Officer (Embryologist)
14.	Samuel Yakubu	B.Sc, M.Sc. MPA, FMLSCN	Med Lab Scientist /Embryologist
15.	Nana Khadijat Abubakar	B.Sc, M.Sc	Prin. Scientist Officer (Embryologist)
16.	Atama Alheri	WASC	Principal Health Asst
17.	Theresa Ocheme	WASC	Senior Health Asst

Contact email: hou.ivf@nationalhospital.gov.ng