Outcomes Of Assisted Reproductive Technologies At The Nairobi In Vitro Fertilisation Centre

Background: Infertility is a common problem affecting up to ten per cent of married couples. A systematic evaluation of aetiologic factors forms the basis for choice of treatment and future fertility. On the global perspective, Assisted Reproductive Technologies (ART) has become internationally recognised treatment option for some infertile couples. A report on the current outcomes of ART practice at The Nairobi IVF Centre is presented.Objective: To describe the practice of assisted reproduction and present a report on the current outcomes. Design: A retrospective survey of data on assisted reproduction practice from August 2005 to July 2008.Setting: The Nairobi IVF Centre a private medical practice in Nairobi, Kenya.Interventions: Treatment of infertile couples by various assisted reproductive technologies including in vitro fertilisation (IVF), intra-cytoplasmic sperm injection (ICSI), uterine fresh embryo transfer (ET), and frozen/thawed uterine ET (FTET).Main outcome measures: Fertilisation, embryo cleavage, ET, embryo freeze/thaw survival, pre-clinical pregnancy and clinical pregnancy rates, live births and other obstetric outcomes.Results: A total of 362 IVF cycles were performed. Following controlled ovarian hyperstimulation, an average of 12 oocytes were retrieved per patient while the fertilisation and subsequent embryo cleavage rates were 67 and 91.2% respectively. An average of three embryos were transferred and the embryo transfer rate was 93.3% per cycle started and 96.6% per oocyte retrieval. Surplus embryos were available for cryopreservation in 106 (50.1%) cycles. On thawing frozen embryos, the survival rate was 65.5%. Following ET, the overall pre-clinical pregnancies were 124 (36.2%) of which 99 (28.9%) developed into clinical pregnancies per cycle. Of the clinical pregnancies, 72 (73%) were singletons, 23 (23%) twin gestations and four triplets (4%). A total of 52 mothers have been delivered either by Caesarian section 45 (86.5%) or spontaneous vertex delivery seven (13.5%) to 61 live babies of whom 36 were females and 25 males. A further 28 IVF clinical pregnancies are ongoing, 26 following fresh embryo transfer and two from frozen/thawed embryos.Conclusion: Our results on ART practice reflects a pregnancy outcome comparable to that reported by other fertility centres globally. Couples with infertility in East and Central Africa for whom ART treatment is indicated may now access the service locally

Environmental and occupational exposure to lead

Objective: To determine the status of environmental and occupational lead exposure in selected areas in Nairobi, Kenya. Design: Cross sectional study. Setting: Kariobangi North, Babadogo, Waithaka and Pumwani for assessment of environmental exposure to lead (Pb) and Ziwani Jua Kali works for assessment of occupational lead exposure. Olkalou in Nyandarua District was the covariate study area. Subjects: Three hundred and eight children and adults participated. Results: Blood lead levels (BLLs) obtained for the entire sample (n = 308) ranged from 0.4 to 65μg/ dl of blood. One hundred and sixty nine (55%) of the total sample had levels equal to or below 4.9μg/dl, while 62 (20%) of the sample had levels ranging from 5.0 to 9.9μg/dl. Blood lead levels above 10μg/dl were recorded in 77 (25%) of the total sample. Within Nairobi, 32 (15.3%) of the study subjects in areas meant for assessment of environmental lead exposure had levels above the WHO/CDC action levels of 10μg/dl of blood. The mean BLL for the occupationally exposed (Ziwani Jua kali) was 22.6 ± 13.4μg/dl. Among the workers, 89% had BLLs above 10μg/dl. In general, 15% of the entire sample (for both environmental and occupational groups) in Nairobi had BLLs above 15μg/dl. The covariate group at Olkalou had a mean BLL of 1.3 ± 0.9μg/dl. Conclusion: The prevalence of environmental lead exposure to the general public is high in Nairobi compared to Olkalou where non exposure was reported. Occupational lead exposure has been identified to be at alarming levels and urgent intervention measures are recommended. East African Medical Journla Vol. 85 (6) 2008: pp. 284-29

Experience with UIDC insertion outside of menses in Kenya

Objective: To determine if women receiving intrauterine devices (IUCDs) outside of menses have an acceptable rate of insertion problems and subsequent IUCD-related complications.Design: Cross-sectional and prospective cohort study of insertions at times other than during menses.Setting: The study was carried out in two government family planning (FP) clinics in Nairobi,Kenya.Subjects: After appropriate pre-test and post-test HIV counselling, 1686 women requesting IUCDs at two FP clinics between 1994 and 1995 in Nairobi were enrolled at baseline into a study examining the effect of human complications. Six hundred and forty nine women (156 HIV-infected and 493 HIVuninfected) were selected for the four month follow up study. They were classified according to their menstrual cycle status at time of IUCD insertion.Main outcome measures: Problems at the time of insertion (pain, bleeding, immediate expulsion) and IUCD-related complications through four months.Results: Rates of immediate insertion problems were low in the women who had insertions during menses (7.0%), outside of menses (4.0%) or had oligomenorrhea/amenorrhea (2.6%). The adjusted odds ratios for IUCD insertion problems outside of menses and in oligomenorrhea/amenorrhea (versus women with insertion during menses) were 0.54 (95% CI 0.18 -1.59) and 0.39 (95% CI 0.12 -1.29) respectively. IUCD-related complications were higher in the iligomenorrhea/amenorrhea (11.5%) or insertion outside of menses (6.9%), than the within menses (4.3%) groups. However, the differences were not statistically significant. Adjusted odds ratios for IUCD outside of menses and oligomenorrhoea/amenorrhea groups were 1.65 (95% CI 0.21 - 12.91) and 2.72 (95% CI 0.34 - 21.71) respectively.Conclusion: The results confirm that the IUCD can be safely inserted outside of menses with minimal insertion difficulties and subsequent complications. Availability of IUCDs outside of menses may enhance IUCD acceptance in Kenya and create better opportunity for visualscreening of the cervix for sexually transmitted infections