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Last Updated: Wednesday, 23 July, 2003, 16:26 GMT 17:26 UK
IVF: An African dream
By Martin Hutchinson
BBC News Online health staff

At least one in five Africans has fertility problems
This weeks sees the 25th anniversary of the birth of Louise Brown - the world's first IVF baby.

In the latest of a series of features, BBC News Online looks at the prospects for "test tube babies" outside affluent developed countries.

Even 25 years on, IVF remains the preserve of the rich.

Tens of thousands of fertility treatments are carried out each year worldwide, but relatively few wealthy countries account for nearly all of them.

In Africa, a continent where, for most, getting hold of lifesaving HIV drugs can be near-impossible, IVF is a luxury item accessible only to the few.

And there is no sign of change in the air.

Due to the perception of infertility being caused by evil forces, many infertile couples often first seek traditional and religious treatments
Professor Friday Okonofua, Benin Hospital, Nigeria
Here, tackling infertility is all about prevention rather than "cure".

Professor Friday Okonofua, a consultant obstetrician and gynaecologist from the University of Benin in Nigeria, said that an estimated 20% to 30% of the population of Africa had fertility problems.

For many couples, infertility is a stigma that can lead to ostracism.

Dr Okonofua said: "Due to the perception of infertility being caused by evil forces, many infertile couples often first seek traditional and religious treatments, while delaying orthodox treatments."

'Not my fault'

Relationship breakdowns are common, he said, with the woman often blamed for the infertility even if it is the man's fault.

And he says that it is not a problem restricted to Africa.

"Both in Africa and Asia, infertility issues are hardly ever addressed by existing programmes - and most organisations don't address infertility.

"This is a big problem to women who often suffer discrimination on issues of fertility."

Measures to control the spread of HIV, boosted by news of multi-billion dollar grants from the US government, could help cut the toll of infertility in developing countries.

Sexually-transmitted infections are a primary cause of infertility, leading to blocked fallopian tubes and reduced sperm counts.

"Preventative treatment measures wouldn't be too expensive," said Dr Okonofua.

Islam is a religion that actively urges followers to seek solutions to their suffering
Dr Marcia Inhorn, University of Michigan
He said that the introduction of fertility clinics should only be considered after countries introduced well-organised prevention campaigns.

Not every African country is notable for poor access to IVF.

In Muslim countries such as Morocco and Egypt, fertility treatments have been embraced, and researcher Dr Marcia Inhorn says that Islam is one of the driving forces behind this.

"Islam is a religion that actively urges followers to seek solutions to their suffering," she told the BBC.

"It's actually a medically pro-active religion.

"IVF has really taken hold in the Muslim Middle East world to an amazing degree."

Important restrictions

There are dozens of clinics across the Middle East and north Africa - some setting up as early as 1984.

Dr Inhorn, from the University of Michigan, said that there remained important restrictions for many Muslims.

While IVF using eggs and sperm taken from the couple in question is allowed, Sunni Muslims are prohibited from using donor eggs or sperm, and surrogacy is also forbidden after the issuing of several "fatwas" from the 1980s onwards from the Al-Azhar University in Egypt.

The Shi'ite position is less strict - within the last five years Ayatollah Ali Khamanei, the current spiritual leader of the Hizbollah movement in Lebanon, permitted the use of donor eggs and even donor sperm under certain circumstances.

"When you are restricted to using only your own sperm or eggs, if a couple can't produce either, for any reason, that that is a real problem," said Dr Inhorn.

Nevertheless, she said, the stereotype that failure to produce children would lead to the breakdown of relationships is not true.

"Most couples accept the situation and continue to remain together in their relationship.

"They believe that this is God's will for them."



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