The Bridge Clinic by Samuel Biss

Welcome Brochure

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We operate to worldwide best practice standards

The Bridge Clinic Welcome Brochure

A new baby is like the beginning of all things wonder, hope, a dream of possibilities Eda J. Le Shan

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The Bridge Clinic Welcome Brochure

Contents Welcome About Us Clinic History Keys to our Success Our Values Achievements Social Responsibility Initiatives Partnership with IVF Clinics Prof Zech

Infertility Treatments Variations of IVF

10 12 14 20 21

Treatment at The Bridge Clinic Planning & Consultations The Treatment Preparing for Pregnancy Emotional Support & Counselling

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38 40 42 44

Assisted Conception: The Facts Understanding Infertility 26 Infertility in Women 28 Infertility in Men 30

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32 34

Useful Information FAQ Arranging A Consultation Get In Touch

48 50 51

The Bridge Clinic Welcome Brochure

Welcome As a father of two, I understand the joy of parenthood and the simple pleasures of watching your children grow. I also know what it feels like to long for the miracle of childbirth and to be overwhelmed by this bundle of joy staring innocently and lovingly into your eyes. Parenthood is a beautiful experience which, decades later, I still cherish. For these reasons I sympathise with the hardship of couples experiencing difficulties conceiving, and how important it is to provide them with hope and opportunity. With the latest technologies and expert staff, we at The Bridge Clinic promise the best possible chance of success in a safe and caring environment. I am proud that we are recognised for our ethos of quality in treatment and care. We work hard at this level of quality every day, so that you are assured of a reliable partner supporting you on every step of your journey to starting a family. All of us at The Bridge Clinic look forward to supporting you on this life-changing journey.

Richardson Ajayi FRCOG Clinical and Managing Director

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The Bridge Clinic Welcome Brochure

Our gratitude goes to the staff of The Bridge Clinic. Words cannot express how happy we are today.â&#x20AC;?

Ahmed & Aisha

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About Us

The Bridge Clinic Welcome Brochure

Clinic History Knowing who we are and where we come from will help you understand how we have come to be the leading fertility clinic in West Africa. Founded in Lagos in 1999, The Bridge Clinic was established with the aim of delivering the highest standard of infertility treatment to West Africa. The concept behind it, however, was formed in London, where Clinical and Managing Director Dr Richardson Ajayi (inspired by the impressive results seen during his time practicing at the Assisted Conception Unit at London’s world-renowned Kings College Hospital, the home of modern IVF) had a vision of bringing to Nigeria a quality of treatment only previously available overseas. The initial two-year start up phase was supported directly by Kings College with intensive transfer of expertise, techniques and technologies, before The Bridge Clinic was transferred to the control of an experienced, trained and highly skilled Nigerian management team. In recent years, it has attracted several high profile, industryleading figures from around the globe to join them and continue the clinic’s development into West Africa’s premier Assisted Conception Unit. This dedication to recruiting the best personnel, combined with ongoing investment in training, facilities and equipment, has seen The Bridge Clinic grow from strength to strength. The group now has 5 branches throughout Nigeria, including Lagos, Port Harcourt and Kaduna. In addition to these, The Bridge Clinic is also committed to developing the next generation of fertility specialists through its partnership with the Lagos University Teaching Hospital (LASUTH) at the Institute of Fertility Medicine (IFM).

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The Bridge Clinic Welcome Brochure

The Keys to Our Success

The Emekwue Twins

At The Bridge Clinic we have worked tirelessly to establish ourselves as leaders of IVF in Nigeria and West Africa, and continue to work tirelessly to develop our fertility treatments and services Breaking Through

Guided by International Standards

The Bridge Clinic was the first IVF clinic in West Africa. We have been helping couples in Nigeria achieve pregnancies for almost 15 years, and with the birth of over 1300 children, we have the required experience and skills to meet your needs.

IVF has been practiced worldwide for over 30 years, of which we have been pacticing for almost half that time. As leaders in fertility care in Nigeria we benchmark our practices to international standards. The Bridge Clinic operates under stringent international guidelines to ensure the services we offer are as safe and advanced as possible.

Our Leadership The Bridge Clinic’s team is lead by Dr. Richardson Ajayi, who trained at the world famous Kings College Hospital in London, and has worked in IVF clinics around the world. This experience means we understand the need for quality management and leading international partners to support and enhance our success. We have a Scientific Advisory Board and an Ethics Committee to support our board of directors, and are also proudly associated with the African Health Fund and the Bill & Melinda Gates Foundation.

Your Safety Assured Through Quality Management The Bridge Clinic implemented a quality management system (QMS) in 2004 to ensure the safety of our clients. We are still the only clinic in West Africa to have this system. Our QMS was certified to meet the required standards by TUV Austria, ahead of many clinics in the United Kingdom. www.TheBridgeClinic.com

International Partners Our international partnership ensures that we remain leaders in fertility care. The Bridge Clinic is committed to being not only the best in West Africa, but equal to the leading European facilities. To this end we are proud partners with the world-renowned Zech group - see p.22 for further information.

Selecting The Best Embryos Only a small proportion of fertilised eggs have the potential to create a baby. We can improve your chances by developing the fertilised eggs out of the body for five days. This improves the chances of transferring competent blastocysts which can lead to a pregnancy.

Choosing The Right Sperm The Bridge Clinic pioneered the introduction of Intracytoplasmic sperm injection (ICSI) for the treatment of couples with a significant male contribution to their infertility, with the birth of the Emekwue

twins in 2000. Nearly 50% of the sperms injected can be treated with intracytoplasmic morphologically selected sperm (IMSI). IMSI uses powerful microscopes to select the most suitable sperms, improving chances of a pregnancy.

Optimising Implantation Many women attending our clinics for IVF have fibroids or other abnormalities of the uterus, such as scarring of the lining (Ashermans syndrome). This can reduce the chances of pregnancy. We take great care to assess and correct these abnormalities if we believe that they are significant enough to reduce the chances of a pregnancy.

with the clinic for over ten years, with their invaluable experience providing guidance on many of the difficult issues that arise in our daily work.

Team Approach At The Bridge Clinic, we ask you to trust in our network of specialists. Successful IVF treatment depends on our doctors, laboratory staff and nurses working together to deliver the best possible results. We run all our operations on the electronic platform DynaMed. This allows all staff review your care daily, thus you can be assured of our hallmark excellent service from all our clinics.

Our Research Working With Ethics Ethics is a branch of philosophy that discusses the concepts of right or wrong behaviour. It is difficult for one doctor to decide what is right and wrong treatment in any society. Owing to the sensitive nature of IVF treatment and the potential implications of misguided choices, ethical decisions can be incredibly difficult. The Bridge Clinic’s Ethics Committee has worked www.TheBridgeClinic.com

We offer our clients the most recent, technically advanced and relevant treatment options tailored to meet each couple’s individual needs. The treatments we offer are tested to ensure that they meet the needs of our clients. This is attested to by our list of scientific publications and research papers. Visit www.thebridgeclinic.com for more information on these publications.

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Our Values: Caring

Our Values: Excellence

When making a potentially life-changing decision, you want to know that your clinic cares passionately about you and your experience.

Never compromise on what really matters; you deserve the very best, especially when it comes to something as important as starting a family.

We understand the delicate, sensitive and highly confidential nature of our service, so we endeavour to make you feel as comfortable and at ease as possible. We understand your needs, respond to your concerns, respect your privacy and offer the highest level of personal service with attentive and supportive staff. Every aspect of our service is geared towards delivering a stress-free experience that is tailored to meet your individual requirements.

We aim to excel in every aspect of the service we provide, setting the highest standards in treatments, client care and service. From the initial enquiry and consultation to treatment, follow-up care and counselling; from research initiatives to community outreach projects, we take the utmost pride in everything we do.

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I thank all the staff, my fertility nurses, who became my precious sisters, who reassured me and always told me not to worryâ&#x20AC;?

Naomi

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Our Values: Conscientious

Our Values: Honesty

What we do and how we do it define who we are. At The Bridge Clinic we understand that our decisions and actions affect the world around us.

Many of the decisions we make are based on trust, and choosing the right IVF clinic is no different. An honest approach makes this decision an easy one.

We understand the responsibilities that come with our standing as the leading assisted conception facility in Nigeria. We have a number of initiatives aimed at helping Nigerians preserve their fertility, detect early signs of infertility and help couples who are suffering with infertility achieve pregnancies, irrespective of their financial capabilities.

In everything we do here at The Bridge Clinic, we are open and honest at all times and always strive to communicate clearly with you. This allows clients to make informed decisions and receive the best possible type of treatment for their individual needs, whilst at the same time ensuring realistic expectations. This honesty is vital in forming the strong doctor-patient relationship that is important to a stress-free treatment process.

I thank wholeheartedly The Bridge Clinic for assisting me in getting pregnant, and their positive attitude in overcoming the obstacles which initailly made us believe it would be impossible.â&#x20AC;?

Ronke

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Our Values: Safety

Our Values: Pioneering

Reassurance, peace of mind, security. Stepping out of our comfort zone can be unsettling, so confidence is key to a stress-free experience.

Pushing the boundaries has always reaped rewards. With our world constantly evolving, being at the forefront is as important as ever.

Operating in a highly technical industry, we at The Bridge Clinic pride ourselves on attention to detail, especially with regards to safety and reliability, prioritising the wellbeing of clients and staff at all times. We go above and beyond to ensure the application of the most stringent safety standards, voluntarily applying the regulatory code of the Human Fertilisation and Embryology Authority (HFEA) and hosting regular external audits by leading European auditors.

As a modern, cutting edge Assisted Conception Unit (ACU), The Bridge Clinic is constantly seeking to explore new territories and introduce new techniques and technologies. Our unique partnership with IVF Clinics Prof Zech, one of the worldâ&#x20AC;&#x2122;s largest providers of assisted conception services, enables us to lead the way in bringing the latest developments from around the world into our marketplace. This means the service available to you is as advanced as at leading European and US facilities.

Thank you to the nurses who were always calling to remind us of our appointment dates and times for administering my injections.â&#x20AC;?

Uche

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Achievements

Social Responsibility Initiatives

Based around our values, setting goals and striving to achieve them has been paramount to the constant development of our clinics.

In keeping with our values, we are always looking for ways to use our knowledge and resources for the greater good. Our latest initiativas include:

Since it was founded, The Bridge Clinic has been at the forefront of West Africa’s IVF industry. Our proudest successes include: The first conception and births by ICSI in Nigeria The first conception and births from surgically collected sperm in Nigeria The first conception and births through IVF surrogacy The first conception and births with Micro Sort sex selection

Certifications The Bridge Clinic voluntarily submits to stringent quality management to ensure best practice, and have been awarded the following accreditations by TUV Austria: 2004 - First clinic in West Africa be awarded an ISO certification (for Quality Management) in accordance with ENISO 9001:2000 2005, 2006 & 2007 – Successful re-audit of The Bridge Clinic’s Quality Management System (QMS) in accordance with ENISO 9001:2000 2010 – Successful audit and upgrade of The Bridge Clinic’s QMS in accordance with ISO 9001:2008 2011 – Successful re-audit of The Bridge Clinic’s QMS in accordance with ISO 9001:2008

Keep It Safe & Simple (K.I.S.S) - A campaign to educate young people about the causes and prevention of infertility, encouraging them to be safe and let pregnancy happen naturally At The Bridge Clinic we often see couples experiencing delays in child bearing due to preventable causes, so we understand the importance of awareness. To this end we run K.I.S.S to educate the young men and women on how to prevent infertility in the future. Our vision is that young people, our country’s future, know how to live their lives in order to minimise the chances of infertility. The K.I.S.S campaign focuses primarily on reaching university campus students.

The Institute of Fertility Medicine (IFM) - A subsidised IVF treatment programme IFM is a corporate social responsibility initiative of The Bridge Clinic for the provision of subsidised in-vitro fertilisation (IVF) services to socio-economically disadvantaged couples. This programme has been set up in collaboration with the Lagos State University Teaching Hospital. Our objective with this partnership is to improve access to IVF services by subsidising the costs of treatment, while assuring clients of the same levels of quality that are available at any of our main clinics. We started this collaboration in 2011 and we have recorded significant success since this initiative began.

INSTITUTE OF FERTILITY MEDICINE Department of Obstetrics & Gynaecology LASUTH

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Partnership with IVF Clinics Prof. Zech Not content with being the leading clinic in West Africa, The Bridge Clinic is teaming up with Europeâ&#x20AC;&#x2122;s finest to raise its standards even further. The IVF Clinics Prof. Zech is one of the most renowned IVF clinics in Europe. With over 25 years of experience and the birth of over 25,000 babies from their clinics, IVF Clinics Prof. Zech are best suited to meet our needs. They run clinics in 6 different countries (Austria, Switzerland, Italy, Czechoslovakia, Liechtenstein and Germany) and thus have extensive experience with a variety of international clients. They have pioneered IVF client management through an enterprise system called DynaMed which focuses on ensuring that client care is at the highest standards of safety, individualised and aligned with world class treatment standards. The collaboration provides The Bridge Clinic with access to DynaMed, which aligns our quality of treatment with that of the Zech Group and ensures that we operate at the highest international standards. The guiding philosophy of the IVF Clinics Prof. Zech is that they provide their clients with the shortest possible time in achieving a pregnancy and this is backed up by one of the highest pregnancy rates in Europe. IVF Clinics Prof. Zech continues to maintain its position at the fore front of the IVF industry by continued research and innovation. These advantages will be available to all our clients in Nigeria. The Bridge Clinic and IVF Clinics Prof. Zech have agreed to adhere to a common code of conduct, ensuring the highest ethical standards and the application of stringent standards in client service and management.

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It is exciting to see the scans of my baby, a new life starting inside me. This is a testament that people should never lose hope.â&#x20AC;?

Bunmi

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Assisted Conception: The Facts

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Understanding Infertility Realising ones challenges in conceiving naturally can be devastating; understanding the reasons behind it provides hope for the future. It is better to consider infertility as challenge that affects a couple rather than the man or the woman. Male fertility manifests through the woman, a fertile woman can compensate for a man with reduced fertility, and vice versa. Infertility can best be understood by having knowledge of the processes involved in human reproduction. The woman releases an egg every month (ovulation). The fallopian tubes transport the egg to the uterus by a combination of contraction and the wafting movement of hair-like lining of the tube. Fertilisation of the egg occurs in the fallopian tube and the fertilised egg is then transported to the uterus for implantation. Infertility is caused by disruption of this process. This can be due to abnormalities of the sperm, or due to abnormalities of ovulation, the Fallopian tubes or the uterus. Whatever the challenges faced, at The Bridge Clinic our expert and epxerienced team is here to guide and support you.

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We are so grateful to all the doctors and nurses for your professionalism and words of encouragement that kept us going.â&#x20AC;?

Frank & Nneka

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Understanding Infertility in Women The complex nature of the female reproductive system leads to complex diagnoses, so providing the client with the right information is crucial. Tubal Damage Tubal infertility is the most common case of female infertility in West Africa. The fallopian tube is the road along which the sperm and egg usually meet. Either blockage of the pathway or impairment of the function of the tube can cause a woman to be infertile. Causes of tubal infertility include pelvic infection, previous pelvic surgery, endometriosis, previous ectopic pregnancy and tubal ligation.

Ovarian Abnormalities Defects of the ovaries cause infertility by disrupting the process of ovulation. Some defects occur in the ovary such as Polycystic Ovarian Syndrome (PCOS), damage to the ovaries (usually by infection) or the menopause, when the woman has run out of eggs. It could also be secondary abnormalities of the hormones that influence the functions of the ovaries, such as Prolactin or Follicle stimulating hormone.

Uterine Abnormalities Abnormalities of uterine anatomy or function may cause infertility by disrupting the process of implantation. These may include leiomyomas (fibroids), endometrial polyps, foreign bodies (e.g. an intrauterine device), intrauterine scar tissue (Asherman’s syndrome), congenital malformations and chronic endometritis (infection).

Additional factors may include: Medical conditions such as Endometriosis, Pelvic tuberculosis, Diabetes, Epilepsy, thyroid, and Bowel Diseases Being overweight, underweight or smoking Regular contact with chemicals or radiation

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To the glory of God on high, I got double for my trouble! The treatment was well worth our gorgeous twins .”

Tosin & Tope www.TheBridgeClinic.com

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Understanding Infertility in Men Male infertility is very common, present in around 80% of couples seeking assisted conception in Nigeria. Male infertility is indicated by abnormalities of the semen under microscopic examination. There are several possible causes, but in many cases the origin cannot be determined. Fortunately this does not impact on our ability to implement a successful treatment. Common causes include:

Hormonal Causes Although a far more common cause of female rather than male infertility, abnormalities of the hormones required for normal sperm production could be the problem. The solution may involve medication, treatment for an underlying condition, or advanced reproductive technology.

Genetic Conditions Certain rare genetic conditions, such as Klinefelterâ&#x20AC;&#x2122;s syndrome, can result in male infertility. These are not routinely screened for unless there is a family history of the condition or a semen analysis reveals azoospermia (a complete lack of sperm in the sample). Some such conditions can be overcome with advanced reproductive technology.

Infections Infections are frequently incorrectly blamed as a cause of male infertility. This is as a result of the frequent isolation of bacteria that live on the body such as Staphylococcus Aureus (Staph.) during semen culture. These organisms do not cause male infertility. However, infection that remains untreated can lead to damage of the tubes that transport sperm and this can lead to azoospermia.

in the production of sperm cells. It is sometimes possible to unblock the tubes by operation, but this rarely leads to a pregnancy. Both obstructive and non-obstructive azoospermia are best treated by surgical sperm collection and intracytoplasmic sperm injection.

Additional factors may include: Diabetes Orchitis (inflammation of the testes) Prior invasive medical treatment, e.g. radiotherapy, surgery or medication Being overweight, underweight or smoking Regular contact with chemicals or radiation

No Cause Diagnosed

This means that the man has no sperm cells in his ejaculate. It can be due to obstruction of the tubes that transport sperms from the site of production in the testes, or it may be due to an abnormality

Most men with abnormal semen will fall into this category. Although men with milder problems may achieve a pregnancy by themselves within three years, those who have not successfully conceived within this timescale and with more severe sperm abnormalities will require advanced reproductive technology.

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Azoospermia

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Infertility Treatments Tailored To You Our wide ranging experience means we know what works; trust us to select the right treatment for your particular needs.

Reassurance and Advice

Ovulation Induction

This may be all that is required for some couples especially when they have only been trying to conceive for a short period of time and no significant abnormalities have been defined. The recommendations may include weight loss or occasionally weight gain, or advice on how to reduce the effect of stress on the chances of conception

This is used to treat women that are not ovulating using tablets or injections to induce ovulation. Couples that have not conceived after six months of successful ovulation will need advanced treatment.

Intra-Uterine Insemination (IUI)

This is the introduction of a prepared sample of the husband’s sperm with the optimum motility into the uterus as the woman approaches ovulation. It is widely used, but particularly so in cases where ovulation induction has failed, or where the man has erectile dysfunction or premature ejaculation. It can be done with or without drugs to stimulate the ovaries. The woman must have normal Fallopian tubes and the man near normal sperm

quality sperm, or is at risk of passing on hereditary disease. The introduction of Intra-cytoplasmic Sperm Injection (ICSI) has reduced the requirement for donor sperm as men with the most abnormal semen parameters can now be assisted to become fathers.

In-Vitro Fertilization (IVF)

The same procedure as IUI, donor insemination involves implementing the use of donor sperm instead of partner sperm. The Bridge Clinic supplies sperm from donors who are in good health and have been thoroughly screened for disease. DI is necessary in cases when a partner is unable to produce sperm, has very low

IVF is the most common and well known form of assisted conception. It involves harvesting the female client’s eggs and fertilising them with the male partner’s sperm in a safe clinical environment. The embryos are then transferred through the cervix into the womb for continued development, and hopefully a natural pregnancy and birth. IVF is primarily used for the treatment of infertility caused by defective fallopian tubes, but due to its high success rates is also often used to treat other causes of infertility.

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Donor Insemination (DI)

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Variations of IVF We have a detailed understanding of all forms of IVF treatment, and how best to implement them to maximise the benefit to you, the client. Intra Cytoplasmic Sperm Injection (ICSI) This is used when the man has abnormal sperm that are unable to fertilise the eggs naturally during conventional IVF. ICSI involves the use of very powerful microscopes with micro manipulators to inject the sperm directly into the egg for fertilisation to occur. The fertilised eggs are further cultured and the resulting embryos are transferred into the womb.

Ovum Donation Women who are unable to produce good quality eggs will require ovum donation. Eggs can be donated either from known donors (such as a sister or friend) or from anonymous donors. These are screened, healthy donors provided by the clinic. In an ovum donation cycle, the eggs are fertilised by the man’s sperm and after fertilisation, the resulting embryos are transferred into the client’s uterus. The transfer can be in a fresh cycle or the embryos can be frozen for transfer in a subsequent cycle

IVF Surrogacy Women with functioning ovaries but without a uterus, who have experienced repeated miscarriages, or with severe medical conditions that are incompatible with pregnancy may require IVF surrogacy. The ovaries of the woman are stimulated; the eggs collected and fertilised with her husband’s sperm and then the embryos are transferred into a surrogate’s womb where the pregnancy will hopefully develop.

Embryo Cryopreservation

Other variations and techniques include:

Assisted Hatching: this is employed to thin out the shell of eggs where it is thought that the shell is too thick and may interfere with implantation. Intracytoplasmic Morphologically-selected Sperm Injection (IMSI) is an assisted reproduction technique that is particularly powerful against male infertility. This is an extension of ICSI, where powerful microscopes are used to individually select the best sperms for the ICSI procedure. Oocyte Cryopreservation: This is used for the freezing of oocytes, usually as part of the ovum donation program, but it is increasingly being used for the preservation of fertility in women who want to delay childbirth or are about to undergo chemotherapy or radiation. Pre-implantation Genetic Diagnosis (PGD) (also known as embryo screening) refers to procedures that are performed on embryos prior to implantation. The PGD is performed by examining a single cell with regard to aneuploidy (maldistribution of chromosomes) and genetic diseases. This can either be done by using the Polymerase Chain Reaction (PCR) or Fluorescence In Situ Hybridisation (FISH) methods. Spindle View: The spindle is an essential organelle of the egg cell, and plays a central role in meiotic development of human egg cells. The spindle is responsible for accurate alignment and distribution of the chromosomes during cell division. Malalignment of the spindle can cause damage to the occyte during ICSI. This can be picked up before ICSI using spindle view.

IVF commonly leads to the generation of spare embryos. Freezing of these embryos for a later transfer provides the couple with another chance of pregnancy. We employ the latest vitrification techniques, and are now able to offer pregnancy rates with frozen embryos comparable to those achieved using fresh embryos.

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Estelle

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Treatment at The Bridge Clinic

The staff of The Bridge Clinic have been so wonderful and supportive throughout this processâ&#x20AC;?

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Planning & Consultations Setting out on the journey with best foot forward sets the tone for the experience that is to follow. Our first-stage assessments run as follows:

The Welcome Visit

The objective of the first visit is to make you feel welcome and relaxed in The Bridge Clinic, and obtain as much information as possible to allow us to plan the appropriate treatment for you. Wherever possible we ask that clients attend with all the results of your past history, including previous treatment and current results of required investigations (the list is available on request). We prefer the results from an ISO 15189 accredited laboratory. After reviewing the history and blood results, the doctor will perform a physical examination and an ultrasound scan. The examination will include the measurement of the length of the uterus and an assessment of the cervix. The visit is completed with the signing of a consent form which will explain all the issues relating to the treatment as well as financial matters.

Assessment Consultation

Some couples are not sure of their particular requirements and wish to talk to a doctor to help them understand what they need. In this case a consultation without any investigations can be booked.

Scheduling the IVF Cycle

Once the client is fully comfortable, prepared and ready for the treatment, they are scheduled for the IVF treatment cycle. This includes provision of all useful information, such as dosages and timing of your medications.

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Planning is bringing the future into the present so you can do something about it nowâ&#x20AC;?

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Alan Lakein

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The Treatment A critical time for any client, knowing the treatment process step-by-step will put you at ease and minimise the risk of unpleasant surprises

Ovarian Stimulation

A woman usually produces a single egg every month. The objective of ovarian stimulation in IVF is to obtain ten to twelve eggs for fertilisation. We commonly employ the long protocol, where the woman takes GnRH analogues for up to 21 days to render her temporarily menopausal. She then commences FSH injections to stimulate the ovaries to produce follicles which contain the eggs.

The Final Scan

This is what is known as a â&#x20AC;&#x2DC;decision scanâ&#x20AC;&#x2122;, from which we can determine if the ovaries have responded and have produced enough eggs to proceed with treatment. The development of the eggs is monitored with an advanced ultrasound technology, pioneered by IVF Clinics Prof Zech, that allows the objective assessment of the volume of the follicles. This assessment allows us to plan the timing of the final injection to stimulate the maturity of the oocytes. Your treatment may have to be cancelled or deferred at this stage if you have over or under responded to ovarian stimulation.

Egg Collection

The eggs are collected in our theatre by a simple ultrasoundguided procedure using state of the art techniques. This is done under mild sedation to minimise any discomfort. The follicular fluid obtained, hopefully containing the eggs, is then passed to the laboratory for fertilisation. In most cases, medications such as antibiotics and hormones will be prescribed to support the lining of womb.

Sperm Collection

On the day of egg collection, a fresh semen sample is required. This can be produced at the clinic or at home if preferred. If the sample is produced at home then it should be kept close to the body during transportation, and reach the laboratory within two hours of production. The preferred method of production is masturbation and the period of abstinence should not exceed two days. www.TheBridgeClinic.com

Embryo Culture

Embryo Transfer

The Pregnancy Test

The Ultrasound Scan

Post Treatment Review

In conventional IVF, fertilisation is achieved by inseminating the eggs with a prepared sample of sperm. However, if after assessment we believe that there is a risk that the sperms will not fertilise the eggs, we will carry out ICSI with IMSI. ICSI/IMSI is increasingly being used electively to optimise fertilisation rates. We then transfer the oocytes to a special nutrient medium and wait until the next morning to confirm that the eggs have been fertilised. Following fertilisation, the embryos are cultured under very special conditions for five days. This identifies embryos that have implantation potential and improves the chances of pregnancy.

The embryos are transferred gently through the vagina and cervix into the uterus using a thin and flexible transfer catheter. This procedure only takes a couple of minutes and is generally painless. We transfer a maximum of two embryos

The transfer is followed by a difficult two weeks of waiting for the pregnancy test. You will be given a specific date to do the tests which can either be done via an early morning urine sample or by taking a blood sample. Our staff will be on hand to support during the wait and discuss your options following the result.

A positive pregnancy test is followed three weeks later by an ultrasound scan. This is to define the presence of a intrauterine sac with a fetal pole and fetal heart action. Clients are referred for antenatal care after this ultrasound scan.

Even with our best efforts, more than half of the clients that we treat still may not achieve a pregnancy. However, this is not cause for despair. All couples with a negative test will have a review to assess the treatment cycle and receive advice on the next steps. We understand that a negative pregnancy test can be source of anger and disappointment, and will be with you through this difficult time. It is very important for all couples that do not achieve a positive pregnancy test to attend the post treatment review.

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Preparing For Pregnancy It is important to understand that what you can do to improve your chances of having a healthy pregnancy and a healthy baby.

General Advice

Nutrition

Pregnancy leads to a significant change in the way the body works and it is important that clients are physically fit for the experience. It is also important to stay away from chemicals and other poisonous substances and radiation for a minimum of 90 days before conception, as there is increasing evidence about the negative effects of a lot of substances that we are exposed to.

It is believed that women with a body mass index (BMI) over 30 have a reduced chance of conception with IVF. However women with excess weight only need to lose about 10% of it and increase their metabolism to minimize the associated risks. Clients should focus on a diet rich in protein and vitamins and low in carbohydrates and fats. Stopping smoking and reducing alcohol consumption to the barest minimum are essential.

Preventing Malformations And Improving Sperm And Egg Quality)

All women attempting to conceive are advised to increase their daily intake of Folic acid to reduce the risks of having a child with the congenital malformation spina bifida. Furthermore, exposure to chemicals, including those found in cigarettes, can lead to damage to the sperms and the eggs. Couples attempting a pregnancy are advised to take supplements which contain Folic acid. A special supplement advised for couples attempting pregnancy is Fertilovit F for women and Fertilovit M for men.

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Emotional Support & Counselling IVF is usually a step in the right direction for couples seeking assisted conception. We are here to assist and support you throughout the journey.

Counselling

Peer to Peer Support Group

The Welcome Forum

A major component of treatment at our clinics is emotional management and support. We understand the emotional demands of infertility treatment, and in addition to the support and comfort that is provided by all our staff, we also have professional counselling services available to all clients whenever required.

No one better understands the physical and emotional demands of assisted conception better than those who have been through it themselves. Our Peer to Peer Support Group involves the peering of new couples with couples that have had a previous treatment cycle so that experiences can be shared, providing open and objective communication about the treatment.

Held on the third Saturday of every month in all our clinics, this forum provides an opportunity to hear about our services, facilities, IVF and the new treatments we have available. It also enables prospective clients to meet the staff in a relaxed ad friendly environment, and receive testimonies from happy and satisfied clients who can confirm the effectiveness of our fertility treatments and services.

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I wish to thank The Bridge Clinic for all their support. May you continue to put smiles on peopleâ&#x20AC;&#x2122;s faces.â&#x20AC;?

Kadidja & Hassan

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Useful Information

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FAQ Any couple undertaking assisted conception will naturally have a great number of questions. Here, we answer some of the most common. 1. Who needs IVF? Couples with blocked fallopian tubes or serious sperm problems; couples with infertility that have been trying to achieve a pregnancy for over 3 years as well as couples where the woman is over 35 years even though they have been trying for less than 3 years. 2. Why should we choose The Bridge Clinic? As pioneers in the practice of IVF in Nigeria as well as ardent drivers of quality healthcare systems, The Bridge Clinic is uniquely positioned to provide you with your best and quickest chances of achieving a pregnancy in Nigeria. We have been doing this for over 13 years now and with the birth of over 1,300 babies form our clinics we have perfected the art and science of assisted reproduction. Through the implementation of quality management systems we assure your safety; the reliability and reproducibility of our results, minimise risks to you and your unborn child and we lay emphasis on your feedback in assuring the quality of our services. All systems are deployed with the objectives of ensuring your safety, fulfilling your desires of a healthy baby and providing you with excellent service. With these in hand, our objectives are to help you make the right choice, the only choice, of where you have your treatment. 3. What are the success rates with IVF? At The Bridge Clinic we have a success rate of close to 50% in women under 35 years of age and we are seeing increasing success rates with clients of all ages who we treat, in particular women over the age of 35. We expect to see this pattern continue to rise with the implementation of new and emerging trends in IVF technology through the support of our technical partners, the IVF Clinics Prof. Zech 4. What does quality management mean to me? Quality management means that the IVF treatment you are receiving is of the highest standard and it is fit for purpose. It provides you with a good chance of a

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pregnancy; it is safe and all risks and on towards effects from the IVF has been minimized. 5. Can I still do IVF even though I am over 40 years old? Yes you can. We are seeing an increased success rate in women over 40, even though there is an age related decline in female fertility. Many women over 40 can still achieve a pregnancy with IVF. In some cases women with reduced ovarian reserves may require treatment with donated eggs. 6. What kind of support is available to us during treatment? Each couple is supported by a fertility nurse, their treating doctor and the counselor throughout the course of your treatment. Further support is available from couples who have undergone treatment at The Bridge Clinic to enable you benefit from a shared experience. 7. Are there any tests should we take before treatment? It is important to ensure that couple will benefit from IVF, and hormonal tests are carried out to define this. It is also important to also ensure that there are no risks of passing any infection on to your unborn child and tests are also carried out to screen for infections. 8. Do I need to remove my fibroids before IVF? The decision to remove ones fibroids depends on the size and the location of the fibroids. It will be necessary to visit a gynaecologist and have a detailed ultrasound scan which clearly shows the location and size of the fibroids. 9. Does IVF deplete my store of eggs and lead to premature menopause? No it does not. Each month a cohort of follicles are recruited from which only one egg is released and all that happens with IVF is that more eggs are recruited from the same cohort of follicles.

10. Is it painful? Most of the procedures involved are not painful. For those that may cause slight discomfort, we routinely administer pain relief to manage these phases. We have also provided couples with the opportunity for more extensive anaesthesia should they indicate a preference for this and we deem it safe to do so. 11. How many embryos are transferred? We transfer a maximum of 2 embryos to minimise the risks of multiple pregnancies and ensure your safety and the safety of your unborn child. 12. How can I be sure that the embryos transferred are mine? The Bridge Clinic has implemented systems which minimise risk and prevent “gamete mix-up” which ensures that your baby is indeed yours. For further reassurance on this please speak to any of our specialists (see p. 51 for contact details). 13. What is OHSS? Ovarian Hyperstimulation Syndrome is one of the commonest complications of IVF which if not aggressively prevented and managed could be lifethreatening. At The Bridge Clinic we have implemented safe stimulation protocols which minimise the risk of development of OHSS and as well as aggressive support measures to manage it should it occur.

IVF treatment include multiple pregnancy, which is directly related to the number of embryos transferred, and ovarian hyperstimulation syndrome (OHSS), which is related to the appropriateness of the stimulation protocols as well as the client’s response. Our objectives are to minimise these risks, especially considering the difficulties with access to good healthcare, while assuring the safety of you and your unborn child. 16. Are there any drugs which can boost sperm count? There is a normal oscillation in the sperm count of all men in the population. This biological variable is not affected by any drugs and there is no evidence of improvement in the sperm counts of male partners of women dealing with infertility. 17. Are children born after IVF normal? The evidence is that children born with IVF are absolutely normal. The vast majority (99.999%) of children born following ICSI are absolutely normal. 18. What are the side effects of IVF drugs? There are a few side effects, similar to those experienced during the menopause, such as hot flushes, dizziness, headaches, weight gain and so on. These are generally transient and resolve following withdrawal of the drugs.

14. What is PCO? Polycystic ovaries; ovaries that have an atypical appearance, increasing the risk of OHSS. They are very common and will be insignificant in most cases.

19. Why is IVF expensive? IVF requires expensive resources such as expensive imported equipment, imported consumables, specialised training for staff and the costs of maintenance of infrastructure such as power management in a developing country contribute to the costs.

15. What are the risks of IVF? The benefits of IVF far outweigh the risks of the procedures. However there are recognised risks with IVF treatment which can be minimized in a clinic setting which is focused on quality. The commonest risks from

20. What does it cost? The costs of IVF vary with each individual couple’s needs. However for an idea of our costs kindly refer to our client information leaflets or view our schedule of fees on our website, www.thebridgeclinic.com.

The Bridge Clinic Welcome Brochure

Arranging a Consultation

Get in Touch

If you require our expert guidance in making a decision, or simply want a specialist opinion, come in and see us for a consultation

Finding out more about assisted conception at The Bridge Clinic is easy; simply call, email, visit our website or pop in and see us.

Appointments Scheduling an appointment with our clinics is very simple. Your options include walking into any of our clinics near you and requesting an appointment following the management of your enquiry. Alternatively you may contact us by phone or complete an appointment request form on our website, stating your preferred date and time for your clinical visit. Subsequently you will receive a confirmation e-mail from our medical services team acknowledging receipt of your appointment request and informing you of the available date and time of your consultation. Our payment section will notify you of the fees for securing your appointment and the modalities of payment at your disposal. You will be required to send us proof of payment via e-mail at least 48 hours before your appointment to assure us of your commitment to attending your clinical visit. Should you desire to cancel or reschedule an appointment, please notify the clinic at least 48 hours beforehand. Working with you we will then find a new appointment at a suitable time.

Monthly Welcome Forum You are invited to attend our interactive client session, the Welcome Forum, which is an opportunity for couples to learn about infertility and the options available to them for its management. These sessions are held on the third Saturday of every month at our centres in Victoria Island, Kaduna and Port Harcourt. .

Information Pack Visit www.thebridgeclinic.com and complete our simple online enquiry form. You will then receive a pack containing details of our services as well as useful information on the management of infertility to help you make your decision.

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Our Clinics Lagos Clinic:

Port Harcourt Clinic:

Plot 1397A Tiamiyu Savage Street Victoria Island Lagos Tel: +234 (1) 461 9006, 08108229623, 08104607790, 08104607791 and 08025643565

41A Evo Road G.R.A Port Harcourt Rivers State Tel: 08108229626, 08129699182

Kaduna Clinic: Ikeja Clinic: 63 Oduduwa Crescent G.R.A Ikeja Lagos Tel: +234 (0) 8191355990

Website: www.thebridgeclinic.com

26A Kinshasa Road Ungwar-Rimi Kaduna Tel: 08108229624, 08129699176

+234 (1) 461 9006

www.thebridgeclinic.com

enquries@thebridgeclinic.com

Lagos Clinic:

Ikeja Clinic:

Port Harcourt Clinic:

Kaduna Clinic:

Plot 1397A

63 Oduduwa Crescent

41A Evo Road

26 Kinshasa Road

Tiamiyu Savage Street

G.R.A. Ikeja

G.R.A. Phase II

Ungwar-Rimi

P.O. Box 70294

Lagos

Port Harcourt

G.R.A. Kaduna North

Victoria Island

Tel: +234 (0) 8191355990

Rivers State

Kaduna State

Tel: 08108229626

Tel: 08108229624

Lagos Tel: 08104607790

www.TheBridgeClinic.com We operate to worldwide best practice standards