Experiences of female clients in the assisted reproductive technology process in Nigeria.

Background: Though assisted reproductive technology (ART) has been a source of hope for many infertile couples, it is known to be associated with physical, social, psychological, and ethical challenges in different settings. Objective: The study objective was to explore the experiences of female clients who accessed services in ART clinics in Nigeria. Methods: An exploratory qualitative design, using snowballing technique was employed. It involved in-depth interviews of eight women who had gone through the assisted conception process, using an interview guide. Data collection was from November 2019 to January 2020. Results: The age range of the participants was 30 - 52 years with a mean of 41.88 years. Majority of the clients presented at advanced age to their ART providers because of lack of funds and ignorance. Other challenges were suboptimal risk disclosure, high cost of services, feelings of shame and stigmatization during and after the process. Conclusion: Cost of ART remain unaffordable to most Nigerians hence the need for government subsidization and in-corporation of ART services into the National Health Insurance Scheme. Additionally, lack of adequate information disclosure, shared decision-making and gendered suffering are areas of great concern among the study participants. A national regulatory guideline will ensure uniform international standard of care.

Gamete donation-A review of ethical and legal issues.

Sperm and oocytes are building blocks in assisted reproduction. Sperm and ovum donation permit separation of the biological act of producing a child from the psychological process of nurturing and raising the child. However, the art of obtaining and use of these gametes are fraught with ethical and legal challenges. Relevant aspects concerning anonymity, genetic screening, consanguinity, informed consent and risk disclosure, compensation for donors, and child welfare are discussed. Though the issue of anonymity remains controversial, the importance of the welfare of the offspring has come to the fore as a result of the debate. Calls for more rigorous genetic testing for donated gametes to avoid genetic disease transmission, though supported by the principle of beneficence, has to be balanced by its possible deleterious effects on the donors and their relatives especially if findings reveal a serious genetic risk that has no medical treatment as yet. Reimbursement for direct and indirect costs, as well as fair compensation for time lost, inconveniences and risks suffered during treatment is recommended for oocyte donors. The risk of consanguinity remains a problem across the world even though the different guidelines limiting the number of pregnancies by a single gamete may be helpful, if enforceable. It is important that egg donors be clearly made to understand in simple language during the informed consent process of the yet unknown health risks involved so that the consent can be truly voluntary. This will protect donors from the backlash of the doctrine of "Volenti Non Fit Injuria". It is also suggested that specific legislation with regards to gamete donation, parenthood, and ART should be passed in countries where these are absent, to avoid controversies that may arise due to current gaps in the law.

Perception of Key Ethical Issues in Assisted Reproductive Technology (ART) by Providers and Clients in Nigeria.

PURPOSE: In the past decade, developments in the field of Assisted Reproductive Technology (ART) have intensified the hopes and the desires of infertile people to overcome infertility, resulting in an increasing demand for such services worldwide. However, as developments in ART have evolved rapidly, so have ethical, social, and political controversies surrounding many aspects arisen. It is known that societal ethics is dependent on the values and culture of a given group. We sought to explore how practitioners and clients in Nigeria perceive some Key ethical issues surrounding ART. MATERIALS AND METHODS: This was an explorative descriptive study involving in-depth interview of three ART providers and eight female ART clients, all domiciled in Southeastern Nigeria. Sampling was by purposive and snowballing techniques for providers and clients, respectively. Ethical approval was obtained from University of Ibadan/University College Hospital and University of Nigeria Teaching Hospital Research Ethics Committees. Responses were grouped into themes for ease of discussion. RESULTS: Providers and clients were in support of sex selection for family balancing, and multiple embryo transfers. They also perceive that the health of the woman should be the factor considered and not biological age for service provision. However, views differed on marital status as an access factor. Participants were in support of legally binding regulations to guide practice. CONCLUSION: A culturally sensitive national regulation is recommended to guide practice in this vital area of reproduction.