Six years after the birth of Jamaica’s first test tube babies – twins Rajesh and Mahesh who were born to Aaron and Suzette Jackson – the Fertility Management Unit (FMU) at the University Hospital of the West Indies in Kingston has become an increasing symbol of hope for couples here and abroad who have difficulty conceiving.

Couples have come from the United States, Canada, The Bahamas, Antigua and Barbuda, the Cayman Islands and the Turks and Caicos Islands, mostly because it is cheaper here to get assisted reproduction.

Overall, the FMU has done 382 treatment cycles resulting in 90 pregnancies using the In-vitro fertilisation (IVF) or IntraCytoplasmic Sperm Injection (ICSI) technique.

The number might seem small, but in the business of making babies, it’s nothing to scoff at.

The unit started out in 2001 with 22 couples, and of that number there were five successful pregnancies. Two years later, the number of pregnancies jumped to 17 from a total of 70 cycles. And by 2005, the number of cycles increased to 76, even though the number of pregnancies remained the same. However, the FMU experienced a significant increase last year, with 26 successful pregnancies from 82 cycles, pushing the unit’s success rate to an impressive 35 per cent.

Head of the unit, Dr Joseph Frederick, said given the success rate, the unit was aiming at 100 pregnancies this year.

IVF, also called test-tube fertilisation, is a technique in which egg cells are fertilised by sperm outside the womb. The term “test tube baby” is often used to refer to children conceived using the IVF technique.

On the other hand, ICSI is an IVF procedure, but instead of leaving the egg and sperm to fertilise on its own, the sperm is injected directly into the egg. This type of method is used when the sperm count is low.

In Jamaica, about 10 to 15 per cent of couples are infertile, Dr Frederick noted, citing worldwide statistics showing that there are about 80 million infertile couples.

A couple is normally deemed infertile after one year of unprotected sexual intercourse. Once the couple establishes that they are unable to conceive the natural way, this is where the FMU comes in.

“The patients are normally referred by doctors to the unit after medical investigations have been done to determine the reason they cannot conceive,” Frederick told the Sunday Observer in an interview. “If the couple is deemed to be suitable for treatment, the unit then begins its own medical investigations to prescribe the type of treatment the patients will receive.”

Supporting Dr Frederick, IVF co-ordinator at the FMU, Nurse Yvonne Walters added: “When we investigate these couples we find out what is the problem associated with the inability to become pregnant. We send the male to do semen analysis. Once we recognise a problem that can be fixed, we offer them a form of assisted conception which includes insemination of the sperm into the uterine cavity of the female around the time of ovulation. Or if the male has no sperm at all we use donor sperm.”

In the case of the Jacksons, they struggled for seven years to conceive and started looking for alternatives after two failed pregnancies.

“We were trying for about seven years and got pregnant twice, but they were both outside the tubes and I lost my tubes,” said Suzette, explaining that she suffered from a condition which caused the development of the embryo outside the uterus and referred to as ectopic pregnancies.

Shortly after, she learnt about the FMU during a visit to the hospital with her husband and immediately became interested.

“When we went to Dr Frederick he explained what would happen and he even drew diagrams, so I was a bit confident with him about it,” Suzette said. “When we started there were many other couples trying to get pregnant and I was pregnant within one week.”

The initial cost of the process is US$6,000 and couples on registration must view a video detailing the process.

“We also introduce them to the psychologist where they get counselling and we do find out in the counselling sessions that some of these couples are not ready,” nurse Walters said. “They think they are, but sometimes they take (emotional) baggage with them. Especially in a situation where the male has the problem, you find sometimes the wife will say the husband is at fault and there is a blame game that goes on.”

Walters also added that the couples are encouraged to approach IVF as a unit. The woman is given fertility medications in the form of injections to control the timing of her eggs ripening and to increase the chance of collecting multiple eggs.

“The first medication is to shut down the system to regulate the body,” Walters said. “The next phase is the stimulation phase where we get the follicles (bears eggs).”

During this period, the husband and wife are usually trained to administer the drug at home.

Aaron had to give his wife the injections. He said he was a bit timid at first, but after the first few times he got used to it.

“I was afraid to push the needle into her leg and her arm,” he related. “I had to mix the things in a bottle and then put it in the syringe. Then I got brave and put it (the needle) in.”

When the procedure is finished, it is time for the eggs to be removed. “I went in and they removed my eggs and then my husband went and they took his sperm,” Suzette filled in.

Denise Everett, the embryologist at the unit, explained that the healthy eggs were identified under a microscope and prepared for fertilisation. The sperm and the eggs are incubated together in the culture media for about 18 hours. By that time, fertilisation should have taken place, the fertilised

egg is passed to a special growth medium and left for about 48 to 72 hours.

“The embryos are placed in a tube and transferred back into the uterus,” Everett said. “The procedure is usually painless, though some women may experience some cramping.”

The number of embryos transferred depends on a woman’s age, cause of infertility, pregnancy history, and other factors. For Suzette, because she was 28 years old at the time, two eggs were transferred to her uterus.

Once the process was over, about three days later she said she told her husband that she “felt like something was different”, like she was pregnant so she decided to take a pregnancy test, which came out positive. “I wanted kids so much and then finally it happened. I didn’t believe it either,” she said with a grin.

“It was like I was in heaven because I was dying for the test to be positive,” Suzette said, her joy evident. “After I realised deep down in my soul that it was happening, I stopped driving, I stopped doing everything and I started going to the doctor.”

Nurse Walters said after IVF, women are encouraged to refrain from wearing shoes with stiletto heels, lifting heavy objects, having intercourse and sitting on hot surfaces. They are also given emergency numbers for the doctors on call. The unit also monitors the foetus to ensure that the pregnancy is progressing normally.

The Jacksons’ ultrasound was especially exciting because about a month after Suzette conceived the couple found out that they would be “blessed with twins”.

“When they did the ultrasound, I saw it was twins, I couldn’t believe it,” she said. “We prayed for a baby and all of a sudden it was two. It was a beautiful gift because I couldn’t get kids. I had no other way of getting kids.”

After that, Suzette had a normal pregnancy, up to the time of delivery. One of her sons was coming out feet first and had to be repositioned.

Not all couples get the same result as the Jacksons, Frederick cautioned.

“The human being is not the most fertile specie in the animal group and therefore even in natural conception between two fertile couples, the pregnancy rate per cycle is going to be about 25 per cent,” said Frederick. “Even if we can fertilise 90 per cent of the eggs we get, when you transfer there is an immunological process that must take place between the conceptus itself and the concepti and, of course, the uterine cavity. Not everything you put in the uterus will be accepted.”

He also noted that there was a risk of foetal abnormality.

Less successful but important to the work of the Fertility Management Unit is artificial insemination, which is also called inuterine insemination (IUI). IUI is the insertion of prepared sperm in the woman’s womb around the time of ovulation. About 207 IUIs have been done at the unit.

Dr Frederick said artificial insemination using the husband’s sperm had a lesser success rate, 11 per cent, as opposed to using donor sperms, which have a success rate of 16 per cent.

Nevertheless, the FMU has also seen several successes as it relates to assisted conception since it began IVF/ISCI.

In 2004, the unit successfully thawed an embryo that was frozen for about a year in liquid nitrogen and implanted it into a woman who gave birth to the island’s first baby by frozen egg transfer (FET).

Three months later, the island’s first twins were born using the same procedure.

The unit offers embryo freezing and sperm freezing at a cost of US$300 and US$200 respectively. In June 2004, the FMU saw its first baby born from surgical sperm transfer and in 2005, the unit’s first triplets from IVF – cousins to Rajesh and Mahesh – were born.

At the same time, the unit also began offering egg donation services. The process started last year and the first cycle is expected to come through in April.

Everett told the Sunday Observer that the unit offered two types of egg donation – shared donation and anonymous donation – for women who have problems with their eggs.

“The difference between shared and anonymous is that anonymous is an altruistic donor, she comes in off the bat by herself wanting to donate her eggs. Shared is donation by somebody who offers to donate part of their eggs to another infertile couple,” Everett explained.

This type of procedure is done at a cost of US$9,000.

The unit also buys sperm overseas for patients and hopes to set up a donor bank in the future.

“We don’t usually have people who donate sperm, but we can buy the sperm from overseas,” Dr Frederick said. “We will eventually come to that stage where we can develop a sperm bank. That is, get the sperm from young, vibrant males and test them and then we will be able to have our own bank. It will take time to develop, though.”

A batch of sperm costs about US$800.

“I have bought sperm three times and I currently have six persons who are waiting on sperm,” she added.