Dimabayaa aims to raise awareness for the much overlooked problem of infertility in Africa and strives to help make infertility care in all its aspects; awareness & education, prevention, as well as diagnosis & treatment, available and affordable for all – in the Gambia, and beyond.
We currently run a small fertility clinic within Africmed Medical Services, a private clinic in Brusubi, the Gambia. Here we have developed a program for fertility counseling, standardized diagnosis and treatment. At the moment we offer OVI, Ovulation Induction and IUI, Intra Uterine Insemination. In the near future we hope to expand our services to Low-cost IVF, at the same time develop educational outreach programs on awareness and prevention.
Fertility Tourism Investment Opportunity
About 25,000 couples annually seek cross-border Fertility Care (2010). Reasons why couples travel abroad for fertility treatment can be legal prohibitions or regulation of the sought treatment in the home country, non-availability of a procedure in the home country, and costs.
Women from countries such as the United States and the United Kingdom may travel for IVF treatment and medications to save money. The cost for 1 IVF cycle in the United States averages US$15,000, while for comparable treatment in Mexico it is about US$7,800, Thailand $6,500, and India $3,300. Increasingly popular are clinics in Eastern Europe like Ukraine and the Czech Republic. Still, the lowest tariffs for conventional IVF found will be at least $1,500 to 2,000 per treatment cycle.
The Gambia offers many advantages. It is one of the safest countries in Africa with a friendly business climate. With English as the official language, the Gambia offers cheap labor force, well-functioning customs and port services, and simplified administrative and business registration and custom procedures.
The Gambia have benefited greatly from the country’s unwavering macroeconomic strategy, liberal trade policies and market-based economy. Finally, the Gambia’s open door policy, respect for human rights and rule of law, provides an ideal investment climate.
There are regular (charter) flights between the Gambia and Europe, flight time being only about 6 hours. The Gambia has excellent hotel facilities, from basic accommodations to 5 star hotels. Furthermore the country is known for its relaxed atmosphere, vast unspoiled beaches, and beautiful nature. Restaurants and other tourist facilities are numerous. The airport can be reached within only 30 min.
The Situation: Infertility in the Gambia, West Africa
In West Africa an estimated 30% of the women suffer from secondary infertility, the inability to conceive after an initial pregnancy. Main causes of infertility are genital tract infections which may be sexually transmitted, or infections caused by traditional practices such as FMG, home deliveries in unhygienic circumstances or illegal abortions. If left untreated these infections often result in bilateral tubal occlusion, which is an indication for in vitro fertilisation, IVF treatment.
In Africa, infertility can have dramatic consequences and lead to stigma, social isolation or even violence. Yet, infertility care is not a priority in the Gambian healthcare system. Medical staff is not familiar with the subject and there is a lot of misconception. Furthermore Infertility is often surrounded by mystification and taboo. Causes of infertility, and therefore also remedies, are sought in the spiritual world. Women suffering from infertility often spend great amounts of money on traditional cures before seeking medical help.
Conventional fertility care, if available, is very basic in the Gambia and involves surgical repair of blocked fallopian tubes or blind stimulation with clomid. Apart from our recently started OVI and IUI program, no other facilities in the Gambia are offering modern artificial reproductive techniques (ART). High tech IVF treatments are available in several African countries (Senegal, Nigeria, Ghana) but prices often even exceed those in Europe. Some Africans travel to Europe, the US or India for these reasons. Most people in the Gambia will not be able to afford this.
Our Approach: Mild Stimulation Low Cost IVF
Because of the high prevalence of tubal pathology, many women in the Gambia require IVF. Conventional IVF, involves large amounts of fertility drugs and highly advanced laboratory conditions. However, there are ways to reduce these costs, yet maintain quality.
How can the Costs of IVF be reduced?
The costs of IVF mainly depend on three factors
- The costs of the medication used
- The costs the laboratory
- Running costs of the clinic
In our model costs will be reduced on all three fronts:
1/ Mild Stimulation
Conventional IVF protocols use large doses of fertility drugs with the aim of stimulating the ovaries to such an extend that they produce large numbers of follicles.This can however affect the quality of the eggs developing in the follicles. Aiming to increase stimulation and collect lots of eggs is not always a healthy approach. Apart from lower egg quality, conventional IVF can give significant side effects.
Mild Stimulation IVF is gaining popularity in the West. In Mild Stimulation IVF, lower dosages of fertility drugs are used than in conventional fertility treatment. This results in a milder response, more natural and friendly to the body. In addition it is safer, has less side effects and is less expensive. This approach results in a number of advantages and success rates with Mild IVF are excellent.
2/ Simplified Culture System (SCS)
With the Simplified Culture System (SCS), an enclosed culture system in a smaller ‘shoe box sized ‘ environment developed by the Walking Egg project, IVF can be carried out without the need of a full laboratory, thus massively reducing the costs.
Studies show that both fertilization and pregnancy rates are the same using the SCS as they are in traditional IVF. More then 50 babies have, so far been born using the SCS method, and more women are currently pregnant as a result of this treatment.
3/ Running costs
The Gambia is a developing country where costs of labor and accommodation are low. At the same time the small West African country offers some excellent facilities; Hotels, transport and airport services and a number of well equipped modern private clinics are all within short reach.
The Extra Mile…
Going through IVF treatment can be stressful and stress is widely believed to be of negative influence on treatment outcome. The Gambia offers a variety of ways to help reduce stress. Beach and nature, sports, dietary and wellness programs as well as and a variety of complementary medicine is available.
Part of our profits we would like to invest in Educational Outreach programs on infertility awareness and prevention.
By educating the public on the matter of Infertility, stigma and mystification will decrease and people will be more willing to seek proper medical help. We also strive to educate health care professionals with the current insights and guidelines for infertility care and create a standardized process for diagnosis and treatment.
We strongly believe these programs should go hand in hand with initiatives on family planning and birth control, women empowerment, the fight against FMG etc. Since the main cause of infertility in Africa is is genital infection primary prevention should focus on informing young people how to avoid STD’s. Secondary prevention involves early diagnosis and treatment of STD’s.
The SCS system costs less than 200 euro’s per treatment cycle, not including staff and medication costs. With very low dose medication schemes we hope to perform SCS IVF treatments in The Gambia for 400 to 500 euro’s.
Low costs of the treatment combined with a safe high quality care will make our program attractive not only for Gambian couples, but also those from the region as well as beyond.
Gambian middle class is growing as well as a growing number of Gambians with access Health Insurance.
2/ People from the Region
Regular transport services within West Africa are established over land as well as by air.
Costs of IVF in Europe can be extremely high. Health insurance will usually only cover for a limited number of treatments. Some Europeans even travel as far as India to pursue IVF treatment