Fertility drugs for Twins in Nigeria (Clomid + Metformin + Letrozole) including Cost

Fertility drugs for Twins in Nigeria (Clomid + Metformin + Letrozole) including Cost, ovulation drugs in Nigeria.

Multiple pregnancy is a term used for a pregnancy with more than one fetus. Twin pregnancy is the commonest type of multiple pregnancy. The incidence of multiple pregnancy has increased world wide and in Nigeria due to increased use of ovulation induction drugs in assisted reproduction techniques(ART).

While the incidence of triplets, quadruplets and other higher older multiple gestation has increased significantly, the same cannot be said of twinning.

Naturally, twinning, is greater in blacks than in caucasians. The incidence is low in Far Eastern countries, about 5 per 1000 births. Among the caucausians , the natural incidence is is about 1:80 births for twins, 1: 1000 births for triplets and 1:500, 000 births for quadruplets.

The twinning rates in Nigeria appear to be on influenced by ethnicity. The twinning rate in Ibadan and its environs, in the purely Yoruba speaking South-western Nigeria, is probably the highest in the world (Igbo-ora, a community in Oyo State have the highest birth rates of twins in the world).

On the other hand, the twinning rate in Lagos, a cosmopolitan city, is the lowest in Nigeria but the rate is still high, about twice compared with that of caucasians.

What causes twinning or multiple gestation?

The following are predisposing factors for twinning:

1.Age: there is increasing incidence of twinning with increasing age of the the woman, this falls after the age of 35 years.

2. Parity: As a woman, the more children you have, the higher your chances of delivering twins.

3. Race: The lowest incidence of twinning is in Japan and the highest is among the yorubas of southwestern Nigeria

4. Familial: Giving birth to twins runs in the family of some women. A daughter usually inherit it form her mother or her maternal grandmother..

5. Diet: Some studies have isolated a clomiphene like substance in yam, a stem crop, which is a staple food in many parts of West Africa.

However, while trying to conceive (TTC) or during pre-conception period, some doctors prescribe some fertility drugs for women who desire to have twin babies. Fertility drugs have a reputation for causing multiple pregnancies—meaning more than one child is conceived at one time, resulting in twins, triplets, or even more babies. Fertility drugs were popularised by invitro fertilization (IVF).

CAVEAT: Fertility drugs have bery deleterious side effects. They are not to be abused or taken without the doctors prescription. For your education, it is important you know them.

List of Available Fertility drugs for Twins in Nigeria.

They are:

1. CLOMID/CLOMIPHENE CITRATE

Clomid works by increasing the number of eggs released during ovulation increasing their chances of being fertilized by the spermatozoa. Studies have shown that women who use this drug for fertility treatment are more likely to have twins than those who don’t.

Ovulation may be induced with clomiphene citrate. 50mg tablets are taken daily from day 2 to day 6 of the cycle. The dose is increased by 50mg every cycle if no pregnancy occurs, till a dose if 150mg daily is reached.

COST: Clomid cost in Nigeria is #5,000 per pack.

2. Human Chorionic Gonadotropin (HCG) and Human Menopausal Gonadotropin (HMG)

Ovulation may also be induced by a combination of Human Chorionic Gonadotropin (HCG) and Human Menopausal Gonadotropin (HMG) by your gynaecologist. It is necessary to use oestradiol assay or cervical mucus scoring or ultrasound to monitor induction of ovulation with HMG to prevent ovarian hyperstimulation syndrome (a serious side effect of fertility drugs).

COST: injectables of HMG or HCG cost around #7,000 – #9,500.

3. METFORMIN

Originally an anti-diabetic drug but was found to be beneficial for ovulation induction, multiple pregnancy and twinning. Metformin apart from stimulating insulin release, helps to reduce the secretion of testosterone. Testosterone interferes negatively with ovulation in women and reducing its level, ensures ovulation takes place unhindered. This can lead to multiple ovulation and twinning.

Metformin may be used to induce ovulation by itself or in combination with clomiphene (CC) or letrozole or injectable gonadotropins at doses of 500-2500 mg daily. Unlike clomiphene, it is taken every day of the month and may be continued in the early stage of pregnancy. To reduce side effects, the dose of metformin should be gradually increased.

COST: #3,500 Naira for a pack in Nigeria

4. Femara (letrozole)

This medication blocks the production of estrogen, thereby stimulating the pituitary to increase production of LH and FSH, which in turn induce ovulation. Though only approved in the U.S. for women previously treated for breast cancer, letrozole has been used extensively in the USA, and Canada and Nigeria for ovulation induction. It is taken as an oral tablet at doses of 2.5-10 mg daily for 5 days each cycle. Ovulation and conception and multiple birth rates (7%) are similar to Clomiphene Citrate.

COST: Letrozole cost #12,000 naira per pack in Nigeria

CREDIT:

1. Textbook of Obstetrics and Gynaecology by Agboola

2. Integris Benett Fertility.