the hub & spoke satellite IVF programme Dr Julian Mamiso MBBS FRCOG The Bridge Centre for Fertility & Genetics London Women’s Clinic LONDON UK

Map of Nigeria

General Demographic details of Nigeria 191,836,6000 (2017 Wikipedia data) population 50% urban dwellers and mainly in the big regional cities & 36 state capitals and Abuja( national capital) Geo-political regions are 6 and they represent a political zoning of the country IVF / ART (level 3 fertility care) is 100% private provision concentrated in the big cities of Lagos, Abuja, Port Harcourt, Benin

The proposed Hub & Spoke IVF Model Big city ART centre SATELLITE Fertility Specialist TEAM

Multicentre IVF MANAGEMENT HUB Large capacity IVF lab to culture and carry out embryo development for 1000 – 2000 cycles / annum Nursing/Admin team to coordinate satellite programme Joint Clinical management of the treatment of the satellite patients effectively SPOKE(s) Regional Fertility Specialists Fertility Nursing team Seamless Communication link to Hub IVF Centre Availability of good Ultrasound, endocrinology/ virology lab SOPs for managing treatment agreed with HUB

The spoke(s) REGIONAL SECONDARY CARE FERTILITY CLINICS @ Federal Medical Centres in the 36 states Designated Fertility Clinics with diagnostic facilities for hormonal assays, fallopian tube assessments, semen analysis, / Transvaginal / abdominal Ultrasound facility Dedicated Fertility Nurse team / Admin Assistants for recording Data & transmission to the HUB. IT facility for fax/email of all data on patients being referred for completion of treatment ( IVF/ICSI, embryo development and transfer & cryopreservation) Standard Operative Protocols (SOPs) that ensure expected standard of patient management – includes pre-treatment screening tests, ovarian stimulation protocols, clear documentation of the schedule of medication, sending up-to- date scans with a final date/time of the final trigger 36 before egg collection

The big wheel & Spoke – London Eye

Challenges & Opportunities the ability to offer ‘high tech ART’ to wider community and achieve success The synergy in the roles played by Secondary Fertility Centres and the Tertiary Centres in developing a system that is mutually beneficial to the couples / referring Fertility Specialist teams at the ‘spoke’ and the Specialised facilities in the ‘hub’ Limited number of days for couples ( 5 days for a blastocyst ET) at the ‘hub’ and returning home to the ‘spoke’ for continued care. Challenges will be setting up 3rd Party Agreements between HUB & SPOKES for all the arrangements including finance and transmission of patient data. WHO TAKES OVERALL CHARGE OF THE PATIENTS’ CARE ?

Sights of London – A megacity thanks for your attention