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

2. Map of Nigeria

3. 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

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

5. Multicentre IVF MANAGEMENT
HUB
Large capacity IVF lab to culture and carry out embryo development for – 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

6. The spoke(s)
REGIONAL SECONDARY CARE FERTILITY 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/ 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

7. The big wheel & Spoke – London Eye

8. 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 ?

9. Sights of London – A megacity thanks for your attention