The issue of Genotype remains one of the fundamental issues to be considered, as it pertains to relationships and marriages in Nigeria. It is also one of the leading causes of relationship heartbreaks in Nigeria as of today.
What is Genotype?
Genotype can simply be defined as the genetic constitution of an individual. It is also defined as a set of genes in a person’s DNA responsible for a particular trait which the person possesses and exhibits.
Types of Genotypes
The genotypes in humans are AA, AS, AC, SS, SC. The AC Genotype is rare while the AS and AC genotype group are quite abnormal.
The Compatibility Chart of the Genotype group is seen below
AA + AA = AA, AA, AA, AA ( Great )
AA + AS = AA, AS, AA, AS, ( Great)
AA + SS = AS, AS, AS, AS, (Fair)
AA + AC = AA, AA, AA, AC. (Good)
AS + AS = AA, AS, SS, SS, (Bad )
AS + SS = AS, SS, SS, SS, (Very Bad)q
AS + AC = AA, AC, AS,SS. (Bad; Advice needed)
SS + SS = SS, SS, SS, SS, (Very Bad)
AC + SS = AS, AS, SS, SS, (Very Bad)
AC + AC = AA, AC, AC, SS. ( Bad; Advice needed)
Genotype and Relationships
As seen from the charts, it is not advisable for carriers of the Sickle gene (AS, SS, SC) to marry fellow carriers of the Sickle gene as it is highly likely that they will give birth to babies with the SS gene.
Many relationships have crashed due to this issue, even long-term relationships where partners who have dated for four to Six years meet their waterloo, when the partners discover their genotype during wedding preparations or when demanded at their workplace.
It is no doubt important to state that lovers ensure they know the genotype of their partner to avoid stories of heartbreaks and loss of a relationship that occur when both parties discover the solemnization of their union might lead to birthing a sickle cell child. The physical, financial, emotional, and psychological stress that is involved in bringing up a child with Sickle Cell Disease is immense and it is often advised that most sickle cell carriers get married to the AA genotype group.
However, there are some considerable options available for partners with the AS gene (AS + AS couples ) or ( AS + SS couples ) if they insist on getting married or raising a family at all costs.
Here are some of the ways AS + AS couples can conceive sickle cell-free children.
1) In Vitro Fertilization (IVF):
IVF is an assisted fertility procedure that is fast gaining prominence in Nigeria and it is one of the first options couples who are finding it difficult to conceive naturally turn to. IVF is also a proven method for Sickle cell carriers couples to conceive children without the sickle cell gene.
The process involves using the sperm or egg of someone else who isn’t a Sickle carrier in the reproduction procedure. As such, the spermatozoa of an AA man can be used to fertilize the egg of an AS woman or the egg of an AA woman can be used to fertilize the spermatozoa of an AS man to metamorphosing into the embryo before it is then transplanted into the woman or surrogate mother.
IVF procedure costs about 700,000 to 2 million Naira in Nigeria, depending on the center the procedure is done at. If the couple uses an anonymous donor, the sperm or egg costs about N50,000 to N100,000 extra. However, it may cost them less or even nothing if the sperm or egg is donated by someone they know, depending on the couple’s agreement with the donor.
It is also important to note that IVF is not a hundred percent guarantee to prevent the birth of sickle cell children by sickle cell carrying couples as it is a 50-50 chance.
2) Natural Conception:
When the couple conceives naturally, they wait till the pregnancy is about 10 weeks old and then conduct a test to check the genotype of the embryo. This is done by the Chorionic Villus Sampling (from 10 weeks) or Amniocentesis (from 13 weeks). A needle is inserted into the pregnant abdomen to collect the cells needed. The cells are cultured and genetic testing is carried out.
The gene of the child is confirmed and once it is discovered to be carrying the sickle cell, the child is medically aborted or left to stay depending on the choice of the parents. The test price ranges from N150,000 to N250,000 while medical abortion costs between N80,000 to N120,000.
3) Pre- Implantation Genetic Diagnosis (PGD)
The couple goes through an IVF cycle; the sperm and egg are fertilized in a petri dish and allowed to grow, then after three to four days, a biopsy of some cells is carried out. Only non-SS babies are then transplanted into the mother. SS embryos are destroyed.
Most fertility centers in Nigeria cannot do the biopsy and so the samples are sent abroad for the test. PGD has a 99.99% success rate. The procedure costs about five million Naira.
There are lots and lots of babies who need a home and an AS + AS couple can provide them one. If the couple is bent on marrying, then they may decide not to have their children biologically and opt for adoption instead and raise the baby as their own.
5) Bone Marrow transplant:
The Couple can decide to get married and conceive SS children that will then go through Bone Marrow transplant later. The only thing that has been proven to change the genotype and cure sickle cell disease in the bone marrow (stem cell) transplant (BMT). It has a 94 percent success rate and very few cases of relapse after transplant. It is however very expensive and the price ranges from 6 million Naira to 9 million Naira.
When you think of the pain, stress, and cost of birthing a child with sickle cell, it is however important to know your genotype and that of your partner at the start of a relationship, this should be an important question you ask when getting to know them.