21st century has gifted us with technology but it has also given birth to lifestyle changes that has resulted in one of the most talked about concerns today – Infertility. Ritika Bisht of Governance Today, in conversation with Dr Anuradha Kapur, Lead Consultant, Department of Obs and Gynae at Max Hospital, discusses the issues leading to infertility and resulting popularity of IVF in India. Edited excerpts:
In-Vitro fertilization or IVF as is commonly known, has seen a rising trend in India since number of couples here dealing with the issues of infertility are also increasing. Can you brief us about different types of fertility treatments that you suggest to your patients?
We take into account those couples who have been trying to conceive for over a year. This is the scenario with the younger couples but we start counseling older couples after 6 months of unprotected intercourse. When a couple has been unsuccessful at achieving pregnancy after one year, both partners need to go through a comprehensive physical and medical assessment.
For the baseline tests on women, we need to know the detailed information on birth control use, menstrual and pregnancy history, surgical history and other health issues. Then we run basic hormone tests like FSH (Follicle Stimulating Hormone), LH (Luteinizing Hormone), Prolactin and baseline ultrasound. For men, we suggest baseline semen analysis. This is the basic and initial tests that are undertaken and if some issues are found during this step then we treat with medication.
However, if both the semen analysis and the other testing return normal results, then we move to additional testing called HSG (Hysterosalpingogram) which is an x-ray of uterus and fallopian tubes. A dye is injected through the cervix into the uterus and fallopian tubes which enables the radiologist to see if there is blockage or some other problem. In case it is polycystic ovary syndrome (PCOS) then we opt for ovulation induction. If for any reason the woman is not ovulating well we give her ovulation induction drug. We give ovulation induction medicines like clomophene for 6 months and if they do not succeed in causing ovulation then we move to injection FSH. The injections are started early in the menstrual cycle and are continued until one or more mature follicles are seen with ultrasound examination of the ovaries. Once the leading follicle(s) reaches 18 mm in diameter, the egg is considered mature and ready for ovulation and this is when the hCG (human chorionic gonadotropin) injection will be given. If the semen count is ok and the uterus and tubes are ok we ask the couple to try naturally. However if couples don’t conceive within next 3-4 months then we move on to intrauterine insemination (IUI). In this procedure, the male would be asked to produce a sperm sample on the day the treatment takes place. The sperm will be washed to remove the fluid surrounding them and the rapidly moving sperm will be separated out from the slower sperm. The rapidly moving sperm will be placed in a small catheter to be inserted into the womb. However, even if this treatment fails then we move to last resort, IVF.
According to studies, stress has been stated as the foremost reason among women who have difficulty in conceiving. Even if they opt for any fertility treatment, there is a high probability that the treatment may not prove to be that effective due to stress level. How do you counsel patients before going through the treatment?
Counseling is very important for couples during this time as we empathize with their situation and thus we let them know about all the available treatments. Stress is the primary factor for infertility among young couples, especially in women as they face lot of pressure from their family members and in-laws to have a child. The problem is even if they come to us for treatment the procedure would work best in the absence of stress. That is why we try to counsel not only couples but also family members so that they understand that pressurizing only deteriorates the situation. Nowadays, in most cases both husband and wife are working and with such a busy lifestyle people hardly get time to work on health issues that can be easily eliminated by daily exercise and good diet. Thus, our first suggestion for couples is to bring down the stress level and initiate yoga, exercise and healthy diet.
While IVF and other related treatments give people hope, are there any serious complications involved during the procedure?
Complications associated with use of these medications include the possibility of overstimulation, called ovarian hyperstimulation syndrome, or OHSS. Hyperstimulation involves enlarged ovaries, abdominal pain, and fluid build-up within the abdomen. However, in majority cases there are mild symptoms which can be easily treated.
Other complications include risk of multiple births which happens if more than one embryo is implanted in a uterus. A pregnancy with multiple fetuses carries a higher risk of early labor and low birth weight than pregnancy with a single fetus does. Then there is also comes the risk of miscarriage with IVF treatments and its possibility increases with maternal age.
What is the success rate of the process?
IVF success is affected by many factors in like age, ovarian reserve tests, sperm count, reproductive history etc. Women with top chances of IVF success have per-cycle success rates of 40 per cent or higher, while the majority of women have per-cycle success rates of 20-35 per cent. The moment we encounter the patient we brief about all the advantages and disadvantages about the procedure. This treatment is costly and that is why we never give them false promise of increased success rate and present them a realistic picture.
What is the future of IVF and other related treatments?
IVF is definitely here to stay. The number of couples facing infertility has increased in last decade and it will continue to increase further. The primary reason for this is that people are getting married late and thus planning for family late. It is further accompanied by massive changes in lifestyle and stress that is adding up to infertility. IVF and other related treatments are boon for couples.