April 10, 2020
Author Name: Dr. Charu Johari || Mentor Name: Dr. Tanu Batra on April 10, 2020
Infertility is a state of emotional roller coaster for couples who have been trying to conceive since long. Its a physical,social, psychological battle that cripples one’s well-being ,state of mind and personal relationships.
Due to modern lifestyle , stress, pollution, disturbed sleeping pattern ,lack of physical exercise ,increased age of marrying , carrier orientation, infections like STDs n TB infertility is on the increase.
It is now a common health issue.
In developing countries one in every four couples have difficulty in conception.
India is a fast growing country and numbers of infertility patients have doubled over the last few decades. According to Indian Society of Assisted Reproduction (ISAR) 10 to 14 percent of Indian population is infertile which is a big number.
Now the question arises that when does the doctor asks the couple to first visit for evaluation and treatment.
It is said that couple should seek medical advice if not able to conceive after trying for one year when the age of female partner is less than 35 years and after six months if the age is more than 35 years should . If there is history of irregular menstrual periods or no periods, very painful periods, more than one miscarriage, known case of endometriosis or any suspected male factor like history of testicular trauma, hernia surgery, chemotherapy then couple should visit without any delay.
But due to ignorance,myths and lack of awareness in our society there is a delay of many years before infertile patients opt for any investigation and treatment .
There are certain protocols and guidelines which are followed in different parts of the world in treating patients .Management can be either expectant, conservative or by ART depending on the cause, duration of infertility ,the age of female partner and the success rate.
Couples are told about the different treatment options available, success rates, risk and benefits of each treatment .
Gynecologists or the family doctor are usually the first to encounter such infertility patients.
First step in management is history taking and complete evaluation . Usually routine tests , ovulation , hormonal profile,tubal patency ,state of uterus , ovarian reserve and semen parameters are checked before resorting to any kind of treatment.
Generally it is seen that the first treatment protocol is ovulation induction .Its the term used in which the doctors stimulates the egg formation in ovaries with oral drugs. Ideally it is started when both the partners have been completely evaluated and tubes are patent n semen parameters are normal with adequate egg reserve n normal’ hormonal profile.
When simple ovulation induction does not work then intrauterine insemination (IUI) is advised.Doctors usually give 6-12 cycles of Ovulation induction before they resort to another treatment like IUI or IVF.
IUI is a procedure, in which washed and prepared sperms are injected into women’s uterus through a small catheter. Most of the time IUI is combined with ovulation induction drugs. IUI is done by doctor when tubes are patent, ovarian reserve is good, sperm count normal. It has 15%- 20% of success, women between 35 to 40 years of age have 10% success rate and those above 40 years have 2 to 5% chances of pregnancy after IUI.
It’s noted that many times 3-4 cycles of IUI with ovulation induction induction have been attempted before the couple seek the advice from infertility specialists.
Sometimes they are also in their late 30 ‘s or 40 ‘s when they decide to visit the Infertility center till the time they are exhausted of their egg reserve.
Ironically even after attempting conservative treatment n many failed IUIs couples do not agree to opt for IVF suggested by thier infertility specialists.People still consider IVF as a social taboo.
But with mass awareness , accessibility and good success rate things are changing gradually and patients opting for IVF.
In Vitro Fertilization (IVF) means fertilization of eggs with the spermatozoa outside the body in controlled conditions inside the laboratory. Then these fertilized eggs or embryos are transferred to the uterus. Whereas Intracytoplasmic sperm injection (ICSI) is a technique in which a single sperm is injected into a mature egg.
In vitro fertilization(IVF) is advocated by the doctor as the primary course of treatment in case of blocked fallopian tube, moderate to severe endometriosis, pelvic adhesions, advanced maternal age, poor ovarian reserve, reduced chances of pregnancy with IUI and fertility preservation in cancer patients before commencing chemotherapy or radiotherapy. ICSI often used for couples with male factor infertility.
The most common complication of IVF is multiple pregnancies. But now with the advanced techniques like blastocyst culture, single embryo transfer is possible reduce the chances of multiple pregnancy and increasing the chances of successful healthy singleton pregnancy.
IVF has allowed many couples to have children who otherwise would not have conceived.
Couples should meet the fertility specialist to get their best treatment plan. The choice of conservative treatment ,IUI or IVF should be made after discussing all the pros and cons related to their particular case.
Remember patience n perseverance can moove mountains and correct evaluation is half the battle won.
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