Dr. Uma Shrivastava
Infertility & IVF specialist
Infertility
Centre
Now-a-days, talking about Test-tube babies
has been a trend among people in Kathmandu . In
Nepal many test-tube babies have been born to infertile couples by the use of
Assisted Reproductive Technology (ART). These couples would not have conceived
by any other way. These couples were longing to have a baby for years & were
treated by various technologies both in the country & abroad. Some of these
babies have been brought in the media & people have watched them just like
the way they would watch the commercials of various noodles. I guess in a few
days time, we may see every advertising agency having pictures of test-tube babies
in every package like superstar Amitabh Bachhan in every Indian commercial. However,
behind the scene success of test-tube baby should be really admired.
How do test-tube babies develop?
These babies are created by the laboratory
scientists in the laboratories by mixing sperms & eggs for fertilization outside
the human body (in vitro) with utmost care & difficulties.
During the process, the women are given
different types of hormone injections for few weeks in order to develop many
eggs in their ovaries. When these eggs ripen, they will have to undergo a small
operation to remove these eggs. In the mean time, the sperm will be collected
from the man & processed. The retrieved eggs properly identified with the
help of a sterio-microscope are then mixed with these sperm & incubated in
an incubator at the temperature close to body temperature & pressure etc.
for fertilization. Because these embryos are fertilized outside the body in
vessels & machines, scientists call the process In Vitro Fertilization
(IVF). Thus, the fertilized embryos proceed for cell division. They are kept
outside the body only for few days till proper cell division. They will be then
transferred back to the uterus after few days for implantation, development of
foetus & delivery of the baby.
Challanges
to the infertility specialist
Normally, couples visiting infertility clinics
for treatment seek the guarantee of success with IVF treatment. But we cannot
blame them, because IVF treatment is expensive. What is the meaning of
guarantee? Nature has a very good control over fertility. Its own fertility
rate is about 25% per cycle in normal fertile couples. Moreover, guarantee of
success in infertile couples depends upon recovery of several defects in the
couples. Will these defects be eliminated with one cycle of test-tube treatment?
Apart from all the ordinary defects, fertility
of any couple is decided mainly by the following factors:
Ø The man must be producing normal sperm count with good motility
(count: 50-150 mln/ml & motility: >50%).
Ø The woman must have normal menstrual cycle with the development of
normal egg.
Ø The woman should have normal uterine cavity with open fallopian
tubes.
If one of the above goes wrong, fertility
becomes impossible. It is the duty of every couple longing to have a baby to
find out what their fertility defect is. Are they properly tested for the above
outlined conditions of infertility? It is sad to say that some couples treated even
for about ten years do not know their underlying defect because they were not
tested properly. There are thousands of couples who have not been counselled
for infertility treatment. Most of the couples are not checked even for their
hormone levels, which, in fact, directly decide their eggs & sperm quality. Some even undergo IVF for unknown reasons. Some
ladies have been repeatedly operated with normal fallopian tubes and yet they
do not know why they were operated due to illiteracy.
Any couple seeking for fertility must check
their problem & should be aware of the proper test they need. ECG, x-ray
abdomen & blood count & biochemistry do not predict fertility. Only a few
of their tests being normal do not decide their fertility.
The age of the female is another predictor
of fertility. Women above 35 years of age have difficulty to conceive for the
first time, mainly due to two factors. The first one is that their ovaries do
not regularly produce quality eggs & the other factor is that the uterus
does not easily implant the embryo.
Who need test-tube baby treatment?
If properly tested & diagnosed, the
patient will definitely recover fertility with conventional infertility
treatment. These are 80% cases of infertility. About 5% of them have no
treatment, and the only way for them is Adoption.
The remaining 15% of infertile couples who
need IVF (test-tube baby) are:
Ø Women with blocked fallopian tubes on both sides
These women cannot pass the sperm to the
ovaries where there is a possibility of meeting with the egg for fertilization
i.e. In Vivo Fertilization or Fertilization inside the body. These are the
women who have no option, but to go for IVF treatment.
Ø Men with low or nil sperm
count & motility
IVF is also done for men who produce less
sperm with low motility either by improving the quality of the husband's sperm
or by using donor's sperm
Ø Women with poor ovarian
capacity to develop eggs
Ladies who are lately married after the age
of 37 do not produce good quality eggs due to poor ovarian reserve. Their estrogen
hormone level is decreased. They may have babies with egg donation
by their sisters or relatives.
Ø Couples with no significant abnormalities after all investigations
& treatment
If a couple is properly investigated & real problem of
infertility has not been identified are also occasionally benefited by this
treatment. Ladies who are lately married after the age of 37 do not produce
good quality eggs due to poor ovarian reserve. They may have babies with
donated eggs by their sisters or relatives.
In Nepal
As outlined above, the cause of infertility
varies from couple to couple. There was an anecdote in one of the foreign newspapers
a few years ago, regarding a child who was born with the help of three couples.
In the first couple, the male had no sperm production, and the female had good
ovaries, good egg production but both her tubes were blocked & also her
uterus contained fibroid tumour causing a bad site for implantation of foetus. What
they had for fertility was only good ovaries with good eggs. Of the
second couple, the male had normal sperm count & motility, but the female
had poorly developed ovaries for egg production & her uterus was also ill
developed. The chances of ovulation & implantation of embryo was almost
impossible in her uterus. This couple had only good sperm for fertility.
The male of the third couple had no sperm production and the female had
developed some tumours in the ovaries & did not have good egg production,
but her uterus was perfect for implantation of embryo. Finally, the IVF
specialist gathered these three couples, counselled about their situation &
explained about the only possibility of a contributory child. The first couple
gave their eggs, the second couple gave their sperm, and the third couple
carried the child (surrogate) till term & finally delivered a healthy
test-tube baby.
Similar situations are encountered by the
Infertility specialists, but they do so with a properly written consent from
the couple who have every right to accept any sort of technical challenges for
the sake of a child in their family. The child when born proves to be a great relief,
rather a medium of shelter for further living.
In all these scientific talks, we should
not forget the role of religion, which plays a major role in a society like
ours. In this country, if a woman does not conceive after certain period of marriage,
she is only blamed although there is equal role of the man for their fertility.
An infertile woman lives in the family with great difficulty, sometimes isolated
from the society suffer from depression, shame, guilt, anger & fear of
polygamy. All this proves very hard for her survival. Some even commit suicide.
Under these circumstances, religion comes secondary to survival. Joint family infertile
woman has to face a torture each day by her in-laws. If she is lucky, one good
day, a well-wisher, family member or friend, may help her find the treatment,
either conventional infertility treatment or IVF. .
The pain of whole
treatment becomes negligible, as soon as the fertility returns & they have
a child in the family.
At some stage every child asks his mother
how he/she was born. Grandmothers were lying that they were found in the bushes.
And now, parents who went for a modern treatment for having a child should have
no hesitation in boldly acknowledging that yes our baby is an IVF baby or again
should we go back to the bush story?
