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Thursday, September 27, 2012

Protocol for Infertility Treatment in Nepal

KATHMANDU: Health experts today suggested for a practical protocol on infertility to handle legal, ethical and technological issues.

The Ministry of Health and Population is drafting the ‘Protocol for Infertility Management in Nepal’ to determine necessary investigations of underlying cause of infertility and for the management of infertility by conventional methods.

Dr Uma Shrivastava, reproductive endocrinologist at Infertility Centre Nepal, said the protocol is essential for the management of infertility by Artificial Reproductive Technologies and for managing the complication of infertility treatment. In addition, the policy is also essential to follow the common procedure by health personnel to identify and treat the cases of infertility.

After identification of the underlying cause, treatment should be managed according to the available facility in rural or urban areas. For unavailable necessary treatment, cases should be referred to the appropriate centres for proper management, said the endocrinologist.

According to Dr Shrivastava, the infertility is estimated to affect about 10-15 per cent of Nepali population.

About one third of infertility cases are due to male factors, other one third due to female factors and the remaining third due to combination of both male and female factors, she said. The origin of the condition of about 20 per cent cases is unidentified or unexplained.

Infertility is more of a social priority than an individual’s need. In most ethnic communities, it is accepted as a defect in the female partner, even though male partners contribute equally, said Dr Shrivastava.

Due to joint family trend, women are emotionally distressed as a consequence of infertility. Therefore, she said, the treatment should target more on counseling the couple about their personal, social and marital distress before their cure.

Chances of infertility are higher in couples who have gone through abortion. The country has recorded 95,000 abortions in the fiscal year 2010/11.

Dr Babu Ram Marasini, chief of the health sector reform unit at the ministry, said the policy is going to incorporate legal issue of surrogate mother, biological father, test tube baby and other ARTs within it.

ARTs are methods used for fertilisation or making women pregnant by artificial means in case of infertility.

This method is also used in fertile couples for genetic reasons. Some of the ART methods practiced in Nepal are Artificial Insemination of Husband, Artificial Insemination Donor and In Vitro Fertilisation.

The country does not have any legal backing for surrogate mother, biological father and ARTs which can create a problem regarding property right, citizenship rights and protection rights in near future, said Dr Marasini.

Pregnancy followed by ARTs could bring many ethical and legal challenges in the country. The government should give the mandate to carry out the procedure for Test tube babies or IVF, he added.  
Article Published on The Himalayan times dated 6/7/2012