Infertility – Social Issues
Infertility is defined as being unable to conceive after more than 1 year of unprotected intercourse. It is estimated that 10 % of people in the reproductive age group are suffering from it.
For a natural conception the sperms, uterus, tube and ovaries need to be healthy. The chance of natural conception in a healthy couple is about 15 % per cycle. Many anxious young couple comes to the infertility specialists, after 3-4 months of marriage, if they fail to conceive. These couples need counseling and reassurance that they will conceive in the near future. However, there are certain patients with tubal block, low sperm count and conditions like polycystic ovarian syndrome and endometriosis. These couples would need medical intervention to help them have a child.
In India, social pressure on the woman to conceive soon after marriage is very high. Even if the problem lies with the man, the burden of infertility is mainly on the woman. She undergoes severe psychological pressure, depression and social ostracisation while facing the problem of infertility. There are two main issues that need to be dealt with. The first one is proper medical awareness among patients as well as the medical fraternity so that these patients get the right treatment at the right time. The second is social awareness to allow the couples face this problem with dignity and privacy.
Many infertile couples end up going to quacks and astrologers who waste enormous amount of precious time and money. If these couples are referred for right medical intervention early on then the chance of successful pregnancy is higher. A woman is born with a fixed number of eggs and by the time she is 35, her ovarian reserve is low. It is better that she receives infertility treatment much before in order to have a successful outcome. Unfortunately many medical practitioners continue treating these patients for years together with ineffective treatment when they should be referred for assisted conception. It is well known that the only treatment successful for the patients with tubal block and low sperm count, is in-vitro fertilization. There is yet another group of couples in the cities now a days that first delay marriage and then delay child bearing. It is important to convey the message that the best chance of child bearing in a woman is before the age of 32.
For most couples with infertility, cure is usually achieved after the right diagnosis is made. For woman with problems like polycystic ovarian disease and endometriosis, there are medical as well as surgical methods to treat these conditions. For this group of patients as well as men with mild male factor problems, inducing multiple egg formation followed by Intra-Uterine Insemination may be the treatment. For patients with tubal blockage and very low sperm count, the treatment usually involves In-Vitro Fertilization with or without Intra-Cytoplasmic Sperm Injection. In this, multiple egg formation is induced through drugs called Gonadotropins. The eggs are retrieved by ultrasound guidance and fertilized by either simply mixing the eggs with the sperms (In-Vitro Fertilization) or injecting each egg with a sperm (Intra-Cytoplasmic Sperm Injection). Once the embryos are formed they are implanted either on the second or the third day into the uterus under ultrasound guidance. If this procedure is done in 10 women who did not get pregnant for more than past 5 years, 4 or 5 patients would get pregnant the first time. The cost of this treatment is between a lakh to 1.5 lakhs of Rupees. This includes the cost of medication. At Max Healthcare there is a fully equipped laboratory with internationally trained staff to perform these procedures. The equipments, which includes the state of the art incubator, ICSI machine and workstation are at par with the best centres in the World. The media that is used for embryo culture is imported and is internationally acclaimed media. The Clinician has worked as a consultant in IVF centres abroad and has established other reputed IVF centres in Delhi. This team of specialists believe in treating patients with dignity and respect and are consistently delivering very good pregnancy rates. The international guidelines of patients dignity, confidentiality, giving the complete and right information and transparency are followed by all the staff members of the Max IVF team.
The issue of social demoralization of these couples especially woman is very high in our country. The value of a woman still lies in her capacity to bear a child rather than any of her academics or career achievements. It is unfortunate that woman themselves are responsible for this situation in many instances. Elderly woman of the family instead of supporting the poor victims of infertility, physically and mentally abuse them. A multi level approach right from the individual level to the government needs to be implemented in a large scale. Empowering the woman of India, when she becomes confident enough to face the world with or without children should be the aim. Banning female infanticide, education and dignity of girl child and employment opportunities to women will come a long way in helping the woman of India. Various infertility fora where patients can interact among themselves and also meet patients who have had successful treatment will help ease the psychological burden of the disease.
I would like to conclude by saying that infertility is mainly a curable disease. The aggrieved couple should get the right treatment at the right time. Society instead of denouncing them should lend forward a helping hand.
Dr. Kaberi Banerjee MD, MRCOG.