Medicosnext
Dr. Swati Kumari, MBBS (KUMS-Dhulikhel), MD-MS (Obstetrics and Gynaecology, TUTH, Maharajganj, has acquired training in infertility and assisted reproductive techniques from Aveya IVF Training Center, Rajouri Garden, New Delhi. Brought up at Stony Brook in Long Island, New York, she completed her high school education at Ward Melville High School, Three Village School District, and was twice awarded the Certificate of Academic Excellence by the president of the United States, in 2000 and 2003. Dr. Swati’s interpersonal communication and medical expertise endear her to her patients.
Is fertility problem increasing in Nepal? If so, what are the reasons?
Yes, there is an increasing trend of infertility problems in Nepal. There are many reasons behind the rise, and some are related to significant changes in the conjugal contours of our society. A few decades ago, couples had their first child at about 17 or 18 years of age. Today, that age is closer to 26 or 27. Many couples wait even longer to start their families—they may want to finish their education first, or get established in their careers. We see a lot more divorces now, and remarriages, too.
When people delay having a family, the passing years may include more exposure to environmental toxins and sexually transmitted diseases. Also, the older partners are more prone to health problems, the treatment of which may lead to infertility.
Age plays a big role, too. For couples who are under 30 and generally healthy, 20 percent of them are able to conceive in the first three months of trying. After the age of 30, a woman’s chances of getting pregnant start dropping quickly with each year, due to a gradual decrease in ovarian reserve.
What do you think is the current percentage of infertility in couples, and is this problem more in husbands or in wives?
Infertility is defined clinically as not being able to achieve pregnancy after one year of having regular, unprotected intercourse, or after six months, if the woman is older than 35 years of age. Approximately 10 percent of the couples worldwide grapple with the condition.
• In one-third of infertile couples, the problem is with the man.
• In one-third of infertile couples, the problem is with the woman.
• In one-third of infertile couples, the problem can’t be identified, or is with both the man and the woman.
What is the success rate of IVF treatment?
Live birth from an IVF cycle is approximately 35 to 40 percent. The success rate varies slightly from one center to another center. At Vatsalya Natural IVF, the success rate is around 60 percent, as two embryos are usually transferred instead of one. The global data of 40 percent is in accordance with a single embryo transfer.
What are the major challenges you see for this treatment to be successful and more acceptable in Nepal?
In our Nepali culture, it is expected that you should have children once you’ve reached a “certain age.” And if you don’t, society stamps you with stigma. When unable to conceive, couples feel embarrassed, or feel a sense of failure and shame. Also, in a patriarchal society like Nepal, many men choose to remarry, rather than to consult a doctor regarding fertility problems. The burden of societal stigma is mostly borne by women, and many times men refuse to take their share of the responsibility.
So, Nepal has a long way to go before fertility services are utilized to its potential. In the 40 years since IVF was introduced, growth in reproductive medicine, egg freezing, and donation have created a brave new landscape. Worldwide, it is estimated that 6.5 million have seen the light of day because of IVF technology. However, in Nepal, there is much stigma regarding IVF, as well, and many people have misconceptions regarding the procedure. I don’t have all the answers, but here are some ideas of how we can make treatment more acceptable in Nepal:
• Increase in awareness drive from the medical community. I think it would be helpful if adults weren’t just educated about how to prevent pregnancy and sexually transmitted diseases, but also informed about the possibility of infertility.
• Make fertility testing more accessible.
• Stop judging and start listening. Perhaps the simplest thing we, as a society, can do is to stop judging people with infertility. Even celebrities face criticism when owning up to the fact that they went through fertility treatments. It’s wrong to judge what we don’t understand. We should listen—really listen—to the stories of those who have struggled with infertility. And, instead of judging them, or offering advice on how to get pregnant, we should applaud them for their bravery to step out and share their stories with sympathy.
• Share more infertility stories. I think the best way for infertility to become less of a taboo is for more people to share their stories about it. As I mentioned above, it is terribly hard to do so. But, when people are brave enough to share their quest for a baby, we should be celebratory towards their success, instead of judging them, criticizing them, or telling them what to do with their bodies. Stories help us learn, connect, and understand. Sharing may be a most powerful tool for removing the ignorance about this painful topic.
• Improve marketing and activism around infertility.
Do we have a sperm bank in Nepal?
Yes. Sperm donation is readily available for couples in need.
What are the current problems in IVF treatment results, such as having twins, triplets, etc.?
The more number of embryos we transfer, the more chance of a multiple pregnancy. At Vatsalya, we do not transfer more than two embryos, so the risk of a multiple pregnancy (besides twins) is minimized.
Other problems include:
Ovarian hyper-stimulation syndrome. Use of injectable fertility drugs, such as human chorionic gonadotropin (HCG), to induce ovulation, can cause ovarian hyper-stimulation syndrome, in which one’s ovaries become swollen and painful.
Symptoms typically last a week and include mild abdominal pain, bloating, nausea, vomiting, and diarrhea. If you become pregnant, however, your symptoms might last several weeks. Rarely, it’s possible to develop a more severe form of ovarian hyper-stimulation syndrome that can also cause rapid weight gain and shortness of breath. In our clinic, we avoid this complication by going for a frozen embryo transfer, instead of a fresh one, so pregnancy does not occur in the same cycle as ovarian stimulation.
Egg-retrieval procedure complications. Use of an aspirating needle to collect eggs could possibly cause bleeding, infection, or damage to the bowel, bladder, or a blood vessel. Risks are also associated with sedation and general anesthesia, if used. However, these risks are minimal.
Stress. Use of IVF can be financially, physically, and emotionally draining. Otherwise, IVF is a relatively a safe outpatient procedure.
