“The most important thing to consider is timely marriage and conception”

 

Dr. Nutan Sharma, Senior IVF Consultant and Laparoscopic Surgeon, Norvic Hospital, tells us about infertility and IVF treatment—what it is, how it’s done, new technologies in the sector, and more.

 

 

What is infertility?
When a married couple has unprotected sex for around a year without using any contraceptives and yet do not conceive: it is called subfertility. The correct term is subfertility, not infertility. Subfertility can be either primary or secondary. Primary subfertility is when someone has never had a baby and is subfertile. Secondary subfertility is when someone has had a baby or an abortion previously and cannot have a baby when they try again.

How prevalent is subfertility in Nepal?
The prevalence of subfertility has definitely increased. By my estimation, based on my practice, I would say that the incidences of subfertility must have increased two folds in the last 10 to 15 years. I think the main reason behind this is advanced maternal age and delayed planning of babies. There was a time 15-20 years back, when people used to get married early and have kids. Nowadays, people are focused on their studies and career, so they delay marriage and conception. Every woman has a fixed number of eggs, and it starts reducing beyond the age of thirty. It drastically reduces after thirty-five. That is why age factor is very important for a woman.
Another reason is increased incidences of abortion and vaginal infection or PID (pelvic inflammatory disease). These infections in the uterus can cause the tubes to get blocked. The tube is the place where the sperm and egg meet for fertilization. If the tubes are blocked, there is no fertilization.

Thirdly, there is an increasing trend in male subfertility. In the last two years, there have been many cases of reduced sperm count and reduced sperm motility. The reasons could include increased smoking, alcohol, unhealthy diet and lifestyle, lack of sleep, stress, working in a laptop for long time, driving for long hours, working in a hot environment, chemical exposure—all these play an important role in male subfertility.

What is IVF and how does it help subfertile couples?
IVF is in-vitro fertilization. Normally, fertilization takes place in the tubes of a person and the embryo transfers and implants in the uterus. When there is some problem in this process—the eggs are less, the sperms are less, the tube is blocked, there is infection—in such cases, we move towards in-vitro fertilization. We take the egg, we take the sperm, we create a media—that is, we simulate the fluids that are inside the tubes. We create an environment that mimics the environment inside the tubes and do fertilization. That is called in-vitro fertilization.

What is the success rate of in-vitro fertilization?
I think in good centers we have a success rate of 60-75%.

Who is the ideal patient for IVF?
There is no ideal candidate for IVF. IVF is the last resort. You do not choose IVF for somebody; you give it as a last treatment option for a couple. When a couple comes to us, they will be evaluated completely to see what the cause of subfertility is. Sometimes it is a simple hormonal imbalance, an infection, correction of thyroid, weight reduction—with a little bit of planning, it is treatable. Sometimes the sperm count or motility is low, so we go for IUI (intrauterine insemination) which works.

In cases where these don’t work—where there is a tubal blockage, or the eggs are not there, the sperms are very, very less—we go for IVF. IVF is the last option we give to a subfertile couple.

The treatment really depends on the cause. If a young 25-year-old couple comes to me, but both of her tubes are blocked, I have no other option than to go for IVF. If a 35-year-old woman comes to me, but she has enough eggs, and she simply has a thyroid problem, we can correct it. If she is not ovulating, we can give her ovulating drugs. If her husband’s sperm count in low, we can do an IUI. The treatment always depends on the cause of infertility and the needs of the patient.

Are there people who cannot be helped even with IVF?
Yes. There are 10-15% of patients who won’t conceive even with IVF. It just doesn’t work. There are factors that we are not aware of. Sometimes the endometrium is just not receptive. Sometimes we do multiple cycles, but we are not successful.

What are some new technologies in IVF that we can see across the world and in Nepal?
I think all the technologies that are out there in other countries are available here in Nepal, as well. If you talk about new processes, there is ICSI (intracytoplasmic sperm injection) which is available in Nepal. We also do cryopreservation, where we freeze your eggs, your sperm, or your embryo. If somebody doesn’t want to get married early and suffer from subfertility in the future, she can freeze her eggs and keep it till the time she wants to get married and have kids. If a married couple does not want children right now, they can freeze their embryo and only transplant it when they’re ready. A male patient who needs to go through chemotherapy can freeze their sperm, so that even after their treatment, they can impregnate their wife.

During IVF, before implantation, we always do PGS (pre-implantation genetic screening), which is when you do take an embryo biopsy and screen it for genetic diseases or abnormalities. You only transplant healthy embryos.

Tell us about IVF treatment in Norvic Hospital
This is the first IVF center that has received permission from the health ministry. It is because this center is very well-equipped and all the criteria have been fulfilled. We have PGS, so we screen all embryos before we do an embryo transfer. We have a world-class lab and a renowned in-house embryologist. We have everything needed in an IVF center, and we also give laparoscopic services.
Our patients can get all the services they need under one roof, which is not very common. Usually, what happens is that they have to do IVF somewhere, and admit the patient in some other place. If the patient happens to have a fibroid, they tell the patient to go get it removed somewhere else and come back. But, here in Norvic, we do everything. This is the only center that provides all services under one roof.

Subfertility is an emotional issue for many people. So, what has the patient response been like after their treatment?
There is a lot of financial and psychological trauma for people who come in for treatment of subfertility. It is very, very painful for them. So, of course we counsel the patients, and keep them cool as we start their treatment. We must be very considerate when treating patients.

What is something people can do to avoid suffering from subfertility?
The most important thing to consider is timely marriage and conception. You can get money, you can get post, you can get professional achievements, but you can’t get your eggs back once you lose them. Our eggs are not replaceable, which has to be understood. So, you either have to have your eggs preserved, or you have to have a baby.

Besides that, don’t go for illegal abortion. Use contraceptives well. If you have an infection, please get yourself treated. Women over 30 should get checked up at least once a year. Always seek medical help if you have a medical problem.

Keeping your body weight in normal BMI, getting regular exercise, having a healthy lifestyle, and quitting smoking and alcohol are also very important.

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