Sunaina Bhargava had everything going for her. Happily married to Rohan for five years she had nothing to complain. Last week, someone enquired when would she be sharing some ‘good news’. Sunaina broke down.
“We had decided to have kids after two years of marriage, but I was unable to conceive’, she explains. For some time they blamed their irregular lifestyle as both travelled extensively for work. Recently her doctor suggested getting an infertility analysis done.
Infertility in India
According to a WHO study published in 2012, one in every four couples in developing countries had been found to be affected by infertility. Statistics reveal that about 15% of the Indian population suffers some form of infertility. India has witnessed a 20-30% increase in infertility cases in the last five years. Every year 10 million new cases of infertility are getting added. The IVF market is expected to grow about $21.6 billion by 2020.
What is Infertility?
Infertility is not just a word. Its diagnosis is a kind of absolute truth that reflects upon the situation. However, it’s okay to talk about it. It doesn’t define anyone. And is nothing to be ashamed of.
It is a medical condition that affects the core of a couple’s life. The diagnosis often manifests as stress, anxiety, depression and creates a sense of futility. Many medical, physical, mental, emotional, financial, social and marital issues are associated with infertility. These entail a lot of trauma. The isolation and depression that this challenge brings, sometimes drives individuals to the brink of being suicidal.
“If a couple is regularly cohabitating for more than one year without any use of contraceptive, with awareness of fertile phase of menstrual cycle and is unable to conceive, then we suggest infertility analysis,” says Dr. Sumitra Bachani Senior Specialist and Assistant Professor VMMC and Safdarjung Hospital, New Delhi.
Infertility is a disease and requires medical intervention to assist conception through procedures like IUI, IVF and ISCI.
Dealing with Diagnosis
When Gitanjali Banerjee received the diagnosis both, she and her husband were clueless. Medical counselling was the hardest part. There was no one they could speak or discuss with.
Infertility diagnosis is a time consuming, complicated and confusing process. Experts suggest a battery of tests. “Understanding the process, sieving out the myths, controlling my anxiousness emanating out of ignorance and inability to control this unexpected situation were huge challenges,” explains Gitanjali.
Her journey was long and arduous. Married at the age of 23, she fought infertility for many years, “Ten long and gruelling years of fighting infertility. Post five miscarriages, three molar pregnancies, one failed IVF, a brush with ovarian cancer and finally successful pregnancy on second IVF attempt, I have seen everything,” she shares.
For Simmu Sharma it was secondary infertility. In primary infertility, a woman has never had a successful birth of a child. While secondary infertility is defined as the inability to conceive after having a successful birth. “I never lost hope,” she says. “The only frustration was going through treatments. But I never felt that it won’t happen.”
Rekha Dhyani struggled with Endometriosis and Ovarian cancer that revealed the issue of infertility.
Factors Affecting Fertility
Dr Sumitra summarises the factors as follows
- Unawareness of fertile period
- Irregular menstrual cycles
- Less frequent intercourse
- Sexual dysfunction
- Male and female infertility factor including tubal blockage, endometriosis or PID including tuberculosis
How they coped?
For Gitanjali her husband’s support was crucial. He helped to get over the depression after every miscarriage. “When I look back to all those years, I feel, our marriage, love and friendship matured owing to infertility journey”, she adds.
Family support is crucial. However, there are myriad experiences. From getting unsolicited advice to facing insults everything happens. Rashmi Hiremath has a supportive family. But found that few of her friends were insensitive. Some were secretive about the news of their pregnancy. She felt isolated with this experience. Her husband’s support helps her while undergoing the treatment and dealing mood swings due to hormone injections.
Rekha’s family was supportive. Her husband helped her to overcome the grief of isolation and deal with the blame game.
Simmu coped with the help of inner strength. “My faith was the biggest help”.
Finding the Right Expert
Finding the right doctor is crucial and requires a lot of effort. According to Gitanjali, there are many malpractices associated in the infertility treatments. “Many times unnecessary tests are advised,” she adds.
Rekha was fortunate to get treated by one of the best gynaecologists in India, who specialised in gynaecologic oncology. Her doctor decided on a laparotomy instead of laparoscopy. She was on steroids and hormones for two years as part of the treatment. Regular ultrasounds and blood tests were done to monitor progress. “The correct decision was taken by my doctor on what the course of treatment should be.”
Rekha sought second, third and fourth opinion before deciding. She could conceive naturally with treatment after surgery for removal of Endometriosis and Ovarian Cancer.
Dr. Sumitra believes in treating the couple rather than the individual. She elaborates, “Counselling for fertile period, predicting ovulation and coupling that with timed intercourse, comes as first line of treatment along with investigations for infertility.” She feels without the relevant information about procedures fear will always remain.
According to her, female infertility needs to be classified as primary or secondary, ovarian failure or dysfunction, tubal blockage or uterine causes. The further treatment options include ovulation induction with timed intercourse or IUI, tubal surgery or IVF with tubal clipping and surrogacy, respectively. The male factor infertility needs to be classified as whether testicular failure or obstruction of passage.
Tests for Diagnosing Infertility
A complete hemogram with ESR with
- For anovulation – history, thyroid profile, serum prolactin levels, EA for HPE
- For genital tuberculosis – history, EB for AFB staining & culture & sensitivity
- USG pelvis for uterus and adnexa for gross uterine malformation, hydrosalpinx or tuboovarian mass
- Tubal patency tests – HSG after genital TB being ruled out.
- Diagnostic hysterolaparoscopy is needed in cases of abnormal pelvic USG, HSG or in cases of no other established cause (after evaluation for male factor infertility) in order to r/o endometriosis and for tuboovarian relationship.
- Before proceeding to any invasive investigation for female infertility, a normal semen analysis is important.
- Semen analysis after minimum of 72 hrs of abstinence
- If normal no further investigation is needed.
- If abnormal, a physical examination by surgeon or urologist to decide further treatment.
Success Rate of Infertility Treatment
The success rate measured by ‘live births’. For any treatment it depends on the age of women, status of endometrial lining of women and type of infertility, male or female.
They are usually mentioned in terms of conception
- Success with ovulation induction (with clomiphene)- 70-75% in 6 to 9 cycles
- Success with IUI- 70-85% in isolated male factor infertility
- Tubal surgery – 25-30% in case of adhesiolysis or mild distal obstruction.
- IVF – in cases of idiopathic infertility around 35- 50%
Cost of infertility treatment IVF is in the range of Rs. 2- 10 lakhs. This includes medicines, complex investigative procedure and medical equipment cost. There is no insurance to cover infertility treatments. For a couple facing infertility these expenses become daunting. They add to the emotional trauma.
In government hospitals, routine investigations are free. Special required investigations are offered at subsidised rates. Some institutions and trusts like, Wadia Assisted Reproduction Technology Centre, Mumbai the offer IVF treatment at half the prevalent rate of treatment. Banks, financial institutions and finance schemes are other options.
Speaking about the expenses, Gitanjali shares that they led a life on a strict budget while undergoing treatment. “I remember once, our friends were going for a trip but we had to declined.”
Rashmi and her husband put every penny they had. “We willingly did it because this was the only way for us,” she explains.
Rekha’s treatment was partially funded through her and her husband’s medical reimbursement.
Infertility is a difficult situation that isolates and alienates couples. Accepting that there is an issue is extremely difficult. Rashmi elaborates “This hurt me like hell. I did a lot of changes and are healthy. No colas, lost weight but still nothing.”
Talking about it scared Gitanjali. “I had fears of being tagged and judged by society”. Today Gitanjali is a happy mother. But she remembers every detail of the struggle. “I can never forget the pain, suffering, loneliness, depression, desperation, isolation and the mental and emotional turmoil .” The challenge has made her strong. It is an important part of her life and personality.
Reading positive stories and surrounding themselves with optimistic people helped both Rashmi and Rekha.
What are IVF and IUF?
In-Virto Fertilization or IVF, is a method of Assisted Reproductive Technology (ART) of manual fertilization. This is the original ‘test-tube’ baby technique developed more than 30 years ago.
IVF treatment starts with a course of hormone therapy to stimulate the development of several follicles in the ovary. Then, the eggs are collected and fertilised in a testtube. After keeping them for four to five days in an incubator they are implanted.
Intrauterine insemination or IUI involves artificially placing the sperm inside a women’s uterus to increase the chances of fertilisation.
Dr. Sumitra emphasises on counselling, creating awareness of fertile period and regular cohabitation with partner. She feels that family support is important as investigations and treatment take a lot of time.
Couples should keep options open. Simmu wasn’t able to conceive. She opted to adopt. Today she is the happy mother of a seven year old girl. “We have been fortunate to meet our baby. Our relationship is amazing because we were united by our souls,” she says happily.
Gitanjali’s tryst with infertility made her reach many women who suffer in silence. Hence, to support women fighting with infertility she created a Facebook group. The positive response amazed her. Understanding the need to create a bigger platform, she launched the website InfertilityDost in August 2016.
- Women should plan pregnancy in twenties as chances of subfertility increase with age.
- Read and research extensively
- Find the right doctor
- Go for a second opinion.
- Don’t compare yourself with others
- Don’t discuss your issues with everyone
- There are high and low days in a IVF cycle
- Don’t lose yourself in the process
- Success of the treatment depends on willingness to recover and respond
- Be kind to yourself
- Pursue a hobby
- Never lose hope. Keep your options open.
- Join a support group.
- Try not to get too obsessed with the issue.
Image Source : Flickr