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Tuesday, 14 October 2014

All izz well!

As a fertility specialist, I meet many people, singles and couples anxious to conceive. As is well known but barely acknowledged is the fact that the success rates of fertility treatments in most cases are less than 50%! That means, as one of my mentor used to tell all patients, you are more likely to not conceive than to succeed from fertility treatments. Yet hope and faith are the two big must-haves for all patients. Indeed I have realised time and again that it is those who have an overdose of hope and faith that do actually get pregnant against all odds!

When I consult, I make every effort to build up a rapport with my patients, I am brutally honest but stop short of breaking that very fragile hope that is their only lifeline. Even after the best efforts, when patients don't conceive, it is upsetting to all involved. More upsetting than I would like to acknowledge.

But equally rewarding is the report of pregnancy which wipes away the negative thoughts but strengthens the resolve to do better and more for the others who seek my advice. I cherish the photos of all the babies that are born and the thought that comes is : "All is well.....keep going...."

Sunday, 12 October 2014

Intrauterine Insemination with Donor Sperm

Intrauterine Insemination or simply IUI has already been described in an earlier post. There are many situations where IUI with donated sperms may be indicated. The reason may be a complete lack of sperms in the husband's semen. Sometimes the semen quality is poor and pregnancy may only be possible with advanced technique of ICSI. This may be unacceptable due to cost implications or due to personal beliefs. Occasionally, donor sperm may also be required to prevent a serious genetic disorder from being transmitted to the offspring. Last but certainly not the least are the single women who do not want to lose out on the chance of having a baby simply because they have not met Mr. Right yet!

The procedure of IUI remains the same except that the sperms belong to a donor. The donor is selected after a rigorous screening process and continue to be tested for any transmissible infections while they are in the process of donation. The semen is processed and motile sperms are frozen. After a period of at least 6 months quarantine, they are released for use. The non-identifying characteristics of the donor are made available to the recipient for selection. This generally includes height, weight, build, complexion, colour of eyes and colour of hair and Blood group. 

In India, as per ICMR guidelines, the donation is anonymous. However the details of the donor may be revealed on request to the offspring born once he/she is 18 years of age. Experts recommend disclosure to the children about the donor although the onus is on the parents. 

In the Indian context, my experience is that the parents rarely even acknowledge to the family and have no intention of disclosing to the children. Before accepting this treatment modality, the most important concern is for confidentiality. The other concern is that the baby may not resemble them and so their secret may get out this way. Reassurance goes a long way in allaying both fears. 

Tuesday, 7 October 2014

Tuboplasty: assumptions versus reality

 When there is a block in the tubes, tubal surgery is offered as an alternative to patients for treatment of infertility. The usual assumption is that tuboplasty should be the first option as it "corrects" what is wrong. Unfortunately it is not as simple as this. I have described the sophistication which is integral to function of the tubes in my earlier post.  

The efficacy with which tubal surgery would work really depends on the extent of damage that has already occurred. If the cells lining the tubes are extensively damaged and the cilia (the hair like structures that assist in moving the egg/embryo towards the uterus) are non-functional or absent the woman would be at a risk of a pregnancy settling in the tube. This condition is called Ectopic Pregnancy and it is potentially life-threatening. Similarly, if the cells that are responsible for secretions that nurture the egg/sperms/embryo and create an environment that allows an embryo to develop are spoiled, the chances of embryo formation fall. How then would tubal surgery done by the best surgeon in the world help?

With the advances in IVF, the chances of pregnancy now are superior to those after tuboplasty. Without a doubt there is a place for tubal surgery and indeed, there have been women who have conceived after a surgery to repair the tubes. Tuboplasty has a role in cases where the damage is minimal to mild and impact on fertility is essentially due to obstruction and so by removing the obstruction, the woman chances of natural conception are restored. The best advantage of surgery is that the effect usually lasts longer term unlike an IVF cycle which is only offering a chance of conception in the treatment cycle. It may be the only option available to couples who have religious or ethical objections to IVF. The major drawback is the uncertainty pertaining the fertility renewal and the very real risk of ectopic pregnancy as a result of tuboplasty. Women who fail to conceive should move on to IVF if no pregnancy occurs within 6-12 months. There is also clear evidence that women with severely damaged tubes that are swollen (called Hydrosalpinx) would benefit from removal or delinking of the tubes prior to IVF.