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Fighting Infertility

Text by: Ankita Jain

The busy and stressed lifestyle that we have adapted to ones the years finds a rise in health complications including more couples being challenged with infertility.

In this technologically advanced world, we have solutions for almost everything including health. Vatsalaya, a fertility clinic, offers a ray of hope to couples finding it difficult to conceive.

In a tête-à-tête with Shristi Khadka, Executive Director, Vatsalaya, we learn more about infertility issues in Nepal and the solutions Vatsalaya offers to its clientele.

What are the major causes leading towards infertility?

There are several reasons causing infertility which are related to males or females, or both. Very few people are born with conditions which lead to infertility. For some, it can be their previous obstetric history which includes infection or abortion.

In men, we have observed that those living in extremely harsh climate especially migrant workers usually come back with very low sperm count. Another major cause of the rising rate of infertility is our sedentary lifestyle. Lack of sufficient physical exercise accompanied by poor eating habits results in obesity and is also a leading cause of infertility. Another reason behind a large number of infertility cases is addiction to alcohol, drugs or caffeine or heavy smoking which can all directly affect a person’s reproductive health.

The other factor is age. Egg count starts declining when a woman hits puberty. With every menstruation cycle, a woman loses eggs. Few people are born with good egg reserve which may go on for years, but for many, it might not be the case. Today, due to various reasons, couples postpone having babies in the initial years of their marriage. By the time they are ready for a baby, it just does not happen. With age the fertility of a person also decreases. Generally after the age of 35, risk of miscarriages and inability to conceive increases manifold.

How do you treat infertility at Vatsalaya?

The inability to conceive naturally doesn’t mean that a couple cannot have children. With medical intervention, many new options are now available. Among them the most promising and popular is IVF. In layman language, IVF means test tube baby. At Vatsalaya, we just don’t do IVF, it’s much more than that. A couple who isn’t able to conceive may not require IVF. Some require small interventions from the doctor such as medication or timings for conception.

IVF is a long process in which sperms and eggs are fertilised outside the body in a laboratory. Once the fertilisation is successful, embryos are kept in the laboratory for a few initial days under supervision and later in frozen stage. Once they are fit to be transferred, the best ones are implanted in the woman’s uterus for further growth. This process of fertilisation is useful for people with unexplained causes of infertility, women with blocked fallopian tube or having ovulation problems, and for men having abnormal or low sperm production.

The probability of conceiving using IVF largely depends on the quality of eggs and sperms retrieved. Also, age plays a major role. Especially for women, using non-donor eggs, chances of conceiving decreases with age. Along with these, the overall health of a person plays a major role in deciding the probability of conceiving.

Though, a very effective alternative, IVF too has certain drawbacks. One big downside is that is an expensive procedure which many people are unable to afford.

In your area of work, what kind of clientele does Vatsalaya cater to?

What we have come across, unfortunately, is that couples come very late. Normally, we receive people who are married for more than 10 years having been unable to conceive and having had tried every possible means. These are the type of clients we usually cater to. Also, it is a huge challenge for us to deliver on results for patients who have failed every treatment.

But there is a growing awareness so we now also have patients come in quite early, but the numbers are quite low.

What we recommend is when you have tried to conceive for six months and have failed or you have been married for 4-5 years and not conceived, it is strongly advisable to seek medical help.

Is infertility becoming a serious concern in Nepal?

Infertility is one of the major issues in Nepal which has been neglected largely. We as a country are so focused towards family planning, birth control devices and awareness campaigns that we have forgotten to address infertility. Here in Nepal, one in every eight women suffers from infertility. The treatment for infertility is very difficult. It is very stressful, mentally, physically and financially for the patient. And when they do not have any kind of support from the government or anywhere else, it becomes even more difficult.

In other countries, the government subsidies certain percent of the cost involved for IVF. This could be a huge relief for those who have limited financial access.

Do people trust fertility centres? How can a patient know that they are being guided correctly?

The treatment of fertility is not something we can show physically, everything is very microscopic. Trust is the utmost factor any patient visiting a fertility clinic should have.

The patient should be aware that if there are chances of getting pregnant, there are equal chances of not getting pregnant as well.

Further, a patient should take the initiative to know about each and every aspect of the treatment process, the reports, the number of eggs, embryos and more. Patients should not hesitate to ask questions with their doctor. Usually, patients have no idea what treatment is being carried out.

In Vatsalaya, we are trying to bring a change in these aspects. We try our best to keep our patients updated about their ongoing treatment, explaining to them the process and making them understand how it functions. I believe this kind of practice helps build trust. Honest, transparent and ethical treatment is the best practice, and one every clinic should aspire to provide their patients.

According to your client experiences, is infertility seen as a social taboo? What are some of the stresses women have to endure?

Infertility has been a huge social taboo which is very less discussed. Many times, women who are not able to give birth are shunned at social gatherings or subjected to abuse at home. This kind of social pressure leads to depression in many cases. The mindset of people here is that if a couple is not able to reproduce, it is always assumed that the woman is infertile; the man is never questioned in our society.

If you had to share three important tips that you have learnt about fertility with our readers, what would they be?

One of the most important things today is that people should get their fertility status checked. It is majorly recommended for those who are planning to conceive late. This helps immensely in planning a family. Second, maintain a good lifestyle. As far as possible, avoid caffeine, smoke, drugs or alcohol. Also, if you are facing any menstrual problem, you should immediately consult a doctor. Lastly, for people who have already been married and are unable to get pregnant, do not even think twice regarding a visit to a fertility centre to seek help.

What are the success rates for pregnancy at Vatsalaya?

If a person is 25 years old with a good number of eggs but somehow she is not able to get pregnant, then through IVF or medication, she has high chance of getting pregnant. But for a woman who is 45 and whose eggs are of poor quality then her chances may be as low up as 30-35%. IVF is an individual process. What a couple should look for is the average success rate of a clinic. At Vatsalaya, we have been treating infertility for the past two years and within this period, we have received more than 700 patients and have a record of 80% success.

What does motherhood mean to you personally?

Motherhood for me is a blessing, a unique and beautiful experience that many of us take for granted. The importance of it is understood only by those who struggle to achieve it. Working in the infertility sector, I have realised giving birth also becomes a social pressure. And that might lessen the real essence and beauty of becoming a mother and limit motherhood to becoming a social responsibility.